Caregiving Roles of Siblings of Adults With Intellectual and Developmental Disabilities: A Systematic Review

Experiences of siblings of children with profound intellectual and multiple disabilities: a qualitative systematic review protocol

OBJECTIVE

The objective of this systematic review is to explore the experiences of siblings of children with profound intellectual and multiple disabilities.

INTRODUCTION

With improved life expectancy of children with profound intellectual and multiple disabilities, the research focus is on care at home and in the community. Although parents are the primary caregivers, siblings often assume the role of young caregivers, bearing the weight of caregiving responsibilities. Thus, a synthesis of qualitative findings is required regarding their experiences to facilitate the development of effective support strategies.

INCLUSION CRITERIA

Siblings of children with profound intellectual and multiple disabilities will be included, defined as children with an IQ of ≤40 or mental development below a 2-year-old's level, coupled with an inability to walk independently. Disabled children aged <20 years will be included. There will be no restrictions on the siblings' age or type of relationship. Qualitative studies on experiences, caregiving burdens, challenges, difficulties, and frustration in daily life will be considered, covering home, community, school, and hospital settings for children with disabilities.

METHODS

We will follow the JBI methodology for systematic reviews of qualitative evidence. The search strategy will be conducted in 3 phases: initial limited search, comprehensive database search, and reference list search of the included articles. The MEDLINE, CINAHL Plus, PsycINFO, Scopus, Ichushi-Web, and CiNii databases will be searched, with no restrictions on language or publication date. Study selection, critical appraisal, data extraction, and data synthesis will be conducted by 2 independent reviewers. We will evaluate the final synthesized findings using the ConQual approach.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42024499042.

A Longitudinal Mixed-Methods Characterization of Family Support from Adolescence to Young Adulthood in Autism and Other Developmental Disabilities

Although caregiving responsibilities and need for support persist and evolve across the life course in families with autistic youth or youth with other developmental disabilities (DDs), little is known about support during their child's adulthood years. Therefore, the present study used a mixed-methods approach to examine change and stability in formal and informal family support across the transition to adulthood. Caregivers of 126 individuals with autism or DDs completed a modified version of the Family Support Scale, including open-ended questions, at five time points from adolescence (age 16) into young adulthood (age 22). Caregivers reported that informal support from family members was the most frequently used, helpful, and valued source of support with relative stability across time. In contrast, the reported helpfulness, use, and value of formal support (e.g., professionals, schools) for caregivers declined over time. Qualitative content analyses revealed characteristics of highly valued support included support type (e.g., instrumental or emotional) and features of the support source (e.g., their understanding). There was a shift to valuing emotional support more than instrumental support over time, especially for caregivers of less able adults. Partnership and dependability emerged as highly valued features of the support source. These findings fit within a social convoy perspective and likely reflect the "service cliff" experienced by autistic individuals or people with DDs and their families. As social networks shrink over time and formal services are less readily available in adulthood, remaining sources of support, particularly from family members, become increasingly important.

Being a sibling of a youth with a neurodisability: A qualitative study about the roles and responsibilities during the transition to adulthood

BACKGROUND

During the transition to adulthood, a common challenge that youth with a neurodisability may experience is learning how to navigate services in the adult care system. During this transition youth may rely on their families, including siblings, for support. However, delineation of sibling roles and responsibilities during this transition period are unclear. This study aims to identify the roles and responsibilities that siblings perceive to have with their sibling with a neurodisability during the transition to adulthood, and describe the decision-making process of how siblings chose these roles.

METHODS

In this descriptive qualitative case study, siblings were eligible to participate if they were between 14 to 40 years old, had a sibling between 14 to 21 years with a childhood-onset neurodisability and spoke English. Semi-structured interviews augmented by techniques of photo elicitation and relational maps were conducted. Reflexive thematic analysis was applied to identify sibling roles, as well as the emotional and decision-making process associated with these roles. Our team partnered with siblings with lived experience in all study phases.

RESULTS

Nineteen participants (median age = 19 years, range = 14 to 33 years) from 16 unique families were interviewed. Six unique roles were described: friend, role model/mentor, protector, advocate, supporter, or caregiver. The emotions that siblings experienced with each role, also known as emotional responsibility, were categorized into levels of low, medium or high. Siblings also described a four-phase decision-making process for their roles: (1) acquiring knowledge; (2) preparing plans; (3) making adjustments; and (4) seeking support. Intrapersonal characteristics, including personal identity, values and experiences, influenced roles assumed by siblings.

CONCLUSIONS

Siblings identified needing support as they process their decisions and emotional responsibility in their roles when their sibling with a neurodisability is transitioning to adulthood. Resources should be developed or further enhanced to support siblings.

'There's a timebomb': Planning for parental death and transitions in care for older people with intellectual disabilities and their families

BACKGROUND

Increasing numbers of older adults with intellectual disabilities are living with ageing parents. These families need support to plan for the future to avoid crisis interventions following parental death.

METHOD

Interviews and focus groups were conducted with people with intellectual disabilities (aged 40+) (N = 9), parents (N = 11) and siblings (N = 16) to understand their perspectives about living with parents and future planning. Data were analysed using framework analysis.

RESULTS

Four themes were identified: 'What matters to me', 'When should we plan', 'What are the options' and 'Who will help'. Participants knew they needed to make plans but did not feel supported to do so. While they viewed moving as an opportunity for independence, they feared there were no viable alternatives.

CONCLUSION

Person-centred resources and support are needed for families to plan for transitions in care, including proactive approaches from social services and help to prepare for conversations with social care professionals.

Randomised controlled feasibility study protocol of the Carers-ID online intervention to support the mental health of family carers of people with intellectual disabilities

BACKGROUND

Family carers play a crucial role in supporting the health and well-being of people with intellectual disabilities. Given their role and responsibilities, many family carers experience significant and ongoing stress and mental health difficulties. Programmes and interventions which provide training and support to family carers have been shown to have a positive impact on levels of stress and quality of life. However, these are often face to face which can create barriers to full participation. Online interventions have been shown to offer flexibility in delivery compared with traditional face-to-face approaches. The primary objective of this study is to determine the feasibility of delivering the Carers-ID online intervention, while the secondary outcome is improved mental health in family carers of people with intellectual disabilities.

METHODS

Family carers (n = 120) will be randomised to receive the intervention (n = 60) or assigned to a wait-list control (n = 60) group. The intervention ( www.Carers-ID.com ) consists of 14 modules which cover topics including the following: promoting resilience, providing peer support, reducing anxiety, managing stress, accessing local supports and managing family conflict and information for siblings who are carers. The intervention has been co-produced with voluntary sector organisations and family carers and tested for acceptability. Primary outcomes for this study include acceptability and feasibility of the outcome measures, recruitment, participation and retention rates and effect sizes. Secondary outcomes will be completed at three time points (baseline, following intervention completion and 3 months after completion). These include the following: the Depression, Anxiety and Stress Scale, the Warwick-Edinburgh Mental Well-being Scale, the Resilience Scale and the Social Connectedness Scale Revised. Participants (n = 12) who have taken part in the intervention arm of the research will be invited to participate in semi-structured interviews as part of the process evaluation.

DISCUSSION

The Carers-ID intervention provides an online resource for family carers to support their mental health and well-being and promote their resilience. It represents an affordable and accessible means of delivering such support. Testing the feasibility of the intervention and related trial procedures is required to determine whether a full-scale randomised controlled trial to evaluate the intervention's effectiveness is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov : NCT05737823.

The psychosocial impact of childhood dementia on children and their parents: a systematic review

BACKGROUND

Childhood dementias are a group of rare and ultra-rare paediatric conditions clinically characterised by enduring global decline in central nervous system function, associated with a progressive loss of developmentally acquired skills, quality of life and shortened life expectancy. Traditional research, service development and advocacy efforts have been fragmented due to a focus on individual disorders, or groups classified by specific mechanisms or molecular pathogenesis. There are significant knowledge and clinician skill gaps regarding the shared psychosocial impacts of childhood dementia conditions. This systematic review integrates the existing international evidence of the collective psychosocial experiences of parents of children living with dementia.

METHODS

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched four databases to identify original, peer-reviewed research reporting on the psychosocial impacts of childhood dementia, from the parent perspective. We synthesised the data into three thematic categories: parents' healthcare experiences, psychosocial impacts, and information and support needs.

RESULTS

Nineteen articles met review criteria, representing 1856 parents. Parents highlighted extensive difficulties connecting with an engaged clinical team and navigating their child's rare, life-limiting, and progressive condition. Psychosocial challenges were manifold and encompassed physical, economic, social, emotional and psychological implications. Access to coordinated healthcare and community-based psychosocial supports was associated with improved parent coping, psychological resilience and reduced psychological isolation. Analysis identified a critical need to prioritize access to integrated family-centred psychosocial supports throughout distinct stages of their child's condition trajectory.

CONCLUSION

This review will encourage and guide the development of evidence-based and integrated psychosocial resources to optimise quality of life outcomes for of children with dementia and their families.

Family Support for (Increasingly) Older Adults with Down Syndrome: Factors Affecting Siblings' Involvement

BACKGROUND

Life expectancy for people with Down syndrome is increasing, but older adults with Down syndrome are at greater risk of developing certain pathologies associated with ageing. When ageing parents can no longer look after their child with Down syndrome, their other children are often expected to shoulder this responsibility.

METHOD

We asked 120 adult siblings of a person with Down syndrome to complete a questionnaire on their current and anticipated relationships.

RESULTS

Most respondents considered these relationships to be positive, but they expressed concerns about the effects of ageing and about having to organise their sibling with Down syndrome's future life. We investigated the impact of factors relating to the respondents and to their sibling with Down syndrome (age, gender, social inclusion, protection regime) on these general tendencies.

CONCLUSION

Siblings need to be given support, for example, via discussion groups, to facilitate the transition to becoming caregivers.

Subjective Poverty Moderates the Association Between Carer Status and Psychological Outcomes of Adult Siblings of People with Intellectual and Developmental Disabilities

Adult siblings are potentially important sources of care, support, advocacy, and friendship for their brothers and sisters with intellectual and developmental disabilities (IDD). Drawing on data about 851 adult siblings who completed an online national survey, we examined predictors and potential key moderators of siblings' mental distress, wellbeing, quality of life, and health outcomes. Moderated regression analyses indicated that siblings experiencing higher levels of subjective poverty; siblings with brothers and sisters with lower levels of independence; and siblings who are carers and also experiencing low levels of subjective poverty, had worse outcomes and may be in need of specific supports. Compared to normative samples, adult siblings of people with IDD had worse outcomes across the measures.

Comparison of Perceptions of Activities of Daily Living of Adult Children with Autism Among Three Groups of Aging Caregivers

Many aging parents care for adult children with autism spectrum disorder (ASD) and an additional loved one. This exploratory study compared differences among compound 1 (caring for an additional family member), compound 2 (caring for a typically developing minor child), and noncompound (solely caring for an adult child with ASD) caregivers on perceptions of the degree of support that care recipients need to perform specific types activities of daily living (ADL) that care recipients need assistance to complete. Each caregiver cared for at least one adult child with ASD. Results from a web-based survey completed by 320 aging caregivers were examined using Kruskal-Wallis ANOVA tests for independent samples. Compound 1 and noncompound caregivers were more likely to be involved in assisting their adult children with some ADLs when compared with compound 2 caregivers. Findings provide insight into the realities of caregivers with regard to ADL needs of their adult children.

Impact of Assistive Technologies to Inclusive Education and Independent Life of Down Syndrome Persons: A Systematic Literature Review and Research Agenda

Since the beginning of the 21st century, the lifespan of people born with Down syndrome (DS) has increased. They now outlive their parents and rely on their relatives who usually sacrifice their own families to care for their disabled siblings. To reduce the pressure on families and the wider community, it is crucial to prepare DS people for independent life from early childhood. Emerging technologies can significantly support the process of acquiring the skills that are necessary for solving real-life problems at home and work. To assess their impact and estimate how much they are implemented in inclusive education, a review of 564 papers published after 2015 was done using the PRISMA review model. After gradual exclusion, 24 papers were used for the final review. Thematic analysis resulted in four themes with one common concept: variety. The results of examining the four research questions defined in the paper’s background confirm that the synergy of emerging assistive technologies and inclusive education has the potential of becoming a very effective strategy for creating an independent life for DS individuals. Many questions remain open, mainly related to a DS persons’ specific needs and capabilities. The acceptance of the proposed synergy will depend on them.

The Experience of Caregiving for an Adult Sibling with Down Syndrome

Adults with Down syndrome are living longer than ever before and are likely to outlive their parents. Adult siblings have been identified as future caregivers, yet little is known about this experience. The prominent caregiving literature focuses on the anticipation of caregiving rather than on the experience of being a caregiver. The aim of this study was to explore the lived experience of being a caregiver to an adult sibling with Down syndrome. A descriptive phenomenological approach was used to interview seven siblings who were partial and full caregivers for an adult sibling with Down syndrome. The participants fulfilled multiple roles in the lives of their siblings throughout their adult lives, but felt unprepared to fulfill the duties of being full-time caregivers upon the death of their parents. Navigation of the social service system was complex and frustrating with no support or guidance. Everyday tasks of caregiving were time consuming and managing the medical and social service needs of their siblings was viewed as a huge responsibility. Participants felt the responsibilities of caregiving put limitations on their personal lives. Despite the challenges, participants felt caregiving had benefits also. The transition to being caregivers was difficult because of the lack of planning by their parents, yet participants have not made plans for the future succession of caregiving. Implications are identified for healthcare and social service professionals to aid families in the care of adults with Down syndrome and in planning for the future transition of caregiving in families.

Compound Caregiving: Toward a Research Agenda

Aging family caregivers of adults with intellectual and developmental disabilities (IDD) have unique circumstances setting them apart from the general caregiving population. Such differences include the extensive duration of the caregiving, and health concerns that manifest in the caregiver and individuals with IDD over time. Because of increasing longevity, family caregivers are likely to become compound caregivers (i.e., individuals caregiving for multiple people). Almost 70% of family caregivers of individuals with IDD experience compound caregiving, yet we know very little about compound caregiving. In this article, we highlight the importance of supporting compound caregivers by identifying research issues that address current challenges and future directions. Implications for research are noted, including the need for multidimensional outcome measures and longitudinal studies.

A Pilot Study of a Future Planning Program for Siblings of People With Intellectual and Developmental Disabilities

Given the increased longevity of people with intellectual and developmental disabilities (IDD), future planning programs are becoming increasingly common. However, although siblings are likely to fulfill caregiving roles for people with IDD, siblings have not been included in future planning interventions. The purpose of this study was to evaluate the outcomes and feasibility of the Sibling Training for Early future Planning (STEP) program. Using quantitative and qualitative data, 18 siblings of individuals with IDD participated in the study. After completing the STEP program, participants demonstrated significantly improved feelings of empowerment, disability connectedness, family communication, and knowledge of adult disability services. The STEP program was also feasible given high attendance, low attrition rates, and high participant satisfaction. Implications for research and practice are discussed.

Exploring the experiences of siblings of adults with intellectual/developmental disabilities during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has caused many adults with intellectual/developmental disabilities (IDD) to lose their daily routines and social support, and as a result, many adults with IDD are increasingly reliant on their family caregivers. Siblings often play a crucial support role for their brothers and sisters with IDD. As such, this study aimed to describe the experiences of adult siblings of people with IDD during the COVID-19 pandemic.

METHODS

The Sibling Collaborative worked with researchers to codesign an online survey, completed by 91 people, exploring sibling supports and concerns during the COVID-19 pandemic. The survey also aimed to identify helpful resources for siblings during this time.

RESULTS

The results showed that the majority of siblings are supporting their brother or sister with IDD during the COVID-19 pandemic and are concerned about the health and well-being of their brother/sister. The most common concern related to disruption of their brother's or sister's routine and activities. Although responses of older and younger siblings did not differ from each other, siblings whose brother or sister with IDD lived with family had some unique concerns relative to those whose siblings no longer lived with family. Siblings described how their own self-care and relationships with others, as well as support for their brother/sister, were particularly helpful during the COVID-19 pandemic.

CONCLUSIONS

Siblings are providing key support to their brother or sister with IDD during the COVID-19 pandemic, and they too must be supported. Siblings should be included in efforts to disseminate resources targeting people with IDD and their feedback and input must be obtained. It is also important to include sibling mental wellness as caregiver supports are created and implemented. More research is needed to further understand how to support sibling caregivers.

Seeing strengths: Young adults and their siblings with autism or intellectual disability

BACKGROUND

Understanding the positive qualities of individuals with intellectual and developmental disabilities can provide a much-needed counterpoint to deficit-based depictions of disability.

METHOD

This study examined how 163 young adults (ages 18-30) viewed the strengths of their brothers and sisters with intellectual disability or autism using the Assessment Scale for Positive Character Traits-Developmental Disabilities (Woodard, 2009). In addition, the authors examined factors that may shape their perspectives.

RESULTS

Overall, siblings' ratings of strengths were moderate to high, indicating an overall portrait of strengths. The majority of brothers and sisters with disabilities was described as having multiple strengths and their profiles on this measure were highly individualized. Lower overall ratings were associated with several variables, including not using speech as a primary mode of communication, exhibiting challenging behaviours, having autism and not currently living together.

CONCLUSIONS

The authors offer recommendations for future research and practice related to supporting siblings with and without disabilities.

Exploring the nature and correlates of caregiving among parents of adults with intellectual and developmental disabilities

BACKGROUND

As adults with intellectual and developmental disabilities (IDD) have longer lives, parents may remain caregivers into old age. In addition, it is unknown who will fulfil caregiving roles after parents are no longer able to be caregivers. In the current study, we explored the nature (e.g. number of hours of caregiving) and correlates of parental caregiving for their adult offspring with intellectual and developmental disabilities and their future caregiving plans.

METHOD

In the United States, data were collected from 334 parents of adults with intellectual and developmental disabilities via a national survey.

RESULTS

Altogether, 55% of the sample spent more than 15 hr conducting caregiving per week. Individual characteristics (e.g. maladaptive behaviour and functional abilities) and parent characteristics (e.g. physical proximity of the adult with intellectual and developmental disabilities and caregiving ability) positively correlated with caregiving hours. Notably, 38.58% of participants were unsure who would fulfil caregiving roles.

CONCLUSION

Implications for research about caregiving and practice are discussed.

Compound sibling caregivers of individuals with intellectual and developmental disabilities

BACKGROUND

Given the increasing lifespans of individuals with intellectual and developmental disabilities (IDD), siblings may fulfil multiple caregiving roles simultaneously for their ageing parents, their offspring, and their brother or sister with IDD. Yet, little is known about compound sibling caregivers. The purpose of this study was to compare the perspectives of compound, single and non-caregiving siblings of adults with IDD.

METHOD

This study investigated 332 adult siblings of individuals with IDD in the United States via a national web-based survey. Participants included: 152 non-caregivers, 94 single caregivers (i.e., caregivers only for their brothers and sisters with IDD), and 86 compound caregivers (i.e., caregivers for their brothers and sisters with IDD and at least one other vulnerable individual).

RESULTS

Single and compound sibling caregivers (versus non-caregivers) had more positive relationships and conducted greater advocacy and future planning activities.

CONCLUSIONS

Given the potential for compound sibling caregiving, further investigation is warranted.

Adult siblings of people with and without intellectual and developmental disabilities: Sibling relationship attitudes and psychosocial outcomes

There is still little research on the relationships between adults with intellectual and developmental disabilities and their typically-developing siblings, despite the importance of these ties for siblings' psychological well-being, especially in terms of depression, anxiety, and life satisfaction. In this study, the sibling relationship attitudes of adult siblings of people with (N = 133) and without (N = 140) intellectual and developmental disabilities were explored. Feelings, behaviors, and thoughts related to sibling relationships were measured using the Lifespan Sibling Relationship Scale; depression was measured using the Beck Depression Inventory-II; anxiety was measured using the Beck Anxiety Inventory; and life satisfaction was measured using the Satisfaction With Life Scale. Results indicate that higher levels of positive sibling relationship attitudes are negatively related to levels of depression and anxiety, and positively related to levels of life satisfaction. Furthermore, adult siblings of people with intellectual and developmental disabilities show less positive sibling relationship attitudes, higher levels of depression and anxiety, and lower levels of life satisfaction. Finally, group membership, indirectly through sibling relationship attitudes, was related to depressive and anxious symptoms, as well as to life satisfaction. Implications for future research and policies are discussed.

Sibling Relationships Over the Life Course: Growing Up With a Disability

The research explores sibling relationships, and the ways in which they are shaped over the life course by family members, in families with a lifelong disability. In-depth, semistructured interviews were conducted with 15 family units including a parent, a sibling, and an adult sibling with a disability. The content analysis revealed five sibling relationship patterns: (a) "Not a child, but a parent caretaker"-the parent-surrogate sibling; (b) "We somehow grew apart"-the estranged sibling; (c) "It is important for me to maintain some kind of distance"-the bystander sibling; (d) "When there's something they want to tell him, they always send me"-the mediator sibling; and (e) "I love him to death"-the friend sibling. These patterns of adult sibling relationships are discussed in relation to family dynamics, values, and legacies; recommendations for practice and research are made.

Siblings of adults with intellectual and developmental disabilities: Their knowledge and perspectives on guardianship and its alternatives

BACKGROUND

Siblings of adults with intellectual and developmental disabilities (IDD) often support their brothers and sisters through caregiving and guardianship.

METHODS

In this qualitative study, the knowledge and views of 10 adult siblings were explored.

RESULTS & CONCLUSIONS

The tripartite impact of limited knowledge of guardianship and alternatives, the viewpoint of full guardianship as necessary and the desired/anticipated roles of siblings combined to create the Sibling Reciprocal Effect (SRE). The present authors define SRE as the phenomenon of siblings to recognize the applicability of complementary forms of guardianship for other adults with IDD, but fail to see the advantage of available decision-making alternatives with their own brothers/sisters. Instead, siblings defer to full guardianship as the preferred mechanism for decision making. Implications for practitioners include informing families of the full range of options for supporting persons with IDD in decision making. Future research suggestions include examining the elements of the SRE and siblings' knowledge regarding guardianship and the alternatives.