Getting to Know Siblings of Youth with Autism Spectrum Disorder: Family Predictors and Clinical Outcomes

Background: Current research findings remain unclear as to whether or not siblings of youth with ASD present with consistent emotional, behavioral, or social “adjustment” difficulties (e.g., Cuskelly, 1999). Many studies have attempted to examine what risks may be associated with this unique sibling experience, but no consistent clinical profile is supported, perhaps due to a narrow view of having a sibling with ASD as a risk factor for these youth (e.g., Orsmond & Seltzer, 2006; Stoneman, 2005). This current status of the literature is especially relevant in light of the growing number of therapy and support programs directed at siblings (Tudor & Lerner, 2015). Thus, there is an apparent need for a clearer understanding of of sibling functioning, as well as potential predictive factors thereof (McHale, Updegraff, & Feinberg, 2015).

Objectives: The goal of the current study was to examine family factors that may predict outcomes for siblings of youth with ASD. A theoretically-based model of these factors was proposed drawing from both TD and ASD literatures (e.g., Goodman & Gotlib, 1999; Feinberg et al., 2012).

Methods: A total of 239 mothers of youth aged 6-17, including one youth with ASD (M=11.14 years; simplex families) and at least one other youth (M=11.74 years), completed a questionnaire battery. Measures reflected familial factors: ASD severity and problem behavior of affected sibling, maternal depression and stress, differential attention towards siblings, family social support, and sibling relationship quality. Mothers also reported on demographic characteristics, such as number of children in family, presence of second parent, and SES, as potential model covariates. An initial theoretical model was proposed. A final model was obtained using confirmatory path analysis and progressive model fitting.

Results: Overall, only 6%-23% of siblings were identified within the clinical range of emotional, behavioral, or social functioning (see Table 1). The final model (see Figure 1) demonstrated that maternal depression positively predicted clinical outcomes while maternal stress predicted less clinical elevations. More positive sibling relationships were associated with poorer emotional, behavioral, and social functioning. Contrary to expectation, ASD symptom severity and ASD problem behavior were not direct predictors of TD sibling outcomes but, rather, predictors of other areas of familial functioning that ultimately predicted TD sibling outcomes.

Conclusions: The current sample represents the largest study of sibling emotional, social, and behavioral functioning to date, and suggests that the majority of siblings are demonstrating emotional, behavioral, and social functioning similar to the general population of youth. Particular family factors may be of especial importance in understanding why some youth may be in need of support or intervention – family factors that have been largely ignored in sibling research to date. The current model is presented as a base for the development of future research and evidence-based programs for supporting the apparent resilience and strengths of siblings while also identifying and serving those who may be at risk.