Prabhjot Kaur*
Max Super Specialty Hospital, Saket, New Delhi, India
Received date: 26/10/2016 Accepted date: 27/10/2016 Published date: 05/11/2016
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Autism Spectrum Disorder [ASD] has been associated with disturbances in communication, socialization, and behavior. These children are limited in their skill to form peer relationships, limited in academics, and unable to manage their daily activities on their own. Siblings, being the ones with whom children with ASD have the first and most important relationship, have a significant impact on the social and play behavior of these children and may prove to be the social agents through which ASD children progress.
Austism, Spectrum disorder, Sibling effect, Social skills, Social development.
Autism is the prototypical form of a spectrum of related, complex, neuro-developmental disorders referred to as autism spectrum disorders (ASD), also known as pervasive developmental disorders (PDD). It is characterized by atypical development in socialization, communication and behavior [1].
ASD are strongly biased towards males with a male to female ratio of 4:1 for classic autism [2]. Precise etiology of ASD remains unknown. Recent studies suggest the programming effects on the developing offspring, resulting from stressful experiences, maternal diet and infections, advanced parental age, prematurity, and low birth weight – to name a few - might act through epigenetic mechanisms resulting in critical determinants of disease predisposition [3].
Children with ASD are unable to interpret the thoughts and feelings of others or predict social events. They have difficulties initiating interactions, responding to others and maintaining conversation. They show deficits in listening and responding to others’ requests and in cooperating in games and other activities [4].
Impaired social skills lead to rejection and non-acceptance by friends, peers, adults and to loneliness and isolation. These, in turn, lead to weak academic progress, social failure, anxiety, depression, abuse, obstacles to social relationships and social isolation [5].
For families with children with ASD, the sibling relationship can be the first and most intense peer relationship [6]. Stalker and Connors found higher level of empathy and patience in siblings of children with ASD compared to siblings of children with other disabilities. It was found that contextual factors such as knowledge about child’s disabilities and coping styles influence relationship among siblings [7].
Families with more members are able to share the responsibility of care for the child with ASD. In such families, sibling relationships represent warm relationship and a tendency of the sibling to teach social skills to the child with ASD through play. This further improves not only the social, but play skills of the child which are impaired in ASD as well [8-10]. However, a few studies have also found negative impact of sibling relationship such as feelings of embarrassment and jealousy of the parents focus their attention more on the ASD child [11].
Smith and Hart stated that sibling relationships play a significant role in the development of children’s understanding of the emotions and thoughts of others [8]. Dewey et al. [9] reported that positive sibling relationships can be an important source of social development and self-worth. Also, El-Ghoroury and Romanczky reported that siblings are important social agents for children with ASD [12].
A study conducted by Perner et al. concluded that pretend play improved in ASD children with more siblings. Also, older siblings tend to have a better effect as they engage in pretend play more often. Sibling relationships in autistic children are marked by less pro-social behavior and less quarrelling and competition. However, this also implies fewer positive interactions and fewer opportunities to negotiate disputes [13]. Cassidy et al. studied effects of gender in siblings of autistic children and found that children with at least one opposite gender sibling performed better than children with only same-gender siblings [14].
The ASD impairments of social interaction, communication and behavior tend to become less severe over time. It may lead to improved sibling relationships over time. The more persistent the siblings are in their efforts, the better social skill improvement in ASD children [15,16].
Evidence supports improvement of social skills in ASD children with social skills training. Peer relationships have also been studied in detail. However, literature is scarce on how presence of a sibling may influence the child in terms of communication, social behavior as well as play skills. Therefore, there is a need to study the relationship of siblings as a source of enhancement towards a better quality of life for ASD children.
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