Can you help me structure my paper on The influence of mental illness on healthy siblings cognitive development?

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timer Asked: Dec 29th, 2018
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You do not have to write the whole paper. It is written but it needs to be structured correctly and the instructions at the end of each section is self-explanatory. See professor's feedback and follow the changes. I need to reduce the 5 research questions into only three which makes sense to the research chosen as secondary data analysis (using the data extracted data from another study [which I will provide] in order to answer my research questions). Please follow the instructions given: at the end of each section; from the professor and on the first page.

Dissertation Prospectus The Influence of Mental Illness on Healthy Siblings’ Cognitive Development Submitted by JOE SALDA 11/22/2018 Dr. Not Assigned Yet Joe, I am so glad we had a chance to talk today. I think you are making good progress and getting the data set will be key. Since you are going to make some major modifications, we focused on the research questions. I commented on this below with the list of things to consider like we discussed on the phone. Here are some overall steps to prepare you for the possibility of getting this to your methodologist: 1. Make the three questions very clear, within the scope of your gap. The gap should drive the questions. However, you data may drive a lot here too given the limitations of secondary data. 2. Then make sure every single instance where you refer to a gap, need for research, problem, purpose, and questions clearly and explicitly align. 3. Make sure the theory and literature review align in terms of chosen theory and themes. Make sure the theory is one that not only explains your constructs but is also ones to which your research can contribute. 4. Make sure every rubric line item is explicitly addressed. Please reach out to me with your questions and concerns. Alycia 2 Prospectus Template v.8.0 3 Dissertation Prospectus Introduction A notable number of psychologists, psychiatrists, psychotherapists, social workers and other professionals in the field of behavior analysis, for over a few decades, have recorded reports showing healthy siblings involvement in care, support and treatment aspects of their mentally ill siblings (Seeman, 2013). There is evidence that parents and healthy siblings who care for children suffering from mental illness such as Austism Spectrum Disorder, experience symptoms of depression such as stress, anxiety, grief, sadness, despair, desolation and other symptoms (Sarris, 2017). Consequently, these symptoms are also experienced by well siblings who live with their mentally ill siblings. Ergo, emotions such as anxiety, sadness, grief, resentment and others, caused by the environment (mothers, well siblings and ill children being anxious and stressed out as they interact) can be highly prejudicial for well siblings’ cognitive development in the lack of proper intervention. Accordingly, some of these negative relationships’ experiences can be detrimental for the well siblings’ cognitive development as it is for parents causing distress and depression (Sarris, 2017). Furthermore, studies found that children who are exposed to high stress (or distress) environments may develop depression, and also activate genes, based on predisposition, that may ultimately lead to a variety of mental disorders including addictions (Sapolsky, 2004). Thus the need for intervention for well siblings at early stages of cognitive development. Historically, the experience of healthy siblings of children suffering with mental illness has been documented by several professionals from different fields such as psychiatry, psychology, social work and others. Moreover, several studies have reported healthy Prospectus Template v.8.0 4 siblings’ negative experiences living with their mentally ill sibling. Societal perception of mental disabilities has contributed to the negative experience that has been marginalizing, stigmatizing and cruel, as these families of individuals suffering with mental illness tend to shy away and become isolated (Sanders et al. 2014). Sanders et al (2014) elucidates that this phenomenon (mental illness and healthy siblings’ relationship with the ill child) impacts the psychosocial dynamics and adaptation of healthy siblings and other members of the family when left without professional intervention. Children of mentally-ill siblings can be cognitively affected by the experience if there is lack of intervention and psychological counseling (Seeman, 2013). Social isolation can cause a series of psychological problems such as depression, inferiority complexes, loneliness, sadness, distress and can be a predictor of future psychological problems in healthy siblings. In addition, healthy siblings of children suffering with Autism Spectrum Disorder, for example, run the risk of emotional psychological adjustment (Bitsika, 2015). Parents of mentally ill children suffer to adapt to the task of caring for the ill child experiencing grief and self-demeaning thought process, becoming often depressed and unfit for caring for their children (Sarris, 2017). In a study conducted by DePape and Lindsay (2014) articles were carefully analyzed and compared with the others in a meta-synthesis analysis showing the detriments of the relationships experiences between well siblings and mentally ill siblings and the themes were identified such as pre-diagnosis, diagnosis, family life adjustment, navigating the system, parental empowerment, and moving forward (DePape & Lindsay, 2014).This proposed study describes the influence of mental illness among siblings (well siblings and their mentally ill brothers or sisters) and the consequences of their relationships with healthy siblings and their cognitive Prospectus Template v.8.0 5 development when left untreated. Thus, it is necessary for society to understand these consequences as well as the relationship influence of mentally ill siblings on healthy siblings’ cognitive development for the preservation of healthy siblings’ cognitive development. In addition, there are numerous cases of mental illness and addictions emerging from these maladjusted relationships which trace back to healthy siblings cognitive development and stress (Sapolsky, 2004). As the mental process or action of acquiring understanding and knowledge through senses, experience and thought, cognitive development in children has a profound effect on well-being, success and survival especially on early ages of development (Sanders et al., 2014). In examining the relationship and experiences of parents caring for children with Autism Spectrum Disorder for example, Depape and Lindsay (2014) explained that the relationship involves abnormal communication, impaired social functioning and restrictive and repetitive interests becoming extremely difficult for parents and siblings to manage, causing high stress levels. The emotional impact caused in healthy siblings living with their mentally ill brother or sister can have lasting effects in healthy siblings’ lives such as feelings of guilt, career outcomes, lingering, academic achievements, and others (Woodgate et al., 2016). This study will be important and will add to the body of knowledge because it will describe these negative relationship experiences between mentally ill and healthy siblings, influencing healthy siblings’ cognitive development. The negative effects of distress and anxiety caused by these relationships described above can be detrimental in stages of development (cognitive development) and consequently their future psychological well-being, causing distress, depression, anxiety and a host of other destructive negative emotions and Prospectus Template v.8.0 6 behaviors which can trigger pre-disposed disorders (Sanders et al., 2014; Sapolsky, 2004). Criteria Learner SelfEvaluation Score (0-3) Chair Evaluation Score (0-3) Reviewer Score (0-3) Introduction This section briefly overviews the research focus or problem, why this study is worth conducting, and how this study will be completed. The recommended length for this section is two to three paragraphs. 1. Dissertation topic is introduced along with why the study is needed. 2.5 2 2. Provides a summary of results from the prior empirical research on the topic. Using results, societal needs, recommendations for further study, or needs identified in three to five research studies (primarily from the last three years), the learner identifies the stated need, called a gap. 2.5 2 2.5 2 3. 4. Section is written in a way that is well structured, has a 2.5 2 logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. NOTE: This Introduction section elaborates on the Topic from the 10 Strategic Points. This Introduction section provides the foundation for the Introduction section in Chapter 1 of the Proposal. Reviewer Comments: Background of the Problem Understanding the nature and experience of mentally ill siblings and their relationship with their healthy siblings is critical for the preservation of the well siblings’ psychological development (cognitive development) (Merwe et al., 2017). According to Sanders et al. (2014), healthy siblings of mentally ill brothers and/or sisters who accept the role of caregiving run the risk factor to develop dysfunctional roles in the family such as stressors that results in objective burden (neglect of other family members, family Prospectus Template v.8.0 7 friction, disturbances to the household routines, and distraction from the relatives’ activities) and subjective burden (stigma, fears about interactions and disturbing behaviors, feelings of resentment, feelings of being trapped and anxiety about the future). Wadman et al. (2015) elucidated that children who become caregivers of their mentally ill siblings run the risk factor of experiencing negative patterns of thoughts which include fear, jealousy, over-worry, resentfulness, anger and other negative patterns of thoughts that are destructive and can influence cognitive development. Clinicians should strategically adopt a lifespan approach in understanding healthy siblings’ psychosocial adjustment (when having mentally ill siblings) and helping individuals with mental disorders (such as Autism Spectrum Disorder, Schizophrenia, Bipolar Disorder and other mental disorders) and their healthy siblings as they develop cognitively (Merwe et al.,2017). Healthy siblings of children with Autism Spectrum Disorder show poor peer relationships and a greater risk for emotional adjustment problems. Parental stress and self-efficacy were contributors to healthy siblings’ adjustment and there was no relationship between siblings’ adjustment and parental therapy involvement. Proper intervention and counseling can provide education with respect to such relationships and spare healthy children from undergoing psychological problems and cognitive deficits due to a lack of proper intervention and counseling (Sanders et al., 2014). Prior studies on mentally ill siblings were focused on the needs and priorities of the mentally ill individual (localized phenomenon) rather than the needs of the well sibling (with emphasis on healthy siblings’ stages of cognitive development) that involves therapeutic and family dynamics approach (Seeman, 2013). Furthermore, understanding the complexity of such relationships, comprehensive and thorough case studies evaluations will be the most Prospectus Template v.8.0 8 suitable approach to understand and describe the relationships between these siblings and suggest approaches such as intervention (coaching, counseling and/or psychotherapy), education and treatment for families of the causal relationship within denoting phenomena. Professionals and parents should intervene in the relationships of mentally ill siblings and healthy siblings with the intention of preserving healthy siblings’ cognitive development (Merwe et al., 2017). The emotional impact caused in healthy siblings living with their mentally ill brother or sister can have lasting effects in healthy siblings’ lives such as feelings of guilt, career outcomes, lingering, academic achievements, and others (Woodgate et al., 2016). Due to social stigma, shame and rejection, families of children suffering with mental illness tend to avoid social interaction (including social events, relationships with peers, coaching, counseling and/or psychotherapy) by isolating themselves (Seeman, 2013). This tendency for social isolation negatively influences the cognitive development of healthy siblings living with their mentally ill brothers or sisters at important stages of development which involves identity formation and development of personality (Lovell & Wetherell, 2015). Hence, the need for further studies concerning these relationships’ influences on well siblings’ cognitive development that could have had evaluated this phenomenon thoroughly, providing existing findings. Furthermore, fear, guilt, shame, stigma and other negative predicaments can cause inhibitions and complexes (inferiority complexes) that will hinder healthy siblings from developing normally, influencing their stages of cognitive development (Sanders et al. 2014). Sanders et al. (2014) concluded on their study that the psychosocial dynamics and adaptation among the entire family when caring for ill siblings (siblings suffering with mental disorders) is crucially Prospectus Template v.8.0 9 important for the psychological wellbeing (of the family as a whole) which confirms the need for psychological intervention (psychosocial dynamics and adaptation). Abrams (2009), studied aspects of the experience of children of siblings suffering from mental illness and concluded that well siblings face a great deal of distress dealing with their mentally-ill siblings. Such distress included negative feelings such as anxiety, fear, shame, guilt and other negative and destructive patterns of thought that can be detrimental for children in several stages of cognitive development. Abrams’ study provides insight on the nature of the negative impact the ill sibling’s relationship can have on healthy siblings and proposes solutions that seek to foster a better adjustment and prevention for the well sibling (Abrams, 2009). Contributing to the negative experience of such relationships described above is society’s perception of mental disabilities, which has been marginalizing, stigmatizing and cruel, as these families of individuals suffering with mental illness tend to seclude themselves, avoiding socialization and counseling (Sanders et al., 2014). Criteria Learner SelfChair or Score Reviewer Evaluation (0-3) Score Score (0-3) (0-3) Background of the Problem This section uses the literature to provide the reader with a definition and statement of the research gap and problem the study will address. This section further presents a brief historical perspective of when the problem started and how it has evolved over time. The recommended length for this section is two-three paragraphs. 1. Includes a brief discussion demonstrating how literature has established the gap and a clear statement informing the reader of the gap. Prospectus Template v.8.0 2.5 1.5 10 Criteria Learner SelfEvaluation Score (0-3) 2.5 Chair or Score (0-3) Reviewer Score (0-3) Discusses how the “need” or “defined gap” 1.5 has evolved historically into the current problem or opportunity to be addressed by the proposed study (citing seminal and/or current research). 3. ALIGNMENT: The problem statement for 2.5 2 the dissertation will be developed from and justified by the “need” or “defined gap” that is described in this section and supported by the empirical research literature published within the past 3-5 years. 4. Section is written in a way that is well 2.5 1 structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. NOTE: This Background of the Problem section uses information from the Literature Review in the 10 Strategic Points. This Background of the Problem section becomes the Background of the Study in Note, this section develops the foundation for Chapter 1 in the Proposal. It is then expanded to develop the comprehensive Background to the Problem section and Identification of the GAP sections in Chapter 2 (Literature Review) in the Proposal. Reviewer Comments: 2. Theoretical Foundations and Review of the Literature/Themes Theories chosen for this study will be the Cognitive Development Theory, having roots in the work of Jean Piaget. Piaget’s work on the Cognitive Development Theory explains stages of cognitive development and the importance of each stage since birth to adulthood with respect to cognition and identity formation (Piaget’s four stages of cognitive development). Cognitive Behavior Theory having its roots in the work of Dr. Alfred Adler and Albert Ellis which examines child development and exaggerated feelings of inferiority will be discussed to shed light upon the concept of environmental behavior and relationships. This theory is important for this study because it outlines stages of development and the importance of each stage in cognitive development as a child develops into adolescence and adulthood. The chaos experienced by healthy Prospectus Template v.8.0 11 siblings as they interact in the environment with their mentally ill siblings and stressed out parents can influence healthy children and/or adolescents in their stages of development (Sarris, 2017). Cognitive development focuses on how children develop in each stage as they learn to process information such as perceptual skills, language learning and other skills as they learn to consciously understand, cognize and articulate their understanding of the world. The theory of Social Interaction in the development of cognition from Lev Vygotsky supports the argument concerning the need for social interaction in cognitive development and examines the problem of healthy siblings’ isolation from society (Woodgate et al., 2016). The role of social interaction between the developing child and linguistically knowledgeable family members is explained in social interaction theory and alludes to the importance of relationships at stages of development. The social interaction approach in this theory is important for this study because it explains the healthy sibling’s construction of a social world in the context of family-child interaction. Siblings that assume the role of being a caregiver for their mentally ill sibling(s) (common among this population) run the risk factor to assume certain dysfunctional roles in the family (Sanders et al., 2014). Based on the theoretical foundation of this proposed study and scientific data showing the predicaments of these relationships it is clear that these well siblings’ dysfunctional roles influence their cognitive development. Sanders et al. discussed the implications for future therapy and research on such relationship. According to Conger and Kramer (2010), the relationship among siblings provide a context for life experiences, framing siblings’ issues within the context of studies on child development and social relationships, during the course of life. Conger and Kramer (2010) concluded that healthy siblings “may need to resolve conflicts Prospectus Template v.8.0 12 and rivalries from childhood and adolescence before they can develop more supportive relationships that would facilitate carrying out the tasks of adulthood”; this concept sheds light on the importance of a healthy cognitive development during childhood. Criteria Learner SelfChair or Reviewer Evaluation Score Score Score (0-3) (0-3) (0-3) Theoretical Foundations and/or Conceptual Framework This section identifies the theory(s) or model(s) that provide the foundation for the research. This section should present the theory(s) or models(s) and explain how the problem under investigation relates to the theory or model. The theory(s) or models(s) guide the research questions and justify what is being measured (variables) as well as how those variables are related (quantitative) or the phenomena being investigated (qualitative). Review of the Literature/Themes This section provides a broad, balanced overview of the existing literature related to the proposed research topic. It describes the literature in related topic areas and its relevance to the proposed research topic findings, providing a short 3-4 sentence description of each theme and identifies its relevance to the research problem supporting it with at least two citations from the empirical literature from the past 3-5 years. The recommended length for this section is 1 paragraph for Theoretical Foundations and a bulleted list for Literature Themes section. 1. Theoretical Foundations section identifies 2 1 the theory(s), model(s) relevant to the variables (quantitative study) or phenomenon (qualitative study). This section should explain how the study topic or problem coming out of the “need” or “defined gap” in the as described in the Background to the Problem section relates to the theory(s) or model(s) presented in this section. (One paragraph) 2. Review of the Literature Themes section: 2 1 This section is a bulleted list of the major themes or topics related to the research topic. Each theme or topic should have a one-two sentence summary. 3. ALIGNMENT: The Theoretical Foundations 2 1 models and theories need to be related to and support the problem statement or study topic. The sections in the Review of the Literature are topical areas needed to understand the various aspects of the phenomenon (qualitative) or variables/groups (quantitative) being studied; to select the design needed to address the Problem Statement; to select surveys or instruments to collect information on variables/groups; to define the population and sample for the study; to describe components or factors that comprise the phenomenon; to describe key topics related to Prospectus Template v.8.0 13 Criteria Learner SelfEvaluation Score (0-3) Chair or Score (0-3) Reviewer Score (0-3) the study topic, etc. Section is written in a way that is well 2 1 structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. NOTE: The two parts of this section use information about the Literature Review and Theoretical Foundations/Conceptual Framework from the 10 Strategic Points. This Theoretical Foundations section is expanded upon to become the Theoretical Foundations section in Chapter 2 (Literature Review). The Theoretical Foundations and the Literature Review sections are also used to help create the Advancing Scientific Knowledge/Review of the Literature section in Chapter 2 (Literature Review). Reviewer Comments: 4. Problem Statement It is not known how healthy siblings experience cognitive development when living with their mentally ill siblings. There is no sufficient scholarly evidence in the field to conclude whether siblings with mental illness can negatively influence healthy siblings’ cognitive development. The focus of this qualitative study is to understand the influence mentally ill siblings have on healthy siblings’ cognitive development. This study can contribute to the education and intervention of families of individuals suffering with mental illnesses and help their healthy siblings undergo healthy cognitive development without interference. The emotional impact caused in healthy siblings living with their mentally ill brother or sister can have lasting effects in healthy siblings’ lives such as feelings of guilt, career outcomes, lingering, academic achievements, all of which influences cognitive development (Woodgate et al., 2016). This study will scrutinize the relationship experiences of families of children with mental illness and their well siblings, shedding light on the concept of healthy siblings’ cognitive development preservation (DePape & Lindsay, 2014). Prospectus Template v.8.0 14 Criteria Learner SelfChair or Reviewer Evaluation Score Score Score (0-3) (0-3) (0-3) Problem Statement This section includes the problem statement, the population affected, and how the study will contribute to solving the problem. The recommended length for this section is one paragraph. 1. States the specific problem proposed for 2.5 1.5 research with a clear declarative statement. Describes the population of interest affected by the problem. The general population refers to all individuals that could be affected by the study problem. 2.5 2 Describes the unit of analysis. 2.5 1 Discusses the importance, scope, or opportunity for the problem and the importance of addressing the problem. 2.5 2 The problem statement is developed based on the need or gap defined in the Background to the Study section. 2.5 1 Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. 2.5 1 For qualitative studies this describes how the phenomenon will be studied. This can be individuals, group, or organization under study. For quantitative studies, the unit of analysis needs to be defined in terms of the variable structure (conceptual, operational, and measurement). NOTE: This section elaborates on the Problem Statement from the 10 Strategic Points. This section becomes the foundation for the Problem Statement sections in Chapter 1and other Chapters where appropriate in the Proposal. Reviewer Comments: Prospectus Template v.8.0 15 Purpose of the Study The purpose of this study will be to describe how mentally ill siblings can influence their healthy siblings’ cognitive development due to stressors (such as stress, anxiety, grief, sadness, despair, desolation and other stressors [Sarris, 2017]) in such relationship by using interviews, questionnaires (open-ended-questions), and Neuropsychological testing. This study will be conducted in Phoenix, Arizona and will use secondary data analysis (data from existing qualitative research) to apply conceptual skills as well as theoretical knowledge in the utilization of existing data to address the research questions (Johnston, 2014). Criteria Learner SelfChair or Score Reviewer Score Evaluation Score (0-3) (0-3) (0-3) PURPOSE OF THE STUDY This section reflects what the study is about, connecting the problem statement, methodology & research design, target population, variables/phenomena, and geographic location. The recommended length for this section is one paragraph. 1. Begins with one sentence 2.5 1 that identifies the research methodology and design, target population, variables (quantitative) or phenomena (qualitative) to be studied and geographic location. Quantitative Studies: Defines the variables and relationship of variables. 2.5 1 2.5 1 Qualitative Studies: Describes the nature of the phenomena to be explored. Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA Prospectus Template v.8.0 16 Criteria Learner SelfEvaluation Score (0-3) Chair or Score (0-3) Reviewer Score (0-3) format. NOTE: This section elaborates on information in the Purpose Statement from the 10 Strategic Points. This section becomes the foundation for the Purpose of the Study section in Chapter 1and other Chapters where appropriate in the Proposal. Reviewer Comments: Research Questions and/or Hypotheses The following research questions guide this qualitative study: RQ1: How do the relationships between mentally ill siblings and healthy siblings lead to cognitive deficits in healthy siblings? Theory of Cognitive Development (Bauer et al., 2015). RQ2: Do healthy siblings run the risk factor of assuming dysfunctional roles when living with their mentally ill siblings? Cognitive Development Theory (Sanders et al., 2013) RQ3: By living with their mentally ill sibling(s), do healthy siblings have trouble coping with relationships? Fifth Stage of Development Theory (Waldman et al., 2016) RQ4: Do healthy siblings decrease socialization when living with their mentally ill siblings? Theory of Socialization (Woodgate et al., 2016). RQ5: Does living with mentally ill siblings influence healthy siblings in assuming or copying roles in moral behavior and emotional regulation? Theory of Cognitive Development (de Achaval et al., 2013). Criteria Prospectus Template v.8.0 Learner SelfEvaluation Score (0-3) Chair Score (0-3) Reviewer Score (0-3) 17 Criteria • • • Learner SelfChair Score Reviewer Score Evaluation Score (0-3) (0-3) (0-3) RESEARCH QUESTION(S) AND/OR HYPOTHESES The recommendation is a minimum of two research questions along with related hypotheses and variables is required for a quantitative study. Also recommended is a minimum of two research questions along with the phenomenon description is required for a qualitative study. Put the Research Questions in the appropriate Table in Appendix B based on whether the study is qualitative or quantitative. The recommended length for this section is a list of research questions and associated hypotheses (quantitative) 1. Qualitative Studies: 2 .5 States the research question(s) the study will answer and describes the phenomenon to be studied. Quantitative Studies: States the research questions the study will answer, identifies and describes the variables, and states the hypotheses (predictive statements) using the format appropriate for the specific design and statistical analysis. Alignment: The research questions are based on both the Problem Statement and Theoretical Foundation model(s) or theory(s). There should be no research questions that are not clearly aligned to the Problem Statement. 2.5 .5 Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. 2.5 1 Prospectus Template v.8.0 18 Criteria Learner SelfChair Score Reviewer Score Evaluation Score (0-3) (0-3) (0-3) NOTE: This section elaborates on the information about Research Questions) &Hypothesis/variables or Phenomena from the 10 Strategic Points. This section becomes the foundation for the Research Question(s) and/or Hypotheses section in Chapter 1 in the Proposal. Reviewer Comments: Advancing Scientific Knowledge and Significance of the Study This study will provide insight into the nature of the relationship between mentally ill and healthy siblings when there is lack of professional intervention and proposes solutions for the problem. In order to foster a better adjustment and prevention for the well sibling(s), the ill sibling and their families, this study will provide solutions that will alleviate the stressors (Seeman, 2013). Parents of mentally ill children suffering from Autism Spectrum Disorder must endure higher stress levels than parents of healthy children which can consequently influence healthy siblings’ normal development. Thus, it is important to understand the experiences of parents, ill child and healthy siblings due to the predicaments of these relationships which can provide detailed families interactions and realities concerning family dynamics. As parents are faced with challenges such as social and economic adjustments, high stress levels for having to dedicate more time and effort to the ill child, and often divorce and relationship problems, well siblings suffer the consequences of the detriments of such relationship issues which can ultimately influence normal cognitive development (DePape and Lindsay, 2014). Moreover, the experiences reported by parents and healthy siblings on how difficult and overwhelming these relationships can be will serve as testimonials of the harmful influence in well siblings’ cognitive development based on the theories of Prospectus Template v.8.0 19 cognitive development, cognitive behavior and social interaction (Lovell and Wetherell, 2015). Among the strategies that will be created by this study (intervention: education and counseling) suggesting solutions for these relationship detriments, families need to seek professional alternatives such as clinical intervention, family therapy and/or support groups. Furthermore, proper intervention will help well siblings overcome some of the environmental negative influences such as developed patterns of negative thoughts, anger, inferiority complexes, depression and social isolation which lead to psychological chaos. This study is important because it addresses the need for intervention (coaching, counseling, psychotherapy) due to these negative predicaments. For example, siblings of children with Autism experiencing greater depressing symptoms and emotional problems when compared with control group as concluded in the study of Lovell (2015). This study will contribute to the practice in psychology for shedding light on the phenomenon (influence of siblings with mental illness on healthy siblings’ cognitive development) and exposing the need for early intervention. The influence of such relationship on well siblings can be detrimental for their stages of cognitive development based of the theory of cognitive development and models of psychological development as children grow up. As an example, according to Bauer et al. (2015), healthy siblings of individuals with bipolar disorder (and their mentally ill siblings) showed cognitive deficits when tested through the Cambridge Neuropsychological Test Automated Battery (CANTAB). The same test results showed differences displaying strong cognitive deficits in affective processing when compared to healthy controls (Bauer et al., 2015). Prospectus Template v.8.0 20 This study will add to the body of knowledge due to the significance of prevention and adjustment in aiding for healthy children and their healthy cognitive development as per the theories of cognitive development, cognitive behavior and social interaction. This study will be supported by these theories which elucidate that stages of cognitive development, behavior development and social interaction are crucially important for one’s psychological health and well-being (Osuchowska-Koscijanska et al., 2014). By describing such phenomenon, this study will educate families and professionals (psychologists, psychiatrists, therapists, social workers and other professionals) on how to prevent healthy siblings from undergoing negative psychological predicaments that can influence healthy children and adolescent’s cognitive development. The future psychological well-being of all children in our society must be preserved and protected which depends on their cognitive development, cognitive behavior and social interaction. Criteria Learner SelfChair Score Reviewer Score Evaluation Score (0-3) (0-3) (0-3) ADVANCING SCIENTIFIC KNOWLEDGE AND SIGNIFICANCE OF THE STUDY This section reiterates the gap or need in the literature and states how the study will address the gap or need and how the research will contribute to the literature, practical implications to the community of interest, and alignment with the program of study. The recommended length for this section is one to two paragraphs, providing a brief synopsis of each criteria listed below which will be expanded in the proposal. 1. Clearly identifies the 2.5 “gap” or “need” in the literature that was used to define the problem statement and develop the research questions. (citations required) Describes how the study will address the “gap” or “identified need” defined in the literature and contribute to /advance the body of literature. (citations Prospectus Template v.8.0 2.5 21 Criteria Learner SelfEvaluation Score (0-3) Chair Score (0-3) Reviewer Score (0-3) required) Describes the potential practical applications from the research. (citations required) 2.5 Identifies and connects the theory (ies) or model(s) that provide the theoretical foundations or conceptual frameworks for the study. (citations required) 2 Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. 2.5 NOTE: This section builds on information about the Literature review and Theoretical Foundations sections in the 10 Strategic Points. This section becomes the foundation for the Theoretical Foundations section in Chapter 2 Reviewer Comments: Rationale for Methodology This proposed study describes how mentally ill individuals may negatively influence their healthy siblings’ cognitive development. Thus, a qualitative research is the proper methodology because it seeks to gather an in-depth understanding of the reasons governing human behavior and cognitive development, producing information on particular cases studied and ultimately describing individuals’ experiences and the consequence of such experiences, given the nature of such relationships (Healthy Siblings Prospectus Template v.8.0 22 and Mentally Ill Siblings) during phases of cognitive development (siblings’ relations experience) (Alasuutari, 2010). A qualitative research will be suitable for this study because it will describe the phenomenon on the attempt to understand it, in order to report the totality of the situation. Qualitative research also focuses on human social behaviors and the psychological human responses to different circumstances in day to day life. A case study (secondary data analysis) will be used for this qualitative research. Secondary data analysis is the only method in qualitative studies that can be used in this study due to the type of data to be collected and analyzed (protected and vulnerable population) and limitations in acquire such type of clinical data (Johnston, 2014). In Secondary data analysis, an investigation of the information, known in this subject area by other researchers, is methodically done and an investigation of what remains to be learned will also be done through existing findings on this topic. Each case study will demonstrate the phenomenon with different experiences from the relationships of healthy siblings and mentally ill siblings and their interactions aligned with the research questions formulated for this study. A qualitative study will use the experiences in the relationships of siblings and help researchers analyze the struggles in the relationships through questionnaires to address the predicaments in such relationships and demonstrate the phenomenon (the influence of such relationships on healthy siblings’ cognitive development) (Alasuutari, 2010). In DePape and Lindsay (2014), the authors elucidated that it is crucially important for parents to understand how to care for a child with cognitive, genetic and developmental disorders that require special care. This study conducted by Lovell and Wetherell (2015) will be the qualitative study chosen from my literature review to be used as secondary data analysis for my proposed study. This study Prospectus Template v.8.0 23 scrutinizes the relationship of families of children with cognitive disorders and developmental disabilities such as ASD and their relationship experiences, explaining through testimonials of siblings concerning their interactions with their siblings suffering with a mental disorder (ASD) and a detail account of parents and siblings’ experiences (well siblings as they interact with their mentally ill siblings). Learner SelfChair or Score Reviewer Score Evaluation Score (0-3) (0-3) (0-3) RATIONALE FOR METHODOLOGY The Rationale for Methodology section clearly justifies the methodology the researcher plans to use for conducting the study. It argues how the methodological choice (quantitative or qualitative) is the best approach to answer the research questions and address the problem statement. Finally, it contains citations from textbooks and articles on research methodology and/or articles on related studies to provide evidence to support the argument for the selected methodology. Criteria The recommended length for this section isone paragraph. 1. Identifies the specific research methodology for the study. Justifies the methodology to be used for the study by discussing why it is an appropriate approach for answering the research question(s) and addressing the problem statement. Quantitative Studies: Justify in terms of problem statement and the variables for which data will be collected. Qualitative Studies: Justify in terms of problem statement and phenomenon. Prospectus Template v.8.0 2 2 2 2 24 Learner SelfEvaluation Score (0-3) Criteria Chair or Score (0-3) Uses citations from seminal (authoritative) sources (textbooks and/or empirical research literature) to justify the selected methodology. Note: Introductory or survey research textbooks (such as Creswell) are not considered seminal sources. 2 2 Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. 3 2 Reviewer Score (0-3) NOTE: This section elaborates on the Methodology and Design in the 10 Strategic Points. This section becomes the foundation for the Research Methodology in Chapter 1 of the Proposal and the basis for developing Chapter 3, Research Methodology. Reviewer Comments: Nature of the Research Design for the Study This study will use qualitative research methodology (case study) acquired from secondary data analysis used to obtain understanding of human behavior and cognition based on the theory of cognitive development (Woodgate et al., 2016). A case study is a process in which detailed consideration is given to the development of each participant and the outcome of their experiences based on their perceptions and opinions about their relationships (Lovell and Wetherell, 2015). Furthermore, in this qualitative research, an in depth examination of samples (through interviews, questionnaires [open-ended Prospectus Template v.8.0 25 questions] and psychological testing) will facilitate a better understanding of the phenomenon (siblings suffering with mental illness influencing healthy siblings’ cognitive development) (Russel et al, 2017). A quantitative study would measure the relationship between variables and find correlations, however, it would not capture the relationship experience. The relationship experiences between siblings (mentally ill and healthy siblings) can only be acquired meticulously through the result of the experiences between siblings to describe the phenomena through a qualitative research method (Lovell and Wetherell, 2015). A group of smaller but focused samples (25 siblings with Autism Spectrum Disorder and their mothers; and a control group of 20 siblings of neurotypical children and their mothers) will help researchers observe behavior through personal interviews (questionnaires) seeking a better understanding of the relationships among mentally-ill siblings and healthy siblings). Criterion Score Learner SelfChair or Score Reviewer Score Evaluation Score (0-3) (0-3) (0-3) NATURE OF THE RESEARCH DESIGN FOR THE STUDY This section describes the specific research design to answer the research questions and why this approach was selected. Here, the learner discusses why the selected design is the best design to address the problem statement and research questions as compared to other designs. This section contains a description of the research sample being studied, as well as, the process that will be used to collect the data on the sample. The recommended length for this section is two tothree paragraphs and must address each criterion. 1. Identifies and describes 2 2 the selected design for the study. Justifies why the selected design addresses the problem statement and research questions. Quantitative Studies: Justifies the selected design based on the appropriateness of the design to address the Prospectus Template v.8.0 2 2 26 Criterion Score Learner SelfEvaluation Score (0-3) Chair or Score (0-3) Reviewer Score (0-3) research questions and data for each variable. Qualitative Studies: Justifies the selected design based on appropriateness of design to address research questions and study the phenomenon. Briefly describes the target population and sample for the study. 2 2 Identifies the sources and instruments that will be used to collect data needed to answer the research questions. 2 2 Briefly describes data collection procedures to collect data on the sample. 2 1.5 Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. 2 1.5 NOTE: This section also elaborates on the Design portion of the Methodology and Design section in the 10 Strategic Points. This section provides the foundation for Nature of the Research Design for the Study in Chapter 1. Reviewer Comments: Research Materials, Instrumentation, and Sources of Data Data for this study will be extracted from existing and published empirical research which include the examination of samples (mentally ill siblings, healthy siblings and healthy control) through interviews, questionnaires (open-ended questions) and Prospectus Template v.8.0 27 psychological testing that will facilitate a better understanding of the phenomenon (siblings suffering with mental illness influencing healthy siblings’ cognitive development) (Lovell & Wetherell, 2015). A group of smaller but focused samples will help researchers observe behavior through personal interviews seeking a better understanding of the relationships among mentally-ill siblings and healthy siblings (Alasuutari, 2010). Criterion Score Learner SelfChair or Score Reviewer Score Evaluation Score (0-3) (0-3) (0-3) RESEARCH MATERIALS, INSTRUMENTATION, OR SOURCES OF DATA This section identifies and describes the types of data that will be collected, as well as the specific research materials, instruments, and sources used to collect those data (tests, surveys, validated instruments, questionnaires, interview protocols, databases, media, etc.). The recommended length for this section is one to two paragraphs. Note: this section can be set up as a bulleted list. QuantitativeInstruments/Research Materials: Provides a bulleted list of the instrumentation and/or materials for data collection. Describes the survey instruments or equipment/materials used (experimental research), and specifies the type and level of data collected with each instrument. Includes citations from original publications by instrument developers (and subsequent users as appropriate) or related studies. Qualitative - Sources of Data: 2 2 Describes the structure of each data collection instrument and data sources (tests, questionnaires, interview protocols, observations databases, media, etc.). Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence Prospectus Template v.8.0 2 2 28 Criterion Score Learner SelfEvaluation Score (0-3) Chair or Score (0-3) Reviewer Score (0-3) structure, uses correct punctuation, and uses correct APA format. NOTE: This section elaborates on the Data Collection from the 10 Strategic Points. This information is summarized high level in Chapter 1 in the Proposal in the Nature of the Research Design for the Study section. This section provides the foundation for Research Materials, Instrumentation (quantitative) or Sources of Data (qualitative)section in Chapter 3. Reviewer Comments: Data Collection This proposed qualitative study will analyze existing data (Secondary Data Analysis) from one related studies that investigated the experiences of healthy siblings who has at least one mentally ill brother or sister and the negative influence their relationships on healthy siblings’ cognitive development. The population in the study chosen will be healthy siblings of mentally ill individuals, the target population will be mentally ill siblings, healthy siblings and healthy control. The set of data to be analyzed will be extracted from a study conducted by Lovell and Wetherell (2015) as it engaged in questionnaires assessing demographic and lifestyle information, family characteristics, child behavior problems, social support and depressive symptomology to extract qualitative evidence of the negative influence in such relationships. The authors for this study have been contacted (for their permission) and asked for a full set of data to be analyzed in this study. This data will be used in this study to support the argument that the relationship experience between healthy siblings and siblings with mental illness influences healthy siblings’ cognitive development when intervention is lacking. Prospectus Template v.8.0 29 Table 2 Qualitative Studies Research Questions: State the Research Questions that will be used to collect data to understand the Phenomenon being studied 1. 1. How the relationships between Phenomenon: Describe the overall phenomenon being studied by the research questions Healthy siblings’ cognitive development is influenced by the relationship with their mentally ill siblings. mentally ill and healthy siblings Sources of Data: Identify the specific approach (e.g., interview, observation, artifacts, documents, database, etc.) to be used to collect the data to answer each Research Question Data will be collected through secondary data analysis through interviews, questionnaires (openended-questions) and psychological testing done in archived data. Analysis Plan: Describe the specific approach that will be used to (1) summarize the data and (2) analyze the data. Data will be analyzed through interviews, questionnaires and psychological testing. influence healthy siblings’ cognitive development? Criteria Learner SelfEvaluation Score (0-3) Chair or Score (0-3) Reviewer Score (0-3) DATA COLLECTION AND MANAGEMENT This section details the data collection process and procedures so that another researcher could conduct or replicate the study. It includes authorizations and detailed steps. The recommended length for this section is a bullet or numbered list of data collection steps that should not exceed one page. Quantitative Studies: Lists steps for the actual data collection that would allow replication of the study by another researcher, including Prospectus Template v.8.0 30 Criteria Learner SelfEvaluation Score (0-3) how each instrument or data source was used, how and where data were collected, and recorded. Includes a linear sequence of actions or stepby-step of procedures used to carry out all the major steps for data collection. Includes a workflow and corresponding timeline, presenting a logical, sequential, and transparent protocol for data collection that would allow another researcher to replicate the study. Data from different sources may have to be collected in parallel (e.g., paper-and-pen surveys for teachers, corresponding students, and their parents AND retrieval of archival data from the school district). A flow chart is ok— "linear" may not apply to all situations Qualitative Studies: Provides detailed description of data collection process, including all sources of data and methods used, such as interviews, member checking, observations, surveys, field tests, and expert panel review. Note: The collected data must be sufficient in breadth and depth to answer the research question(s) and interpreted and presented correctly, by theme, research question, and/or source of data. Describes the procedures for obtaining participant informed consent and for protecting the rights and well-being of the study sample participants. 2 Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, 2 Prospectus Template v.8.0 Chair or Score (0-3) Reviewer Score (0-3) 31 Criteria Learner SelfEvaluation Score (0-3) Chair or Score (0-3) Reviewer Score (0-3) uses correct punctuation, and uses correct APA format. NOTE:This section elaborates on the Sample and Location and Data Collection in the 10 Strategic Points. This section provides the foundation for the Data Collection Procedures section in Chapter 3 in the Proposal. And it is summarized high level in Chapter 1 in Nature of the Research Design for the Study in the Proposal. Reviewer Comments: Data Analysis Procedures The data analysis will be done through secondary data analysis or archived data to support the problem statement and answer the research questions. All siblings or participants in the study from which data will be extracted from will take part in instruments such as interviews, questionnaires (open-ended-questions) and saliva testing to measure levels of cortisol (stress levels). However, since more information is needed for the analysis, data will also be prepared and organized in its original form used for in the study conducted as an analysis of the predicaments in the relationship of mentally ill siblings and healthy siblings. Data will be analyzed through instruments such as interviews, questionnaires and psychological testing to measure cognition. This study will provide basic features of the data and simple summaries about the sample. Major steps for data analysis: 1- Data will be analyzed and compared among siblings, providing specific challenges and difficulties faced by the relationship of parents, heathy siblings and ill siblings. 2- An analysis of major negative aspects of the relationships between healthy siblings and mentally ill siblings will be conducted. Prospectus Template v.8.0 32 3- Thematic Analysis of data will be performed in this study. 4- Patterns of data sets (thematic data coding) will help describe the phenomenon. 5- A detailed account of the relationship between healthy siblings, ill siblings and parents will shed light on the negative aspects of the influence on well siblings cognitive development. Criteria Learner SelfEvaluation Score (0-3) Chair or Score (0-3) Reviewer Score (0-3) DATA ANALYSIS PROCEDURES This section provides detailed steps for the analytic procedures to be used to conduct data analysis. The recommended length for this section is one to two paragraphs, can also be presented in bulleted format. Describes in detail the relevant data collected for each stated research question and/or each variable within each hypothesis (if applicable). Quantitative Studies: "In detail" means scales (and subscales) of specified instruments AND type of data for each variable of interest. IMPORTANT: For (quasi) experimental studies, provide detailed description of all treatment materials per treatment condition, as part of the description of the independent variable corresponding to the experimental manipulation. What: Describes, in detail, statistical and non-statistical analysis to be used and procedures used to conduct the data analysis. Quantitative Studies: (1) describe data file preparation (descriptive statistics used to check completeness and accuracy; for files from different sources, possibly aggregating data to obtain a Prospectus Template v.8.0 2 2 33 Criteria Learner SelfEvaluation Score (0-3) common unit of analysis in all files, necessarily merging files (using the key variable defining the unit of analysis); (2) computation of statistics for the sample profile; (3) computation of (subscales and) scales; (4) reliability analysis for all scales and subscales; (5) computation of descriptive statistics for all variables of interest in the study (except those already presented in the sample profile); (6) state and justify all statistical procedures ("tests") needed to generate the information to answer all research questions; and (7) state assumptions checks for all those statistical procedures (including the tests and / or charts to be computed). Qualitative Studies: This section begins by identifying and discussing the specific analysis approach or strategy, followed by a discussion of coding procedures to be used. Note: coding procedures may be different for Thematic Analysis, Narrative Analysis, Phenomenological Analysis, or Grounded Theory Analysis. Why: Provides the justification for each of the (statistical and non-statistical) data analysis procedures used in the study. 2 Show Steps that Support Evidence 2 Quantitative Analysis states the level of statistical significance for each test as appropriate, and describes tests of assumptions for each statistical test. Qualitative Analysis - Prospectus Template v.8.0 Chair or Score (0-3) Reviewer Score (0-3) 34 Criteria Learner SelfEvaluation Score (0-3) Chair or Score (0-3) Reviewer Score (0-3) evidence of qualitative analysis approach, such as coding and theming process, must be completely described and included the analysis /interpretation process. Clear evidence from how codes moved to themes must be presented. Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. 2 NOTE: This section elaborates on the Data Analysis from the 10 Strategic Points. This section provides the foundation for Data Analysis Procedures section in Chapter 3 in the Proposal. Reviewer Comments: Ethical Considerations There are minimum risks and ethical issues involved in this study since data will be extracted from existing studies (Secondary Data Analysis) that have already been approved by the Institutional Review Board (IRB), site authorization has already been obtained and the studies had already been published. Information about human subjects and data has become public data since the researches chosen had already become part of the public domain. There is no need for subject recruiting and informed consent. In using Secondary Data Analysis, this learner will be cautious on using data extracted from empirical research that proved reliability and validity. Prospectus Template v.8.0 35 Criteria Learner SelfChair or Reviewer Evaluation Score Score Score (0-3) (0-3) (0-3) Ethical Considerations This section discusses the potential ethical issues surrounding the research, as well as how human subjects and data will be protected. It identifies how any potential ethical issues will be addressed. The recommended length for this section is one paragraph. 1. 2. 3. 4. Describes site authorization process, subject recruiting, and informed consent processes. Describes how the identities of the participants in the study and data will be protected. Discusses potential ethical concerns that might occur during the data collection process. ALIGNMENT: Ethical considerations are clearly aligned with, and relate directly to the specific Data Collection Procedures. This section also identifies ethical considerations related to the target population being researched and organization or location as described in the Purpose Statement section. 2 2 2 2 Section is written in a way that is well structured, has a 2 logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. NOTE: This section does not include information from any of the 10 Strategic Points. This section provides the foundation for Ethical Considerations section in Chapter 3 in the Proposal. Reviewer Comments: Prospectus Template v.8.0 36 References Abrams, Madeleine Seifter (2009). The well sibling: Challenges and possibilities. American Journal of Psychotherapy. Vol. 63. Issue 4, p305-317. 13p. Alasuutari, Pertti (2010). The rise and relevance of qualitative research. Department of Social Research. University of Tampere. International Journal of Social Research Methodology. Vol. 13. No. 2. Bauer, Isabelle E.; Wu, Mon-Ju; Frazier, T.W.; Mwangi, Benson; Spiker, Danielle; Zunta-Soares, Giovanna B.; Soares, Jair C. (2015). Neurocognitive functioning in individuals with bipolar disorder and their healthy siblings: A preliminary study. Journal of Affective Disorders 201- (2016). pp: 51-56. Conger, Katherine Jewsbury; Kramer, Laurie (2010). Introduction to the special section: Perspectives on sibling relationships: Advancing child development research. Child Development Perspectives. Society for Research on Child Development. Vol. 4. Number 2. Pp:69-71. de Achaval, Delfina; Villarreal, Mirta F.; Salles, Arleen; Bertomeu, M. Julia; Costanzo, Elsa; Goldschmidt, Micaela; Castro, Mariana N.; van der Poel, Iris; Nemeroff, Charles B.; Guinjoan, Salvador M. (2013). Activation of brain areas concerned with social cognition during moral decisions is abnormal in schizophrenia patients and unaffected siblings. Journal of Psychiatric Research. Vol. 47(6).pp. 774-782. ISSN: 0022-3956. DePape, Anne-Marie; Lindsay, Sally (2014). Parents’ experiences of caring for a child with Autism Spectrum Disorder. Qualitative Health Research. Sage I-15 doi: 10.1177/10497323. Prospectus Template v.8.0 37 Grand Canyon University (Ed.). (2017). GCU doctoral research: Writing the research prospectus. Retrieved from: http://lc.gcumedia.com/res880/gcu-doctoral-researchwriting-the-research-prospectus/v1.1/ Hesse, Tessa L.; Danko, Christina M.; Budd, Karen S. (2013). Siblings of children with autism: Predictors of adjustment. Research in Autism Spectrum Disorder. 7:13231331. http://dx.doi.org/10.1016/j.rasd.2013.07.024 Johnston, Melissa P. (2017). Secondary Data Analysis: Method of which the Time Has Come. Qualitative and Quantitative Methods in Libraries. Vol. 3. No. 3 (2014):Sept. Issue. http://www.qqmljournal.net/index.php/qqml/article/view/169/170 Lovell, Brian; Wetherell, Mark A. (2015). The psychophysiological impact of childhood autism spectrum disorder on siblings. Research on Developmental Disability.Northumbria University. Department of Psychology. Elsevier. 49-50. Osuchowska-Koscijanska, Anna; Charzynska, Katarzyna; Chadzynska, Malgorzata; Drozdzynnska, Anna; Kasperek-Zimowska, Beata; Bednarek, Agata; Sawicka, Maryla (2014). Sense of coherence and ways of coping in the relationship with brother or sister in healthy siblings of mentally ill persons. PsychiatriaPolska. Vol. 48. Issue 2. pp: 371-382. Pitman, Erica (2004). The SMILES program: A group program for children with mentally ill parents or siblings. American Journal of Orthopsychiatry. Vol. 74(3). Pp.383-388. ISSN: 0002-9432. Prospectus Template v.8.0 38 Russell, B.H., Wutich, A.Y., & Ryan, G.W. (2017). Analyzing qualitative data: Systematic approaches (second edition). Thousand Oaks, CA: Sage Publications. Sanders, Avihay; Szymanski, Kate; Fiori, Kate (2014). The family roles of siblings of people diagnosed with a mental disorder: Heroes and lost children. International Journal of Psychology. Vol. 49. No. 4. pp: 257-262. Doi: 10.1002/ijop.12020. Seeman, Mary V. (2013). Spotlight on sibling involvement in schizophrenia treatment. Taylor & Francis. Vol. 76(4). pp. 311-322. PMID: 24299090. ISSN: 1943281X. Stalberg, Gabriela; Ekerwald, Hedvig; Hultman, Christina M. (2004). At issue: Siblings of patients with schizophrenia: Sibling bond, coping patterns, and fear of possible schizophreniaheredity. National Institute of Mental Health. Schizophrenia Bulletin. Vol. 30(2). pp. 445-458. Thompson, A. B.; Curtner, M. E.; O’Rear, M. R. (1994). The psychosocial adjustment of well siblings of chronically ill children. Children’s Health Care. 23(3): 211-226. (16p). ISSN: 0273-9615. Vejar, Cynthia (2010). Birth order & educational achievement. Research Starters: Education. Online Edition. Waldman, Barry; Perlman, Steven P.; Garey, Misha (2015). Siblings of children with disabilities. American Academy of Developmental Medicine & Dentistry. EP Magazine. Issue 4/15. Williams, P. D.; Williams, A. R.; Hanson, S.; Graff, C.; Ridder, L.; Curry, H.; Liebergen, Prospectus Template v.8.0 39 A.; Karlin-Setter, R. (1999). Maternal mood, family functioning, and perceptions of social support, self-esteem, and mood among siblings of chronically ill children. Children’s Health Care. 28(4): 297-310. 14p. ISSN: 0273-9615. Woodgate, R. L.; Edwards, M.; Ripat, J. D.; Rempel, G.; Johnson, S. F. (2016). Siblings of children with complex care needs: Their perspectives and experiences of participating in everyday life. Child: Care, Health and Development. United Kingdom: Wiley-Blackwell Publishing. Vol. 42(4). pp. 504-512. Van der Merwe, Christine; Bornman, Juan; Donohue, Dana; Harty, Michal (2017). The attitudes of typically developing adolescents towards their sibling with autism spectrum disorder. South African Journal of Communication Disorders. 64(1): pp:1-7. Prospectus Template v.8.0 40 Table to Use to Complete your 10 Strategic Points Ten Strategic Points Broa d Topic Area Lit The influence of mentally ill siblings on healthy siblings’ cognitive development. a. Background of the problem/gap Review i. Prior studies examine the impact of mental illness in the lives of children suffering with mental disorder (localized phenomenon), identified need for family education (roles and dynamics) but they do not examine the influence of mental illness on healthy siblings’ cognitive development. Family counseling as a method of intervention and strategy is recommended in most related studies in the literature of this research as it can eliminate stressors (anxiety, fear, guilt, anger, social stigma). ii. Dr. Mary V. Seeman (2013), a Professor Emerita in the Department of Psychiatry of the University of Toronto, concluded that well siblings constitute a crucially important role in the treatment of children suffering with Prospectus Template v.8.0 Comme nts or Feedback 41 schizophrenia. iii. Dr. Avihay Sanders, Dr. Kate Szymanski and Dr. Kate Fiori (2014), concluded that the psychosocial dynamics and adaptation among the entire family in cases of siblings suffering with mental disorder is crucially important for the psychological wellbeing of the family as a whole. b. Theoretical Foundations 1- Cognitive Development Theory (4 factors that influence cognitive development) from Jean Piaget. The significance of the problem studied relates to this theory with respect to the influence of mental illness in the lives and experiences of healthy siblings. 2- The theory of Social Interaction in the development of cognition from Lev Vygotsky. This study supports the argument questioning the need for social interaction in cognitive development and the problem of healthy siblings’ isolation from society studied by Woodgate et al. (2016) According to Abrams (2009), well siblings Prospectus Template v.8.0 42 face a great deal of distress dealing with their mentally ill siblings which include negative feelings such as anxiety, fear, shame guilt and a host of other negative and destructive patterns of thought that can be detrimental for children in several stages of development. Abrams’ study provides insight on the nature of the negative impact the relationship of ill sibling can cause on the healthy sibling and proposes solutions to foster a better adjustment and prevention for the well sibling. c. Review of Literature i. Historical Events: Historically, the impact on well siblings of children suffering with mental illness has been documented by psychiatrists and psychotherapists for only a few decades, however, an in depth evaluation of healthy siblings cognitive development in these relationships has not been conducted (Seeman, 2013). ii. Family Life: Contributing to the impact is society’s perception of mental disabilities, which has Prospectus Template v.8.0 43 been marginalizing, stigmatizing and cruel, these families of individuals suffering with mental illness tend to shy away and become isolated (Sanders et al. 2014). iii. Cognitive Development As the mental process or action of acquiring understanding and knowledge through senses, experience and thought, cognitive development in children has a profound effect on well-being, success and survival; especially on early ages of development (Sanders, 2014). Children of mentally Ill siblings can be cognitively affected by the experience if there is a lack of intervention and psychological counseling (Seeman, 2013). According to Bauer et al. (2015), healthy siblings and mentally ill sibling (bipolar disorder cases) showed cognitive deficit as psychological testing were administered when compared to healthy controls. In a study conducted by Woodgate et al. (2016), healthy siblings prioritize the relationship with their ill siblings and neglect Prospectus Template v.8.0 44 their own social and individual needs. Healthy siblings of individuals with schizophrenia may copy dysfunctional roles in emotion regulation and moral behavior from their mentally ill siblings (de Achaval et al., 2013). iv. Qualitative Case Study Design: Prior studies on Mentally ill siblings have been focused on the needs of the individual (localized phenomenon) rather than the needs of the well sibling which involves therapeutic and family dynamics approach. However, a comprehensive and thorough case study will be the most suitable approach to intervene and educate families of the causal relationship within denoting phenomena. In a study conducted by Waldman et al. (2015), healthy siblings have trouble coping with relationships, having conflicting feelings such as anger, shame, fear, resentfulness, pressure, sadness, over-worry and depression. d. Summary: i. The impact on well siblings of children suffering with mental illness. Prospectus Template v.8.0 45 ii. Due to stigmatism and rejection, families of children suffering with mental illness tend to isolate themselves and negatively impact the psychological development of healthy siblings. iii. Gap in relation to additional research exists in order to further investigate existing findings. iv. Case study design is the most suitable for a thorough comprehension of causal relationship within phenomena. Resea a. How does the relationship between mentally ill and rch Questions healthy siblings influence healthy siblings’ cognitive development? b. Does the relationship between siblings lead to healthy siblings’ cognitive deficits? (Bauer et al., 2015) c. Does the relationship of healthy and mentally ill siblings increase risk factor for healthy siblings to assume dysfunctional roles? (Sanders et al, 2014) d. Does the relationship between healthy siblings and mentally ill siblings lead to healthy siblings’ trouble coping with other relationships? (Waldman et al., 2016) Prospectus Template v.8.0 46 e. Does the relationship between healthy siblings and mentally ill siblings lead to healthy siblings’ socialization? (Woodgate et al, 2016) Samp a. Location: The State of Arizona of the United States of le America. b. Target Population Children, adults and emerging adults of families with at least one mentally ill sibling and other healthy siblings. c. Sample: Healthy siblings, their mentally ill siblings and healthy controls. Descr ibe Understanding the nature and influence of mentally ill siblings and their relationship with healthy siblings is critical Phenomena for the preservation of psychological development. (qualitative) or Define Intervention and counseling can provide education with Variables/Hy respect to such relationship and couching in order to spare potheses healthy children from undergoing through psychological (quantitative) problems due to a lack of proper intervention and counseling. Meth odology & The methodology for this study is qualitative. The design is multiple case studies extracted from existing Design research (secondary data analysis). Purp ose Statement Prior studies examined the predicaments of such relationship but do not investigate the influence of mentally siblings on healthy siblings’ cognitive development. The Prospectus Template v.8.0 47 purpose of this case-study is to understand the influence of the relationship of mentally ill siblings in the lives of well siblings (the influence on well siblings’ cognitive development). The author in this study suggests proper intervention and therapeutic efforts that can improve psychosocial dynamics and adaptation for siblings of mentally ill children: The importance of education and therapy on the attempt to alleviate stressors and negative feelings such as fear, guilt, shame which is detrimental in childhood and adolescence. Data a. Data will be collected through secondary data analysis Collection or the analysis of previous studies. Approach b. Data information regarding treatment, strategies and successes for families of mentally ill children and healthy siblings. c. Data extracted from existing studies includes healthy siblings of mentally ill individuals (children and adults), mentally ill siblings and healthy control. d. Instruments used in these secondary data extracted: - 1-interviews 2-open-ended questions 3-psychological and neuropsychological testing Prospectus Template v.8.0 48 a- Interview Questionnaire: open-ended questions b- Role Behavior Inventory (RBI) combined with open-ended questions (Sanders et al., 2014). c- ECOMAPS- Flow diagram for mapping family systems’ processes Data a. Data will be prepared and organized for analysis from Analysis chosen studies of the predicaments in the relationship Approach of mentally ill siblings and healthy siblings. b. The study will provide basic features of the data in the study. c. The study will provide simple summaries about the sample. d. A narrative of the case study will be performed within the research questions. e. The data analysis will be done through secondary data analysis to support the problem statement and answer the research question. Prospectus Template v.8.0
Research in Developmental Disabilities 49–50 (2016) 226–234 Contents lists available at ScienceDirect Research in Developmental Disabilities The psychophysiological impact of childhood autism spectrum disorder on siblings Brian Lovell *, Mark A. Wetherell Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK A R T I C L E I N F O A B S T R A C T Article history: Received 18 March 2015 Received in revised form 21 October 2015 Accepted 24 November 2015 Available online 23 December 2015 Objective: The negative impact of caring for a child with autism spectrum disorder (ASD) on parents’ psychophysiological functioning has been widely evidenced. However, siblings, who also face emotional, social and physical challenges associated with having a brother/sister with ASD, have been less widely studied. This study examined the psychophysiological impact of childhood ASD on siblings. Methods: A sample of 25 siblings of children with ASD (and their mothers) and a control group of 20 siblings of neuro-typical children (and their mothers) completed questionnaires assessing: (a) demographic and lifestyle information, (b) family characteristics, (c) child behaviour problems, (d) social support and (e) depressive symptomology. Saliva samples were collected at several time points on two consecutive days, and estimates of the cortisol awakening response (CAR), diurnal cortisol slope and mean diurnal cortisol output were derived. Results: Total depressive symptoms were higher in siblings of children with ASD compared with controls. Group differences with respect to depressive symptomology were driven more by emotional than functional problems. With respect to physiological functioning, groups were comparable on all cortisol indices. In siblings of children with ASD, social support, especially from parents and close friends, predicted total depressive symptoms, as did the behaviour problems of their brother/sister with ASD. Conclusion: Siblings of children with ASD experience greater emotional problems and overall depressive symptoms compared with a control group. Interventions that enhance social support, as well as helping siblings better understand the behaviour problems of their brother/sister with ASD, might be effective for alleviating depressive symptoms. ß 2015 Elsevier Ltd. All rights reserved. Keywords: Cortisol Behaviour problems Depression Siblings Social support 1. Introduction Caring for a child with a developmental disability (DD) such as ASD has been widely used as one model for examining the effect of chronic stress on psychophysiological functioning (Lovell & Wetherell, 2011). Indeed, the challenges of caring for a child with a DD, which include financial hardship (Kogan et al., 2008), social isolation (Yantzi, Rosenberg, & McKeever, 2006), negotiating a fragmented service system (Griffith & Hastings, 2013), stigma and social judgement (Cantwell, Muldoon, & Gallagher, 2015), far outstrip those of parenting a neuro-typical child. That caregivers of children with a DD experience increased psychological distress has been widely evidenced, with studies reporting on higher levels of psychological * Corresponding author. Tel.: +44 0 191 227 3983. E-mail address: brian.lovell@northumbria.ac.uk (B. Lovell). http://dx.doi.org/10.1016/j.ridd.2015.11.023 0891-4222/ß 2015 Elsevier Ltd. All rights reserved. B. Lovell, M.A. Wetherell / Research in Developmental Disabilities 49–50 (2016) 226–234 227 symptoms such as perceived stress (Cantwell, Muldoon, & Gallagher, 2014), hopelessness (Bandeira et al., 2007), anxiety (Ruiz-Robledillo and Moya-Albiol, 2013) and depression (Cantwell et al., 2015; Smith & Grzywacz, 2014). In addition, compared with parents of neuro-typical children, caregivers’ levels of anxiety and depression were found to be more likely to satisfy criterion for clinical mood disorder (Gallagher, Phillips, Oliver, & Carroll, 2008). That caregiving stress is associated with poorer psychological functioning was also demonstrated in two recent meta analyses (Easter, Sharpe, & Hunt, 2015; Hayes & Watson, 2013) and review studies (Cousino & Hazen; Fairthorne, de Klerk, & Leonard, 2015). The stress of caring for a child with a DD has also been linked with alterations in a variety of health relevant, physiological parameters. For example, perturbations in cardiovascular (Gallagher & Whiteley, 2012), neuroendocrine (Bella, Garcia, & Spadari-Bratfisch, 2011; Ruiz-Robledillo and Moya-Albiol, 2013; Seltzer et al., 2009) and immune (Gallagher & Hannigan, 2014; Lovell, Moss, & Wetherell, 2012) functioning have been widely implicated as plausible physiological pathways linking chronic caregiving stress with downstream disease. Fewer studies have examined the psychophysiological impact of childhood disability on other family members living at home. This is surprising given that siblings, much like their parents, face a number of challenges associated with having a brother/sister with a DD. For example, to alleviate some of the burden on their parents, siblings often take on additional household chores and responsibilities (Dyke, Mulroy, & Leonard, 2009), thus limiting opportunities for social and peer interaction, and extracurricular activities (Barak-Levy, Goldstein, & Weinstock, 2010; Moyson & Roeyers, 2012). In addition, parents, who are overburdened by their caregiving role, have been found to be less physically and emotionally available for their other children (Macks & Reeve, 2007). Indeed, in two recent qualitative studies, sibling adjustment was, along with lack of support and stigma, one of the biggest concerns raised by caregivers of children with a DD (Ludlow, Skelly, & Rohleder, 2012; Oruche, Gerkensmeyer, Stephan, Wheeler, & Hanna, 2012). Perhaps most challenging, many siblings actively contribute to the caretaking role, participating in activities such as feeding, dressing and bathing their disabled brother/sister (Randall & Parker, 1999). Relative to normative controls, siblings of children with a DD such as ASD have been found to report higher levels of separation anxiety (Lobato et al., 2011), emotional problems (Petalas, Hastings, Nash, Lloyd, & Dowey, 2009) and internalising behaviours (Fisman, Wolf, Ellison, & Freeman, 2000). Findings from a review paper (Barlow & Ellard, 2006) and recent meta analysis (Vermaes, van Susante, & van Bakel, 2012) also suggested that siblings of children with a DD might be at greater risk for psychological adjustment difficulties, with internalising behaviours and depressive symptoms found to be higher when compared with a control group. However, not all findings have been consistent, such that several studies observed no effect (Benson & Karlof, 2008; Tomeny, Barry, & Bader, 2012), or an adaptive effect (Macks & Reeve, 2007), of childhood disability on siblings’ psychological functioning. These inconsistent findings highlight the need for additional research in this area. Siblings’ psychological adjustment to childhood disability has been shown to be moderated by a range of variables. For example, family characteristics such as socioeconomic status (Macks & Reeve, 2007; Petalas et al., 2009), family size (Kaminsky & Dewey, 2002; Labay & Walco, 2004) and parental stress (Giallo & Gavidia-Payne, 2006) have been shown to predict emotional and internalising problems in siblings of children with a DD. In addition, research has shown that siblings’ psychological well being is, at least in part, affected by characteristics of their disabled brother/sister, especially their behavioural problems. For example, in two recent studies, child behaviour problems (CBP), and in particular, hyperactivity and conduct behaviours positively predicted depression symptoms in their siblings (Meyer, Ingersoll, & Hambrick, 2011; Neece, Blacher, & Baker, 2010). These findings resonate with studies involving parental caregivers of children with a DD, where CBP were found to account for much of the variance in caregivers’ feelings of depression (Gallagher et al., 2008; Lovell, Moss, & Wetherell, 2015). Most recently, in a study involving siblings of children with ASD, Shivers, Deisenroth, and Taylor (2012) found that CBP, along with maternal stress, uniquely predicted siblings’ feelings of anxiety. Perceived availability of social support has also been shown to be influential for the psychological adjustment of siblings of children with a DD. for example, socially supported siblings, much like their parents, have been found to report lower levels of negative affective symptoms such as depression (Barrera, Fleming, & Khan, 2004), loneliness (Kaminsky & Dewey, 2002) and anxiety (Nolbris et al., 2010). The impact of childhood disability on siblings’ physiological functioning has, we believe, yet to be determined. Cortisol, the final effector hormone of the hypothalamic–pituitary–adrenal (HPA) axis, displays a robust basal diurnal pattern; levels are high in the morning upon waking, reach an acrophase 30–45 min post waking (i.e., the cortisol awakening response: CAR), gradually decline across the day (i.e., diurnal cortisol slope) and reach a nadir around midnight (Saxbe, 2008). However, if overused by chronic (i.e., repeated) stress, the normal operating levels of physiological, stress responsive systems such as the HPA axis have been shown to shift. For example, atypical patterns of cortisol secretion characterized by flatter cortisol slopes (Seltzer et al., 2009), greater CAR magnitude (Ruiz-Robledillo and Moya-Albiol, 2013) and hyposecretion of cortisol across the day (Bella et al., 2011; Seltzer et al., 2010) have been observed in parental caregivers of children with a DD. Moreover, alterations in basal HPA activity have been implicated as one physiological indicator for downstream disease outcomes such as infectious disease (Edwards, Hucklebridge, Clow, & Evans, 2003), cardiovascular pathologies (Seldenrijk, Hamer, Lahiri, Penninx, & Steptoe, 2012) and sleep problems (Lasikiewicz, Hendrickx, Talbot, & Dye, 2008). Like their parents, the sustained social, physical and emotional sequelae associated with having a brother/sister with a DD might, via repeated activation of physiological processes such as the HPA axis, confer potential health implications for siblings. Indeed, basal stress hormone activity, though yet to be investigated in siblings of children with a DD, has been 228 B. Lovell, M.A. Wetherell / Research in Developmental Disabilities 49–50 (2016) 226–234 shown to be altered in the context of other chronic childhood stressors. For example, reduced CAR magnitude (Gunnar, Morison, Chisholm, & Schuder, 2001) and flatter diurnal cortisol slopes (Wolf, Nicholls, & Chen, 2008) have been observed in the context of chronic childhood stressors such as maltreatment and family discord. Most recently, flattening of the diurnal cortisol slope, which is indicative of HPA dysregulation, was also observed in peer victimized children (Knack et al., 2011), as was diminished cortisol reactivity to stress in the lab (Vaillancourt et al., 2011). The current study had several aims: (a) to assess the impact of childhood ASD on siblings’ depressive symptoms, (b) to move research in the area forward by assessing the impact of childhood ASD on siblings’ basal stress hormone activity, and (c) to determine whether variations in siblings’ psychological and physiological adjustment to childhood ASD might be explained by individual difference variables such as social support and CBP. 2. Method 2.1. Participants A sample of (N = 25) siblings of children with ASD (and their mothers) was recruited from caregiver support groups, charities, and special schools. All siblings were screened against the following criteria: (a) aged 7–17 years, (b) at least one brother/sister with ASD aged between 3–21 years living at home full time, (c) not experiencing long term stressors such as parent divorce, bereavement or recent change of school, (d) not experiencing serious medical or psychiatric problems, and (e) not taking steroid or statin based medication. A control group of (N = 20) siblings (and their mothers) of neuro-typical children was recruited according to the same criteria, but in order to be eligible must not: (a) have a brother/sister, or any other person living in the family home (e.g., parent, grandparent, friend etc) living with chronic illness. This study and all its procedures were approved by the Institutional Ethics Review Board; all siblings (and their mothers) provided written consent to take part. Of (N = 45) participants recruited, (N = 5) failed to return any questionnaires or saliva samples, and (N = 2) reported a delay between waking and collection of the waking cortisol sample on one saliva collection day. As non compliance with the saliva collection protocol can invalidate the reliability of resultant cortisol data (Clow, Hucklebridge, Stalder, Evans, & Thorn, 2010), only protocol adherent data, i.e., from the remaining collection day, was used for statistical analysis. Statistical analysis was conducted on a final sample of (N = 22) siblings of children with ASD and (N = 18) siblings of neuro-typical children. Sample characteristics by group are presented in Table 1. 2.2. Demographic and family characteristics Participating siblings completed a short questionnaire to assess their age, gender, weight, and exercise frequency. Mothers of participating siblings completed a short questionnaire to assess their age, marital status and number of children Table 1 Summary characteristics by group (N = 38). Siblings of children with autism (N = 20) Siblings of neuro-typical children (N = 18) p Gender (%) Female Male 45.5 55.5 53.0 47.0 Mean age (SD), yrs 12.6 (3.1) 11.0 (3.0) .12 103.2 (36.3) 85.4 (48.0) .23 2.2 (2.0) 2.9 (1.7) .29 2.3 (.5) .15 Mean weight (SD), lbs Mean exercisea (SD) .64 Mean NOC (SD) 2.8 (1.4) Mean AHI (SD) 41,937.5 (19,964.9) 52,562.5 (25,554.7) Mean age of mother (SD), yrs 42.9 (5.7) 40.9 (6.2) Mother’s LOE (%) School College Undergraduate Postgraduate 11.1 16.7 16.7 55.5 5.6 .0 11.1 83.3 Mother’s marital status (%) Partnered Not partnered 83.3 16.7 94.4 5.6 .20 .34 .21 .29 Note. a Measured as number of occasions per week. NOC = number of children (total number of children living in the family home). AHI = annual household income in pounds sterling. LOE = level of education. B. Lovell, M.A. Wetherell / Research in Developmental Disabilities 49–50 (2016) 226–234 229 living at home. As a proxy measure of socioeconomic status, mothers also disclosed their annual household income and highest level of education. 2.3. Depressive symptomology Participating siblings completed the Children’s Depression Inventory-2 (CDI-2), a 27 item questionnaire that yields a total score (which can range between 0 and 56 and is derived by summing across all items), two scale scores (emotional and functional problems) and four subscale scores (negative self esteem, negative mood, interpersonal problems and ineffectiveness). Scale responses range from 0, symptom free to 2, showing definite symptoms, with higher scores reflecting greater depressive symptoms. The CDI-2 (Kovacs, 2011) has been shown to have good internal consistency in previous studies involving siblings of children with ASD (Macks & Reeve, 2007), and this was also the case here (a = .90). 2.4. Social support Participating siblings completed the Social Support Scale for Children (SSSC), a 24 item questionnaire that measures support from: (a) parents, (b) classmates, (c) teachers, and (d) close friends (Harter, 1985). Scale responses range between 1, lowest level of support and 4, highest level of support. A total score for each subscale can range between 1 and 24, with higher scores reflecting greater perceived support. The SSSC has been shown to have excellent psychometrics in previous studies involving siblings of children with ASD (Kaminsky & Dewey, 2002), and internal consistency in the current sample was also good (a = .91). 2.5. Child behaviour problems (CBP) The 25 item Strengths and Difficulties Questionnaire (SDQ) was used to measure the behaviour problems of the child with ASD. Mothers of participating siblings were asked to rate whether behaviours were, 0 (not true), 1 (somewhat true), or 2 (certainly true) for their child with ASD. The SDQ measures child problematic behaviours across four subscales: emotional symptoms (e.g., nervous or clingy in new situations), conduct problems (e.g., often fights with other children), hyperactivity (e.g., restless, overactive, cannot sit still for long), and peer relationships (e.g., generally liked by other children). A total SDQ score, which can range between 0 and 40, was derived by summing across all four subscales, with higher scores reflecting more CBP. The SDQ has achieved good psychometrics in previous studies of a similar nature (Meyer et al., 2011), as was the case here (a = .75). 2.6. Physiological measures Basal HPA axis functioning was assessed by measuring cortisol in saliva at waking, 30 min post waking, 1200 h and 2200 h on two consecutive weekdays. Collected samples were centrifuged for 10 min, 400  g at 20 8C and tested in-house using an enzyme-linked immunosorbant assay (ELISA), Salimetrics Ltd, Suffolk, England. Mean inter and intra assay coefficients were 7.1% and 10.7%, respectively. Raw cortisol data was log10 transformed to correct for positive skew. Log data for each sampling day was treated in two ways to provide different markers of HPA axis activity. Findings from a recent meta analysis indicated that cortisol reactivity from waking is, compared with measures of overall cortisol volume (i.e., area under the curve), a more appropriate measure for estimating HPA activity during the post waking period (Chida & Steptoe, 2009). Therefore, in accord with other recent studies (Kudielka, Gierens, Hellhammer, Wust, & Schlotz, 2012), the cortisol awakening response (CAR) was calculated as the difference between cortisol values at waking and 30 min post waking. Second, to capture the diurnal cortisol slope, a linear regression line was estimated for each participant that predicted cortisol decline from time since waking (Smyth et al., 1997). Steeper cortisol slopes, which indicate a greater rate of diurnal decline, are represented by smaller b values (i.e., larger negative values). Higher b values (as they approach, or cross zero) on the other hand reflect flatter diurnal slopes and are indicative of dysregulated cortisol secretion. In accord with other work, and to avoid any influence of the CAR, cortisol values at 30 min post waking were removed from estimates of the diurnal slope (Brant, Wetherell, Lightman, Crown, & Vedhara, 2010). In keeping with recent work, cortisol values were averaged across sampling days to provide more reliable estimates of basal HPA axis functioning (Holland, Thompson, Tzuang, & Gallagher-Thompson, 2010), 2.7. Procedure A participation pack containing self report measures of demographic and lifestyle factors, depressive symptomology (CDI-2) and social support (SSSC) was sent to participants by post. Mothers were asked to oversee and to ensure siblings’ accurate completion of these questionnaires. The pack also included questionnaires to measure family characteristics (e.g., mother’s age and marital status, and number of other children living in the home) and child behaviour problems (SDQ). These questionnaires were to be completed by the mother only. Materials for the ambulatory collection of salivary cortisol were also included in the pack, as were detailed written instructions emphasising the time sensitive nature of the hormone. Poor adherence with the saliva collection protocol can invalidate the reliability of resultant cortisol data (Kudielka et al., 2012). That is, inaccurately timed morning samples, both in relation to waking (Okun et al., 2010) and to each other (Kudielka, Hawkley, Adam, & Cacioppo, 2007), have been linked with erroneous interpretations of cortisol indices such as the CAR. 230 B. Lovell, M.A. Wetherell / Research in Developmental Disabilities 49–50 (2016) 226–234 Therefore, to encourage protocol adherence, siblings were asked to record waking and saliva collection times on each sampling day using a paper diary (Lovell et al., 2015). A delay > 10 min between waking and collecting the waking sample was used as criterion for the exclusion of inaccurate cortisol data (Lovell et al., 2012). Physiologic data were also excluded if collection of the waking and subsequent post waking saliva sample deviated by > 10 min from the requested 30 min interval (Bhattacharyya, Molloy, & Steptoe, 2008). In addition, for 30 min prior to the collection of any sample, siblings were instructed to abstain from behaviours known to affect the measurement of cortisol in saliva (Fries, Dettenborn, & Kirschbaum, 2009). These behaviours included: consuming food and/or caffeinated drinks, exercising, brushing teeth and/or using mouthwash. Saliva was collected using the salivette device (Sarstedt, UK), whereby participants are asked to chew a sterile cotton swab for 1–2 min before depositing the saturated swab into a plastic collection tube. For the present study, mothers were instructed to oversee and ensure participants’ accurate collection of saliva. Completed questionnaires and collected saliva were returned to the research team using prepaid addressed envelopes. As recompense for their time, all participants were entered into a prize draw to win an Apple IPad. 2.8. Statistical analysis Chi square (x2) and univariate ANOVA were used to assess group differences with respect to sibling demographic and lifestyle factors, and family characteristics. One way ANOVA was also used to compare groups on total CDI-2 and SSSC scores, and on aspects of the diurnal cortisol pattern, CAR magnitude and diurnal cortisol slope. Mixed ANOVA was used to test for group differences with respect to cortisol values per individual sampling point and mean cortisol output across the day. Variations in degrees of freedom reflect missing values and, where appropriate, Huynh Feldt was applied to correct violations of sphericity. Subsequent analysis used multiple regression analysis to determine whether psychophysiological outcomes in siblings of children with ASD might be differentially affected by social support and CBP. 3. Results 3.1. Demographic and family characteristics Groups were comparable with respect to gender, age, weight and exercise (all ps > .11). Groups were also indistinguishable on all family characteristics: mother’s age (F (1, 32) = .93, p = .34, hp2 = .03), mother’s marital status (x2 (1) = 1.13, p = .29), mother’s highest level of education (x2 (3) = 4.53, p = .21), annual household income (F (1, 30) = 1.72, p = .20, hp2 = .05), and total number of children living at home (F (1, 34) = 2.20, p = .15, hp2 = .06). As such, none of these variables were included in subsequent analyses. 3.2. Self report measures Groups could not be differentiated with respect to scores on the negative self esteem (F (1, 38) = 1.00, p = .32, hp2 = .03), ineffectiveness (F (1, 38) = 2.97, p = .09, hp2 = .07) and interpersonal problems (F (1, 38) = 1.57, p = .22, hp2 = .04) subscales of the CDI-2. Levels of negative mood were, however, higher in ASD siblings compared with controls (F (1, 38) = 6.98, p = .01, hp2 = .16). Scores on the emotional problems scale of the CDI-2 were also higher in siblings of children with ASD (F (1, 38) = 4.38, p = .04, hp2 = .10), as were total (CDI-2 scores) depressive symptoms (F (1, 38) = 4.22, p = .05, hp2 = .10). There was also a trend for greater functional problems in siblings of children with ASD (F (1, 38) = 2.86, p = .09, hp2 = .07). These results reflect the fact that depressive symptoms were higher in siblings of children with ASD, and this was largely due to greater emotional, rather than functional, problems. Data indicated that groups could not be differentiated on SSSC subscales: parents (F (1, 37) = .24, p = .63, hp2 < .01), close friends (F (1, 37) = .05, p = .83, hp2 < .01), peers (F (1, 37) = .43, p = .52, hp2 = .01), and teachers (F (1, 37) = .06, p = .81, hp2 < .01). 3.3. Physiological measures A two (group: siblings of children with ASD vs. siblings of neuro-typical children)  four (time: waking, 30 min post waking, afternoon, before bed) mixed ANOVA yielded a significant main effect of time (F (2.4, 84.6) = 99.84, p < .01, hp2 = .74), reflecting normal variation in diurnal cortisol secretion. However, groups were comparable with respect to mean diurnal cortisol output (F (1, 35) = .28, p = .60, hp2 < .01) and pattern of change across the day (F (2.4, 84.6) = .43, p = .55, hp2 = .01). One way ANOVA also revealed that groups could not be differentiated on HPA markers, CAR magnitude (F (1, 35) = .94, p = .34, hp2 = .03) or diurnal cortisol slope (F (1, 35) = .10, p = .75, hp2 < .01). Means and standard deviations for psychophysiological outcomes by group are presented in Table 2. 3.4. Within group analysis No association between any of the demographic and family characteristics, and siblings’ total CDI-2 scores were observed (all ps > .06). Similarly, siblings’ total depressive symptoms were not related to age of the child with ASD (r = .35, p = .14). As such, none of these variables were included in the regression model. B. Lovell, M.A. Wetherell / Research in Developmental Disabilities 49–50 (2016) 226–234 231 Table 2 Means and standard deviations for psychophysiological outcomes by group. Siblings of children with ASD (N = 22) Child behaviour problems (SDQ) 19.5 (8.8) Social support (SSSC) Parents Classmates Teachers Close friends 21.5 19.4 20.5 21.0 (2.6) (3.8) (3.0) (4.4) Depression (CDI-2) Negative mood Negative self esteem Ineffectiveness Interpersonal problems Functional problems Emotional problems Total CDI-2 score 3.8 1.8 3.7 1.0 4.8 5.6 10.4 (2.9) (2.3) (2.4) (1.6) (3.7) (4.9) (8.2) HPA markers CAR (nmol/L) Diurnal slope (b) Mean diurnal output (nmol/L) 1.48 (5.4) .87 (.16) 5.5 (2.1) Siblings of neuro-typical children (N = 18) 6.8 (4.2) 21.9 20.1 20.8 20.8 (2.7) (2.5) (3.7) (3.9) p <.01 .63 .52 .78 .83 1.8 (1.7) 1.2 (1.2) 2.4 (2.5) .05 (1.0) 2.9 (3.2) 2.9 (2.3) 5.8 (4.9) .01 .32 .09 .22 .09 .04 .05 .96 (6.8) .89 (.15) 6.0 (2.9) .34 .72 .60 Note: CAR—cortisol awakening response. In competing analysis where all SSSC subscale scores and total SDQ scores were entered simultaneously, support from parents (b = -.32, t = -2.40, p = .03) and close friends (b = .89, t = 3.99, p < .001), and CBP (b = .30, t = 2.27, p = .04) predicted siblings’ total scores on the CDI-2. The model accounted for 82.0% of the variance in siblings’ depressive symptoms (F = 13.61, p < .001). Subsequent analysis found that social support and CBP did not predict siblings’ basal levels of cortisol (all ps > .20). 4. Discussion This study examined the psychophysiological impact of childhood ASD on siblings. Data indicated that total depression symptoms were higher in siblings of children with ASD compared with a normative control group. Data suggested that group disparities with respect to depressive symptoms were driven more by emotional than functional problems. That is, ASD siblings scored higher on the emotional problems scale of the CDI-2; scores on the functional problems scale, while higher in siblings of children with ASD, approached, but failed to reach statistical significance. These findings are commensurate with several recent studies, in which depression and other psychological markers such as emotional problems and internalising behaviours were found to be higher in the context of having a brother/sister with ASD (Lobato et al., 2011; Petalas et al., 2009). These findings also resonate with those from a recent meta analysis, in which siblings of children with DD, including ASD, reported higher levels of depressive symptoms compared to a control group (Vermaes et al., 2012). That some studies have observed no effect (Benson & Karlof, 2008; Tomeny et al., 2012) or an adaptive effect (Macks & Reeve, 2007) of childhood disability on siblings’ psychological functioning might be explained by methodological variations. That is, many previous studies used parent reports to measure siblings’ psychological adjustment to having a brother/sister with a DD. However, as used in the current study, sibling self report data has been found to be more reliable (Macks & Reeve, 2007). In fact, it has been suggested incumbent on researchers to collect psychological data directly from the participating sibling (Guite, Lobato, Kao, & Plante, 2004; Stoneman, 2005). Groups were comparable with respect to basal HPA axis activity, such that both groups displayed the typical descending pattern of cortisol secretion across the day and were comparable on HPA markers, CAR magnitude and diurnal slope. This finding might be deemed unexpected given that atypical patterns of cortisol secretion have been observed in the context of other chronic childhood stressors such as family discord (Wolf et al., 2008), maltreatment (Gunnar et al., 2001) and peer victimization (Knack et al., 2011; Vaillancourt et al., 2011). Age related changes in basal stress hormone activity might provide one explanation. For example, in the current study, siblings of children with ASD (mean = 12.6 years) were, on average, almost two years older than controls (mean = 11.0 years). Basal (Gunnar, Wewerka, Frenn, Long, & Griggs, 2009) and reactive cortisol levels (Stroud et al., 2009) undergo marked changes during the transition from childhood to adolescence. As such, in the context of the current study, any effect of childhood ASD on siblings’ basal HPA axis functioning might have been masked by age related variations. In addition, failure to observe cortisol disparities between the groups might reflect having recruited a relatively high functioning group of children with ASD. Indeed, recent research has highlighted the predictive value of ASD symptom severity for the physiological functioning of parental caregivers (Ruiz-Robledillo et al., 2014). Data reported here indicated that siblings’ depressive symptoms were, at least in part, influenced by their availability of social support. Indeed, along with the behaviour problems of their brother/sister with ASD, social support accounted for a significant portion of the variance in siblings’ total scores on the CDI-2. In particular, support from parents and close friends 232 B. Lovell, M.A. Wetherell / Research in Developmental Disabilities 49–50 (2016) 226–234 inversely predicted siblings’ depressive symptoms. These results reflect the fact that greater support, especially from family and close friends, might buffer against the psychological sequelae associated with having a brother/sister with ASD. These findings resonate with several other studies, in which socially supported siblings of children with a DD reported lower levels of depression (Barrera et al., 2004) and other psychological symptoms such as loneliness (Kaminsky & Dewey, 2002). The adaptive effect of social support for siblings’ psychological adjustment to childhood disability was also highlighted in recent qualitative research. In a study by Moyson and Roeyers (2012), siblings of children with intellectual disabilities, including ASD, commented that support, particularly from parents and close friends, helped them forget about the stress associated with being a sibling. Moreover, social support groups, which allow siblings of children with a DD to come together, make friends and share experiences, have been linked with positive psychological changes such as fewer depressive symptoms (Houtzager, Grootenhuis, & Last, 2001). Based on findings reported here, interventions that enhance siblings’ perceived availability of support, especially support from parents and close friends, might be adaptive for alleviating depressive symptoms. Data also indicated that siblings’ depressive symptoms were partially contingent on the behaviour problems of their brother/sister with ASD. That is, CBP were found to positively predict siblings’ total CDI-2 scores. That CBP might affect psychological outcomes such as depression in siblings of children with a DD has also been observed in other recent studies (Meyer et al., 2011; Shivers et al., 2012). These findings might have implications for the design and delivery of psychotherapeutic interventions. For example, researchers might look to corroborate and extend the findings of Lobato and Kao (2005), in which positive psychological adjustments such as higher levels of self competence were reported by siblings who participated in a psychoeducational skills training intervention to learn more about the behavioural manifestations of ASD. Findings of this study should be evaluated in the context of its limitations. First, the cross sectional nature of the work precludes drawing inferences about the relationship between study variables. As such, future studies might use longitudinal designs to better delineate the direction of the relationships between social support, CBP and depressive symptoms in siblings of children with ASD. Second, the small size of the sample is a notable limitation of the study, with post hoc power analysis indicating that (N = 43) participants would be needed to provide adequate power (80%; a = .05) to detect a moderate effect size (f2 = .15). However, despite being underpowered, significant relationships between social support and CBP, and siblings’ depressive symptoms were observed. Moreover, owing to the demands of the caregiving experience, parents of children with ASD (who were asked to oversee siblings’ participation in the study) have little free time (Yantzi et al., 2006), thus making it difficult to engage with research opportunities. As such, the modest size of the sample, which matches the size of other studies of a similar nature (Quintero & McIntyre, 2010), might be expected. Third, characteristics of the child with ASD such as symptom severity (Rao & Beidel, 2009) and birth order (Tomeny, Barry, & Bader, 2014) have been shown to be associated with the psychological adjustment of neuro-typical siblings. These important measures were omitted from the current study and, as such, caution should be exercised when interpreting the findings. In conclusion, relative to a normative control group, siblings of children with ASD reported greater depressive symptoms. Data indicated that support from parents and close friends, and the behaviour problems of their brother/sister with ASD predicted siblings’ total scores on the CDI-2. These findings might inform the design and delivery of interventions with a view to better supporting siblings of children with ASD, and their families. Conflict of interest statement None declared. Acknowledgement We would like to thank the Baily Thomas Charitable Trust for funding this research. References Bandeira, D. R., Pawlowski, J., GonÇalves, T. R., Hilgert, J. B., Bozzetti, M. C., & Hugo, F. N. (2007). Psychological distress in Brazilian caregivers of relatives with dementia. Aging & Mental Health, 11(1), 14–19. Barak-Levy, Y., Goldstein, E., & Weinstock, M. (2010). Adjustment characteristics of healthy siblings of children with autism. Journal of Family Studies, 16, 155–164. Barlow, J. H., & Ellard, D. R. (2006). The psychosocial well-being of children with chronic disease, their parents and siblings: An overview of the research evidence base. Child: Care, Health & Development, 32(1), 19–31. Barrera, M., Fleming, C. F., & Khan, F. S. (2004). The role of emotional social support in the psychological adjustment of siblings of children with cancer. Child: Care, Health & Development, 30(2), 103–111. Bella, G. P., Garcia, M. C., & Spadari-Bratfisch, R. C. (2011). Salivary cortisol, stress, and health in primary caregivers (mothers) of children with cerebral palsy. Psychoneuroendocrinology, 36, 834–842. Benson, P. R., & Karlof, K. L. (2008). Child, parent, and family predictors of latter adjustment in siblings of children with autism. Research in Autism Spectrum Disorders, 2, 583–600. Bhattacharyya, M. R., Molloy, G. R., & Steptoe, A. (2008). Depression is associated with flatter cortisol rhythms in patients with coronary artery disease. Journal of Psychosomatic Research, 65, 107–113. Brant, H., Wetherell, M. A., Lightman, S. L., Crown, A. L., & Vedhara, K. (2010). An exploration into physiologic and self-report measures of stress in pre-registration doctors at the beginning and end of a clinical rotation. Stress, 13(2), 155–162. B. Lovell, M.A. Wetherell / Research in Developmental Disabilities 49–50 (2016) 226–234 233 Cantwell, J., Muldoon, O. T., & Gallagher, S. (2014). Social support and mastery influence the association between stress and poor physical health in parents caring for children with developmental disabilities. Research in Developmental Disabilities, 35, 2215–2223. Cantwell, J., Muldoon, O. T., & Gallagher, S. (2015). The influence of self-esteem and social support on the relationship between stigma and depressive symptomology in parents caring for children with intellectual disabilities. Journal of Intellectual Disability Research, 59(10), 948–957. Chida, Y., & Steptoe, A. (2009). Cortisol awakening response and psychosocial factors: A systematic review and meta-analysis. Biological Psychology, 80, 265–278. Clow, A., Hucklebridge, F., Stalder, T., Evans, P., & Thorn, L. (2010). The cortisol awakening response: More than a measure of HPA axis function. Neuroscience and Biobehavioural Reviews, 35, 97–103. Cousino, M. K., & Hazen, R. A. (2013). Parenting Stress among caregivers of children with chronic illness: A systematic review. Journal of Paediatric Psychology, 38(8), 1–20. Dyke, P., Mulroy, S., & Leonard, H. (2009). Siblings of children with disabilities: Challenges and opportunities. Acta Pædiatrica, 98, 23–24. Easter, G., Sharpe, L., & Hunt, C. J. (2015). Systematic review and meta-analysis of anxious and depressive symptoms in caregivers of children with asthma. Journal of Paediatric Psychology, 40(7), 623–632. Edwards, S., Hucklebridge, F., Clow, A., & Evans, P. (2003). Components of the diurnal cortisol cycle in relation to upper respiratory symptoms and perceived stress. Psychosomatic Medicine, 65, 320–327. Fairthorne, J., de Klerk, N., & Leonard, H. (2015). Health of mothers of children with Intellectual disability or autism spectrum disorder: A review of the literature. Medical Research Archives, 3, 1–21. Fisman, S., Wolf, L., Ellison, D., & Freeman, T. (2000). A longitudinal study of siblings of children with chronic disabilities. Canadian Journal of Psychiatry, 45, 369–375. Fries, E., Dettenborn, L., & Kirschbaum, C. (2009). The cortisol awakening response (CAR): Facts and future directions. International Journal of Psychophysiology, 72, 67–77. Gallagher, S., & Hannigan, A. (2014). Depression and chronic health conditions in parents of children with and without developmental disabilities: The growing up in Ireland cohort study. Research in Developmental Disabilities, 35, 448–454. Gallagher, S., Phillips, A. C., Oliver, C., & Carroll, D. (2008). Predictors of psychological morbidity in parents of children with intellectual disabilities. Journal of Paediatric Psychology, 33(10), 1129–1136. Gallagher, S., & Whiteley, J. (2012). Social support is associated with blood pressure responses in parents caring for children with developmental disabilities. Research in Developmental Disabilities, 33, 2099–2105. Giallo, R., & Gavidia-Payne, S. (2006). Child, parent and family factors as predictors of adjustment for siblings of children with a disability. Journal of Intellectual Disability Research, 50(12), 937–948. Griffith, G. M., & Hastings, R. P. (2013). He’s hard work, but he’s worth it. The experience of caregivers of individuals with intellectual disabilities and challenging behaviour: A meta-synthesis of qualitative research. Journal of Applied Research in Intellectual Disabilities, 27(5), 401–419. Guite, G., Lobato, D., Kao, B., & Plante, W. (2004). Discordance between sibling and parent reports of the impact of chronic illness and disability on siblings. Children’s Health Care, 33, 77–92. Gunnar, M. R., Morison, S. J., Chisholm, K., & Schuder, M. (2001). Salivary cortisol levels in children adopted from Romanian orphanages. Development and Psychopathology, 13, 611–628. Gunnar, M. R., Wewerka, S., Frenn, K., Long, J. D., & Griggs, C. (2009). Developmental changes in hypothalamus–pituitary–adrenal activity over the transition to adolescence: Normative changes and associations with puberty. Development and Psychopathology, 21, 69–85. Harter, S. (1985). The self-perception profile for children: Revision of the perceived competence scale for children. Manual, University of Denver. Hayes, S. A., & Watson, S. L. (2013). The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(3), 629–642. Holland, J. M., Thompson, L. W., Tzuang, M., & Gallagher-Thompson, D. (2010). Psychosocial factors among Chinese American women dementia caregivers and their association with salivary cortisol: Results of an exploratory study. Ageing International, 35(2), 109–127. Houtzager, B. A., Grootenhuis, M. A., & Last, B. F. (2001). Supportive groups for siblings of paediatric oncology patients: Impact on anxiety. Psycho-Oncology, 10, 315–324. Kaminsky, L., & Dewey, D. (2002). Psychosocial adjustment in siblings of children with autism. Journal of Child Psychology and Psychiatry, 43(2), 225–232. Knack, J. M., Jensen-Campbell, L. A., & Baum, A. (2011). Worse than sticks and stones? Bullying is associated with altered HPA axis functioning and poorer health. Brain and Cognition, 77, 183–190. Kogan, M. D., Strickland, B. B., Blumberg, S. J., Singh, G. P., Perrin, J. M., & van Dyck, P. C. (2008). A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005–2006. Pediatrics, 122(6), e1149–e1158. Kovacs, M. (2011). The Children’s Depression Inventory 2: Manual. North Tonawanda, NY: Multi-Health Systems Inc. Kudielka, B. M., Gierens, A., Hellhammer, D. H., Wust, S., & Schlotz, W. (2012). Salivary cortisol in ambulatory assessment: Some do’s, some don’ts, and some open questions. Psychosomatic Medicine, 74, 418–431. Kudielka, B. M., Hawkley, L. C., Adam, E. K., & Cacioppo, J. T. (2007). Compliance with ambulatory saliva sampling in the Chicago health, aging, and social relations study and associations with social support. Annals of Behavioural Medicine, 34(2), 209–216. Labay, L. E., & Walco, G. A. (2004). Brief report: Empathy and psychological adjustment in siblings of children with cancer. Journal of Pediatric Psychology, 29(4), 309–314. Lasikiewicz, N., Hendrickx, H., Talbot, D., & Dye, L. (2008). Exploration of basal diurnal salivary cortisol profiles in middle-aged adults: Associations with sleep quality and metabolic parameters. Psychoneuroendocrinology, 33, 143–151. Lobato, D. J., & Kao, B. T. (2005). Brief report: Family-based group intervention for young siblings of children with chronic illness and developmental disability. Journal of Paediatric Psychology, 30(8), 678–682. Lobato, D. J., Kao, B. T., Plante, W., Seifer, R., Grullon, E., Cheas, L., et al. (2011). Psychological and school functioning of Latino siblings of children with intellectual disability. Journal of Child Psychology and Psychiatry, 52(6), 696–703. Lovell, B., Moss, M., & Wetherell, M. A. (2015). The psychophysiological and health corollaries of child problem behaviours in caregivers of children with autism and ADHD. Journal of Intellectual Disability Research, 59(2), 150–157. Lovell, B., Moss, M., & Wetherell, M. A. (2012). The psychosocial, endocrine and immune consequences of caring for a child with autism or ADHD. Psychoneuroendocrinology, 37, 534–542. Lovell, B., & Wetherell, M. A. (2011). The cost of caregiving: Endocrine and immune implications in elderly and non elderly caregivers. Neuroscience and Biobehavioural Reviews, 35, 1342–1352. Ludlow, A., Skelly, C., & Rohleder, P. (2012). Challenges faced by parents of children diagnosed with autism spectrum disorder. Journal of Health Psychology, 17(5), 702–711. Macks, R. J., & Reeve, R. E. (2007). The adjustment of non-disabled siblings of children with autism. Autism and Developmental Disorders, 37, 1060–1067. Meyer, K. A., Ingersoll, B., & Hambrick, D. Z. (2011). Factors influencing adjustment in siblings of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 1413–1420. Moyson, T., & Roeyers, H. (2012). ‘The overall quality of my life as a sibling is all right, but of course, it could always be better’. Quality of life of siblings of children with intellectual disability: The siblings’ perspectives. Journal of Intellectual Disability Research, 56, 87–101. Neece, C. L., Blacher, J., & Baker, B. L. (2010). Impact on siblings of children with intellectual disability: The role of child behaviour problems. American Journal on Intellectual and Developmental Disabilities, 115(4), 291–306. Nolbris, M., Abrahamsson, J., Hellström, A. L., Olofsson, L., & Enskär, K. (2010). The experience of therapeutic support groups by siblings of children with cancer. Pediatric Nursing, 36(6), 298–304. Okun, M. L., Krafty, R. T., Buysse, D. J., Monk, T. J., Reynolds, C. F., Begley, A., et al. (2010). What constitutes too long of a delay? Determining the cortisol awakening response (CAR) using self report and PSG-assessed wake time. Psychoneuroendocrinology, 35, 460–468. 234 B. Lovell, M.A. Wetherell / Research in Developmental Disabilities 49–50 (2016) 226–234 Oruche, U. K., Gerkensmeyer, J., Stephan, L., Wheeler, C. A., & Hanna, K. M. (2012). The described experience of primary caregivers of children with mental health needs. Archives of Psychiatric Nursing, 26(5), 382–391. Petalas, M. A., Hastings, R. P., Nash, S., Lloyd, T., & Dowey, A. (2009). Emotional and behavioural adjustment in siblings of children with intellectual disability with and without autism. Autism, 13(5), 471–480. Quintero, N., & McIntyre, L. L. (2010). Sibling adjustment and maternal well-being: An examination of families with and without a child with an autism spectrum disorder. Focus on Autism other Developmental Disabilities, 25(1), 37–46. Randall, P., & Parker, J. (1999). Supporting the families of children with autism. New York, NY: John Wiley & Sons. Rao, P. A., & Beidel, D. C. (2009). The impact of children with high functioning autism on parental stress, sibling adjustment, and family functioning. Behavior Modification, 33, 437–451. Saxbe, D. E. (2008). A field (researcher’s) guide to cortisol: Tracking HPA axis functioning in everyday life. Health Psychology Review, 2(2), 163–190. Ruiz-Robledillo, N., & Moya-Albiol, L. (2013). Lower electrodermal activity to acute stress in caregivers of people with autism spectrum disorder: An adaptive habituation to stress. Journal of Autism and Developmental Disorders, 45, 576–588. Ruiz-Robledillo, N., De André s-Garcıa, S., Perez-Blasco, J., Gonzalez-Bono, E., & Moya-Albiol, L. (2014). Highly resilient coping entails better perceived health, high social support and low morning cortisol levels in parents of children with autism spectrum disorder. Research in Developmental Disabilities, 35, 686–695. Seldenrijk, A., Hamer, M., Lahiri, A., Penninx, B. W. J. H., & Steptoe, A. (2012). Psychological distress, cortisol stress response and subclinical coronary calcification. Psychoneuroendocrinology, 37(1), 48–55. Seltzer, M. M., Almeida, D. M., Greenberg, J. S., Salva, J., Stawski, R. S., Hong, J., et al. (2009). Psychosocial and biological markers of daily lives of midlife parents of children with disabilities. Journal of Health and Social Behaviour, 5, 1–15. Seltzer, M. M., Greenberg, J. S., Hong, J., Smith, L. E., Almeida, D. M., Coe, C., et al. (2010). Maternal cortisol levels and behaviour problems in adolescents and adults with ASD. Journal of Autism and Developmental Disorders, 40(4), 457–469. Shivers, C. M., Deisenroth, L. K., & Taylor, J. L. (2012). Patterns and predictors of anxiety among siblings of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(6), 1336–1346. Smith, A. M., & Grzywacz, J. G. (2014). Health and well-being in midlife parents of children with special health needs. Families, Systems, & Health, 32(3), 303–312. Smyth, J., Ockenfels, M., Gorin, A., Catley, D., Porter, L., Kirschbaum, C., et al. (1997). Individual differences in the diurnal cycle of cortisol. Psychoneuroendocrinology, 22, 89–105. Stoneman, Z. (2005). Siblings of children with disabilities: Research themes. Mental Retardation, 43, 339–350. Stroud, L., Foster, E., Handwerger, K., Papandonatos, G. D., Granger, D., Kivlighan, K. T., et al. (2009). Stress response and the adolescent transition: Performance versus peer rejection stress. Development and Psychopathology, 21, 47–68. Tomeny, T. S., Barry, T. D., & Bader, S. H. (2012). Are typically developing siblings of children with an autism spectrum disorder at risk for behavioral, emotional, and social maladjustment? Research in Autism Spectrum Disorders, 6, 508–518. Tomeny, T. S., Barry, T. D., & Bader, S. H. (2014). Birth order rank as a moderator of the relation between behavior problems among children with an autism spectrum disorder and their siblings. Autism, 18(2), 199–202. Vaillancourt, T., Duku, E., Becker, S., Schmidt, L. A., Nicol, J., Muir, C., et al. (2011). Peer victimization, depressive symptoms, and high salivary cortisol predict poorer memory in children. Brain and Cognition, 77, 191–199. Vermaes, I. P. R., van Susante, A. M. J., & van Bakel, H. J. A. (2012). Psychological functioning of siblings in families of children with chronic health conditions: A meta-analysis. Journal of Paediatric Psychology, 37(2), 166–184. Wolf, J. M., Nicholls, E., & Chen, E. (2008). Chronic stress, salivary cortisol, and a-amylase in children with asthma and healthy children. Biological Psychology, 78, 20–28. Yantzi, M. N., Rosenberg, M. W., & McKeever, P. (2006). Getting out of the house: The challenges mothers face when their children have long term care needs. Health & Social Care in the Community, 15, 45–55.

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J Autism Dev Disord. Author manuscript; available in PMC 2017 February 01.
Published in final edited form as:
J Autism Dev Disord. 2016 February ; 46(2): 589–602. doi:10.1007/s10803-015-2611-6.

Siblings of Youth with Autism Spectrum Disorders: Theoretical
Perspectives on Sibling Relationships and Individual Adjustment
Susan M. McHale,
College of Health and Human Development, 14 Henderson, The Pennsylvania State University,
University Park, PA, 814-865-2663

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Kimberly A. Updegraff, and
T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Box 3701,
Tempe, AZ 85287, 480-965-6669
Mark E. Feinberg
College of Health and Human Development, 314 Biobehavioral Health, The Pennsylvania State
University, University Park, PA, 814-865-7375
Susan M. McHale: mchale@psu.edu; Kimberly A. Updegraff: kimberly.updegraff@asu.edu; Mark E. Feinberg:
mef11@psu.edu

Abstract

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A burgeoning research literature investigates the sibling relationships of youth with Autism
Spectrum Disorder (ASD) and their implications for individual adjustment. Focusing on four
relationship domains-- behaviors, emotions, cognitions and involvement—and toward advancing
this generally atheoretical literature, we review and apply tenets from a range of theoretical
perspectives in an effort to illuminate the mechanisms underlying sibling relationship experiences
and their adjustment implications. Our review suggests new directions for research to test
theoretically-grounded hypotheses about how sibling relationships develop and are linked to
individual adjustment. In addition, we consider how identifying underlying bio-psycho-social
processes can aid in the development of interventions to promote warm and involved sibling
relationships and positive youth development.

Keywords

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Sibling Relationships; Youth Adjustment; Family; Close Relationship Theory; Prevention;
Intervention
Sibling relationships are unique and have unique implications for individual development
and adjustment. Siblings can influence one another directly, such as in their roles as
companions and playmates and when they provide or receive caregiving and support
(McHale, Updegraff & Whiteman, 2012). As social partners, siblings also afford

Corresponding author: Susan M. McHale, 114 Henderson, The Pennsylvania State University, University Park, PA 16801. Phone:
814-865-2663. ; Email: mchale@psu.edu.
Susan M. McHale, College of Health and Human Development, The Pennsylvania State University. Kimberly A. Updegraff, The
Sanford School of Social and Family Dynamics, Arizona State University. Mark Feinberg, College of Health and Human
Development, The Pennsylvania State University.

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opportunities for developing social competencies such as perspective taking, conflict
resolution, and communication skills (Dunn, 2007). Sibling relationships vary considerably,
however, and can also serve as a training ground for learning coercive, aggressive, and other
deviant behaviors and (Bullock & Dishion, 2002; Patterson, 1984), and a gateway to risky
behaviors such as delinquency and substance use (Brook, Whiteman, Brook & Gordon,
1991). In addition to their direct influences, siblings affect one another indirectly by their
effects on larger family dynamics, as when they take on family roles such as peacemaker or
scapegoat (Ansbacher & Ansbacher, 1956), dilute family resources (Downey, 2001), or serve
as a focus for social comparison and parents’ differential treatment (Shanahan, McHale,
Crouter & Osgood, 2007) or a source of family stress (Patterson, 2002).

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In short, through their daily contact and experiences growing up together, and because
sibling relationships are the longest lasting relationships in most individuals’ lives, siblings
have substantial opportunity to influence one other’s development. Their shared history
means that siblings can develop deep and unique understandings of one another and remain
fixtures in one another’s lives-- sources of security and support, rivalry and antagonism or
disaffection and indifference-- across the lifespan.

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Recognition of substantial variability in sibling relationships, sibling-related family
dynamics, and sibling influences on individual development among typically developing
siblings provides a context within which to understand the experiences of youth whose
siblings have Autistic Spectrum Disorder (ASD). The literature on typically developing
siblings (TDSibs) whose sisters or brothers have ASD (ASDSibs) emerged from a body of
research on families with children with disabilities and chronic illnesses (Stoneman, 2005).
Rapidly rising rates of ASD, however-- evidence suggests an increase in diagnosis rates of
289.5% between 1997 and 2008 (Boyle, et al., 2011)--have led practitioners, parents, and
researchers to raise questions about the potentially unique issues that arise in families with a
child with ASD. Indeed, studies have focused increasingly on the experiences of youth with
ASDSibs, with some extending to adult TDSibs (Orsmond & Seltzer, 2007a). Suggestive of
the breadth of interest, this work has been reviewed in disciplines including nursing (Smith
& Elder, 2010), psychology (Orsmond & Seltzer, 2007b; Shivers, & Plavnick, 2014), special
education (Ferrailoi & Harris, 2010; Meadan, Stoner, & Angell, 2010), and family science
(Tsao, Davenport, & Schmiege, 2012), with a focus on (a) adjustment in TDSibs, and (b)
characteristics of sibling relationships.

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These reviews provide for some general conclusions about the nature of ASD-TDSib
relationships and their implications for TDSibs’ adjustment, but also highlight substantial
inconsistencies. Relationships of ASDSibs have been described as generally positive; they
also may involve less conflict, but less warmth and involvement than those of typically
developing siblings (Kaminsky & Dewey, 2001; McHale, Sloan, & Simeonsson, 1986;
Orsmond, Kuo & Seltzer, 2009) and distress in response to the ASDSib’s aggressive and
disruptive behaviors (Mascha & Boucher, 2006). With respect to adjustment, youth with
ASDSibs are generally well-adjusted and some may benefit from their experiences in their
social competencies and self concept (Kaminsky & Dewey, 2002; Macks & Reeve, 2007;
Pilowsky, Yirmiya, Doppelt, Gross-Tsur, & Shalev, 2004; Verte, Roeyers & Buysse, 2003),
but there also is evidence of adjustment problems in TDSibs (Hastings, 2003; Shivers,

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Deisenroth, & Taylor, 2013). Reviews target research designs and methods as a basis for
inconsistencies across studies (Hodapp, Glidden & Kaiser, 2005; Meadan et al., 2010):
Small sample sizes, samples of convenience, inattention to family structure, samples that
differ in comparison group, age, and data sources mean that it is difficult to compare results
across studies. Together, however, this literature suggests substantial variation in the sibling
relationships and adjustment of TDSibs and directs attention to two questions: (1) How do
TDSibs and ASDSibs develop involved and affectionate relationships? And, (2) How do
relationship experiences shape the adjustment of both TDSibs and ASDSibs?

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Toward a translational research agenda aimed at promoting positive sibling relationships and
individual adjustment for TDSibs and ASDSibs, the goal of this paper is to begin to fill the
theoretical void that is a key limitation of the literature on ASDSibs and siblings with other
kinds of developmental disabilities (Stoneman, 2005). Their complex and multifaceted
nature means that sibling dynamics can be best understood via a multi-disciplinary
approach. Thus, we draw from social learning, ethological/psychoanalytic, developmental
and social psychological, and sociological, anthropological and systems theories in an effort
to illuminate the hows and whys of sibling relationships and their influences, and argue for a
research agenda to test integrative hypotheses in empirical investigations. Building on a
model developed by Feinberg, Sakuma, Hostetler and McHale (2013) that served as the
foundation for an evidence-based program for promoting relationships between typically
developing siblings, SIBlings are Special (SIBS), we consider four interrelated dimensions
of sibling dynamics: behaviors, emotions, cognitions and involvement. In sections that
follow, we describe relevant theories and illustrative empirical literature on both typically
developing and TDS-ASD sibling relationships. A developmental perspective implicates
childhood and adolescence as periods when socio-emotional orientations and relationship
patterns are established. Further, given the limited literature on adults siblings, we focus on
youth’s experiences in childhood and adolescence, but where relevant, incorporate insights
from studies of siblings in adulthood—a key direction for research.

Theoretical Perspectives on Sibling Relationship Behaviors
Overview of Empirical Research

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Among typically developing siblings, research on positive sibling relationship behaviors
focuses on helping, teaching and caregiving, provision of advice, support, and warmth, and
sharing and turn-taking in play (Dunn, 2007). Longitudinal studies reveal that these
behaviors decline across adolescence as youth focus on the world beyond the home (Kim,
McHale, Osgood, & Crouter, 2006). Positivity in sibling relationships, however, continues to
be linked to more positive psychological adjustment into young adulthood and beyond
(Voorpostel & van der Lippe, 2007). Sibling conflict behaviors include verbal (tease, argue),
relational (social exclusion, undermining) and physical aggression (Dunn, 2007). Sibling
conflict is common—up to eight times per hour in childhood, as is aggression, with more
than half of siblings engaging in physical violence (Berndt & Bulleit, 1985; Steinmetz et al.,
1981). Sibling conflict also affects other family subsystems. For example, sibling conflict is
most parents’ number one child rearing concern (Perlman & Ross, 1997). Importantly,
positivity and negativity are not opposite ends of the same continuum: The same

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relationships can include both high negativity and frequent engagement and support
(McHale et al., 2012)

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Our review yielded studies of positivity and conflict in TDSib-ASDSib relationships that
compared these relationships to those of typically developing siblings and to siblings with
other kinds of disabilities. Acknowledging the difficulty of generating matched comparison
groups, findings suggest that the relationships of siblings with ASDs and other disabilities
may involve less conflict (Kaminsky & Dewey, 2001; McHale et al., 1986). Positive sibling
behaviors, however, also may be less frequent (Pollard, McNamara, Freedman, & Kotchick,
2013; Knott, Lewis, & Williams, 2007). Longitudinal data on TDsib-ASDsib relationships
are rare, but combined with cross-sectional findings, suggest declines in positive sibling
exchanges as contact between siblings decreases from adolescence through middle
adulthood (Hodapp & Urbano, 2007; Orsmond & Seltzer, 2007b). Importantly, experimental
interventions reveal that TDSibs can be trained in teaching and helping behaviors, and that
these experimentally induced changes spill over to promote more positive sibling
involvement (Shivers & Plavnick, 2015). Together, findings suggest that sibling relationships
are highly variable, underscoring the need to identify individual, family, and larger
contextual factors that shape siblings’ behaviors.
Social Learning Perspectives on Sibling Relationship Behaviors

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Most literature on positive and conflictual sibling behaviors is grounded in social learning
theories. Patterson (1984) described how sibling conflict and aggression emerge and escalate
through social reinforcement processes, as when a child positively reinforces a sibling by
“giving in” to aggressive or aversive behavior-- and that child is negatively reinforced for
giving in because the sibling’s problem behavior temporarily ceases. This pattern of
reinforcement means that coercive cycles escalate in intensity over time. And, behaviors
learned in sibling relationships generalize to other settings, meaning that sibling
relationships can serve as a training ground for problem behaviors. Thus, TDSibs may
inadvertently “train” maladaptive behaviors in efforts to placate their sibling and keep the
peace. Further, youth may withdraw from engagement with their siblings when they have no
effective strategies for limiting aversive behaviors. Recognizing and managing coercive
behavior cycles are a focus of some evidence-based parent education programs (Martinez &
Forgatch, 2001), and can be applied to siblings. In the SIBS program, a focus is to break
cycles of negative sibling exchanges, including by training siblings in social problem solving
skills and teaching them to reinforce positive behaviors with compliments and praise
(Feinberg et al., 2013).

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Although we found no reports of efforts to train TDSibs to manage problem behaviors of
ASDSibs, small scale studies show that TDSibs can shape social and adaptive behaviors,
that behavior changes are maintained, and that intervention effects spill over to affect
TDSibs’ evaluations of their sibling (Celiberti & Harris, 1993; Schreibman, O’Neil, &
Koegel, 1983; Shivers & Plavnick, 2015). A research direction is to determine whether
TDSibs’ efficacy in managing their ASDSibs’ aversive behaviors promotes their positive
sibling relationships and adjustment of both children. Because of their individualized focus,
behavior modification programs may be perceived as cost prohibitive. Yet, social skills

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training programs (Bierman, 2004; Greenberg & Kusche, 1992) and parent education
programs that target social reinforcement (Kazdin, 1997) have proven cost effective,
suggesting that these kinds of evidence-based curricula may be adapted to promote positive
TDSib-ASDSib behaviors.

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Also grounded in social learning theories is research showing that siblings affect one
another’s development through deviance training such as by reinforcing rule breaking and
risky behaviors (Bullock & Dishon, 2002). Because siblings spend considerable time
together in the absence of supervision, opportunities for sibling deviance training abound.
Parental exhortations that more mature siblings set a good example are commonplace in
family life, and the behaviors of siblings who take on caregiver roles can benefit from their
appreciation of the strength and implications of their influence. The SIBS program, for
example, included activities and messages about developmental differences between siblings
and the importance of older siblings’ recognition and appreciation of their roles as positive
models (Feinberg, et al., 2013). For higher functioning youths with ASD who struggle to
find a place in the peer group, TDSibs should recognize the serious negative implications of
serving as the gateway, even inadvertently, to risky activities, including sexual behaviors,
substance use and associations with deviant peers.

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Observational learning is another social learning mechanism invoked to explain sibling
influences. This research highlights sibling influences on risky behaviors (Brook, et al.,
1991), but some reveals sibling influences on positive development (Lam, et al., 2012). In
this line of work, sibling influences are inferred from findings that the behaviors of siblings
are positively correlated, controlling for the shared influence of parent characteristics. Social
learning tenets hold that individuals are more likely to imitate models who are high in status,
nurturant, and similar to the self (Bandura, 1977). Thus, younger siblings are more likely to
model their more mature sisters and brothers than the reverse, and modeling is more evident
in warmer sibling relationships and same-sex dyads (McHale et al., 2012).

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We know little about modeling processes involving TDSibs and ASDSibs. Shivers and
Plavnick (2015) identified only five studies--four with sample sizes of N = 3 or less--in
which TDSibs served as models to teach specific behaviors to ASDSibs in experimental
interventions. Effects were limited, particularly in efforts to promote task-related skills,
although one study found that play behaviors learned via sibling modeling generalized
beyond the sibling relationship (Reagon, Higbee, & Endicott, 2006). In these studies
ASDSibs were mostly young and lower functioning. Thus, research directions on TDSibs as
models include extending intervention efforts to higher functioning ASDSibs and to domains
wherein siblings may have specialized competencies, such as appearance, social skills and
peer relationships (Brewton, Nowell, Lasala, & Goin-Kochel, 2012). Also important is to
study the extent to which ASDSibs serve as models for TDSibs: ASDSibs’ difficult
behaviors may garner considerable time and attention from parents, making them a focus for
modeling, particularly by young TDSibs.
Another direction is to examine sibling relationships and modeling including the conditions
under which youths are more effective models and the implications of modeling for sibling
dynamics. Youths who recognize their role in their ASDSibs’ adjustment may develop

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feelings of warmth, a sense of efficacy, and inclinations for involvement over the longer term
(Ferrailoi, et al., 2012; Shivers & Plavnick, 2015). Some work shows that the socioemotional development of TDSibs is enhanced relative to youth with typically developing
siblings (Macks & Reeve, 2007; Verte et al., 2003), and observing sibling exchanges may
shed light on what TDSibs learn from their sibling experiences.

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Finally, from a broader family perspective, social learning mechanisms also come into play
in parental influences on sibling dynamics. For instance, reinforcement and modeling have
been invoked to explain links between supportive and conflictual behaviors in parent-child
relationships and corresponding behaviors in siblings, and in their marriage relationships,
parents may serve as role models for sibling interaction (Kim et al., 2006). Finally, some
research has have moved beyond a focus on dyadic parent-child relationships to study
parenting of the sibling dyad. Results from an experimental intervention, for example,
showed that parents shape their children’s social problem solving behaviors around sibling
conflict (Ross & Lazinsky, 2014). Social learning processes also may come into play in
findings that authoritarian parenting (threats, physical punishment) in response to sibling
conflicts is linked to more conflict and less warmth among typically developing siblings
(McHale et al., 2002).

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Most research on TDSib-ASDsib relationships is based on between group comparisons, with
those of typically developing dyads relative or those of youths with other kinds of
developmental disabilities. We know much less about factors that explain within-group
variations in the experiences of TDSib-ASDSib dyads. Although factors such as parents’
mental health, parenting stress, and social support have been studied as correlates, mediators
and moderators of the links between experiences with ASDSibs and TDSibs’ adjustment
(Hastings, 2003; Orsmond & Seltzer, 2009; Shivers et al., 2013; Sikora, Moran, Orlich, Hall,
Kovacs, Delahaye, Clemons, & Kuhlthau, 2013), we found no studies that investigated
parent-child relationship correlates of TDSib-ASDSib relationship behaviors. Further,
beyond research on parents’ differential treatment of siblings, discussed in the following
section, we found no studies of parenting directed at the TDSib-ASDSib dyad. Research on
how parents promote positive exchanges and involvement of TD and ASDSibs is sorely
needed. Finally, findings of links between marital stress and TDSIB-ASDSib relationship
quality (Rivers & Stoneman, 2003) were consistent with social learning tenets and research
on typically developing siblings, but more work is needed on the role of family dynamics in
TDS-ASDSib relationship behaviors.

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In sum, studies of TDSib-ADSib relationship positivity and negativity suggest that social
learning perspectives can be usefully applied in understanding sibling relationship behaviors.
Moving beyond description, a next step is to apply this knowledge, putting theory to the test
in prevention and intervention programs to promote positive involvement and reduce conflict
and negativity between siblings, and evaluating the effects of such interventions on the
adjustment and development of both TD and ASDSibs. Both siblings and parents may be
appropriate targets for intervention: Siblings may develop skills in managing their own and
modulating their siblings’ behaviors, and parents, strategies for parenting the sibling dyad.
Finally, it will be essential to consider the roles of siblings’ individual characteristics and the
implications of resources and stressors in the larger family context in efforts to promote

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positive sibling behaviors. In addition, drawing on concepts from other theoretical
perspectives may enhance the effectiveness of intervention efforts that target siblings’
behaviors. We turn next to a set of theories whose tenets may be usefully integrated into
such intervention efforts—those that focus on the role of emotion in sibling relationship
dynamics and influences.

Theoretical Perspectives on Emotion in Sibling Relationships

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Although emotions such as anger and warmth are expressed as overt behaviors during
siblings’ conflicts and positive exchanges, psychoanalytic/ethological theories hold that
emotions have deeper bio-psycho-social underpinnings. We focus here on feelings of rivalry
and security in the sibling relationship. Beginning with sibling rivalry, Adler’s theory of
Individual Psychology highlights its role in personality development and adjustment
(Ansbacher & Ansbacher, 1956). From this perspective, siblings have different experiences
based on their position in the family. Starting in childhood, youth strive against feelings of
inferiority that emerge, in part, based on how they are treated by parents –particularly how
they are treated relative to their siblings. Indeed, a body of work on typically developing
siblings documents links between parents’ differential treatment (PDT) and both sibling
relationships and youth adjustment. For example, controlling for their dyadic relationships
with mothers and fathers, youth who experience less parental warmth or more conflict
relative to their siblings exhibit less sibling warmth and more conflict, as well as more
depressive symptoms and risky behavior (Conger & Conger, 1994; Shanahan, et al., 2007).
In this way, feelings of rivalry and what Adler termed, the “style of life” that individuals
pursue to compensate for feelings of inferiority, are central to individual emotional
development as well as sibling and family dynamics. And, although their underlying feelings
may not be recognized or acknowledged, youth’s overt negativity toward a sibling may be
grounded in rivalry and jealousy that emerge when youth believe their siblings are favored
by parents. Building on Adlerian ideas, Schachter and Stone (1987) investigated sibling
deidentification processes whereby siblings differentiate from one another to establish a
unique identity and family niche and reduce sibling rivalry.

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Literature on emotion in TDSib-ASDSib relationships has touched on sibling rivalry in
discussing how the needs and concerns of the ASDSib may absorb family resources and
make demands on TDSibs for caregiving and other responsibilities. For example, youth with
ASDSibs and siblings with intellectual disabilities reported poorer relationship quality when
they believed their mother showed favoritism toward their siblings (McHale, et al., 1986).
Links between children’s dissatisfaction with mothers’ differential treatment and sibling
relationships also emerged in a study of children with ASDSibs (Rivers & Stoneman, 2008).
In another study that led to a line of research on moderators of PDT effects, mothers of
children with intellectual disabilities exhibited more PDT than did mothers of two typically
developing siblings--but PDT was less closely linked to sibling relationship and adjustment
problems in families of children with intellectual disabilities (McHale & Pawletko, 1992).
We concluded, and later research confirmed that when youth understand the reasons for PDT
and/or perceive it to be fair, PDT may no longer give rise to sibling relationship and
adjustment problems (Kowal & Kramer, 1998). Such findings qualify claims about the
inevitability of sibling rivalry and suggest a target for psycho-educational programs. For
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example, the SIBS curriculum includes activities aimed at helping siblings understand the
reasons why their parents treat them differently and that fairness does not always equate to
siblings being treated the same (Feinberg et al., 2013).

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Although they may sometimes foster rivalry, inborn drives also may motivate youth to treat
their siblings as sources of emotional security. Also grounded in an analytic/ethological
perspective that stresses the survival value of behavior, attachment theory holds that a central
task of development is establishment of emotional bonds (Hazan & Shaver, 1994). Children
with secure attachments trust in the sensitive responsiveness of attachment figures, and these
figures provide comfort in times of stress as well as a secure base from which children can
explore the world to become more autonomous. Attachment relationships develop with a
range of significant others, including siblings (Teti & Ablard, 1989). Also suggestive of
siblings’ role as sources of emotional security are findings that greater sibling warmth and
intimacy may emerge in families with more troubled marriages (Kim et al., 2006). Thus,
youth may turn to their siblings as sources of emotional support to compensate for problems
in other areas of their lives.

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Building on attachment theory, Cummings and Davies (1996) targeted emotional security as
fundamental to adjustment. The emotion security hypothesis goes beyond attachment
theory’s focus on innate drives, however, in conceptualizing emotional security as based in
systems-wide processes, ranging from the physiological (e.g., hormone-based arousal), to
the social-cognitive (e.g., emotion regulation), to the contextual—with a focus on family
stressors. Most research on the emotional security hypothesis examines children’s responses
to parents’ marital conflicts, but one, focused on youth who had siblings with disabilities,
found that these youth were more reactive to family conflict than those with typically
developing siblings: In response to vignettes describing family conflict, they reacted
strongly to even low levels of conflict, reported more emotional distress, and perceived more
threat and personal responsibility for conflicts than did youth with typically developing
siblings (Nixon, Cummings & Davies, 1999). The systems concepts underlying the emotion
security hypothesis may provide a foundation for future research on adjustment and family
relationships of TDSibs.

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We could find no research focused on attachment relationships between TD and ASDSibs.
Given TDSibs’ roles as caregivers and nurturers (Diener, Anderson, Wright, & Dunn, 2014),
and that this role may extend into adulthood (Hodapp & Urbano, 2007), siblings’ roles as
sources of emotional security may be an important research direction. Consistent with
family systems tenets, a shared history of family experiences, family routines and family
rituals may help to promote siblings as sources of emotional security because of their
connection to what is familiar and valued (Patterson, 2002). Most sibling research has
focused on the adjustment and sibling experiences of TDSibs, but we might also expect that
issues of felt security would be important for ASDSibs’ development. Thus, another
research direction is to explore TDSibs’ role as a secure base for their ASDSibs and source
of comfort in times of stress. Attachment theory and its offshoot, the emotional security
hypothesis, require measurement approaches that have not been used in prior research on
TD-ASDSib relationships, however. In addition to expanding on the measurement of
relationship experiences, longitudinal research is essential to determining how dimensions of

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emotion in sibling relationships play out over time and whether they provide a foundation
for siblings’ long-lasting involvement and well-being. Finally, integrating concepts
pertaining to sibling attachment into basic and translational research on TDSib-ASDSib
relationship behaviors is an essential next step, as is integrating theory and research in the
domains of cognition and involvement that we review in the following sections.

Theoretical Perspectives on Cognition in Sibling Relationships

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Social psychological theories highlight how cognitions, including attitudes, expectations,
and social comparisons that emerge in close relationships, have implications for close
relationships as well as individual well-being. From a cognitive developmental perspective
comes the additional idea that such processes are grounded in emerging cognitive abilities
that shape and set limits on social understanding. These ideas can provide a foundation for
research on developmental and individual differences in TDSib-ASDSib relationships and
potential directions for intervention programming. In this section, we begin with an
overview of a cognitive developmental approach to youth’s relationships, a perspective that
was the basis of early sibling relationship research (Dunn, 2007). We then consider
perspectives from social psychology, specifically, social comparison theory, equity and
social exchange theories, and the theory of planned behavior, which have been applied in
research on close relationships--though in keeping with their relative neglect in the
literature-- rarely to the study of siblings.
Social Cognitive Development

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Research on children’s social cognitive skills, highlights abilities such as emotion
understanding, perspective taking and social problem solving as key dimensions of social
competencies that are essential to satisfying interpersonal relationships. Although this
research focuses on peer social competence (Bierman, 2004), studies of sibling relationships
reveal that they also serve as a training ground for the development of social understanding:
In everyday life, children have strong motivation and substantial opportunity to try out and
practice social strategies on siblings—including those that help them get their way and
establish their status in the family, and that they can apply skills honed in the sibling
relationship in other close relationships (Dunn, 2007; Howe & Recchia, 2014).

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Observational research on young siblings reveals that mothers can promote siblings’ social
understanding: For example, mothers’ labeling of siblings’ emotions and explanations of
their perspectives were linked to more positive sibling relationships (Dunn, 2007). In middle
childhood, a parental “coaching involvement” style was associated with more positive
sibling relationships (Milevsky, Schlechter, & Machlev, 2011). And as noted, intervention
studies by Ross and colleagues documented that mothers can learn to be mediators of sibling
conflict: Compared to control group children, middle childhood-aged siblings whose parents
participated in sibling conflict mediation training were more likely to ask one another about
their feelings and develop plans to resolve conflicts and that conflict resolutions were more
likely to take younger siblings’ perspectives into account (Ross & Lazinsky, 2014).
Intervention programs for siblings also highlight social cognitive development, particularly
social understanding and emotion regulation. The More Fun with Sisters and Brothers
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Program, focused on 4–8 year old siblings, aimed to promote siblings’ social cognition
around emotion regulation, and evaluation data revealed that participation in the program
gave rise to more positive sibling relationships (Kennedy & Kramer, 2008). In the SIBS
intervention, siblings learned to recognize and label emotions, including feelings of jealousy
in themselves and their siblings, to calm down when experiencing negative emotions, to
explain their points of view and listen to their siblings’, and to problem solve with their
siblings toward “win-win” solutions of sibling disagreements (Feinberg et al., 2013). At
post-test, children in the intervention showed higher levels of teacher-rated social
competence relative to controls, consistent with the idea that sibling relationships can serve
as a tr...

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