Understanding how the cognitive, emotional and behavioural components of sibling attitudes interact with one another at various stages of a sibling’s lifespan will allow clinicians to provide better support to children with autism spectrum disorder (ASD) and their families. However, no research exists which focusses on describing the attitudes of adolescent siblings of children with ASD within the South African context towards their sibling with an ASD. The primary aim of this study was to investigate how typically developing adolescents recall their past attitudes and describe their present attitudes towards their sibling with an ASD.
Thirty typically developing adolescents who have siblings with ASD were selected to complete the survey instrument, the Lifespan Sibling Relationship Scale, using a cross-sectional design.
Results indicate that the measure has internal consistency within this sample. Wilcoxon signed-ranks tests were used to test for significant differences between the mean values for the two self-reported time periods. Friedman analysis of variances (ANOVAs) was used to test for significant differences in the three components of attitudes, namely affect, behaviour and cognition. Results indicate that participants held more positive attitudes towards their siblings with ASD as adolescents compared with when they were younger and that adolescents rated their current emotions towards and beliefs about their sibling with ASD to be more positive than their current interaction experiences.
As siblings’ attitudes appear to change over time, clinicians should use a lifespan approach to sibling attitudes when designing and implementing supports for siblings of children with ASD.
Similar to international trends, the prevalence of autism spectrum disorder (ASD) in South Africa appears to be increasing (Bateman,
Sibling interactions often provide children with ASD with their first socialisation experiences (Meadan, Stoner & Angell,
The aforementioned core characteristics of autism (
The results of research regarding the impact of ASD on siblings’ psychosocial adjustment have been mixed (see Meadan et al., It is not clear whether the children actively held these tensions between acceptance and change, or whether these often contradictory views were evidence of ongoing cognitive processing and appraisal. (p. 389)
Notwithstanding this lack of consensus in the literature, it is clear that typically developing siblings of children with ASD hold varying degrees of positivity towards their relationship with their sibling with ASD.
On the contrary, a recent systematic review that investigated the effectiveness of sibling support for children with intellectual disabilities indicates that not all siblings are likely to be in need of support (Tudor & Lerner,
To capture the changes in the sibling relationship over time, Riggio (
It is, therefore, evident that the sibling relationship between typically developing siblings and children with intellectual disabilities, including autism, has received substantial attention in international literature. However, there are only a handful of South African studies that explore issues relating to siblings of children with developmental disorders or disabilities. The authors are aware of two studies that have been conducted that explore the attitudes of siblings of children with severe speech and language difficulties (Hansen, Harty & Bornman,
To date, however, no research exists which focusses on describing the attitudes of adolescent siblings of children with ASD within the South African context towards their sibling with ASD. This study, therefore, sought to describe and compare participants’ self-reported past and present attitudes towards their sibling with ASD, as well as to explore the association between the components of attitudes and the two life stages under examination, namely childhood and adolescence.
This study uses a cross-sectional survey design. Given that both of these attitudes (past and present) were assessed at a single point in time, it is partially a retrospective design.
The LSRS (Riggio,
The psychometric properties of the LSRS have been established with a sample of 711 undergraduate and graduate students (62% female and 38% male). The LSRS (Riggio,
Sample items from the Lifespan Sibling Relationship Scale modified for completion by the adolescents.
Variable | Attitude components | Statement | Riggio ( |
---|---|---|---|
Child | Affect | I remember loving my sibling a lot when we were younger. | 0.89 |
Behaviour | My sibling and I spent time together after school when we were younger. | 0.84 | |
Cognition | My sibling and I had a lot in common when we were younger. | 0.88 | |
Adolescent | Affect | My sibling frequently makes me angry. | 0.91 |
Behaviour | My sibling and I do a lot of things together. | 0.87 | |
Cognition | I believe that I am very important to my sibling. | 0.91 |
, total scale α = 0.96.
Permission to conduct this study was obtained from the relevant ethics authorities. Data were collected at two special schools for children with ASD, one in Cape Town and the other in Pretoria, as part of a ‘Sibling support day’. The aim of the day was to provide information to siblings about ASD, as well as to create an opportunity for them to discuss issues of concern in a safe environment. Content covered included the children’s understanding of what ASD was, the different expectations parents may have of the adolescents, compared with their sibling with ASD, the siblings’ experience of having a sibling with ASD (both the positive and negative aspects) and what their hopes and fears were regarding the sibling at that point in time as well as in the future. The LSRS was completed prior to the commencement of the activities for the Sibling support day, to ensure that the planned activities did not influence the adolescents’ responses. Both of the Sibling support days were facilitated by the first author.
A flyer was distributed through the networks of Autism Western Cape and Autism SA. Letters were also sent to schools specialising in the education of children with ASD in both Cape Town and Pretoria. Parents received a flyer containing information about the study, which they were encouraged to share with the participants. Written consent was obtained from the parents of the sibling. Before data were collected, the adolescents themselves also provided written assent. There were a number of families who indicated a willingness to participate but were unable to attend either of the Sibling support days for a variety of reasons. A copy of the survey was sent to these typically developing siblings either through email or through the school, depending on their personal preference. They completed the survey at home and returned it to the researcher either through email or through the school.
Thirty typically developing siblings completed and returned the questionnaire. The demographics of the participants and their families were collected using a biographical questionnaire developed specifically for this study. Thirteen participants completed the questionnaire during one of the two Sibling support days, whereas seventeen (who wanted to complete the questionnaires but who could not attend the Sibling support days) completed the questionnaires at home. A Fischer’s exact test indicated that there was no significant difference between the group who completed their questionnaire at the Sibling support day and those who completed the questionnaire at home, in terms of gender (
The majority of the adolescents were living in the same house as their sibling at the time of data collection (90%,
The ages of the adolescent siblings ranged from 13 to 20 years (M = 15 years; SD = 1.69). An equal number of male participants (
The age of the siblings with ASD ranged from 7 to 21 years (M = 10 years; SD = 3.50). Ninety per cent (
Data were analysed using the Statistical Package for the Social Sciences 24 (SPSS). Firstly, data were checked for accuracy, normality and outliers. The Shapiro–Wilk test for normality suggested that each of the subscales exhibited normality (AAff:
In order to test whether the LSRS (Riggio,
Means, standard deviations and Cronbach’s alpha values for the three subscales and Wilcoxon rank mean difference and
Components of attitude | Adolescent | Child | Difference | |||||
---|---|---|---|---|---|---|---|---|
Mean | SD | Cronbach’s alpha |
Mean | SD | Cronbach’s alpha | Mean rank diff | ||
Affect | 3.80 | 0.75 | 0.92 | 3.38 | 0.89 | 0.97 | 11.45 | -4.25 |
Behaviour | 2.62 | 0.69 | 0.80 | 2.79 | 0.64 | 0.79 | 0.48 | -1.25 |
Cognition | 3.65 | 0.79 | 0.86 | 2.81 | 0.62 | 0.71 | 6.36 | -3.74 |
, total scale α = 0.83.
,
In order to compare the components of present attitudes towards siblings with ASD to past attitudes, Wilcoxon signed-rank tests were run on the data, which are also presented in
The first analyses were conducted to compare participants’ scores between child and adolescent affect. The results showed a statistically significant increase from CAff (mean rank = 17.85) to AAff (mean rank = 6.40),
In order to gain a better understanding of the three components of attitudes, a Friedman ANOVA was conducted to explore how the components of attitudes (affect, behaviour and cognition) differed within each life stage.
The first ANOVA showed that there were significant differences within child attitudes, χ2 (2,
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed voluntary consent was obtained from all individual participants included in the study.
The purpose of this study was to examine and compare adolescents’ past and present attitudes towards their siblings with ASD. Attitudinal scores were calculated in the areas of affect, behaviour and cognition. There are two main findings from the study. The first is that the results of the analyses indicated that the adolescents who participated in this study experienced their relationships with their siblings with ASD more positively as they grew older. The second point to discuss is the significant differences found within the attitudinal components within each of the two life stage periods (childhood and adolescence).
A possible explanation as to why the adolescents in this study reported that their relationships became more positive as they grew older is that over time the adolescents’ abilities to understand and cope with their siblings with ASD may have increased. Research suggests that, compared with younger children, adolescents are more able to engage with material explaining autism and its effects (Bloch & Weinstein,
A significant difference was found between the scores of the participants’ affect and behaviour components when compared with their cognition scores during adolescence. In other words, adolescents rated their present emotions towards their sibling with ASD (affect component) and their present beliefs about their relationship with their sibling with ASD (cognition component) higher than their present positive interactions with their sibling with ASD (behaviour component). This may be due to the fact that, no matter how positive their feelings towards their sibling are and how well they understand ASD, they still need to manage their own behaviour in relation to the obstacles that their sibling with ASD is likely to have in social relationships (Rivers & Stoneman,
Participants were also asked to recall their past attitudes about their sibling with ASD when they were both younger. Within the child life stage, a significant difference was found between their higher affect scores when compared with their lower behaviour and cognition scores. Thus, when participants recalled their relationship with their sibling with ASD when they were younger, they reported that they felt more positive emotion towards their sibling with ASD (affect component) compared with their feelings about interactions with their sibling with ASD (behaviour component) and beliefs about their relationship (cognition component). Perhaps this is their own reflection of their limited awareness of how to navigate atypical interactions when they were younger. These data corroborate results from Bitsika et al. (
However, a recent systematic review indicated that clinicians should be cautious in applying a one-size-fits-all approach to sibling support. Tudor and Lerner ( In addition to psychological and behavioural functioning and sibling impairments, familial psychopathology, problematic family functioning, amount of attention given toward siblings, and sibling social skills impairments could all be of import in identifying at-risk youth and selecting appropriate services. (p. 18)
Acknowledging this caution, we nevertheless believe that these data provide some implications for how clinicians develop and provide support for siblings of children with ASD. When talking about their present attitudes, data indicate that the behaviour component of their attitude was most impacted by the presence of ASD, whereas when they were younger, it was the cognition component of attitudes that appeared most problematic. In other words, findings from this study indicate that support provided to young children should focus on providing an understanding of the disability and its potential impact on sibling relationships, as suggested by Glasberg (
Research has also demonstrated that siblings can have direct effects on one another’s development when they serve as social partners and role models as well as indirect influences through their impact on larger family dynamics – such as family structure, favouritism or diluting family resources (McHale, Updegraff & Whiteman,
Certain methodological issues must be considered before generalising the findings too broadly. The first issue was the relatively small sample size that was recruited. Future research should endeavour to obtain a sample that is more representative of the sibling population within the South African context at large. The second issue was the self-report nature of the questionnaire, as participants may have provided responses that they thought were appropriate rather than truthful, thereby creating a Hawthorne effect. Self-report methodology is, however, the typical method of collecting data for attitudinal research, as no one can better report on their attitudes than the participants being surveyed. The third issue was the retrospective way that past attitudinal data were collected. Despite the fact that the LSRS (Riggio,
The results of this study add to the empirical data documenting sibling relationships where one sibling has ASD. Findings indicate that the sibling attitudes change depending on whether the participant is thinking about their attitudes at the present moment, or when they recall their attitudes when they were younger. As a result, supports for siblings should be differentiated to account for the differences in the components of attitudes as reported in these data. Data suggest that sibling support interventions should acknowledge the developmental life stage of the sibling and focus on teaching strategies to bolster the component of attitude which is reported as being the least positive at that life stage. In conclusion, when designing and implementing supports for siblings of children with ASD, clinicians should use a lifespan approach to sibling attitudes to ensure that supports to bolster the cognition, affect and behaviour components which influence attitudes to the sibling relationship.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
J.B. was the project leader. C.v.d.M. collected the data. J.B, C.v.d.M, M.H. and D.D. analysed the data. M.H., J.B., C.v.d.M. and D.D. prepared the manuscript.