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Effects on Sibling Relationships When One Sibling Has Autism Spectrum Disorder: A Critical Review of Literature

by Shannon M. Campbell A Research Paper Submitted in Partial Fulfillment of the Requirements for the Master of Science Degree III

Family Studies and Human Development

Approved: 2 Semester Credits

. ' 7£ ~vin Dof 1, Ph,D

The Graduate School University of Wisconsin-Stout May 2011

2 The Graduate School University of Wisconsin-Stout Menomonie, WI

Author:

Campbell, Shannon M.

Title:

Effects on Sibling Relationships When One Sibling Has Autism Spectrum Disorder: A Critical Review of Literature

Graduate Degree/Major: MS Family Studies and Human Development Research Adviser:

Kevin Doll, Ph.D.

Month/Year:

May, 2011

Number of Pages:

33

Style Manual Used: American Psychological Association, 6th edition Abstract Sibling relationships in general have been overlooked and understudied by researchers. While the topic has drawn more attention in recent years, the study of sibling relationships when one sibling has autism is still limited. This paper is a critical review of current literature on sibling relationships focusing on sibling relationship quality, social interactions, and adjustment of typically developing children who have a sibling with autism. Family systems theory, ecological theory, and social learning theory were also used to look at the associations between sibling relationship quality and parental differential treatment.

3 The Graduate School University of Wisconsin Stout Menomonie, WI Acknowledgments First, I need to thank my parents, Sherry and Brett Cook, for supporting me emotionally and financially while finishing this paper. Second, I want to thank my brother, Derek, for his expertise in editing and his support and prayers. Third, a special thank you goes to my best friend Melissa, who helped me to see the light at the end of the tunnel. Forth I need to especially thank my sister Ali, for whom which this paper would not have been completed. She was always there when I needed to talk something out, was frustrated or just needed that extra push forward. Most importantly I need to thank God for always being there when I needed him. Last, I want to thank ALL my family and friends who have supported me throughout the entire process of writing this paper and obtaining my masters. I want to dedicate this paper to my dad, Rocky, who I know would be so proud of me and is looking down on me now.

4 Table of Contents .................................................................................................................................................... Page Abstract ............................................................................................................................................2 Chapter I: Introduction ....................................................................................................................6 Definition of Terms..............................................................................................................6 Methodology……………………………………………………………………………....6 Theoretical Framework……………………...…………………………………………….7 Purpose of the Study ............................................................................................................8 Chapter II: Sibling Relationships ...................................................................................................10 Sibling Relationships………………………………………………………………..…...10 How sibling relationships change over lifespan…………………………………………10 Gender differences……………………….………………………………………………13 Birth Order……………………………………………………………………………….14 Illness…………………………………………………………………………………….15 Chapter III: Autism Spectrum Disorder .........................................................................................17 What is Autism…………………………………………………………………………..17 Characteristics and Symptoms of Autism………………………………………………..17 Prevalence………………………………………………………………………………..19 Causes…………………………………………………………………………………....20 Diagnosis…………………………………………………………………………………20 Treatment/Interventions………………………………………………………………….21 Autism and the Family .......................................................................................................21 Chapter IV: Discussion ..................................................................................................................23

5 Sibling Relationship Quality…….……………………………………………………….23 Social Interactions ………………………………………………………………………24 Adjustment.................................................................................................................…...25 Family Functioning………………………………………………………………………26 Chapter V: Conclusion ...……………………………………………………………………….. 28 Limitations ........................................................................................................................28 Recommendations ..............................................................................................................28 References ......................................................................................................................................30

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Chapter I: Introduction The study of sibling relationships is important in order to enhance understanding of children’s social, emotional and sociocognitive development (Modry-Mandell, Gamble, & Taylor, 2006). Siblings influence each other’s development by providing “a frequent source of companionship, play, help, and emotional support” (Karos, Howe, & Aquan-Assee, 2007, p. 578). In the past, studies examining sibling relationships have been understudied and overlooked by researchers (Recchia and Howe, 2009b). This is especially true when looking at the relationship quality between typical developing children and their sibling with autism (Kaminsky & Dewey, 2001). However, according to Rivers and Stoneman (2008), studies focusing on children with Autism Spectrum Disorder (ASD) and their relationships with their sibling(s) are increasing as researchers are becoming more aware of the importance of sibling relationships within the family system. Definition of Terms The following definitions have been added to enhance understanding of this review of literature: Autism spectrum disorders (ASDs). ASDs “are a group of developmental disabilities that can cause significant social, communication and behavioral challenges (Facts about ASDs, 2010). Parental differential treatment (PDT). PDT refers to the differences in a parents’ relationship with each sibling (Richmond, Stocker, & Rienks, 2005). Methodology Scholarly journals dating from 2000 were utilized using electronic databases PsycINFO, ERIC, PsycArticles, and Academic Search Complete. Keywords used were “sibling relationships”, “autism” and “siblings & autism”. More than 40 peer reviewed journal articles

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were found, the majority of the articles used came from the following journals; Journal of Child Psychology and Psychiatry, Journal of Autism and Development Disorders, Child Development, and Journal of Family Psychology. Other well-known and accredited Internet sites, such as the Center for Disease Control, Autism Society of Minnesota and Autism Speaks, were also used for information gathering. Theoretical Framework Three theoretical frameworks were used to assist in the understanding how having a sibling with ASD may affect sibling relationships. The theory most relevant to the focus of this study was Rogoff’s (1990, 1998) socioconstructivist model, which suggests that children’s development is influenced by social relationships (Howe and Recchia, 2009). The teaching and learning that occurs within sibling relationships a bidirectional process. This means that it is not always the older sibling teaching the younger sibling, but that each sibling can take on the role of teacher or learner at any time based on the task involved and skills of the individual sibling. The second perspective I referred to when examining sibling relationships and the changes that occur within the family system was an ecological systems view (Volling, 2005). A developmental ecological systems (DES) model is used to examine the intrafamilial and extrafamilial systems that may affect the development of children. A child’s development is influenced by events that happen within the family context such as birth of a sibling. The quality of parent-child, marital or sibling relationships also has an effect on children’s development. Other life events such as a parent working more or less hours or a sibling attending school can influence a child’s development as well. The third and last, but most prevalent perspective in the literature is family system theory (FST). FST states that families are made up of subsystems and the relationship quality of these familial relationships influences the development of children (Hakvoort, Bos, Van Balen, &

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Hermanns, 2010). FST focuses on how one familial relationship influences another. This is referred to as “spillover perspective” (pp. 183). An example of spillover perspective that is relevant to this literature review is expressed in how characteristics of the parent-child relationship may spillover into the sibling relationship. Purpose of the Study The intent of this study is to examine current literature in order to discern the effects having a sibling with ASD has on typically developing siblings and identify issues lacking in current literature. The focus is on four key concepts, which include sibling relationship quality, conflict between siblings, social interactions and adjustment of the typically developing sibling (TDS). For the purpose of this study, TDS refers to children with no known disability (Kaminsky & Dewey, 2001). Also examined is the association between PDT and sibling relationship quality, specifically when there is a child with autism in the home. Based on typical sibling research I arrived at the following hypotheses: (a) having a sibling with autism will lead to poor sibling relationship quality; (b) typically developing siblings will have more conflictual sibling relationships, as well as struggle with social, cognitive and emotional interactions with their sibling; (c) children who were unsatisfied with PDT would have poor SRQ. Chapter two reviews sibling relationships, how they change over life’s course, birth order and gender differences, as well as how a child with an illness or disability affects the TDS. Chapter three consists of an overview of autism and how autism affects family functioning. Chapter four explores family functioning using FST and ecological theory. Chapter five focuses on how the sibling relationship and the typical developing sibling are affected when a child in the family has an ASD. The final chapter finishes with a conclusion, limitations of current literature and recommendations for future research.

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Although many studies have found that sibling relationships are critical in understanding childhood adjustment and family functioning, research is limited on the topic. Even more scarce is research on diverse family units. Therefore, for the purpose of this study sibling relationships will be restricted to mostly biological siblings from two parent, white, middle class families. The sibling relationships examined in this paper will also focus on birth through adolescence in order to narrow the research needed for this literature review.

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Chapter II: Sibling Relationships Sibling Relationships Sibling relationships are generally the longest relationship one has throughout his or her lifetime (Kim, Mchale, Osgood, & Crouter, 2006). Important and unique characteristics of sibling relationships are the influences they have on each other’s development, the extensive amount of time spent together and the degree to which the relationship changes over time (Pike, Coldwell, & Dunn, 2005). Through interactions with siblings, children learn and develop social, emotional and cognitive skills (Karos, Howe, & Aquan-Assee, 2007). Siblings may help each other learn to appreciate viewpoints and ways of thinking that are different from their own. By providing emotional support, siblings can lean on each other when stressful events occur within the family as they may have a better understanding of each other’s perspective than do outsiders. Siblings may also be an invaluable asset for teaching, guiding and instructing their younger brothers or sisters. However, in addition to providing support and friendship, children may also experience conflict and negative interactions with their sibling. How Sibling Relationships Change Over the Life Span Longitudinal studies in which sibling relationships from birth throughout childhood are examined for changes in relationship quality are limited, even though there is evidence to support the influence of sibling relationships on adjustment in adolescence (Kim, McHale, Crouter, & Osgood, 2007). Some studies have found that overall SRQ remains consistent throughout childhood when one experiences little life change or interventions (Kramer & Kowal, 2005). However, there are many important events throughout childhood that may change sibling relationships. Such events include becoming a sibling, developing relationships outside the

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family, and the influence of PDT (Volling, 2005; Kramer & Kowal, 2005; Richmond, Stocker, & Rienks, 2005) Volling (2005) defines the term transition to siblinghood as “the change in status from an only child to an older sibling” (pp. 542). Children begin the process of transitioning into siblinghood before their sibling is even born through early social experiences they have with friends and peers (Volling, 2005). This is important to note as the relationships children build with friends and peers can set the stage for relationships with siblings by helping children learn to communicate effectively and deal with conflicts (Kramer & Kowal, 2005). Early and middle childhood Sibling relationships in early childhood offer unique opportunities for promoting social development, social behaviors and social support (Kim, McHale, Crouter, & Osgood, 2007). Because sibling relationships involve intraindividual change, it is normal to expect that change in the relationship would result in changes with each child’s development and adjustment (Richmond, Stocker, & Rienks, 2005; Kim, McHale, Osgood & Crouter, 2006). Research has shown that sibling relationship quality stays fairly consistent throughout middle childhood. Therefore, it is important that sibling relationships get off to a good start, so they may remain a positive influence on children’s development (Kramer and Kowal, 2005). The sibling relationship is not always a positive part of growing up. Siblings may have conflict and disagree with each other throughout their childhood. Conflict may be cause for adjustment problems and deviant behavior (Kim, McHale, Crouter, & Osgood, 2007). Kim, et. al (2007) states that “sibling conflict during the school-age years has been described as a training ground for aggression”. This leads into discussion of sibling relationships as they enter adolescence.

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Adolescence As children enter adolescence, the relationship they have with their sibling changes. The “support, intimacy and companionship” they experienced in early to middle childhood decreases (Kim, McHale, Crouter, & Osgood, 2007; Kim, McHale Osgood & Crouter, (2006). According to Kramer & Kowal, (2005) as children enter adolescence, their relationships with siblings may become less intimate. This most likely has to do with the increase in the amount of time spent with peers and with activities outside the home. On the other hand, the relationships children have with their peers may help them maintain positive relationships with their siblings throughout adolescence. Research has also found that the stability of the sibling relationship in early and middle childhood is linked to adjustment as one enters adolescence. While sibling relationship quality may decrease and sibling conflict may increase in adolescence, research shows that the opposite happens as adolescents mature and gain social skills (Howe & Recchia, 2009a, Kim, et.al, 2006). Parental, family and external Influences An important factor to consider when looking at changes in sibling relationships is the influence of the relationship children have with their parents. Studies have found that children thrive when the interactions with their parents are positive and each child’s needs are addressed on an individual basis (Kramer & Kowal, 2005). In addition, Kramer and Kowal (2005) state that sibling relationships may actually improve in adolescence as the relationship with parents changes. As children are very aware of, and sensitive to, any differences in how they are treated in comparison to their sibling, parent-child relationships may also impact the sibling relationship negatively. In a study by Richmond, Stocker, & Rienks (2005) it was found that PDT is positively associated with children’s externalizing behaviors as well as depressed moods for

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younger siblings only; although, further research is needed to corroborate this. The less favored a child is by their parents, the more they may act out behaviorally. In situations where there is divorce or economic hardship, positive parenting may decrease and therefore the quality of the sibling relationship may suffer (Kramer & Kowal, 2005). On the other hand, siblings may form close relationships to offset the stressful events occurring in their family. For the above reasons and because children are sensitive to changes in their environment it is important to take into account internal and external events that may have direct or indirect influence on sibling relationships. Gender Differences in Sibling Relationships While many studies have not taken characteristics such as gender into account when studying sibling relationships, some have found gender differences when it comes to adjustment of adolescents (Kim, McHale, Crouter, & Osgood, 2007; Richmond, Stocker, & Rienks, 2005). One reason few studies focus on gender differences is the social learning principle. Kim, et. al (2007) describes social learning principle as the practice of imitating those most similar to oneself. Most research therefore focuses on same sex dyads. With that in mind, some research has found significant gender differences in regards to sibling relationships. Sisters tend to have closer more affectionate relationships than brothers (Kim, et.al, 2007; Kim, et.al, 2006). Interestingly, when looking at mixed-dyad pairs, intimacy decreased during middle childhood but increased in adolescence. There was no change over time in same-sex dyad pairs. This study suggests that intimacy is the greatest difference when factoring gender into sibling relationships, but also that once siblings are in adolescence gender becomes less of a factor. Kim, et.al (2007) found differences in gender when looking at depressive symptoms of adolescents. Girls’ depressive symptoms increased, while boys’ symptoms decreased or

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stabilized from middle through late adolescence. This finding is corroborated with a study by Richmond, Stocker, & Rienks, (2005), which found that younger sisters had more of an increase in depressive symptoms than younger brothers. Another interesting finding from this study was that children with younger sisters, as opposed to brothers, tended to have higher levels of depressed moods. This could be attributed to older siblings feeling the need to protect their younger sisters; where as younger brothers may be seen as less dependent on older siblings. Finally, spinning off social learning perspective, a study by Howe and Recchia (2009) focused on siblings as teachers. The findings report that “sisters engage in more frequent teaching and positive guidance than brothers” specifically during middle childhood and when teaching younger sisters. Also noteworthy is that younger sisters were usually more willing to take part in learning when being taught by an older sister rather than an older brother. This brings us to the next section, siblings and birth order. Birth Order The transition into siblinghood can be one of ambivalence for a firstborn sibling (Volling, 2005). The experience of becoming a sibling can be a positive event for some children, while others may experience negative reactions, such as an increase in problem behavior. Volling (2005) suggests using a DES model to examine the adjustment of firstborn children after the birth of a second child, as well as the influence of a firstborn’s problem behavior on family dynamics. As an older sibling, one can expect to hold the role of “teacher”, while younger siblings are usually the “learner” (Howe & Recchia, 2009). Rogoff’s socioconstructivist model, which is discussed in a recent article by Howe and Recchia (2009), is used to examine the learning styles of firstborn versus second born siblings. Being that there are times when younger siblings act as the “teacher”, both younger and older siblings were given the role of teacher and learner. It was

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found that second born siblings as teachers often gave more positive feedback to their older sibling. If firstborn siblings used guided participation when teaching younger siblings, the second born was able to obtain skills used by their older sibling. Also important to note in this study was the finding that birth order may not be as significant as age when looking at siblings as teachers. Younger siblings may also learn negative behaviors or interactions from their older siblings. In line with Patterson’s “sibling-trainer” hypothesis, as well as McElwain and Volling (2005) found that older siblings often take on the role of managing or teaching their younger siblings. They are also more likely to intimidate or pressure their younger siblings into negative behaviors. When relationship quality of siblings is low and conflict arises, the older sibling usually comes out on top. Older versus younger siblings can have differing conflict strategies, in some cases older siblings may be more aggressive, in particular this may occur when in conflict with siblings who cannot defend themselves (Recchia & Howe, 2009a). Recchia and Howe found that overall, if relationship quality was good in times of conflict younger siblings will give their older siblings the benefit of the doubt. On the other hand, if relationship quality was low and the younger sibling did not have an understanding of the conflict, compromise between the siblings was unlikely. Based on the above research, younger siblings seem to benefit more from positive relationships with their siblings. Older siblings usually have the upper hand and benefit from being the firstborn. Illness With all the advances in the medical field, many children with illnesses or disabilities are living longer and being cared for by their families instead of dying early or living in an institution (O’Brien, Duffy, & Nicholl, 2009). While overall this is a positive thing, the families

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of these children are experiencing a significant amount of stress and siblings’ needs may go undetected by parents, mental health and the health care systems (O’Brien, et.al, 2009; Abrams, 2009). Research on the impact having a disabled or chronically ill sibling has on the well sibling is inconclusive. Some studies have found that siblings are well-adjusted and coping well with having an ill or disabled sibling. While other studies have found that the well siblings were at risk for adjustment and emotional problems (O’Brien, et.al, 2009). O’Brien, et.al (2009) examined literature to find the impact on siblings who had a disabled or ill brother or sister. They found that while there were reports of adjustment difficulties, the level of adjustment problems was dependent on a variety of factors, including the severity of the disability. A suggestion to parents and health care providers was to consider siblings of children with disabilities at risk, so they may receive the support and acknowledgment they deserve. A study by Abrams (2009), reviewed the many ways in which siblings of ill children are affected and what can be done to ensure positive adjustment. Abrams discusses six ways in which children who have disabled siblings may be affected. Well siblings may disassociate themselves from the ill sibling, become overly responsible caretakers, become mature and independent prematurely, feel guilty, feel neglected by parents, or become neglected by the mental health and health care systems. To prevent negative adjustment outcomes and promote positive sibling relationships, Abrams recommends giving the well child a voice and provide support when needed.

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Chapter III: Autism Spectrum Disorder The term autism was first used in 1943 by Dr. Leo Kanner. He believed that autism was caused by unloving, cold mothers (What is autism, 2010). It was not until the 1960s and 1970s that Dr. Bernard Rimland debunked that myth, stating that autism was a biological disorder. What is Autism Autism or autism spectrum disorder (ASD) is a developmental disability that affects brain development in children from the time they are born or soon thereafter (Autsim spectrum disorder, 2010). Autism is a “spectrum disorder”, which means the severity and characteristics differ for each individual. Asperger’s syndrome, pervasive developmental disorder- not otherwise specified (PDD-NOS) are also included on the spectrum (What is autism, 2010). For the purposes of this study, the term ASD will refer to only to autism, as this was the term used in the majority of the research found. Characteristics and Symptoms of Autism Four main aspects of development that are typically affected by autism: social interactions, communication, repetitive behaviors and physical and medical conditions (Smith & Elder, 2010; What is Autism, 2010; Symptoms of autism, 2010). Because the symptoms and severity of autism manifest differently in each individual who has an ASD, the following is not meant to be an exhaustive list, nor is it meant to be assumed that these characteristics are the same for all. Social symptoms. Children with autism may struggle with social interactions in the following ways: 

Avoid eye contact

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Prefer to be alone

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Resist attention

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Fail to seek comfort

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Seem unconnected

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Difficulty interpreting others’ thoughts or feelings

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Unable to interpret gestures and facial expressions

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Difficulty seeing others’ points of view

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Difficulty regulating emotions

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May become physically aggressive towards self or others

Communication difficulties. Children with autism may struggle with communication in the following ways: 

Delayed speech or never learn to speak

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Speak in single word sentences

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Repeat words or phrases heard - echolalia

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Difficulty starting and/or sustaining conversations

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Repeat lines from a favorite movie or song - scripting

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Unable to interpret or understand sarcasm

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Facial expressions, gestures or tone of voice may not match what they are trying to say

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Difficulty expressing needs - may scream or grab for what they want

Repetitive behaviors Children with autism frequently display and participate in various behaviors that may seem odd to others. Some of these behaviors include: 

Lining up vehicles in a specific way

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Flapping arms

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Walking on tip-toes

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Unable to cope with change in their environment or schedule

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Intense interest in subjects, objects or topics

Physical and medical conditions. Many children with autism experience additional symptoms that affect them physically: 

Seizure disorders or Epilepsy

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Genetic Disorders

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Gastrointestinal Disorders o Children may be put on a diet free of dairy or gluten - Gluten Free Casein Free (GFCF)

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Sleep Dysfunctions

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Sensory Integration Dysfunction o Children with Autism may experience difficulties processing sensory information o Sensory information includes: sight, touch, taste, auditory, smell, as well as sense of movement and position

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Pica – consumption of non-edible objects

Some children show symptoms of autism at birth while others may develop typically until about 18-24 months of age (Facts about ASDs, 2010). Those with autism may experience symptoms throughout their lifetime, while others’ symptoms decrease or disappear completely over time. Prevalence The Centers for Disease Control and Prevention estimates that currently 1 in 110 “children in the United States have an ASD” (Data & statistics, 2010). Statistics show that there is more prevalence in boys than girls, with about 1 in 80 boys and 1 in 240 girls being affected by ASDs. Autism affects children of all races, ethnicities, socioeconomic and religious backgrounds. According to Autism Speaks, autism is more common in children than “cancer,

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juvenile diabetes and pediatric AIDS combined”. More astounding is that the rate of autism diagnoses is increasing by 10-17% annually. The reasons for this are unknown, but evidence shows it may be a combination of broader and improved diagnosis and environmental factors. The prevalence of having ASD increases significantly for siblings. If one identical twin is diagnosed with autism, the other twin has a 60-96% chance of also being on the spectrum. In non-identical twins, the chances decrease to 0-24%. When one child has autism, the chance of a non-twin sibling having it as well is only 2-8%. Causes Being that autism is a spectrum disorder, there are most likely multiple causes. A combination of genetic, biological and environmental factors has been linked to autism (Facts about ASDs, 2010). Some risk factors have been agreed upon as possible contributors to having autism. Some of these factors include having a sibling or parent with an ASD, medical conditions such as Fragile X, and certain drugs taken during pregnancy. Two of the most common possible causes, as well as the least research backing them as causes, are vaccines and infections. Although there is not enough evidence to support vaccines alone as a cause of autism, many parents feel they play a part in their child having autism (Symptoms of autism, 2010). There is a definite need for further research in the field before a more concrete cause can be determined. Diagnosis According to the Centers for Disease Control and Prevention website, the earliest children are diagnosed is between 4.5 and 5 years on average (Data & statistics, 2010). However, 51-91% of children show signs of autism long before age three. In fact, studies show that 80% of parents saw symptoms in their children before they turned one. In spite of evidence that children 18 to 24 months can be identified as having an ASD, most are not diagnosed that early.

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In order for a child to receive an autism diagnosis, they must meet certain criteria set by the DSM-IV (What is autism, 2010). If the child is not yet in school, typically the parents bring concerns of their child’s developmental delays to their pediatrician. Once children are in a school setting they are often referred for a diagnosis by school personnel. Regardless of how and when a child is diagnosed with autism, it is a shock for the parents and family (Your family and autism, 2010). Figuring out the next steps of caring for a child with autism can make parents feel overwhelmed. It is important for parents to remember they are not to blame. Parents should become knowledgeable about ASDs so they can make informed decisions about their child’s care. Lastly, parents should find resources and reliable support systems that they can utilize when the stress of having a child with a disability becomes too much. Treatments/Interventions While there is no cure for autism, it is treatable (Facts about ASDs, 2010; What is autism, 2010). Research has shown repeatedly that early intervention is the key to a child with an ASD living a fulfilling life. There are many treatment and intervention programs available to choose from. Two therapies that have been proven to be successful are applied behavior analysis (ABA) or play therapy (What is autism, 2010). Some children may also benefit from food, speech and occupational therapies as well. While finding the most appropriate treatment for a child is a daunting task, the most important thing to remember is that early intervention can make the difference of a lifetime for a child with autism. Autism and the Family One is never really prepared for the news that their child or loved one has autism (Your family and autism, 2010). Families may go through the stages of grieving process. Initially one may feel shock, sadness, anger, denial, and loneliness. With time these feelings may subside and

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families will learn to accept that their loved one has autism. Individuals go through these stages at different times and may experience similar feelings many times throughout a lifetime. Kathryn Smerling, Ph.D., recommends several tips for parents and siblings in helping them to deal with the challenge of having a loved one with autism (Your family & autism, 2010). Parents are encouraged to be an advocate for their child, talk about their feelings and appreciate even small accomplishments their child may achieve. For siblings, Smerling suggests they recognize the feelings they have in regards to having a brother or sister with autism, but to also be proud of them. Siblings should be sure to spend time alone with parents, and also find an activity they and their sibling can do together. Finding a way to connect with their sibling will help promote positive sibling relationships.

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Chapter IV: Discussion As previously discussed, research on sibling relationships is limited and often inconsistent in findings. Studies including sibling relationships in which there is a child with an ASD in the home and that examine the effects on the well sibling are even more limited. Although research on the topic is increasing as researchers are becoming more aware of the need for it and as the prevalence of autism continues to increase (Rivers & Stoneman, 2003; Rivers & Stoneman, 2008). Sibling Relationship Quality When looking at typically developing sibling relationships, research has found that in general the quality of the relationship remains consistent throughout childhood (Kramer & Kowal, 2005). That said, the quality of a sibling relationship can be affected by many factors, and having a sibling with autism adds yet another dynamic to the relationship (Rivers & Stoneman, 2003). Rivers and Stoneman used FST to explore sibling relationships within families with a child with autism. Overall findings concluded that the TDS rated sibling relationship quality positively. The TDS also tended to rate SRQ more positively than their parents did. Interestingly, when the sibling with ASD was younger, the TDS was more satisfied with the relationship. SRQ declined as the child with autism grew older. This could be due to the TDS becoming more aware of their sibling’s behaviors which perhaps incur feelings of embarrassment. Another study by Rivers and Stoneman (2008) explored sibling relationship quality when accounting for child temperament. Temperament was described as impulsivity and behavioral inhibition. Impulsivity consisted of “strong negative emotions in the face of frustration”, sustained attention to task (persistence) and “intense, frequent physical movement”. Behavioral inhibition is defined as the “tendency to become upset or to withdraw in novel social

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situations”. Studies have found that children with autism often have a more difficult temperament in comparison to typically developing children based on symptoms of autism and the components of temperament. Research has also shown that siblings with similar temperaments tend to get along better and therefore have a more positive relationship. One could assume then that a sibling of a child with autism may have poorer relationship quality than typically developing sibling pairs. This is exactly what Rivers and Stoneman found in their study. When children with ASD or their brother/sister were better able to focus their attention on a task for extended periods of time, relationship quality was higher. This could be attributed to two factors: if it were the typically developing sibling that had this ability, they may have been able to tune out their sibling’s behaviors more so than a child with low persistence. If the sibling with autism had higher persistence he or she may have been more likely to initiate interactions and partake in social exchanges with their typically developing sibling. Social Interactions As discussed in chapter two, children learn social queues from their siblings (Kim, McHale, Crouter, & Osgood, 2007). One area in which children with autism struggle most is social interactions (Knott, Lewis, & Williams, 2007). When one sibling has autism the reciprocity of social exchanges may be missing. This is particularly important to note in the instance when the older sibling has autism and may be unable to teach their younger sibling in ways a typical child may teach their younger sibling. As children age the relationship they have with siblings becomes more balanced, and both siblings contribute equally to the relationship. Knot, et al (2007) studied interactions between children with autism and their typically developing siblings to see if their relationships followed the same pattern of becoming egalitarian as typically developing sibling pairs do. They found that as the typical children (most were younger than their sibling with autism) aged and achieved more developmental and

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cognitive milestones than their sibling, the relationship became asymmetrical. Also noteworthy is that the typically developing children supported their siblings attempts at social interaction. While children with autism imitated their siblings less often, siblings tended to use imitation more often when engaging in play activities with their sibling with autism. It was also found that children with autism show greater social interactions with their siblings than with peers. Similar results were found in a study by Kaminsky and Dewey (2001). Because children with autism often have deficits in communication this may explain the lack of initiating interactions with their siblings. They also found that children with autism are less likely to engage in social exchanges with their sibling. In some cases it has proved beneficial to include the TDS in interventions of their siblings with autism (Tsao & Odom, 2006). In keeping with the literature, siblings are a great resource for each other. They promote social, cognitive and emotional development, as well as support each other. Using siblings to encourage social interaction in children with autism is not a new phenomenon, but has received little recognition in research. In a recent study Tsao and Odom (2006) discuss using joint attention to increase the social development of children with autism when used in conjunction with their TD sibling: joint attention refers to the use of gestures or gazes by two people in regards to an object. Findings indicate that children with autism increased social interactions and joint attention when supported by their TD sibling. These results could not, however, be generalized to situations outside the home environment. Adjustment of Typical Sibling Even with the prevalence of autism on the rise along with the challenges having a child with autism in the home, the effects on adjustment of the TDS is limited (Macks & Reeve, 2007). Many of the studies on this topic have reported that the TDS of children with autism will struggle with self-esteem and adjustment. However, other studies have indicated that the

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adjustment of typically developing siblings is effected by factors other than just having a sibling with autism, such as family size, gender, birth order and socioeconomic status of the family. In a study by Macks and Reeves (2007) it was found that children who had siblings with autism had a more positive self-concept and were more mature than siblings of typically developing children. In a similar study by Pilowsky, Yirmiya, Doppelt, Gross-Tsur, & Shalev (2004) it was reported that while findings on the adjustment of TDS of children with autism is inconclusive, they found the TDS to be well-adjusted and not differing from peers in regards to functioning levels. In a more recent study, data from adolescents who had siblings with autism was analyzed for adjustment and well-being (Orsmond & Seltzer, 2009). Findings conclude that sisters and not brothers reported higher levels of depressed moods, which is in line with studies discussed in the gender section of chapter two. A commonality from the above three studies is the impact that parental and external factors have on the sibling relationship. Family Functioning Family systems theory is helpful in gaining a deeper understanding of the complexity of sibling relationships by exploring associations between PDT, marital and sibling relationships (Rivers & Stoneman, 2003; Rivers & Stoneman, 2008). Sibling relationships are affected both positively and negatively by interactions with other family members within the family unit. While there are opposing views, some research does support that having a child with an ASD in the home can lead to marital stress. That said, stressors within the family have also been linked to the quality of sibling relationships (Rivers & Stoneman, 2003). In a recent study, findings indicate that when there was more marital stress, typical children were dissatisfied with

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their sibling relationships and often displayed harmful behaviors when interacting with their sibling with autism (Rivers & Stoneman, 2003). As previously stated in this paper, children are sensitive to how their parents treat them in relation to their sibling (Kramer & Kowal, 2005). However, research suggests that it is not the differential treatment itself that has an effect on the sibling relationship but how satisfied the child is with the DPT. In their study on differential parenting and sibling relationships, Rivers and Stoneman (2008) found that when typical children, as well as those with an ASD, are able to engage in structured activities for significant periods of time, the parents are better able to balance time spent with each sibling. In this case the typical sibling may be more satisfied with DPT and therefore have a better quality sibling relationship.

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Chapter V: Conclusion Conclusion Based on the literature siblings of children with autism are not less well-adjusted in comparison to typically developing sibling dyads. Sibling relationship quality appears to be associated with temperaments of each child and PDT as opposed to having a sibling with autism. Overall SRQ remains consistent throughout childhood, even when one sibling has autism. While researchers are finding that studying sibling relationships, especially those involving a sibling with autism, research on the topic is limited. Several limitations and recommendations were found and are listed in the following paragraphs. Limitations There were several limitations found throughout the literature. As mentioned previously sibling relationships in general are understudied and studies including autism and sibling relationships are even less frequent. Also underrepresented is the use of family systems theory when studying sibling relationships. However, as more is learned about constantly changing family dynamics and the ways in which family dyads interact and affect each other, the more research is being done. The majority of the studies used for this literature review had small to medium sized samples. Sample populations consisted of mainly Caucasian, middle class families. Therefore, findings cannot be generalized. Recommendations for Future Research Recommendations for future research on sibling relationships when one sibling has autism should include the following three points: 1. Studies should use theory to investigate how sibling relationships are affected by external and internal relationships and events. Socioconsturctivist model, DES model and family systems theory provide valuable insights into how children and sibling

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relationships are influenced by relationships around them, along with changes in their environment. 2. It may be useful for researchers to use longitudinal studies in order to investigate changes in sibling relationships throughout childhood, adolescence and into adulthood. Longitudinal studies would provide important information as to the impact childhood sibling relationships have on the sibling relationship one has as an adult. Third including diverse sample populations, including random sampling and various family types would allow for the ability to generalize studies, as most of the current research is limited to white, middle-class families.

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References Abrams, M. S. (2009). The well sibling: Challenges and possibilities. American Journal of Psychotherapy, 63(4), 305-317. Autism spectrum disorders. (2010). The Autism Society of Minnesota. Retrieved Ocotber 9, 2010, from http://www.ausm.org/autismInfo/index.asp. Data & statistics. (2010). Centers for Disease Control and Prevention. Retrieved October 8, 2010, from http://www.cdc.gov/ncbddd/autism/data.html. Facts about ASDs. (2010). Centers for Disease Control and Prevention. Retrieved October 8, 2010, from http://www.cdc.gov/ncbddd/autism/facts.html. Hakvoort, E. M., Bos, H. M., Van Balen, F., & Hermanns, J. M. (2010). Family relationships and the psychosocial adjustment of school-aged children in intact families. The Journal of Genetic Psychology, 17(2), 182-201. Howe, N., & Recchia, H. (2009). Individual differences in sibling teaching in early and middle childhood. Early Education and Development, 20(1), 174-197. Kaminsky, L., & Dewey, D. (2001). Sibling relationships of children with autism. Journal of Autism and Development Disorders, 31(4), 399-410. Karos, L. K., Howe, N., & Aquan-Assee, J. (2007). Reciprocal and complementary sibling interactions, relationship quality and socio-emotional problem solving. Infant and Child Development, 16(6), 577-596. Kim, J.-Y., McHale, S. M., Crouter, A. C., & Osgood, D. W. (2007). Longitudinal linkages between sibling relationships and adjustment from middle childhood through adolescence. Developmental Psychology, 43(4), 960-973.

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Kim, J.-Y., McHale, S. M., Osgood, D. W., & Crouter, A. C. (2006). Longitudinal course and family correlates of sibling relationships from childhood through adolescence. Child Development, 77(6), 1746-1761. Knott, F., Lewis, C., & Williams, T. (2007). Sibling interaction of children with autism: Development over 12 months. Journal of Autism and Developmental Disorders, 37(10), 1987-1995. Kramer, L., & Kowal, A. K. (2005). Sibling relationship quality from birth to adolescence: The enduring contributions of friends. Journal of Family Psychology, 19(4), 503-511. Macks, R. J., & Reeve, R. E. (2007). The adjustment of non-disabled siblings of children with autism. Journal of Autism and Developmental Disorders, 37(6), 1060-1067. McElwain, N. L., & Volling, B. L. (2005). Preschool children’s interactions with friends and older siblings: Relationship specificity and joint contributions to problem behavior. Journal of Family Psychology, 19(4), 486-496. Modry-Mandell, K. L., Gamble, W. C., & Taylor, A. R. (2007). Family emotional climate and sibling relationship quality: Influences on behavioral problems and adaptation in preschool-aged children. Journal of Child and Family Studies, 16(1), 61-73. O’Brien, I., Duffy, A., & Nicholl, H. (2009). Impact of childhood chronic illness on siblings: A literature review. British Journal of Nursing, 18(22), 1358, 1360-1365. Orsmond, G. I., & Seltzer, M. M. (2009). Adolescent siblings of individuals with an autism spectrum disorder: Testing a diathesis-stress model of sibling well-being. Journal of Autism and Developmental Disorders, 39(7), 1053-1065. Pike, A., Coldwell, J., & Dunn, J. F. (2005). Sibling relationships in early/middle childhood: Links with individual adjustment. Journal of Family Psychology, 19(4), 523-532.

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Pilowsky, T., Yirmiya, N., Doppelt, O., Gross-Tsur, V., & Shalev, R. S. (2004). Social and emotional adjustment of siblings of children with autism. Journal of Child Psychology and Psychiatry, 45(4), 855-865. Recchia, H. E., & Howe, N. (2009a). Associations between social understanding, sibling relationship quality, and siblings’ conflict strategies and outcomes. Child Development, 80(5), 1564-1578. Recchia, H. E., & Howe, N. (2009b). Sibling relationship quality moderates the associations between parental interventions and siblings’ independent conflict strategies and outcomes. Journal of Family Psychology, 23(4), 551-561. Richmond, M. K., Stocker, C. M., & Rienks, S. L. (2005). Longitudinal associations between sibling relationship quality, parental differential treatment, and children’s adjustment. Journal of Family Psychology, 19(4), 550-559. Rivers, J. W., & Stoneman, Z. (2003). Sibling relationships when a child has autism: Marital stress and support coping. Journal of Autism and Developmental Disorders, 33(4), 383394. Rivers, J. W., & Stoneman, Z. (2008). Child temperaments, differential parenting, and the sibling relationships of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 38(9), 1740-1750. Smith, L. O., & Elder, J. H. (2010). Siblings and family environments of persons with autism spectrum disorder: A review of the literature. Journal of Child and Adolescent Psychiatric Nursing, 23(3), 189-195. Symptoms of autism. (2010). Autism Speaks. Retrieved October 8, 2010, from http://www.autismspeaks.org/whatisit/symptoms.php.

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Tsao, L., & Odom, S. L. (2006). Sibling-mediated social interaction intervention for young children with autism. Topics in Early Childhood Special Education, 26(2), 106-123. Your family & autism. (2010). Autism Speaks. Retrieved October 8, 2010, from http://www.autismspeaks.org/family/index.php. What is autism. (2010). Autism Speaks. Retrieved October 8, 2010, from http://www.autismspeaks.org/whatisit/index.php. Volling, B. L. (2005). The transition to siblinghood: A developmental ecological systems perspective and directions for future research. Journal of Family Psychology, 19(4), 542549.