Early Childhood Educ J (2012) 40:4754

DOI 10.1007/s10643-011-0488-3

Supporting Siblings of Children with Autism Spectrum Disorders

Ling-Ling Tsao Randy Davenport
Cynthia Schmiege

Published online: 8 November 2011

Springer Science+Business Media, LLC 2011

Abstract Research studies have shown the importance of

early intervention services for young children with autism
spectrum disorders (ASD) and their families. However,
most attention has been given to the effectiveness of
treatments solely for children with ASDs. Because the
family centered practice has been emphasized and supported by many researchers and legislation, involving
family members other than children with ASDs and their
parents in the assessing, planning, and implementing
interventions is seen as crucial. The purpose of this article
is to review what sibling relationships look like for a typically developing sibling of a child with an ASD and what
resources are available for parents and specialists to support siblings of children with ASDs.
Keywords Autism spectrum disorder (ASD)
Siblings

Early childhood
Support

Introduction
Autism is a pervasive developmental disorder. It affects
essential human behaviors such as the ability to communicate ideas and feelings, imagination, and the establishment
L.-L. Tsao (&)
C. Schmiege
Family & Consumer Sciences, University of Idaho,
83844-3183 Moscow, ID, USA
e-mail: ltsao@uidaho.edu
C. Schmiege
e-mail: cynthias@uidaho.edu
R. Davenport
Department of Psychology, University of Idaho,
83944-3183 Moscow, ID, USA
e-mail: dave7122@vandals.uidaho.edu

of relationships with others (National Research Council

2001). In a recent report, the Centers for Disease Control and
Prevention (2009) estimates an average of 1 in 110 children
in the U.S. has an Autism Spectrum Disorder (ASD). Due to
these alarming statistics, the topic of ASDs has become a
nation-wide concern, prompting discussions among professionals and parents seeking the best possible intervention
approaches to support families of children with ASDs
(OBrien and Daggett 2006). There are many unknowns
about the most effective treatment strategy for children with
ASDs. However, it is generally agreed that early intervention programs are crucial and effective. The National
Research Council recommends that educational services
begin as soon as a child is suspected of having an autistic
spectrum disorder (p. 6, NRC 2001). Given the importance
of early intervention for a child with an ASD, much attention
is being devoted to the characteristics of effective educational interventions for children with an ASD.
In the family context, attention is typically focused on
effective intervention for a child with an ASD. However,
many parents, specialists, and researchers have concerns
for other children in the family as well (Hastings 2007).
Particularly, there is concern about how best to support
typically developing siblings of children with an ASD
(Kilmer et al. 2008; Lock 2009; Schuntermann 2009).
Consequently, the purpose of this paper is to review and
synthesize the literature on support for siblings of children
with an ASD. With this purpose in mind, this review
focuses on approaches for supporting and fostering positive
sibling relationships, with consideration of the family
system where appropriate.
For the purpose of this paper, we refer to a child with an
ASD as the focal child, and we refer to a typically developing sibling of a child with a disability or an ASD as the
sibling or siblings. We focused on two basic questions

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about what it means to be a sibling of a child with an ASD:

What is it like to grow up as a sibling of a child with
autism? And what can we do to support siblings of children
with autism? These questions helped guide us as we
reviewed the literature, and we hope to address these
questions throughout this review. Before discussing the
available support for siblings, it is important to consider
what has been researched and what is currently known
about sibling relationships.

Sibling Relationships
One special characteristic of sibling relationships is that
they share biological and affective ties with parents.
Brothers and sisters can be a source of companionship,
help, and emotional support. In their interactions with each
other, siblings may acquire many social and cognitive skills
that are central to healthy social development (Furman and
Buhrmester 1985). Travis and Sigman (1998) suggested
that siblings may be especially important for children with
autism because they provide opportunities to socially
interact with other children under maximally supportive
conditions (Rivers and Stoneman 2008). Research suggests
that children with ASDs need exposure to typically
developing children to gain experience and learn about
proper social interaction and relationships (Knott
et al.1995; Tsao and Odom 2006). Typically developing
siblings have great potential to influence children with
ASDs, particularly in early development, and in the
acquisition of social competencies.
Related to the discussion of sibling relationships is the
discussion of what it is like to grow up as a sibling of a
child with an ASD. McHale et al. (1986) interviewed 30
siblings of children with autism, 30 siblings of children
with cognitive disabilities, and 30 siblings of typically
developing children between the ages of 6 and 15. The
children were asked questions about their sibling relationships, their attitudes, and their perceptions of their siblings.
For both the group with siblings of children with autism
and the group with siblings of children with cognitive
disabilities, negative sibling relationships were associated
with worries about the future of the child with a disability,
perceptions of parental favoritism toward the child with a
disability, and feelings of rejection toward the child with a
disability.
Mascha and Boucher (2006) interviewed 14 siblings of
children with autism between the ages of 11 and 18 and
identified negative reactions, such as feelings of embarrassment related to the focal childs behavior problems
(i.e., aggression or uncontrolled anger). Gold (1993) found
siblings of boys with autism scored higher on the depression measure of the Childrens Depression Inventory than

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siblings of typically developing boys. Thereby, siblings of

children with autism may have potentially more internalizing symptoms particularly when they are moving into
adolescence. (However, the researchers cautioned generalizing the finding due to a disproportionate number of
adolescent siblings compared to the control group).
Compared to siblings of typically developing children,
higher levels of attentional problems, loneliness, and
problems with peers have been found in siblings of children
with autism (Bagenholm and Gillberg 1991). Kaminsky
and Dewey (2001) also found that in families with a child
with an ASD, sibling relationships were characterized by
less intimacy, less prosocial behavior and less nurturance as
measured by siblings perceptions of their relationships on a
sibling relationship questionnaire. This is consistent with
another study by Knott et al. (1995), who reported that
children with autism and their typically developing siblings
spent less time together than typically developing sibling
dyads.
In contrast to these potentially negative findings concerning sibling relationships, McHale et al. (1986) indicated that siblings with a good understanding of their
brother or sisters disability, had positive sibling relationships when they perceived that parents and peers had
positive reactions toward their sibling with a disability.
Mates (1990) found that siblings of children with autism
had high self-concepts, healthy academic performance, and
healthy behavioral adjustment as rated by their parents and
teachers. These positive findings are also in line with other
similar research studies (i.e., Berger 1980; McHale et al.
1986). Although autism has doubtlessly had an impact on
the family (e.g., Hastings 2003a; Hastings et al. 2005; Ross
and Cuskelly 2006), these positive findings indicate that in
some instances, siblings of children with autism seem to
adjust well to their family situation, and occasionally perform better in some aspects of their social emotional
development (e.g., the development of their mean self
concept) than the normative sample (Mates 1990). Other
positive impacts related to having a sibling with a disability
may involve more acceptance (Roeyers and Mycke 1995),
no deficits in social competence (Kaminsky and Dewey
2002; Rodrigue et al. 1993), and greater admiration and
less competition and quarrels (Knott et al. 1995).
Siblings with positive perceptions and experiences
related to their sibling with a disability are likely to adapt
successfully to the impact of having a disability on the
family (Taunt and Hastings 2002). When siblings perceived their parents and peers as reacting positively to the
child with a disability, they reported more positive relationships with their sibling (Petalas et al. 2009).
The impact of having a sibling with an ASD may vary
among children; as Stoneman (2001) pointed out, the
research on sibling relationships is often contradictory and

Early Childhood Educ J (2012) 40:4754

difficult to interpret. Numerous researchers have found that

the relationship between children with disabilities and their
siblings is usually positive (McHale et al. 1986; Stoneman
et al. 1987; Bagenholm and Gillberg 1991; Lobato et al.
1991). However, some negative impacts of ASD on sibling
relationships have also been found (e.g., Bagenholm and
Gillberg 1991; Kaminsky and Dewey 2001). Certain variables may directly or indirectly affect the adaption of
typically developing siblings to their brothers or sisters
with disabilities, such as gender, age, information, knowledge about the disability of the child with a disability, or
age difference between the typically developing siblings
and children with disabilities (Unal and Baran 2011).
While there is little or nothing that can be done about the
age of children, their ordinal position or the severity of the
ASD, there are strategies that can be implemented to promote and facilitate positive relationships between typically
developing siblings and their brother or sister with an ASD
(Beyer 2009).

Supports and Approaches

Only a limited number of researchers have directly
attempted to empirically validate support strategies for
siblings that help them develop positive, mutually satisfying relationships with their brothers and sisters (Stoneman
2001). The lack of research on this topic is remarkable
because intervention may help ensure that positive rather
than negative outcomes of sibling relationship development occur (Mascha and Boucher 2006). Society has no
greater task than to provide for the healthy, positive
development of children; the ultimate goal is to support
children with disabilities and their siblings in ways that
enhance their chances of growing into psychologically
healthy adults with firmly established positive interpersonal relationships (Stoneman 2005, p. 347).
Parenting
For a variety of reasons, parents may not treat all of their
children identically. Not only is each child a unique individual, but parents also experience developmental changes
over the course of parenting. This is perhaps particularly an
issue for families with a child with a disability. For typically developing children, research has shown that differential parental treatment of siblings is linked to adjustment
problems (Feinberg and Hetherington 2001). Many studies
have also documented increased differential parenting in
families with children with disabilities, generally favoring
the child with a disability (Lobato et al. 1991; McHale and
Pawletko 1992). Dunn and McGuire (1992) highlight an
impressive consensus from the research that maternal

49

differential treatment is linked to the quality of sibling

relationships for typically developing children (e.g., Boer
1990; Brody and Stoneman 1987; Bryany and Crockenberg
1980, Dunn and Plomin 1990) and even for siblings of
children with disabilities (McHale and Gamble 1989).
When siblings are dissatisfied with differential parenting,
the quality of the sibling relationship suffers (Rivers and
Stoneman 2008). It is not simply a matter of poor sibling
relationships and parental favoring that lead to increased
psychological difficulties, but it is a more complex issue
involving children who are sensitive to changes in the wider
sibling context (Richmond et al. 2005; Schuntermann
2007).
Siblings may not always perceive differential parenting
as favoritismsiblings attitudes concerning how they
perceive the differential treatment has much to do with
their satisfaction with the sibling relationship. Children do
not always object to being treated differently from their
siblings, as long as they can find meaning in the difference
and perceive the difference as being fair (Kowal et al.
2002). Similarly, McHale et al. (2000) found that differential treatment from parents does not always have negative implications for siblings; it is important to consider the
subjective evaluation and the legitimacy of the differential
treatment of the siblings themselves. Both children who
have a sibling with a disability and children who have
typically developing siblings experience a full range of
feelings related to their brother or sister, their parents,
themselves and other people in general. Many siblings
experience similar emotions. Some feel excitement, anger,
frustration and others might feel unfavorable or loneliness.
Parenting Strategy: Communication
It is very important to acknowledge the impact of siblings
perceptions about parenting on their sibling relationship
before trying to support siblings. Therefore, open communication is one way parents can provide support for
siblings of children with autism. Gold (1993) stressed the
benefits experienced by siblings when open communication
was possible, especially when family members were free to
communicate openly about the child with a disability. For
more information on specific strategies for facilitating
effective family communication (e.g., good listening skills
for creating an atmosphere where siblings can feel free to
reveal personal thoughts and feelings to parents), see Harris
and Glasberg (2003).
In addition to good communication, it may be helpful for
siblings to learn to label their emotions. This may help
children understand their emotions by linking their own
feelings of concerns about their sibling to their perceptions of
their parents emotional state (e.g., stress about care for every
family member). Meanwhile, providing age appropriate

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explanations about what autism is can help siblings understand and manage their perceptions about why their sibling
with an ASD receives extra attention and support (Harris and
Glasberg 2003; Gallagher et al. 2006). Parents should do
their best to understand what their typically developing
children are saying concerning their sibling with an ASD.
Furthermore, siblings will feel more supported when parents
provide them with clear feedback that what they say has been
received and taken into account by their parents. Acknowledgment of siblings feelings will help them feel respected.
When determining how to best support siblings, it may
be beneficial to consider not only good communication in
general and education about autism, but also to consider
the demands placed upon siblings as a result of having a
brother or sister with an ASD. Do typically developing
siblings of a brother or sister with an ASD take on more
household and care responsibilities than siblings in families
without disabilities? Interestingly, Gold (1993) found that
siblings of children with autism report doing less domestic
work than siblings of typically developing children. Perhaps this is due to parental fears and guilt about potentially
burdening siblings by over-relying on them for help with
childcare and a desire to not over-burden siblings with
extra housework responsibilities.
Parental expectation about sibling responsibilities is one
aspect of the parentchild relationship, which illustrates
that the relationship between each child and parent can
influence the siblingsibling relationship. Such aspects of
the parent child-relationship should be taken into account,
and parental awareness of each individual childs needs in
a family constellation can reduce sibling rivalry and bring
the family members closer together (Cancro 2008). Bryant
and Crockenberg (1980) found that parents who are
responsive to their childrens behavior are likely to foster
prosocial behaviors between their children (Furman and
Buhrmester 1985).
Support Group
Having a child with an ASD in the family not only has the
potential to influence sibling relationships and the emotional well-being of siblings, it can also affect the emotional well-being of the parents. Research has found that
parents of children with ASDs have higher rates of
depression and stress compared to parents who have children with other disabilities and parents with typically
developing children (e.g., Hastings 2003b; Hasting et al.,
2005; Ross and Cuskelly 2006). Parents need a good support network. Having access to a support network and
receiving specific support related to their child yielded
great benefits for parents of children with autism (Guralnick
et al. 2008). Parent support groups should involve meeting
other parents of children with similar conditions. Such

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meetings offer parents the knowledge, understanding, and

acceptance they seek (Banach et al. 2010). Through programs like a family support group or a parent-to-parent
group, families have a place to share their joys and concerns, learn lessons to better support their childs needs,
exchange information, and generally support each other.
Family support groups are good for parents and children.
There is evidence that social support might moderate the
severity of symptoms exhibited by the child with an ASD
and might be related to adaptive coping and adjustment of
siblings (Banach et al. 2010; Hastings 2003b; Law et al.
2001; Stoneman 2005). Many non-profit organizations
provide support group services for families who have a
child with autism, such as the Autism Society of America
or the ARC of the United States at state and local levels.
Some organizations also provide childcare services so that
parents can attend without making babysitting arrangementsa potential challenge for many families with children who have disabilities. When parents have access to
quality emotional and informational resources, they are
better positioned to reach out for help and cope more
effectively.
Parent Training and Support
Parental attitudes about support for each of their individual
children are vital for promoting positive sibling relationships. Parents can act as both support agents and agent
trainers; however, before getting to this level, parents need
the right information and training themselves. Support
groups and community agencies are again likely to be a
valuable source for these kinds of resources. A program
focused on training parents to teach social skills to young
siblings can not only promote positive, adaptive behavior,
but can also capitalize on the powerful socialization effects
of parents and siblings (i.e., parents and siblings are
uniquely situated to make a profound impact on a childs
development) (Tiedemann and Johnston 1992).
Parents may need assistance developing strategies to
enhance childrens social competencies. Programs exist to
aid parents with the endeavor of creating their own intervention plan and can help parents create a custom intervention tailored to their families specific needs. Programs
such as these can also help parents understand different
intervention approaches, which may help parents overcome
the limitations of some existing interventions (e.g., limited
ability to generalize from other interventions and maintenance issues; Tiedemann and Johnston, 1992). Parent
training is necessary for teaching parents how to appropriately reinforce and maintain sibling efforts to positively
interact with their brother or sister with an ASD (Petalas
et al. 2009). For example, Lobato and Kao (2002) conducted an integrated sibling parent group intervention for

Early Childhood Educ J (2012) 40:4754

typically developing siblings of children with a chronic

illness or developmental disability and their parents. When
parents implemented good reinforcement and maintenance
strategies, the authors found improved sibling connectedness and found that siblings had a better knowledge of the
childs disorder and behavior problems (Petalas et al.
2009).
Sibling Play Intervention
Play provides the prime social context for children to create
reciprocal roles, define power relationships, and facilitate
mutual social exchanges (Stoneman 2001). Through trial
and error informed by social feedback, typically developing
children learn to accommodate their siblings disabilities
and facilitate social interaction (Stoneman 2001). However,
the siblings role as an agent for social skills training is not
without challenges. Research indicates that it is more difficult for typically developing siblings to create and lead
play behaviors when their brother or sisters disruptive
and negative behaviors are more severe (Bagenholm and
Gillberg 1991; Knott et al. 1995; Mascha and Boucher
2006; Strain and Danko 1995). Therefore, an individualized
play based social intervention may be an effective strategy
for supporting siblings needs.
Tsao and McCabe (2010) provided a protocol for parents or early intervention specialists to develop a sibling
play intervention focused on supporting proper interactions
between a child with autism and a typically developing
sibling. The intervention begins by observing the childrens
play and routines. Early intervention specialists and parents
then search for opportunities to use the focal childs preferred toys or activities to create play sessions with specific
objectives for both children. The key to success for an
intervention such as this requires taking the siblings
motivation into consideration (e.g., the specialist and parents should consider whether the sibling enjoys learning
new ways of interacting with the focal child). Motivated
siblings can be a significant resource for the family, making
the situation less difficult and allowing the family to cope
more effectively.
Again, siblings can be successful social agents for
children with autism. Siblings can facilitate initiations and
learn to respond strategically to their siblings (El-Ghoroury
and Romanczyk 1999; Tsao and Odom 2006). Siblings
adept at selecting activities that actively engage both
children, will make more effective play partners than
children who select activities that exclude one child or the
other (Lobato et al. 1991; Stoneman et al. 1987). Through
ongoing interactions, siblings with the social skills to
appropriately understand and respond to the needs of their
brother or sister with a disability can develop high quality
sibling relationships (Stoneman 2005). Interaction training

51

for siblings of children with ASDs may prove to be a

valuable approach for an intervention. Such training could
potentially enhance the social interactions and communication between siblings and thus, reduce conflict. Continuity of training and periodic reassessment will ensure that
siblings are provided with the necessary resources to meet
the changing demands as the sibling dyad develops and
each child grows older (Petalas et al. 2009).
It is possible that skills siblings gain in intervention and
sharpened through interactions with their brother or sister
can generalize to contexts beyond the siblingsibling
relationship. (Mascha and Boucher 2006). For example,
Colletti and Harris (1997) taught siblings of children with
ASDs behavior modification techniquestechniques that
could potentially be applied to other relationships and
conflict management situations (e.g., relationships with
friends and other children at school).
A few studies have begun to address the issue of supporting siblings and providing them with the skills and
resources they need to be powerful social skill trainers and
models for their brother or sister with autism. For example,
Celiberti and Harris (1993) taught typically developing
siblings behavioral skills to engage their brother or sister in
play. Tsao and Odom (2006) taught typically developing
siblings how to play more effectively with their brothers
(who had an ASD) and found that children with ASDs
initiated more interactions with their siblings at the end of
the intervention than at the beginning. They also observed
more play behaviors between both children suggesting that
the children were more socially engaged after the intervention. Parents also mentioned that children played like
they were real siblings (e.g., played together and played
more often). When siblings see their important role in
helping their brother or sister, and see that they are making
a positive impact, it is affirming. As a result, showing
typically developing siblings how to best enhance their
brother or sisters abilities and social skills can potentially
boost siblings self esteem, and help them form stronger
relationships with each other (Mascha and Boucher 2006).
Sibling Support Groups
Given the importance of social support from family
members, friends, neighbors, professionals, and parent
groups, it is possible that social support specifically for
siblings may also play an important role in the healthy and
adaptive adjustment of siblings (Kaminsky and Dewey
2002). One well-documented program for supporting siblings is Sibshops (Meyer and Vadasy 2007). Sibshops
resulted in increased positive feelings about the brother or
sister with a disability and siblings acquired useful coping
strategies (Johnson and Sandall 2005; Conway and Meyer
2008).

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Bagenholm and Gillberg (1991) interviewed 60 children

between the ages of 5 and 20 who had a brother or sister
with autism, cognitive disabilities, or no apparent physical
or cognitive disorders. They found that siblings of children
with disabilities talked more about their brothers and sisters
than siblings of typically developing children. Children in
ordinary families do not talk very much about their
siblings (p. 304). As a result, Bagenholm and Gillberg
(1991) believed that if there is something to talk about
good or badit may be a relief for siblings to have the
opportunity to talk about their experiences both at home
and with friends and other supportive adults. Simply providing opportunities for siblings to express their feelings is
a good start, but a more structured and clinical approach
may be even better. Mascha and Boucher (2006) indicated
that it might be beneficial to work directly with siblings by
helping them explore their thoughts and feelings, including
reflecting on their experiences with their brother or sister,
their understanding of the disability, and the role of each
family member within the family system. Therefore, it is
often good practice to utilize a professional counselor when
possible. Providing resources and appropriate support to
siblings is essential, and can potentially have long-term
benefits for both siblings. Siblings of persons with disabilities can their brothers and sisters live dignified lives
from childhood throughout adulthood (Meyer and Vadasy
1997).

Discussion
The majority of brothers and sisters of children with autism
function well (Ferraioli and Harris 2010). Research has
shown that relationships between siblings when one child
has a disability are not identical to the relationships that
exist between typically developing siblings (Stoneman
2001). However, having a brother or sister with a disability
does not cause maladaptation or pathology in children
(Stoneman 2005; Rodrigue et al. 1993). Instead, siblings of
children with disabilities engage in a rich and complex set
of roles, such as that of teacher, caregiver, modeler, and
confidant, which may promote developmental benefits
(Stoneman and Brody 1982). Many siblings of children
with disabilities successfully achieve mutually acceptable
interactional role relationships, artfully crafted to fit their
life contexts (Stoneman 2001, 2005). Certainly, this is in
keeping with family theories that suggest that families
define situations. The use of available resources and the
important aspects of a good intervention, as identified in
this review, can assist families to not only cope with a
stressor event but also adapt and thrive with their unique
challenge.

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On the other hand, the behavioral problems frequently

associated with an ASD (e.g., aggression or temper issues)
can cause a variety of negative emotions for typically
developing siblings. Therefore, there is a clear need for
proper support of siblings of children with autism (Mascha
and Boucher 2006). Siblings are an integrative component
of the family system and are key players shaping the
experiences and learning opportunities available to children with special needs (Kresak et al. 2009).
It is not always clear what the impact of a disability will
be on sibling relationships. There are many factors (e.g.,
environmental factors) that make studying the effects of an
ASD on the sibling relationships difficult (Beyer 2009).
Because children on the autism spectrum vary in the
severity of their condition, it is difficult to ascertain how
the disability impacts a family. The extent of developmental delay could impact how much a family is affected
by the disorder. These differences should be taken into
account when making decisions about how to support
siblings and what kinds of interventions are appropriate for
individual families.
The role of siblings who have a brother or sister on the
autism spectrum, has been underexplored, despite the siblings potential to significantly enhance family life and
foster social skills in children with autism. Efforts should
be made to raise parental and professional awareness of the
potential issues faced by siblings to promote dialogue in
families and between families and professionals. This may
prove especially significant later in life, as sibling relationships are often long-lasting relationships. It is recommended that practitioners acknowledge and build on the
positive views held by siblings. This may help siblings
recognize their personal strengths and abilities, promote
positive family relationships characterized by open channels of communication, and provide opportunities for
families to bond. Additionally, increasing siblings access
to developmentally appropriately information and support
that promotes positive perceptions and experiences may
have lasting effects on sibling adjustment and sibling
relationships (Petalas et al. 2009). Use of resources (e.g.,
material, informational, and emotional/social resources,
etc.) can impact the dynamic functioning of a whole family, including typically developing siblings. Hence, future
autism sibling studies should take a life course approach
and consider the context of life stages (Beyer 2009), as
well as the impact on the family system as a whole.

Conclusion
Each family member plays an important role in his or her
own family system. Siblings are uniquely situated to help

Early Childhood Educ J (2012) 40:4754

children with ASDs and other disabilities. The take-home

message of this review is that empowering siblings to be
effective intervention partners can potentially yield great
benefits for the sibling, the child with a disability, and the
greater family constellation. Parents need to utilize the
resources and support networks available to them to help
them cope with the potential challenges of having a child
with a disability. With proper support and resources, parents can ensure the much-needed support of their typically
developing children. Parents can also facilitate the training
of typically developing siblings, thereby including siblings
in the larger intervention plan for the child with an ASD or
other disability. Asking what is it like to grow up as a
sibling of a child with autism and what can we do to
support siblings of children with autism, led to the identification of several important considerations for supporting
siblings and designing effective interventions. These considerations included open communication, opportunities
for siblings to express their feelings, utilization of support
networks, parenting considerations, and training of both
parents and siblings. Viewing the sibling in the larger
family context and providing siblings with proper support
are vital issuesthe reward of which is too great to ignore.

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