Adolescent siblings of individuals with an autism spectrum disorder: testing a diathesis-stress model of sibling well-being

Risk and resilience factors impacting the mental health and wellbeing of siblings of individuals with neurodevelopmental conditions: A mixed methods systematic review

OBJECTIVE

This pre-registered systematic review synthesised and evaluated the existing literature on self-reported mental health and wellbeing of siblings of individuals with neurodevelopmental conditions (NDCs).

METHODS

From 2437 identified studies published 2000-2022, 81 studies were included: 14 population- or cohort-based, 39 quantitative, 7 mixed method, and 21 qualitative outcome studies.

RESULTS

Seven sibling mental health (any psychiatric disorder, anxiety, depression, bipolar disorder, schizophrenia, internalising and externalising difficulties) and five wellbeing indicators were identified (quality of life, emotional adjustment, social wellbeing, somatic/physical wellbeing, and resilience/growth). Overall, siblings had increased risk of any psychiatric disorder, but they also reported experiences of growth and resilience, primarily in qualitative studies. 41 risk factors and 24 resilience factors associated with these outcomes were identified; the most frequently cited risk factor was symptom severity of the NDC sibling, while the most common resilience factor was adaptive/active coping at the individual sibling level. Studies showed high methodological heterogeneity and 90 different self-report measures were used.

CONCLUSIONS

Sibling mental health indictors are heterogeneous and cumulative risk factors may result in poorer wellbeing. There is a need for consistent reporting of family and sibling characteristics, a strengths-based approach to assessment, and identification of protective and resilience-promoting factors.

Sibling Influences on Trajectories of Maladaptive Behaviors in Autism

Siblings play an important role in the behavioral trajectories of individuals with autism spectrum disorder (ASD). While having siblings has been associated with positive outcomes in ASD, including stronger adaptive functioning, social and non-verbal communication, and theory of mind, little is known about the impact of siblings on more negative outcomes, such as maladaptive behaviors. To address this gap, the present longitudinal study tested sibling predictors of trajectories of maladaptive behaviors (e.g., teacher- and parent-reported hyperactivity, irritability, and social withdrawal) from childhood through early adulthood among individuals with ASD and non-spectrum delays. Multilevel models revealed that, while the mere presence of a sibling did not impact maladaptive behavior trajectories apart from teacher-reported hyperactivity, the diagnostic profile of the sibling (e.g., emotional/behavioral disorder, ASD, medical condition) emerged as an important predictor. Specifically, although findings varied across teacher and parent reports, more hyperactivity and irritability across time was identified when the sibling had diagnoses of an emotional/behavioral disorder, ASD, and/or a medical condition. Overall, this study provides novel insight into the broader family-level factors that influence the presentation of maladaptive behaviors across time and across contexts.

Predictors of Suicide Attempts of Individuals with Autism and Their Siblings

The occurrence of mood- and anxiety-related conditions among family members of individuals diagnosed with autism spectrum disorder (ASD) increases the risk of suicide attempts and has also created assessment and treatment issues for clinicians and parents. Recorded rates of mental health disorders comorbid with suicide attempts among individuals on the spectrum range from 29% to 52%. The purpose of this study was to investigate the presence of predictors of suicide attempts among sibling dyads (pairs of siblings in which one sibling is on the autism spectrum). Growing evidence in the literature indicates a link between a diagnosis of autism and mental health. A web-based survey was used to collect data from individuals on the spectrum and their siblings. A sample of 144 individuals was finalized for the analyses. Logistic regression analysis was conducted to assess the predictors of suicide attempts in the sample. Depression, anxiety, sexual orientation, and marital status were all used as predictors in the logistic regression analyses. Both levels of anxiety and sexual orientation were found to be significant predictors for suicide attempts. Recommendations for future research, assessment, and treatment are presented.

Developmental and mental health risks among siblings of patients with autism spectrum disorder: a nationwide study

Studies have suggested that unaffected siblings of patients with autism spectrum disorder (ASD) have some other neurodevelopmental abnormalities. However, the risks of mental and developmental disorders have rarely been investigated among unaffected siblings. Using Taiwan's National Health Insurance Research Database, 1304 unaffected siblings born between 1980 and 2010 with ASD probands and 13,040 age-/sex-/family structure-matched controls were included in our study and followed up from 1996 or birth to the end of 2011. Developmental delay, language delay, developmental coordination disorder, attention-deficit hyperactivity disorder (ADHD), anxiety disorders, disruptive behavior disorders, unipolar disorder, and bipolar disorder were identified during the follow-up period. Unaffected siblings were more likely to develop any developmental delay, developmental speech or language disorder, developmental coordination disorder, intelligence disability, ADHD, anxiety disorders, unipolar depression, and disruptive behavior disorders compared with the control group. Brothers of patients with ASD had a higher risk of neurodevelopmental abnormalities, ADHD, anxiety disorders, and disruptive behavior disorders; sisters were prone to having neurodevelopmental abnormalities, ADHD, anxiety disorders, unipolar depression, and disruptive behavior disorders. Unaffected siblings of patients with ASD were prone to developing any developmental or mental disorder later in life. Clinicians and public health officials should pay more attention to the developmental condition and mental health of unaffected siblings of patients with ASD.

Through the eyes of a child: Sibling perspectives on having a sibling diagnosed with autism

BACKGROUND

Sibling perspectives on the experiences of families caring for an autistic child are often overlooked in autism research. While qualitative research on these lived experiences has grown, it continues to primarily focus on parent reports.

AIMS

This study explored how having a sibling with autism impacts the non-autistic siblings within a family systems framework. The goal of the current study was to expand the literature by exploring the impacts of autism on the sibling subsystem as reported by the parents and the non-autistic siblings themselves.

METHODS AND PROCEDURES

The researchers interviewed 15 non-autistic siblings (aged 7-17) and 15 parents of children with autism to understand the experience of growing up with a sibling with autism. Content analysis was used to develop the interview protocol and analyze responses. Parent and non-autistic sibling reports of both siblings' effects on each other's development are triangulated with existing research.

RESULTS

Findings indicate novel emotional skill-building occurs in non-autistic siblings, as well as some unique risk factors for internalizing and externalizing problems if non-autistic siblings' needs become deprioritized. Family stress, external relationships, intrapersonal and social skill development, and other implications of this unique relationship are discussed.

Feelings of Loneliness and Social Dissatisfaction in Siblings of Children with Autism Spectrum Disorders: The Role of Birth Order and Perceived Social Support

Loneliness has been associated with several adverse psychosocial outcomes in childhood and adolescence. The present study aimed to investigate feelings of loneliness and social dissatisfaction in school-aged typically-developing (TD) siblings of children with an autism spectrum disorder (ASD). For this purpose, 118 siblings of children with ASD and 115 siblings of TD children and one of their parents participated in this study. Siblings of ASD-children reported higher levels of loneliness and social dissatisfaction than the controls. The hierarchical multiple regressions performed revealed that those feelings were inversely associated with being the first-born and with specific aspects of social support as perceived by the parent. The younger siblings of ASD-children seem to be in need of certain interventions beyond social support.

Impact of Working Together for adults with autism spectrum disorder: a multifamily group intervention

BACKGROUND

Adults with autism spectrum disorder (ASD) have lower engagement in their communities, higher rates of unemployment/underemployment, and continued difficulties with challenging behavior compared to their neurotypical peers. Multi-family psychoeducation emphasizes education and problem-solving with the goal of improving these outcomes for the individual with the disability.

METHODS

Using a randomized waitlist control design, the present study evaluated a multi-family group psychoeducation intervention, Working Together, for adults on the autism spectrum without intellectual disability (n = 40). Five waves of data were collected at 3-month intervals. In this design, families in the intervention condition participated in intervention during the 6 months between baseline and time 3 data collection; the waitlist control condition received the intervention immediately after the time 3 data collection. We compared these two conditions, intervention group (n = 20) vs waitlist control group (n = 20), on key outcomes for the adults with ASD: engagement in work-related activities, engagement in meaningful activities, and behavior problems.

RESULTS

Results indicated medium to large effect sizes associated with the Working Together intervention across key outcomes, including adults on the spectrum experiencing significant increases in meaningful activities and decreases in internalizing problems. Although increases in work-related activities were not statistically significant, an observed one-half of a standard deviation difference from before to after the intervention indicated clinically significant change. We also found maintenance of the treatment effect through 6 months post-treatment for the intervention group and replication of the treatment effect within the control group after they received the intervention.

CONCLUSION

Working Together is a promising multi-family group psychoeducation intervention designed to improve functioning during adulthood. These findings highlight the need for more intervention services research during adulthood and specifically the need for family-centered supports.

Challenges and Growth: Lived Experience of Adolescents and Young Adults (AYA) with a Sibling with ASD

Adolescent and young adult (AYA) siblings of individuals with autism experience unique challenges that can promote both growth and emotional maladjustment. This study explored sibling and parent reports of siblings' lived experiences and identified learning, stressors, and concerns from those experiences. 20 neurotypical (NT) AYA siblings (ages 13-24), and 21 parents were interviewed. Themes that emerged from the data analysis included: (1) learning, empathy, and compassion (2) relationship between the degree of functional impairment and the nature of the sibling relationship; (3) reluctance to share information about siblings with peers; (4) hypervigilance associated with unpredictable behavior; (5) worries and concerns about the future. These findings contribute to the existing literature on the impact and nature of neurotypical siblings' lived experience.

Empathy and Prosocial Behavior in Siblings of Children with Autism Spectrum Disorder: a Systematic Review

Siblings of children with ASD have, as a group, more autistic traits than typically developing individuals. A high prevalence of autistic traits may (or may not) include lower scores on measures of empathy and prosocial behavior compared with typically developing individuals. The purpose of this study was to conduct a systematic review of studies of empathy and prosocial behavior in siblings of individuals with ASD. We conducted a comprehensive literature search of studies published until March 2020. We identified 16 studies with a total of 1066 siblings that met inclusion criteria. Based on the review, we conclude that the current literature suggests that siblings of individuals with ASD exhibit normative empathic abilities and prosocial behavior.

Conflicting and harmonious sibling relationships of children and adolescent siblings of children with autism spectrum disorder

BACKGROUND

The presence of a child with autism spectrum disorder (ASD) could have a strong psychological and emotional impact on typical development (TD) siblings, with different ways of adjustment and perception of fraternal relationships. In this study, we aimed to investigate the experience of the TD siblings of children with ASD, combining both quantitative and qualitative methodologies.

METHOD

An explanatory sequential design was employed. Forty-four TD siblings of children with ASD, aged 6 to 17 years old, participated in the study. Each participant completed the Sibling Relationship Inventory that investigated warmth, rivalry and conflict in sibling relationships. Moreover, in order to thoroughly evaluate the participants' perception of their sibling relationship, they were asked to draw themselves with their sibling with ASD in a condition of harmony and conflict. The drawings were collected and coded using the well-validated Pictorial Assessment of Interpersonal Relationships. Quantitative and qualitative analyses were conducted.

RESULTS

In general, TD siblings showed affection for their siblings with ASD. However, males showed more conflict than females. Quantitative analyses of the drawings showed high levels of similarity between the siblings, despite the disability. In drawings, greater cohesion emerged in conditions of harmony and greater distancing in situations of conflict. Content analysis of the drawings showed that the conflict is represented mainly at home and the siblings often show opposite emotions, with TD siblings experiencing negative emotions. Moreover, adolescent TD siblings displayed more annoyance, shame and embarrassment than child TD siblings.

CONCLUSIONS

It is important to combine quantitative and qualitative tools to understand the experience of TD siblings in detail. In particular, drawing is a useful tool for providing quantitative and qualitative information, supplying rich and detailed information that can be well integrated with the results coming from quantitative tools.

Seeing the siblings: Gender differences in emerging-adult siblings of individuals with autism spectrum disorder

BACKGROUND

The present study focused on typically developing siblings (TDS) in emerging adulthood of individuals with autism spectrum disorder (ASD) and sought insight into how gender may interact with positive and negative affects in this population. In addition, we aimed to explore the gender differences as a moderator in the link between personal resources (i.e., family cohesion and flexibility coping strategy) and positive and negative affects among such TDS. An understanding of gender differences in this population should prove relevant to the development of potential interventions.

METHOD

A total of 116 emerging adult (age 18-29) TDS of younger siblings with ASD (the latter were under the age of 18 at the time of data collection), 80 females and 36 males, participated in the study. All participants completed self-report measures.

RESULTS

Female TDS reported higher negative affect than male TDS, while no differences emerged regarding positive affect. Female siblings reported higher family cohesion and higher flexibility in the forward-focused subscale of flexibility coping strategy, but not in its trauma-focused subscale, compared to male siblings. Additionally, gender moderates the links between family cohesion and positive affect but not negative affect. Gender also moderates the association between flexibility and negative affect, but not positive affect.

CONCLUSIONS

This study highlights the gender differences among TDS in emerging adulthood of individuals with ASD in relation to negative affect, family cohesion, and flexibility coping strategy. Understanding the gender-specific internal and external experiences of TDS as interplaying with their resources, at the unique developmental stage of emerging adulthood, may afford to identify TDS in need and to suggest potential interventions.

Self-reported Health-Related Quality of Life (HRQOL) and Anxiety Among Greek School-Age Siblings of Individuals with Autism Spectrum Disorders (ASD) in Relation to Parental Mental Health and Social Support

Health-Related Quality of Life (HRQOL) and anxiety were measured in 233 school-age siblings of individuals with Autism Spectrum Disorders (ASD) and siblings of Typically Developing (TD) children in Greece. The aim of the study was to investigate for any association between siblings' HRQOL or anxiety and parental mental health, perceived social support as well as major demographic factors. It was found that the disability group (ASD-sibs) showed elevated anxiety levels and poorer HRQOL than controls. In hierarchical multiple regression models, the anxiety of ASD-sibs was significantly associated with parental anxiety independent of parental perceived social support and demographic factors, whereas the HRQOL of ASD-sibs was associated with perceived social support independent of parental physical and mental health and demographic factors.

Functioning Among Typically Developing Siblings of Individuals with Autism Spectrum Disorder: A Meta-Analysis

The literature on typically developing siblings of individuals with autism spectrum disorder (ASD-Sibs) provides inconsistent results, with some studies reporting ASD-Sibs are more likely to have negative outcomes than comparison groups, and others reporting no significant differences. Therefore, the purpose of this study was to meta-analytically aggregate study effect sizes to more accurately calculate the degree to which ASD-Sibs function similarly or differently compared to siblings of people who do not have ASD. Studies were eligible for inclusion if they had a sample of ASD-Sibs older than 5; reported on emotional, psychological, behavioral, or social functioning; and provided information necessary for calculating relevant effect sizes. Results from 69 independent samples indicated that ASD-Sibs have significantly more negative outcomes than comparison groups overall (g = - 0.26); specific areas of functioning in which ASD-Sibs fared worse include internalizing behavior problems, psychological functioning, beliefs, social functioning, and the sibling relationship, but no significant differences in adjustment, attention/hyperactivity, externalizing behavior problems, coping, or family functioning. Noteworthy sub-areas of functioning in which ASD-Sibs also fared worse included beliefs about disability (g = - 0.56), anxiety symptoms (g = - 0.25), and depression symptoms (g = - 0.36). In terms of comparison group, ASD-Sibs had significantly lower functioning than siblings of individuals with other intellectual and developmental disabilities (g = - 0.31), including Down syndrome (g = - 0.40) and siblings of individuals without any disabilities (g = - 0.31). Clinicians and service providers should work to ensure that ASD-Sibs are included in family interventions and support strategies, and researchers should further explore individual differences that may relate to enhanced or impaired functioning in ASD-Sibs.

Randomized controlled trial of a sibling support group: Mental health outcomes for siblings of children with autism

LAY ABSTRACT

Typically developing siblings of a child with autism spectrum disorder may show mental health difficulties. A support group is one approach to help typically developing siblings. During support groups, typically developing siblings discuss their feelings, learn coping strategies and problem-solving skills, and develop a peer network. We compared a support group to participation in a similar group without a focus on the sibling with autism spectrum disorder. Some areas of mental health improved. Improvements were also impacted by autism spectrum disorder symptom severity in the sibling with autism spectrum disorder. Findings suggest continuing to examine how support groups can help typically developing siblings and for which siblings support groups might be particularly effective.

In their own words, in their own photos: Adolescent females' siblinghood experiences, needs and perspectives growing up with a preverbal autistic brother or sister

Thus far very little research has focused on siblings in early adolescent years growing up with an autistic sibling. Adopting a community-based participatory research (CBPR) approach, 11 typically developing sisters actively collaborated in the study to collect and analyse data as well as disseminate their experiences, needs and perspectives in their local communities. This is the first study to use a modified Photovoice methodology which provided typically developing sisters an active participatory role. The results highlighted the feelings, needs and thoughts the sisters expressed in their role as siblings, friends, but also as students and citizens with a passion for advocacy, and limited support in the community due to unhelpful attitudes of members of their community towards autism. The findings indicated that the current method used can successfully co-generate research findings with family members by ensuring pathways for engaging local community. This is crucial in shifting the balance between vulnerability and resilience in families raising an autistic child. Furthermore, when knowledge about the lived experience is drawn directly from the perspective of the actual people (siblings) involved in the phenomenon (siblinghood and autism), a more appropriate, responsive and need-fulfilling strategy of supportive and proactive support systems can be initiated.

'I don't live with autism; I live with my sister'. Sisters' accounts on growing up with their preverbal autistic siblings

BACKGROUND

The experiences of siblings in early adolescent years who grow up with an autistic brother or sister have received very little research interest, especially in terms of sisters' experiences. Hence our understanding of wellbeing opportunities and challenges in siblings' everyday life is inadequate and not reflected in the current clinical practices.

METHODS

Semi-structured interviews utilising an active, non-judgemental and curious stance to explore how sisters make sense of their everyday experiences (inspired by the notion of mentalizing) were conducted to capture important experiences of nine typically developing female siblings.

RESULTS

Interpretative Phenomenological Analysis (IPA) was employed. The master themes included: (i) sisters' interactions with their siblings- 'I don't live with autism, I live with my sister' (ii) sisters' interactions with their parents- 'Always there for us, but often asking too much', (iii) practical struggles of caring- 'Like a lonely fighter, tired but always on duty', (iv) perceived sisters' needs- 'I care about my brother and I want society to care about us'.

DISCUSSION

As experts of their own lived experience, sisters shed light on their day-to-day experiences. The themes derived from their experiences may help to draw attention to an appreciation of everyday life including planning for the parts that remain a struggle. This latter point is discussed in terms of implications and adoption of an existential view of wellbeing for future research and practice.

Comparing Behavioral-Emotional Difficulties in Siblings of Children with and without Sensory Impairments

BACKGROUND

Siblings of children with disabilities are the most likely family members to be affected by the child's disability due to the long-lasting nature of relationships between siblings compared to those of other family members. The aim of the present study was to compare the emotional-behavioral difficulties (EBD) in siblings of children with and without Sensory Impairments (SI).

METHODS

The statistical population of this causal-comparative research included all siblings of children with and without SI in Shiraz, southern Iran in 2016. The sample consisted of ninety-one siblings of children with (38) and without (53) SI in Shiraz. Sample of siblings of children with SI was recruited by purposeful sampling and sample of siblings of children without sensory impairments were selected through a multistage random sampling method. Strengths and Difficulties Questionnaire (SDQ) was utilized for measuring EBD. Two way ANOVA and MANOVA tests were used for data analyses.

RESULTS

Total EBD and two subscales of EBD (emotional problems and peer relationship problems) in siblings of children with SI were significantly greater than the comparison group (P<0.001). Furthermore, no significant difference was observed in the two subscales (conduct problems, and hyperactivity) between these two groups.

CONCLUSION

This study provides strong evidence that siblings of children with SI are significantly at a higher risk of psychological problems, and accordingly we suggest for the related supports and services.

Adult Siblings Who Have a Brother or Sister with Autism: Between-Family and Within-Family Variations in Sibling Relationships

Prior research on the sibling relationship in the context of autism spectrum disorder (ASD) has included only one sibling per family. We used multi-level modeling to examine aspects of the sibling relationship in 207 adults who have a brother or sister with ASD from 125 families, investigating variability in sibling relationship quality and pessimism within and between families. We found that there was greater variability in aspects of the sibling relationship with the brother or sister with ASD within families than between families. Sibling individual-level factors were associated with positive affect in the sibling relationship, while family-level factors were associated with the sibling's pessimism about their brother or sister's future. The findings illustrate the unique experiences of siblings within families.

Brief Report: Sibling Feelings Toward their Brother or Sister With or Without Autism or Intellectual Disability

The present study examined 97 adolescent siblings of individuals with autism spectrum disorder (ASD), intellectual and developmental disabilities (IDD), or no disabilities. Siblings reported on their feelings toward their brother or sister (anxiety, hostility, and positive affect), and parents reported on general optimism, child behavior problems, and perceptions of how the child impacts the family, including the sibling. There were no differences between siblings of individuals with ASD and siblings of individuals with IDD on any sibling self-reported feelings toward their brother or sister, though parents of individuals with ASD reported significantly less optimism and more negative perception of the child's impact on the family than did parents of children with IDD or no disability.

Predictors of remission from probable depression among Hong Kong adolescents - A large-scale longitudinal study

BACKGROUND

This study investigated the incidence of remission from probable depression among adolescents in Hong Kong. Remissions were defined as having Center for Epidemiological Studies Depression Scale (CESD) scores changed from ≥16 at baseline to <16 over the 12-month follow-up period. The study tested the predictors of remissions, including perceived changes in family support, self-efficacy, self-esteem, positive affect, negative events, social anxiety, and loneliness.

METHODS

The study surveyed 9666 secondary school students and identified 5487 (57%) students with probable depression in Hong Kong. A questionnaire assessing the levels of the aforementioned variables was completed at baseline and at the 12-month follow-up.

RESULTS

Among participants with probable depression at baseline, 23.2% remitted from depression at follow-up. Remissions were more common among males than females. Univariate logistic regression showed that perceived changes in all the aforementioned variables significantly predicted remission for both males and females. The same is true for most of these variables when they were entered together into multiple logistic regression models (with and without controlling for baseline CESD scores), except for family support in the female model and self-efficacy in both male and female models.

LIMITATIONS

Limitations include potential self-report bias and only one follow-up observation over time. The design treats cases of probable mild to severe depression as a single group (CESD≥16).

CONCLUSIONS

The findings are potentially useful for designing and guiding related intervention programs. Results highlight the importance of long-term follow-up of those screened as probable depression to understand the course of changes in levels of depression.

The Role of the Broader Autism Phenotype and Environmental Stressors in the Adjustment of Siblings of Children with Autism Spectrum Disorders in Taiwan and the United Kingdom

The influence of the broader autism phenotype (BAP) on the adjustment of siblings of children with autism has previously been researched mainly in Western cultures. The present research evaluated a diathesis-stress model of sibling adjustment using a questionnaire study including 80 and 75 mother-typically developing sibling dyads in Taiwan and the United Kingdom (UK). UK siblings reported elevated adjustment difficulties compared to the Taiwanese sample and to normative data. Whilst higher BAP levels were generally associated with greater adjustment difficulties, differences were found across cultures and respondents. Although significant diathesis-stress interactions were found, these were in the opposite direction from those predicted by the model, and differed across cultural settings. Implications for culturally-sensitive sibling support are considered.

Transitioning Together: A Multi-family Group Psychoeducation Program for Adolescents with ASD and Their Parents

Currently there are few evidence-based programs available for families of individuals with ASD during the transition to adulthood. The present study provided a preliminary evaluation of a multi-family group psychoeducation intervention using a randomized waitlist control design (n = 41). Families in the intervention condition participated in Transitioning Together, an 8-week program designed to reduce family distress and improve social functioning for adolescents. Findings indicated significant improvements in parental depressive symptoms and problem solving from pre- to post-intervention for parents in the intervention condition but not for parents in the control condition. Social interactions also improved for youth in the intervention condition relative to controls. Parents reported satisfaction with the program and particularly valued the opportunity to interact with other families.

Transitioning Together: A Multi-family Group Psychoeducation Program for Adolescents with ASD and Their Parents

Currently there are few evidence-based programs available for families of individuals with ASD during the transition to adulthood. The present study provided a preliminary evaluation of a multi-family group psychoeducation intervention using a randomized waitlist control design (n = 41). Families in the intervention condition participated in Transitioning Together, an 8-week program designed to reduce family distress and improve social functioning for adolescents. Findings indicated significant improvements in parental depressive symptoms and problem solving from pre- to post-intervention for parents in the intervention condition but not for parents in the control condition. Social interactions also improved for youth in the intervention condition relative to controls. Parents reported satisfaction with the program and particularly valued the opportunity to interact with other families.

Multi-informant assessment of siblings of youth with autism spectrum disorder: Parent-child discrepancies in at-risk classification

BACKGROUND

The behavioral and emotional functioning of typically-developing (TD) siblings of youth with autism spectrum disorder (ASD) has been frequently assessed in the literature; however, these assessments typically include only one informant, rarely considering differences between parent and self-reports of sibling adjustment.

AIMS

This study examined parent-youth reported informant discrepancies in behavioral and emotional functioning, including whether parent and youth reports yielded the same conclusions regarding TD sibling risk status.

METHODS, PROCEDURES, AND RESULTS

Among 113 parents and TD siblings of youth with ASD, TD siblings self-reported more overall, conduct, hyperactivity, and peer problems (compared to parent reports). Although few siblings were considered at-risk, those who were identified were not usually identified as at-risk on both informants' reports. Moreover, ASD symptoms, broader autism phenotype symptoms, parent mental health concerns, and social support from parents were all related to differences in at-risk classification between parent- and sibling self-report.

CONCLUSIONS AND IMPLICATIONS

This paper highlights the necessity of multi-informant reporting when considering TD sibling psychological functioning.

WHAT THIS PAPER ADDS

This study helps to address gaps in the literature on assessment of emotional and behavioral functioning of TD siblings of youth with ASD. The results highlight the importance of utilizing both parent- and self-report when identifying TD siblings at-risk for maladjustment. Although few siblings were considered at-risk, those who were identified were not usually identified as such on both informants' reports, and a variety of sibling- and parent-factors were associated with differences in at-risk classification. Thus, inclusion and examination of both parent- and self-report of TD sibling psychological functioning is vital for accurately identifying numbers of TD siblings at-risk of maladjustment.

Automated screening for Fragile X premutation carriers based on linguistic and cognitive computational phenotypes

Millions of people globally are at high risk for neurodegenerative disorders, infertility or having children with a disability as a result of the Fragile X (FX) premutation, a genetic abnormality in FMR1 that is underdiagnosed. Despite the high prevalence of the FX premutation and its effect on public health and family planning, most FX premutation carriers are unaware of their condition. Since genetic testing for the premutation is resource intensive, it is not practical to screen individuals for FX premutation status using genetic testing. In a novel approach to phenotyping, we have utilized audio recordings and cognitive profiling assessed via self-administered questionnaires on 200 females. Machine-learning methods were developed to discriminate FX premutation carriers from mothers of children with autism spectrum disorders, the comparison group. By using a random forest classifier, FX premutation carriers could be identified in an automated fashion with high precision and recall (0.81 F1 score). Linguistic and cognitive phenotypes that were highly associated with FX premutation carriers were high language dysfluency, poor ability to organize material, and low self-monitoring. Our framework sets the foundation for computational phenotyping strategies to pre-screen large populations for this genetic variant with nominal costs.

Siblings of Children with Autism: the Siblings Embedded Systems Framework

Purpose of Review

A range of interacting factors/mechanisms at the individual, family, and wider systems levels influences siblings living in families where one sibling has autism. We introduce the Sibling Embedded Systems Framework which aims to contextualise siblings’ experience and characterise the multiple and interacting factors influencing family and, in particular, sibling outcomes.

Recent Findings

Findings from studies that have reported outcomes for siblings of children with autism are equivocal, ranging from negative impact, no difference, to positive experience. This is likely due to the complex nature of understanding the sibling experience. We focus on particular elements of the framework and review recent novel literature to help guide future directions for research and practice including the influence of culture, methodological considerations, and wider participatory methods.

Summary

The Siblings Embedded System Framework can be used to understand interactive factors that affect sibling adjustment and to develop clinically, educationally and empirically based work that aims to enhance and support sibling adjustment, relationships, and well-being in families of children with autism.

Sibling relationship quality and psychosocial outcomes among adult siblings of individuals with autism spectrum disorder and individuals with intellectual disability without autism

Research on adult typically-developing (TD) siblings of individuals with developmental disabilities remains limited, and outcomes for TD siblings appear to vary widely. For the current study, 82 adult TD siblings of individuals with autism spectrum disorder (ASD) or intellectual disability (ID) completed questionnaires about themselves and their affected sibling. Results of this study suggest that the attitudes possessed by adult TD siblings are important to consider when understanding adult TD sibling outcomes. Specifically, data indicate that higher levels of positive sibling relationship attitudes are related to TD siblings providing more aid/support to their sibling with a disability, along with having higher levels of general life satisfaction, and negatively related to levels of stress and depressive symptoms among TD siblings. Consistent with previous child research, siblings of individuals with ASD reported fewer positive sibling relationship attitudes compared to siblings of individuals with ID. Finally, group membership related to aid provided, depressive symptoms, and stress of TD siblings indirectly through sibling relationship attitudes. Overall, results indicate that sibling relationship attitudes may be particularly important to consider when conceptualizing sibling relationships when one sibling has an intellectual or developmental disability.

Adolescent Siblings of Individuals With and Without Intellectual and Developmental Disabilities: Self-Reported Empathy and Feelings About Their Brothers and Sisters

Siblings of brothers or sisters with intellectual and developmental disabilities (IDD) are important but understudied family members. As many previous studies have relied on parent report of sibling outcomes, the use of sibling self-report is an important addition to the research. This study assessed the feelings of adolescent siblings toward their brothers or sisters with and without IDD, as well as broader aspects of sibling empathy. Data were collected via a national, online survey from 97 parent-sibling pairs. Siblings of individuals with IDD reported higher levels of anxiety toward the target child than did siblings of typically developing individuals. Sibling feelings toward the target child were related to both parental and target child factors, but only among families of individuals with IDD.

The Experience of Social Participation in Everyday Contexts Among Individuals with Autism Spectrum Disorders: An Experience Sampling Study

This study explored the everyday life experiences of individuals with an autism spectrum disorder (ASD). Fourteen Australians and 16 Taiwanese (aged 16-45 years) with Asperger syndrome/high functioning autism recorded what they were doing, level of interest/involvement, emotional reactions and preference for being alone 7 times/day for 7 days. Multilevel analyses showed that 'solitary/parallel leisure' and 'social activities' were positively associated with interest and involvement. Engaging in these two activities and interacting with friends were positively associated with enjoyment. However, engaging in 'social activities' and having less severe ASD symptoms were associated with in-the-moment anxiety. Severity of ASD and social anxiety moderated experience in social situations. The findings highlight the importance of considering the in-the-moment experience of people with ASD.

Risk Factors for Behavioral and Emotional Difficulties in Siblings of Children With Autism Spectrum Disorder

This study examined risk factors for behavioral and emotional problems in 1973 siblings of children with autism spectrum disorders (ASD). Results revealed six correlates of sibling internalizing and externalizing problems: male gender, smaller family size, older age of the child with ASD, lower family income, child with ASD behavior problems, and sibling Broader Autism Phenotype. Siblings with few risk factors were at low risk for behavioral and emotional problems. However, siblings with many risk factors were at increased risk for both internalizing and externalizing problems. These results highlight the need to assess risk for individual siblings to best identify a sub-population of siblings who may be in need of additional support.

Siblings of Youth with Autism Spectrum Disorders: Theoretical Perspectives on Sibling Relationships and Individual Adjustment

A burgeoning research literature investigates the sibling relationships of youth with autism spectrum disorder (ASD) and their implications for individual adjustment. Focusing on four relationship domains—behaviors,emotions, cognitions and involvement—and toward advancing this generally a theoretical literature, were view and apply tenets from a range of theoretical perspectives in an effort to illuminate the mechanisms underlying sibling relationship experiences and their adjustment implications. Our review suggests new directions for research to test theoretically-grounded hypotheses about how sibling relationships develop and are linked to individual adjustment. In addition, we consider how identifying underlying bio-psycho-social processes can aid in the development of interventions to promote warm and involved sibling relationships and positive youth development.

Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protective Factors

This study compared sibling adjustment and relationships in siblings of children with Autism Spectrum Disorder (ASD-Sibs; n = 69) and siblings of children with typical development (TD-Sibs; n = 93). ASD-Sibs and TD-Sibs demonstrated similar emotional/behavioral adjustment. Older male ASD-Sibs were at increased risk for difficulties. Sibling relationships of ASD-Sibs involved less aggression, less involvement, and more avoidance than those of TD-Sibs. Partial support for a diathesis-stress conceptualization of sibling difficulties was found for ASD-Sibs. For TD-Sibs, broader autism phenotype (BAP) was related to psychosocial difficulties regardless of family stressors. For ASD-Sibs, BAP was related to difficulties only when family stressors were present. This suggests that having a sibling with ASD may be a protective factor that attenuates the negative impact of sibling BAP.

Family wellbeing of individuals with autism spectrum disorder: A scoping review

Families play an important role in supporting individuals with autism spectrum disorder across the lifespan. Indicators of family wellbeing can help to establish benchmarks for service provision and evaluation; however, a critical first step is a clear understanding of the construct in question. The purpose of the current scoping review was to (a) summarize current conceptualizations and measurements of family wellbeing, (b) synthesize key findings, and (c) highlight gaps and limitations in the extant literature. A final review of 86 articles highlighted the difficulty of synthesizing findings of family wellbeing in the autism spectrum disorder literature due to varied measurement techniques and the limited use of a common theoretical direction. Considerations for future research are presented with an eye toward policy relevance.

Maternal perceptions of sibling adaptation in Korean families of children with Down syndrome

BACKGROUND

It is estimated that more than 500 infants with Down syndrome (DS) are born each year in Korea. DS affects not only these individuals, but family members as well. Some siblings deal successfully with the challenges of living with a child with DS and adapt well while others struggle or fail to adapt. The aims of this descriptive study were to explore how Korean mothers of children with DS perceive the adaptation of their typically developing (TD) children aged 4 to 19 and how family variables contribute to sibling adaptation.

METHOD

This descriptive, cross-sectional study was conducted with 105 Korean mothers.

RESULTS

Most mothers indicated that their TD children were not experiencing psychological or behavioural problems; however, many described problems in the sibling relationship. It was found that family factors (i.e. condition management effort, condition management ability, child's daily life, parental mutuality, family hardiness and social support) were strong predictors of sibling psychological, behavioural and relational adaptation. Demographic characteristics of the child with DS, the mother and the family appeared to significantly influence sibling adaptation.

CONCLUSIONS

These findings highlight the importance of familial contexts in understanding sibling adaptation. Knowledge of family factors associated with better adaptation in Korean siblings of child with DS will facilitate the development of culturally appropriate interventions for these children and their families. In addition, an awareness of demographic characteristics associated with sibling adaptation will help health care professionals identify siblings who are at increased risk of experiencing difficulties in adapting.

Family function, Parenting Style and Broader Autism Phenotype as Predicting Factors of Psychological Adjustment in Typically Developing Siblings of Children with Autism Spectrum Disorders

OBJECTIVE

Siblings of children with autism are at a greater risk of experiencing behavioral and social problems. Previous researches had focused on environmental variables such as family history of autism spectrum disorders (ASDs), behavior problems in the child with an ASD, parental mental health problems, stressful life events and "broader autism phenotype" (BAP), while variables like parenting style and family function that are shown to influence children's behavioral and psychosocial adjustment are overlooked. The aim of the present study was to reveal how parenting style and family function as well as BAP effect psychological adjustment of siblings of children with autism.

METHOD

The Participants included 65 parents who had one child with an Autism Spectrum Disorder and one typically developing child. Of the children with ASDs, 40 were boys and 25 were girls; and they were diagnosed with ASDs by a psychiatrist based on DSM-IV-TR criteria and Autism Diagnostic Interview-Revised (ADI-R). The Persian versions of the six scales were used to collect data from the families. Pearson's correlation test and regression analysis were used to determine which variables were related to the psychological adjustment of sibling of children with ASDs and which variables predicted it better.

RESULTS

Significant relationships were found between Strengths and Difficulties Questionnaire (SDQ) total difficulties, prosocial behaviors and ASDs symptoms severity, parenting styles and some aspects of family function. In addition, siblings who had more BAP characteristics had more behavior problems and less prosocial behavior. Behavioral problems increased and prosocial behavior decreased with permissive parenting style. Besides, both of authoritarian and authoritative parenting styles led to a decrease in behavioral problems and an increase in prosocial behaviors. Our findings revealed that some aspects of family function (affective responsiveness, roles, problem solving and behavior control) were significantly correlated with behavioral problems and prosocial behaviors in typically developing (TD) siblings of children with ASDs.

CONCLUSION

Siblings of children with ASDs, due to genetic liability, are at a greater risk of psychological maladjustment. Furthermore, environmental factors like parenting styles and family function also have a significant effect on psychological maladjustment.

The self-esteem and anxiety of children with and without mentally retarded siblings

BACKGROUND

The study was carried out with the aim of determining the factors affecting and to evaluate anxiety situations and self-esteem of children with and without mentally retarded siblings.

MATERIALS AND METHODS

The sampling included 227 healthy children: 108 of them have mental retarded sibling and 119 of them do not have mental retarded sibling. The context of this study consisted of 15-18 year of age healthy children with mentally retarded siblings and 15-18 year of aged healthy children having at least one sibling between the dates February 15(st) and June 26(st) 2010. Personal Information Form, Rosenberg Self-Esteem Scale and Trait Anxiety Scale were used.

RESULTS

It was found out that trait anxiety of 17-18 aged of children with mental retarded sibling (47.04 ± 7.3) was higher than that of the children without mental retarded siblings (44.05 ± 11.23) (P < 0.05). It was observed that self-esteem of children with mentally retarded sibling was not affected from the handicap of their siblings (P > 0.05). Trait anxiety score averages of children with mentally retarded sibling and experience some difficulties due to his or her siblings's handicap (47.00 ± 7.76) were found higher than those of those of the children without any problem with the environment (42.61 ± 7.48) (P < 0.05).

CONCLUSION

Although the average score of trait anxiety and self-esteem in both groups were not significant different, score of trait anxiety for children with mentally disabled siblings was higher in comparison. It was concluded that anxiety of children with and without mentally retarded siblings increased as self-esteem of these children decreased.

Patterns and predictors of anxiety among siblings of children with autism spectrum disorders

The purpose of this study was to examine patterns of anxiety among siblings of children with autism spectrum disorders (ASD), and determine the characteristics of the child with ASD and their parents that predicted anxiety. Data was collected from 1,755 siblings of children with ASD whose families participated in the Simons Simplex Collection; siblings ranged in age from 3 to 18 years (M = 9 years). Male siblings were at increased risk for sub-clinical anxiety problems during middle childhood. Parental history of anxiety disorders, higher maternal pragmatic language, and more proband behavior problems predicted higher anxiety. While siblings overall did not show elevated anxiety symptoms, higher rates of sub-clinical anxiety problems among males and siblings in middle childhood are cause for concern.

The well-being of siblings of individuals with autism

Objective. The purpose of this review of the literature was to summarise studies regarding the psychosocial impact of growing up with a sibling with autism and to identify gaps in the related literature. Methods. Electronic databases were reviewed in order to critically appraise the 14 articles relevant to the topic. The search included a combination of the following key words: autism∗, quality of life, well-being, sibling∗, ASD, ASD sibling∗, family, adjust∗, psychological functioning. Results. The majority of studies involved mixed children and adolescent samples, leading to confounding results and an inability to draw accurate conclusions about these distinct life stages. Autism appears to contribute to unique environmental stressors for the typically developing sibling. When experienced in the context of additional demographic risk factors, these stressors can result in difficulties adjusting to the demands of a special-needs child. Despite some vulnerability to behavioural and emotional dysfunction in at-risk children, siblings have the potential to not only adjust but to thrive in the face of disability adversity. Conclusion. Growing up with a sibling with autism appears to manifest in both positive and negative outcomes for siblings, depending upon important demographical, family, and individual variables.

Emotional and behavioral adjustment in typically developing siblings of children with autism spectrum disorders

Research findings describing the emotional and behavioral functioning of typically developing (TD) siblings of children with autism spectrum disorders (ASD) are contradictory. Methodological issues, such as small study sample sizes and reliance on parent report, may contribute to inconsistent findings. The purpose of this study was to use parent and teacher report to describe presence of internalizing and externalizing behaviors among a large sample (n = 486) of TD siblings of children with ASD. Results indicated that siblings did not exhibit a disproportionate prevalence of internalizing or externalizing symptoms in comparison to the standardization sample of the rating scale. The presence of a sibling with an ASD may not be considered a risk-factor for adjustment problems among TD siblings.

Birth order rank as a moderator of the relation between behavior problems among children with an autism spectrum disorder and their siblings

Variability within the literature investigating typically-developing siblings of children with an autism spectrum disorder suggests that the quality of sibling outcomes may depend on specific factors. For this study, 42 parents of a child with an autism spectrum disorder and a typically- developing sibling provided data via online questionnaires. Birth order rank of the child with an autism spectrum disorder significantly moderated the relation between externalizing behaviors in children with an autism spectrum disorder and externalizing behaviors in their typically-developing siblings. Children with an autism spectrum disorder and higher levels of behavior problems had typically-developing siblings with higher levels of behavior problems only when the child with an autism spectrum disorder was older. These results provide a hint of clarification about the complex nature of sibling relations, but a great deal more research is needed to further examine outcomes of typically-developing siblings of children with an autism spectrum disorder.

TARGETED TREATMENTS IN AUTISM AND FRAGILE X SYNDROME

Autism is a neurodevelopmental disorder consisting of a constellation of symptoms that sometimes occur as part of a complex disorder characterized by impairments in social interaction, communication and behavioral domains. It is a highly disabling disorder and there is a need for treatment targeting the core symptoms. Although autism is accepted as highly heritable, there is no genetic cure at this time. Autism is shown to be linked to several genes and is a feature of some complex genetic disorders, including fragile X syndrome (FXS), fragile X premutation involvement, tuberous sclerosis and Rett syndrome. The term autism spectrum disorders (ASDs) covers autism, Asperger syndrome and pervasive developmental disorders (PDD-NOS) and the etiologies are heterogeneous. In recent years, targeted treatments have been developed for several disorders that have a known specific genetic cause leading to autism. Since there are significant molecular and neurobiological overlaps among disorders, targeted treatments developed for a specific disorder may be helpful in ASD of unknown etiology. Examples of this are two drug classes developed to treat FXS, Arbaclofen, a GABA(B) agonist, and mGluR5 antagonists, and both may be helpful in autism without FXS. The mGluR5 antagonists are also likely to have a benefit in the aging problems of fragile X premutation carriers, the fragile X -associated tremor ataxia syndrome (FXTAS) and the Parkinsonism that can occur in aging patients with fragile X syndrome. Targeted treatments in FXS which has a well known genetic etiology may lead to new targeted treatments in autism.

Concerns and considerations among caregivers of a child with autism in Qatar

BACKGROUND

Autism impacts the lives of the family looking after a child with the condition in different ways, and forces family members to modify their daily lives to suit their reality. To our knowledge, no previous research investigated concern and considerations of parents/caregivers of children with autism in Qatar or the Arabic speaking Middle Eastern region.

METHODS

Caregivers of a child who was between the age of 3 to 17 years old at the time of the study and who was diagnosed with ASD (Autistic Group or AG) were recruited from the two main developmental pediatric and children rehabilitation clinics in Qatar. The control group (non-autism group, or NAG) was represented by caregivers of a non-autistic child between the age of 3 to 17 years old at the time of the study and who were visiting a family clinic of a primary health care facility for routine medical check-up. Data collected from both groups included related to the child (e.g. the child's date of birth, his/her relation to the caregiver, number of siblings, number of hours of sleep in a day, number of hours spent watching television or videos prior to age 3, time spent indoors prior to age 3, absenteeism from school, and use of a nanny to care for the child) and to the caregiver (education level, profession, level of consanguinity using the phylogram method). In addition to these questions, caregivers in the AG were asked specific questions around maternal concern and considerations in respect to the future of their children and the specialized services they receive.

RESULTS

Children in the autism group spent more time indoors, watching television, or sleeping than children in the non-autism group. Only around 40% of caregivers in the autism group said they would encourage their child to get married and become a parent when s/he grows up. A number of caregivers of children with autism frequently utilize specialized rehabilitation services; others did express their needs for these services and made comments about having to wait a long time before they were provided with some of the services. Religious faith helped caregivers in accepting having a child with autism. General health-related quality of life did not differ significantly between the caregivers of the two groups, although mental health was consistently poorer in the autism group of caregivers.

CONCLUSIONS

The study draws attention to the concerns of the families of children with autism and their expectations about the future of their children. The findings can be used by policy makers in planning services to support these families in Qatar.

The siblings relationship of adolescents with and without intellectual disabilities

The sibling relationship of adolescents with and without intellectual disabilities was examined. Participants were 70 sibling dyads--each dyad was comprised of one 12-year old adolescent with (N=23) or without intellectual disabilities (N=47). Sibling relationships, behavior problems, and social skills were assessed using mother reports. Results revealed three findings. First, for typically developing adolescents, mothers reported more warmth in the sibling relationship for opposite sex dyads. For adolescents with intellectual disabilities, mothers reported more warmth in the sibling relationship for same-sex dyads. Second, for typically developing adolescents, mothers reported more status/power differences when the sibling was younger than when the sibling was older. For adolescents with intellectual disabilities, birth order did not affect status/power in the sibling relationship. Third, for typically developing adolescents, conflict was related to internalizing behavior problems. For adolescents with intellectual disabilities, conflict was related to externalizing behavior problems. Implications, limitations, and future directions are discussed.