Benefits of Including Siblings in the Treatment of Autism Spectrum Disorders

doi:10.1016/j.cbpra.2010.05.005

Cognitive and Behavioral Practice

Volume 19, Issue 3, August 2012, Pages 413-422

https://doi.org/10.1016/j.cbpra.2010.05.005 Get rights and content

Abstract

Having a brother or sister with an autism spectrum disorder (ASD) can significantly impact the life of a typically developing sibling. These relationships are generally characterized by less frequent and nurturing interactions than are evident in sibling constellations with neurotypical children or children with other developmental disabilities. One way to address this issue is to teach typically developing siblings skills to participate in a brother or sister's treatment. Including siblings in behavioral interventions is documented to be beneficial to both children, and is associated with generalization of skills for the sibling with ASD. Here we review this body of literature, present case examples from clinical practice, and make treatment recommendations for utilizing sibling-mediated behavioral approaches.

Section snippets

The Research to Date

There is an extensive research literature on teaching peers to relate to their classmates with ASD in the classroom and on the playground (e.g., Garfinkle and Schwartz, 2002, Morrison et al., 2001); that work is reviewed elsewhere in the present volume. There is also significant research on the psychological impact of growing up having a brother or sister on the autism spectrum (e.g., Hastings, 2003, Macks and Reeve, 2007, McHale et al., 1986). For example, Knott, Lewis, and Williams (1995)

Current Issues in Research

The current issues in research on the role of siblings in treatment in many respects parallel some of the issues involved in teaching a broad repertoire of social skills to children with ASD, especially as reflected in the school-based peer training literature. As the work on social skills and the role of peers has expanded, so too has the potential role of siblings as companions and playmates for their brothers and sisters with ASD. The role of siblings as teachers and playmates is, however, a

Research Vignette 1

In their 2009 study, Ferraioli and Harris taught typically developing 6- to 8-year-olds an established behavioral intervention to increase JA in their siblings with autism. The JA training program progressively targeted eight behaviors related to alternating attention and demonstrating interest: responding to putting the child's hand on a toy, responding to tapping a toy, responding to showing a toy, establishing eye contact, following a distal point, following a gaze shift, initiating a gaze

JA Assessment

Systematic assessment of social skills can be challenging because they tend to be complex and are rarely conducive to universal quantification. The quality of social skills is also salient during real-world interactions, but is often difficult to measure. It is therefore important to consider a system that includes observable behavior when tracking targeted skills throughout the baseline and intervention phases of a treatment.

Two types of JA measures were used in the 2009 sibling study. The

Treatment Plan

The behavioral intervention package to teach JA was successfully implemented by children as young as 6 years old; this current section outlines specific procedures for teaching these skills to siblings of children with autism. When teaching behavioral techniques to siblings, it is important to emphasize the “whys” of the intervention procedures. A child's ability to understand his role can add to his motivation to faithfully carry out teaching steps and to evoke behavior change in his sibling

Treatment Implementation

The intervention begins with six sequential skill sets to teach appropriate responding to JA; these procedures were adapted from those described by Whalen and Schreibman (2003). Before starting the intervention, the sibling is shown all the steps that he will be targeting throughout his role as a teacher; however, each skill is taught to both the sibling and the target child sequentially. At the start of a new skill, the steps for presenting the cue, prompting, and reinforcement are described

Research Vignette 2

A 1993 study by Celiberti and Harris utilized siblings as behavioral interventionists for their younger brother or sister with autism. Siblings were taught three sequential sets of behavioral skills aimed at increasing the quality and quantity of their play interactions. These training sets emphasized pivotal skills in acquiring and sustaining an interaction: eliciting play and play-related language, reinforcing appropriate responses, and successfully prompting incorrect or noncompliant

Skill Assessment

In the developmental literature, effectively capturing and coding play behavior requires an intricate system that is highly sensitive to social nuances. Often, small social behaviors that the typical observer takes for granted (e.g., the coordination of point and eye gaze in referencing an object) are lacking in children with autism. By dividing their 1993 intervention into three behavioral skill sets, Celiberti and Harris targeted a small number of behavioral skills at a time, a necessary

Treatment Plan

It has been established that siblings can effectively learn how to implement and teach a behavioral intervention to their brother or sister with autism. As with any research involving young children, and particularly with siblings, it is important that the goals of the study be important and relevant to the child to increase motivation. Therefore, the use of motivating materials and capitalization on the preferences of the child with ASD were especially highlighted in the treatment program.

Treatment Implementation

The Celiberti and Harris (1993) study described above focused on the progressive acquisition of three behavioral skill sets within the children's home. To gather information regarding the children's typical level of play, baseline data were collected across three sessions in which the children were instructed to “play as you normally would” with a set of toys reserved specifically for this study. Following these sessions, training was demonstrated on the first skill set with the child with the

Treatment Considerations and Recommendations

Although research suggests that typically developing siblings are willing and eager to participate in the treatment of a sibling on the spectrum, there are several factors that may affect the experience of both siblings. Several of these considerations, such as age, procedural understanding, and the presence of challenging behavior, relate to the typically developing sibling's ability to implement the intervention. A large body of literature on children's perception of illness illustrates the

Author Note

Many thanks to David Celiberti, Ph.D., whose original research inspired our continuing interest in the role of siblings as teachers in the context of play.

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Cited by (44)

Siblings and social interaction development of individuals with ASD: A systematic review
2023, Research in Autism Spectrum Disorders
Sibling relationships may play a unique role in the social development of individuals with autism spectrum disorder (ASD). Research suggests that the involvement of siblings within focused intervention contexts can be beneficial for the social skills improvement of individuals with ASD. However, compared to research focusing on the impact of individuals with ASD on their siblings, there is relatively little research about the influence of siblings on the social interaction development of individuals with ASD. As an important exploratory step, this systematic review aims to summarize existing literature that investigated siblings relative to the development of social interactions of individuals with ASD. A total of 105 studies were included in this review regarding social interaction development of siblings and individuals with ASD, and a subset of 24 studies that focused on the influence of siblings on individuals with ASD were further analyzed. The results suggested that the majority of included studies (77.14%) focused on the social interaction outcomes of the siblings rather than individuals with ASD with variability regarding studies’ variables of interest. Implications and future directions are also discussed.
A systematic review of social support for siblings of children with neurodevelopmental disorders
2022, Research in Developmental Disabilities
Citation Excerpt :
Unpredictability of the family situation, with associated factors such as sense of control and access to information, has also been found to affect sibling risk (Incledon et al., 2015). Having a sibling with a chronic disorder is also associated with positive outcomes such as effective coping skills, development of compassion and empathy, and positive attitudes towards providing aid to others (Bontinck, Warreyn, Paelt, der, Demurie, & Roeyers, 2018; Ferraioli, Hansford, & Harris, 2012; Orm & Vatne, 2021; Shivers, 2019). Conceptually, there are therefore strong implications for understanding sibling adjustment through a family system framework which presupposes that siblings are influenced by the bidirectional and dynamic family context, and also the wider cultural and societal systems in which they grow up (Kovshoff, Cebula, Tsai, & Hastings, 2017; Rossiter & Sharpe, 2001).
Social support is a protective factor for siblings of children with neurodevelopmental disorders.
We reviewed studies on social support received by siblings of children with neurodevelopmental disorders.
We conducted a pre-registered systematic review (CRD42020207686), searching PsycINFO, MEDLINE, Web of Science, and Scopus.
Fifteen articles were eligible for the review, 13 of which used cross-sectional designs. Two studies investigated sibling social support after an intervention. Multiple variables were negatively related to social support (e.g., sibling depression, loneliness, stress). Variables that were positively related to social support included prosocial behavior, competence (academic, social, and activity-related), problem-focused coping, and family quality of life. Potential moderators of the relationship between social support and psychosocial adjustment included the type of disorder of the affected sibling and the type of social support provider. We conclude with an overview of the reliability and validity of the seven social support measurements used across the studies.
Lower levels of social support are associated with more negative psychosocial adjustment among siblings of children with neurodevelopmental disorders. We encourage future researchers to further investigate ways to increase social support for siblings to improve outcomes.
Measuring family communication in pediatric nursing: Psychometric properties of the Parent-Child Communication Scale – Child Report (PCCS-CR)
2022, Journal of Pediatric Nursing
Citation Excerpt :
Opportunities for siblings to discuss their emotional experiences and thoughts regarding their brother or sister with the condition is essential and parents are the most natural interlocutor in this matter (Incledon et al., 2015). Strengthening parents' communication skills is important in order to consider siblings' needs, and enhanced sibling well-being can possibly have a positive influence on the child with a disability (Ferraioli et al., 2012; Fjermestad et al., 2019; Rum, Zachor, & Dromi, 2021). It is important to note that our results suggested that paternal education could explain group differences in child-reported parent-communication, but not child-communication.
Communication quality is an essential indicator of family functioning and represents an important outcome after pediatric nursing interventions. However, few well-documented child-report questionnaires for family communication exist. We aimed to document the psychometric properties of a previously developed child-rated family communication scale for use in pediatric nursing.
We examined the Parent-Child Communication Scale – Child Report (PCCS-CR) in terms of factor structure, convergent validity against the Experiences in Close Relationships-Relationship Structures scale (ECR-RS), and known-groups validity between a sample of siblings of children with pediatric health conditions and controls. The sample comprised 101 siblings of children with a pediatric health condition and 44 controls (M age = 11.5 years, SD = 2.2).
We confirmed a two-factor structure of the PCCS-CR. One factor is communication from the child to the parent, labelled child communication (e.g., “I discuss problems with my parents”) and the other is communication from the parent to the child, labelled parent communication (e.g., “My parent is a good listener”). Convergent validity of the PCCS-CR was demonstrated through correlations with ECR-RS (r = −0.73 to −0.22, p ≤ .05). Further, construct validity through differences between families with and without a child with a pediatric health condition was demonstrated (g = 0.36–0.83, p ≤ .052).
The PCCS-CR appears to be a psychometrically sound measure of parent-child communication from the child's point of view.
The PCCS-CR can be administered in pediatric nursing care and can be used to target and measure the outcomes of interventions aimed at enhancing family functioning.
Through the eyes of a child: Sibling perspectives on having a sibling diagnosed with autism
2021, Research in Developmental Disabilities
Citation Excerpt :
This finding is corroborated by the responses of non-autistic siblings in this study. Ferraioli, Hansford, and Harris (2012) found that the shared learning experience facilitates positive bonding and promotes social ability. This was clearly evidenced in the current study by reports that the non-autistic sibling helped their sibling with autism learn coping skills and self-control while also learning new social skills themselves.
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.
Using neurotypical siblings as intervention agents to guide individuals with Autism Spectrum Disorders: A systematic review
2021, Research in Autism Spectrum Disorders
Citation Excerpt :
Second, playing with a sibling is a natural context. Having NT siblings serve as agents of interventions and providing them with behavioral strategies and intervention skills could potentially decrease the need of teaching each skill in varied situations, as they could generalize the learned strategies/skills in other contexts in their everyday life (Ferraioli, Hansford, & Harris, 2012; McGee, Krantz, & McClannahan, 1985). Lastly, with the experience of guiding their sibling with ASD as an intervention agent, a NT child could gain maturity and develop a sense of responsibility, boost competency and self-esteem, act more enthusiastically and effectively while playing, and overcome the difficulties in communicating with their sibling with ASD (Celiberti & Harrism, 1993; McHale & Gamble, 1989).
Siblings share a unique and long-lasting relationship. Their involvement in the upbringing of an individual with a disability may lead to long-term positive developmental outcomes. The purpose of this systematic review is to summarize existing interventions where neurotypical (NT) siblings served as intervention agents to guide their brothers/sisters with Autism Spectrum Disorder (ASD).
Within this review we describe the training provided to NT siblings and how they delivered interventions to their brothers/sisters with ASD. We also summarize social validity outcomes to understand the social importance of the goals and effects as well as the social appropriateness of the intervention procedures from the perspectives of parents, siblings, and naïve observers.
The 16 included studies provided training of intervention strategies/skills (e.g., Stay-Play-Talk curriculum, delivering prompts and reinforcers, and giving play instructions) to NT siblings. After training, NT siblings implemented the intervention through play or other interactions with their siblings with ASD. Social validity outcomes from raters indicated the agreement on the intervention goals, appropriateness and acceptance of the procedures, and satisfaction of the behavioral changes of the included studies.
Findings from this systematic review should be used to guide the development of appropriate training for NT siblings and inform the procedures within interventions delivery. Limitations of existing studies and areas for future consideration are discussed.
Sibling-Based Treatments for Autism Spectrum Disorder: A Systematic Review
2024, International Journal of Systemic Therapy

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Benefits of Including Siblings in the Treatment of Autism Spectrum Disorders

Abstract

Section snippets

The Research to Date

Current Issues in Research

Research Vignette 1

JA Assessment

Treatment Plan

Treatment Implementation

Research Vignette 2

Skill Assessment

Treatment Plan

Treatment Implementation

Treatment Considerations and Recommendations

Author Note

Behavior Therapy

The use of multiple peer exemplars to enhance the generalization of play skills to the siblings of children with autism

Child and Family Behavior Therapy

The role of cognitive level and sibling illness in children's conceptualizations of illness

American Journal of Orthopsychiatry

Behavior modification in the home: Siblings as behavior modifiers, parents as observers

Journal of Abnormal Child Psychology

Play interactions of family members towards children with autism

Journal of Autism and Developmental Disorders

Teaching joint attention to children with autism through a sibling-mediated behavioral intervention

Peer imitation: Increasing social interactions in children with autism and other developmental disabilities in inclusive preschool classrooms

Topics in Early Childhood Special Education

Child, parent, and family factors as predictors of adjustment for siblings of children with a disability

Journal of Intellectual Disability Research

The development of siblings' understanding of autism and related disorders

Journal of Autism and Developmental Disorders

Parents' experiences of home-based applied behavior analysis programs for young children with autism

Journal of Autism and Developmental Disorders

Behavioral adjustment of siblings of children with autism engaged in applied behavior analysis early intervention programs: The moderating role of social support

Journal of Autism and Developmental Disorders

Multiple effects of joint attention intervention for children with autism

Behavior Modification