Autism's Collateral Effects: How Are Siblings Affected?

Dear Mr.R,
We have chosen this topic because we feel that it's very important for one to gain knowledge and understanding about Autism Spectrum Disorder's (ASD) invisible victims, that is the siblings of autistic individuals. In addition, we also provide information about the effects of autism on parents and on family units as a whole. We would like to thank you for choosing Group 93 to provide you with further research for your article. Being researchers, we have learned a great deal of information about this topic and we are hoping that our research can contribute to your understanding of the topic.
-N'ttendre, Cassandra, Avdeep, Arvinder & Michele

Autism

What is Autism?

Autism is a spectrum of closely related disorders with a shared core of symptoms. Autism Spectrum Disorders (ASD) appears in infancy and early childhood, causing delays in many basic areas of development such as learning to talk, play, and interact with others.

Autism is a complex disorder that usually affects a person’s capability to communicate, form relationships and respond to their environment. People who suffer from Autism normally have difficulties communicating, learning and social skills. Autism Spectrum Disorder (ASD) refers to the wide description of Autism, which includes Pervasive Developmental Disorder (PDD), Rett’s Syndrome, Asperser’s Syndrome, and Childhood Disintegrative Disorder (Geneva Centre for Autism, 2013).

The signs and symptoms of Autism vary widely, as do its effects. Some Autistic children have only mild impairments, while others have more obstacles to overcome. However, every child on the Autism Spectrum has problems, at least to some degree, in the following three areas:
Social Interaction- Communicating verbally and non-verbally (American Academy of Pediatrics, 2013)
• Relating to others and the world around them
Certain Behaviours- Thinking and behaving flexibly (American Academy of Pediatrics, 2013)

Signs

Three major early signs of ASD to notice if you think your child has developed autism. The first is to observe if there is a lack of social interaction between your child, yourself and others. Examples of this would be no eye contact, little interaction and playing with others (Anderson Live, 2012). Another sign is limited communication, for instance if your child's vocabulary is decreasing and if they are not using single words, less sounds and do not continue to apply and think as other children their age would do (Anderson Live, 2012). Lastly, an additional sign to look for is to see if your child shows abnormal behaviours like hand flapping (which is very common amongst Autistic children), doesn't follow your movements or facial expressions, or if your child doesn't follow objects visually. These however are only a few of many early signs of Autism Spectrum Disorder (Anderson Live, 2012).

Causes

Until recently, most scientists believed that Autism Spectrum Disorder is caused mostly by genetic factors. But groundbreaking new research indicates that environmental factors may be just as important in the development of autism—if not more so—than genes.
It appears that certain babies are born with a genetic vulnerability to Autism that is then triggered by something in the external environment, either while he or she is still in the womb or sometime after birth.
It’s important to keep in mind that the environment, in this context, means anything outside the body. It’s not limited to things like pollution or toxins in the atmosphere. In fact, one of the most important environments appears to be the prenatal environment.

Impact of Autism on Siblings

Sources of Stress for Siblings

Goehner, A. L. (2007, Monday December 24, 2007). Autistic kids: The sibling problem. Time Magazine,1-3.

This article is organized in a way that provide readers with challenges siblings have growing up with an autistic brother or sister and then the corresponding solutions to cope with these challenges. The development process of siblings of autistic individuals is atypical and abnormal from others. Though there are positive aspects to it, there are also various emotional issues siblings face early on.

There are several challenges this article covers that play a vital role in the development of siblings. The first challenge is children having social interactions with their autistic sibling. Because of the social impairment in people with ASD, they are not able to reciprocate and communicate as effectively. To a young child this may seem undoubtedly difficult to understand especially during playtime.

Another challenge is receiving less attention from caregivers. Since parents spend an immense amount of time looking after and catering to the autistic child, siblings often feel comparatively less important. Children will, especially at a young age, view this as unjust and unfair that they are constantly being overshadowed by their autistic sibling.

Fear is the another challenge siblings experience. Some autistic individuals will display aggressive behaviours which in turn can frighten their siblings . Subsequently, the feelings of embarrassment may occur often as well.

Siblings share much of their time together and can eventually develop a sense of responsibility. However, this feeling is amplified in siblings with autistic children since it requires more effort, care and attention on their part. This type of responsibility at a very young age can become a burden and come with high levels of stress. What is more is that in adulthood, siblings eventually “take on the role of guardian and advocate” (Goehner, 2007, pg 1).

On top of all these challenges is experiencing guilt afterwards for having these feelings. This article is informative in listing the many emotional challenges siblings of autistic people face. This gives readers the understanding of the vastly different set of obstacles they faced compared to “normal” siblings growing up.

(Coping solutions will be discussed in the “Coping Strategies” heading).

Cain, B. (2012, November 30). Time.com. Ideas Autisms Invisible Victims The Siblings Comments. Retrieved March 6, 2014, from http://ideas.time.com/2012/11/30/autisms-invisible-victims-the-siblings/

This article, written by Barbara Cain explores the complicated relationship between siblings of children with autistic disorders and the collateral effects of autism. Over the course of five years, Cain, a clinical psychologist, conducted in-depth interviews with thirty-five children who had autistic siblings. Through narrative stories told by these children, she gathered rich qualitative information that exposed similar experiences, feelings and emotions shared by individuals that “[grew] up with a parent or sibling with a chronic, debilitating disease.” (Cain, 2012) One of the common themes of the stories was the incredible responsibility and devotion these children had towards their autistic sibling. As a result many of them sacrificed their own aspirations in order to stay close and provide care for their autistic sibling. Consequently, these siblings, who are often overshadowed by a disabled sibling, were inclined to mature beyond their years. Overall Cain’s interviews reveal that not only is autism a health crisis but it is also a family crisis which impacts every member in the family. This article is beneficial for a researcher who feel that is an important to uncover how autism spills over into the personal lives of siblings from an early age. 

Balancing Relationships Between Siblings

American Academy of Pediatrics (2013, July 8). Siblnigs of children with autism spectrum disorders. Retrieved from http://www.healthychildren.org/English/health-issues/conditions/developmental-disabilities/pages/Siblings-of-Children-with-Autism-Spectrum-Disorders.aspx

Raising a child with Autism places some extraordinary demands on parents as individuals and on the family as a whole. Prime among these demands is the lack of enough hours in the day to do all one wishes. Specifically, the time involved in meeting the needs of a family member with Autism may leave parents with little time for their other children.

Many parents feel that even as they do all they can for their child with Autism, they are always struggling with how best to respond to the needs of the family as a whole. They say that although their own life as an individual may be put "on hold" and a couple may share an understanding of the need to make sacrifices on behalf of their child with Autism, few parents are willing to make that same demand of other children in the family. As a result, there is a continual tension between the needs of the child with Autism and those of the other children.

When it comes to balancing time between your Autistic child and their siblings you have to share the attention. If not, there can be a negative impact on the siblings life especially younger siblings. For instance younger siblings may get frightened and think they are a target and can easily get jealous (American Academy of Pediatrics , 2013). Additionally, with adolescent siblings their relationship with Autistic sibling may make them worry, increase stress due to their roles in assisting parents in caring (American Academy of Pediatrics , 2013). Overall, all these can make siblings of Autistic children frustrated create sibling rivalry and lessen relationship amongst the children in your family (American Academy of Pediatrics , 2013).

AutismMediaChannel. (2012, February 1). Being an Autism Sibling. YouTube. Retrieved April 2, 2014, from https://www.youtube.com/watch?v=LsJBhuyq6zQ.

Winfrey, O. (2012, October 3). Oprah Winfrey Show - April 5, 2007 - Segment on Autism & Siblings, featuring Andrew Marshall. YouTube. Retrieved April 1, 2014, from https://www.youtube.com/watch?v=-hKvDDjVfUI&list=WLv15k1LdXrAALPk7xeJgwjG.

The videos above are interviews and testimonies from young siblings of autistic persons that recount many of the feelings and challenges they face on a daily basis. Their accounts have reoccurring themes of neglect and unequal attention from caregivers; embarrassment in public situations, and frustration from emotionally unavailable autistic sibling(s). The AutismMediaChannel video published in 2012 does a good job of depicting the similarities of experiences siblings of autistic persons face through group discussions. All these are vital source are rich qualitative data that provide audiences, straight from the source, with what it is like to grow up with someone suffering from ASD.

Effect on Sibling Development

Terms:

  • infant screening: tests of infants, generally under the age of 2 months, to screen for severe diseases most of which are genetic. Certain biomarkers are associated with particular diseases such as ASD (Mizejewski, Lindau-Shepard & Pass, 2013, pg 503) and can be identified during the screening process.
  • genetic counselling: “is a health care service aimed at helping individuals and families understand the science of genetics and how it may relate to them. Counsellors are health professionals with specialized education, training, and experience in medical genetics and counselling. They work with people who may have an increased chance of having a child with an inherited condition or with a birth difference or defect. They provide information that helps families make personal decisions about pregnancy, child care and genetic testing” (Mount Sinai Hospital Joseph &Wolf Lebovic Health Complex, 2013).

Ozonoff, S. (2011). Recurrence Risk for Autism Spectrum Disorders: A Baby Siblings Research Consortium Study. Paediatrics: Official Journal of the American Academy of Paediatrics, 128(3), 10. Retrieved February 20, 2014, from http://pediatrics.aappublications.org/content/early/2011/08/11/peds.2010-2825.abstract.

This scientific research paper summarizes the findings of the recurrence risk of autism spectrum disorders (ASD) in families, more specifically in children of affected siblings. Researchers conducted a longitudinal study of 664 infants with older biological siblings that have ASD. These infants were followed for 36 months and then they were diagnosed by an expert clinician as having or not having ASD. The results revealed that 18.7% of the infants developed ASD. Not only that but the greater the number of affected older siblings, the greater the risk the infants have of having ASD. 

Besides the number of affected older siblings the study also unearthed gender of the infant to be a predictor of ASD. In fact, approximately 80% of autistic individuals are male and so researchers found that there was an expected increase in risk of ASD if the infant was male. 

Before this study, there were previous estimates of the sibling recurrence rate being between 3% and 14%. This study proved that not only was this inaccurate and misguiding but that infants with older autistic siblings were at a substantially greater risk of having ASD themselves. This article’s findings reflect “the [importance] for infant screening and genetic counselling” (Ozonoff et al., 2011, pg 7) that parents should be aware of to be better prepared for future children. 

Resources That Are Available for Your Child

Helping Your Child

Once you discover your child may have a developmental delay, it's important to get help. Even before a formal diagnosis of Autism is made, your child can begin early intervention to address language and other delays. Some parental guidelines on learning about their Autistic child is to first do personal research to gather additional information and background about Autism to better understand your child. By gaining personal knowledge about your child’s disorder, it would assist you to notice any first warning signs your child is experience (American Academy of Pediatrics, 2013). By further educating yourself it helps you to provide a correct structure for your child in terms of rewards, punishments and safety (American Academy of Pediatrics, 2013). Moreover, giving your child a comfortable, caring and loving environment, will strengthen and facilitate more communication and a closer relationship between you both. This will also allow your child to be more comfortable and will help you notice your child's strengths, weaknesses and what you may need to improve on. Unfortunately, treatment can be expensive and often is not reimbursed by insurance companies. However, through researching you can find assistance such as federally funded grants that cover the costs of Autism services or research studies that diagnose, evaluate, and treat kids with Autism.

To find out what's available to your child, contact:
•Your doctor or health care system
•Your township or county department
•Health and education departments
•Churches and other charitable organizations
•Local chapters of autism advocacy groups, discussion meetings (like Autism Speaks)
•Your Country/Province's Government Website for additional support

Unfortunately there is no actual treatment to cure ASD or lessen the symptoms. However there are some medications that can help children with Autism Spectrum function better and more efficiently. For instance, medication can help to control focus abilities, seizures and depression. To keep in mind, not all medications works the same for every child; as parents you need to consult with your family physician to find out what best would work for your child in order to get the results. It is always recommend to have your child get regular checkups with your family physician when using a new medication to make sure your child is receiving the results the medication is suppose to help with. There are many different types of treatments offered for children who experience ASD (Centers for Disease Control and Prevention, 2014).

Treatments are broken down into 4 main categories, which are:

Behaviour and Communication Approaches (Centers for Disease Control and Prevention, 2014)
Dietary Approaches (Centers for Disease Control and Prevention, 2014)
Medication (Centers for Disease Control and Prevention, 2014)
Complementary and Alternative Medicine (Centers for Disease Control and Prevention, 2014)

Behaviour and Communication Approaches

A common treatment for children who experience ASD is called Applied Behaviour Analysis (ABA). This approach has been used by many health care professionals and in schools as well to help people with Autism. It encourages positive behaviour to help improve children’s skills. However there are different types of ABAs available and as parents; it’s best to find out which approach is best for your child and your family (Centers for Disease Control and Prevention, 2014).

Some types of Applied Behaviour Analysis are:

Discrete Trial Training (DTT) – In this training, each step is separated into trials to help teach child the desired behaviour. (Centers for Disease Control and Prevention, 2014)
Pivotal Response Training (PRT) – In this training, the aim is to increase the child’s motivation to learn, ability to communicate with others and to observe their own behaviour. (Centers for Disease Control and Prevention, 2014)
Verbal Behaviour Intervention (VBI) – This type of training is to aid in improving the child’s verbal skills. (Centers for Disease Control and Prevention, 2014)

There are many therapies available for children who experience ABA; the most common one is Developmental, Individual Differences, Relationship- Based Approach (DIR), which is also called “Floortime”. This therapy is focused on relationship (relationship with family, caregivers) and emotional (feelings) developments. This therapy also focuses on the child’s ability to cope with their smells, sounds and sight (Centers for Disease Control and Prevention, 2014).

Dietary Approaches

For dietary approaches, this is mainly aimed at what the child eats and how it can relate to their actions and behaviours. So by removing or adding a certain type of food can cause them to react a certain way. Foods recommend for children with ASD are vitamin enriched foods. Find out what your child lacks in vitamins and minerals. It’s best to talk to your doctor or a nutritionist about this and plan a dietary menu for your child (Centers for Disease Control and Prevention, 2014).

Medication

As mentioned there isn’t a medicine that can cure ASD or the main symptoms. Although there are medications that are available to help control your child’s energy level, seizures or depression (Centers for Disease Control and Prevention, 2014).

Complementary and Alternative Treatments

To help with symptoms, many families and health care professionals use treatments that are outside of what pediatricians normally suggest. These additional treatments are referred to Complementary and Alternative Treatments (CAM). Examples of this may be special diets, chelation (a treatment to remove heavy metals from the body, such as lead), or body-based systems (such as deep pressure). These examples are treatments are very debatable and not everyone would agree with accepting them for their child. Before considering these treatments, check with a health care professional to have back up information (Centers for Disease Control and Prevention, 2014).

Coping Strategies

Terms:

  • developing children: non-autistic siblings

For some parents, the attempt to cope or deal with such a condition within the household can be very challenging; however there are plenty of studies that prove coping with this can be made easier. It can be extremely frustrating at first, but once you found some ideas and solutions that can help your family and yourself, it can become easier. One coping strategy that is recommended is to first have open discussions; not only with your children but with your partner as well. These open discussions are more helpful when the entire family is included; in this way everyone will have the same opportunity to express them self and anything they have on their mind. These discussions can help the parents and siblings because it will provide the parents ideas on what their children are thinking and for your partner it will aid in what you both can work on together. As for yourself as a parent, it also allows to speak and express yourself as well; by placing things out there in the open would allow others to know what area needs more help and what doesn’t (American Academy of Pediatrics , 2013).

Having more than one child can be difficult at times, how ever having a child with Autism and having other children can be more difficult. Parents can feel guilty and confused because they don’t know if they are being good parents and how to treat their children. For parents there are many challenges they face when dealing with their Autistic child and their siblings. What is recommended is that they should explain to their children what Autism Spectrum Disorder (ASD) is and that their sibling may act differently. There are ways to explain to your child(ren) what Autism is, such as finding out what they don’t about the disorder first and then further explaining what it is (Raising Children Network, 2013).

Some children adjust well to their sibling and once they know what the disorder is and more information about it, they turn out to be okay with it and become more comfortable. They may develop a special kind of bond with their sibling and feel angry when others bully their sibling or be mean to them. However some children don’t cope as well and turn out to become jealous and feel neglected. These children who feel this way may become jealous because of the time amount that their parents spend with their autistic children; they may become embarrassed because of their sibling and could possibly bullied because of their sibling as well (Raising Children Network, 2013).

Parents may feel guilty for not being able to spend time with their other child since their time is so consumed and spent with their autistic child. Parents need to realize that their other children also will feel loved when they receive the same attention and positive attitude that their autistic child need. Some tips for parents are to make special time for their other children to bond and make them feel loved and close. Parents should try to encourage a close relationship, be fair and find outside support if needed in order to encourage the child to talk and be open in these discussions (American Academy of Pediatrics , 2013). When making special time for children, include favourite activities that they enjoy like swimming, bed time stories or just talking each day (Raising Children Network, 2013).

Coping Strategies for Parents

Altiere, M., & Kluge, S. (2009). Family functioning and coping behaviors in parents of children with autism. Journal of Child and Family Studies, 18(1), 83-92. doi:10.1007/s10826-008-9209-y.

This article analyzed family dynamics and coping behaviors of parents of a child with an autistic spectrum disorder. It is suggested that moderate levels of cohesion and adaptability yield positive coping, and that the more coping strategies a family implements, the better the family functions. The method used was a family system’s approach where the relationships are measured by the variables of cohesion, adaptability, social support, and how they assisted in positive family functioning. They found that a more collaborative approach to coping assists the family better in extreme challenges. This article would be useful because the research uses a mixture of interpretive causal and effect approaches to parental perspective on how best to cope in extreme conditions.

Tarter, L. (2012). Family functioning and coping styles: A Parent’s perspective of raising a child with autism. (Psy.D, Alliant international School of Psychology).1-177.

The study wants to examine the coping styles of parents who have an autistic child or children and how these focuses affect their overall family function. The methods used are WAYS and FAD family assessment devices. The three main coping styles parents have are Emotion-Focused, Cognitive Problem Solving, and Avoidant Coping. With emotion-focused coping, parent(s) regulate emotions by blaming other or taking too much responsibility to deal with their autistic child than seeking help from a spouse, relative or outside source. Secondly, cognitive problem solving is where a parent may try something productive to reduce the stress that comes with an autistic child; such things could be hobbies, exercising etc. Lastly, avoidant coping is where the parent isolates themselves physically and emotionally from their stressful situation that may come with raising an autistic child; for example, the parents taking a vacation with their spouse or date night away from the kids. This study will be a useful source as it explains the types of coping mechanisms that some parents may experience.

Coping Strategies for Siblings

Rivers, J. W., & Stoneman, Z. (2008). Child temperaments, differential parenting, and the sibling relationships of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 38(9), 1740-1750. doi:http://dx.doi.org/10.1007/s10803-008-0560-z

In this study measurements made of the association between sibling temperaments and differential parenting and the quality of relationships between autistic children and their developing siblings. In the study they gathered 50 families with autistic children around from ages 4-12 and their developing siblings ages 7-12. These families were given questionnaires; one for the parent and another for siblings. This study is important to your research because it uses tools to gather data about the treatment of developing siblings differently than their autistic sibling based on the parent’s attention to both. The article gives insight on how much differential parenting affects siblings and provides recommendations on what type of coping or parental styles works best to have a positive functioning family.

Goehner, A. L. (2007, Monday December 24, 2007). Autistic kids: The sibling problem. Time Magazine,1-3.

The 3 paged article from TIME Magazine gives insight on real life interviews of families with developing siblings and autistic children. The article shares various challenges of both parents and developing siblings. Using sub heading such as "I am embarrassed!" Many developing siblings can get embarssed by the actions of their autistic brother or sister, but a way that siblings cope with these embarrasing moments is by being honest to their friends. Many would explain,"'Yes, that's my brother/ sister. He/she has special needs. Do you have any questions?"(42 Goehner,Amy Lennard 2007). I believe this article can assist in showing some things that siblings do to cope, and show that not all siblings are jealous or embarrased of their autistic brother or sister. This article is useful because it gives various perspective on sibling coping.

Some other coping strategies are to find help and support. There are many support systems out there for families who have Autistic children or face Autism challenges on daily base. Struggling with Autism on an everyday base can be extremely frustrating, difficult and overwhelming; but NEVER give up. There are always supports out there for families and for you. Parents may not know it but there are many places that offer families support, a helping hand and advice; one example is Autism support groups; where families who face ASD come together and meet others who experience similar events in their lives (Smith, Segal & Hutman, 2013). These groups allow families to share their experience, tips and advice to others who need it, especially to new families. There may also be respite care; this type of care allows families to take a break from dealing with Autism (Smith, Segal & Hutman, 2013). Parents can take their Autistic child to one of these resources and another care giver can take care of your child, while you take a break (Smith, Segal & Hutman, 2013). There are also counselling groups for families, where you can have open discussions as well (Smith, Segal & Hutman, 2013). Lastly, there are Free Government services for families who have Autistic children (Smith, Segal & Hutman, 2013). These services may provide a monthly fee to help with financial areas. And also special education services to help your children as well with their skills (Smith, Segal & Hutman, 2013).

State Public Broadcasting. (2010, November 19). Autism and Sibling Relationships. YouTube. Retrieved April 2, 2014, from https://www.youtube.com/watch?v=O4D7kXC-wVY&list=WLv15k1LdXrAALPk7xeJgwjGEDaGfU.

This source discussed the many coping strategies that are geared towards children with an autistic sibling. Through various interactions with families dealing with autism, a clinical psychologist by the name of David Celiberti, proposes these strategies. Celiberti discouraged informing young children the complexity of autism and why their sibling(s) is not “normal”. Instead he suggests teaching a common ground on which children can interact with their sibling. For example, not touching them. Moreover, Celeberti believes that early intervention should not be exclusively focused on the autistic child but should include siblings as well. This reduces feelings of isolation and jealously through inclusion. In particular, play therapy is a critical approach that encourages relationship building and connection. This source is critical in understanding how families can include siblings early on to build cohesiveness and a stronger sibling bond. These strategies prevent, or at least reduce, feelings of neglect in siblings.

Wood Rivers, J. (1998). Siblings relationships when a child has autism. (Master's thesis, The University of Georgia, Athens, Georgia, Georgia, United States).

This article explicitly studies the relationships between siblings of an autistic child and the challenges that come along with it as well as the quality of the relationship that they share. This study examines the correlation between siblings relationships and marital stress in a family household. It stresses the difficulty that comes from attempting to cope with having a sibling that is autistic and different ways families try to cope with this. It notes that there are very few studies on the relationships of children with siblings who were diagnosed with autism, and that most generally focus on the negative reactions that children have their sibling has a disability. However, this study reveals that children cope quite well with siblings that are diagnosed with autism.

Higgins J., D. (2005). Factors associated with functioning style and coping strategies of families with a child with an autism spectrum disorder. Manuscript submitted for publication, Deakin University, Deakin University, Australia, Deakin, Australia.

This study was conducted to further investigate the stress that is assumed to be brought on in a household from parenting and being a sibling of an autistic child. It draws the conclusion from its studies that having a child that suffers from ASD in the household adds stress to the marriage, and can add stress to finances and family time spent together. Studies on coping strategies were conducted (multiple regression analyses were used) and what was found was that marital happiness, family cohesion, family adaptability, and self esteem was not improved very much from coping strategies.

References

Altiere, M., & Kluge, S. (2009). Family functioning and coping behaviors in parents of children with autism. Journal of Child and Family Studies, 18(1), 83-92. doi:10.1007/s10826-008-9209-y.

American Academy of Pediatrics (2013, July 8). Siblnigs of children with autism spectrum disorders. Retrieved from http://www.healthychildren.org/English/health-issues/conditions/developmental-disabilities/pages/Siblings-of-Children-with-Autism-Spectrum-Disorders.aspx.

Anderson Live. (2012). Dr. levine outlines 11 signs of autism [Web- Youtube video]. Retrieved from http://www.youtube.com/watch?v=r8clNVwg9pY.

AutismMediaChannel. (2012, February 1). Being an Autism Sibling. YouTube. Retrieved April 2, 2014, from https://www.youtube.com/watch?v=LsJBhuyq6zQ.

Cain, B. (2012, November 30). Time.com. Ideas Autisms Invisible Victims The Siblings Comments. Retrieved March 6, 2014, from http://ideas.time.com/2012/11/30/autisms-invisible-victims-the-siblings/.

Centers for Disease Control and Prevention. (2014, March 13). Autism Spectrum Disorder (ASD) Treatment. Retrieved from http://www.cdc.gov/ncbddd/autism/treatment.html.

Definition of Newborn screening. (2013, August 28). Medterms. Retrieved March 12, 2014, from http://www.medterms.com/script/main/art.asp?articlekey=4564.

Geneva Centre for Autism. (2013). What are autism spectrum disorders?. Retrieved from http://www.autism.net/resources/about-autism/40-what-are-autism-spectrum-disorders.html.

Goehner, A. L. (2007, Monday December 24, 2007). Autistic kids: The sibling problem. Time Magazine,1-3.

Higgins J., D. (2005). Factors associated with functioning style and coping strategies of families with a child with an autism spectrum disorder. Manuscript submitted for publication, Deakin University, Deakin University, Australia, Deakin, Australia.

Mizejewski, G., Lindau-Shepard, B., & Pass, K. (2013). Newborn screening for autism: in search of candidate biomarkers. Biomarkers in Medicine, 6(4), 503-506. Retrieved February 12, 2014, from http://www.futuremedicine.com/doi/abs/10.2217/bmm.12.108?journalCode=bmm.

Ozonoff, S. (2011). Recurrence Risk for Autism Spectrum Disorders: A Baby Siblings Research Consortium Study. Paediatrics: Official Journal of the American Academy of Paediatrics, 128(3), 10. Retrieved February 20, 2014, from http://pediatrics.aappublications.org/content/early/2011/08/11/peds.2010-2825.abstract.

Rivers, J. W., & Stoneman, Z. (2008). Child temperaments, differential parenting, and the sibling relationships of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 38(9), 1740-1750. doi:http://dx.doi.org/10.1007/s10803-008-0560-z.

Raising Children Network. (2013, November 20). Helping siblings of children with autism spectrum disorder. Retrieved from http://raisingchildren.net.au/articles/autism_spectrum_disorder_siblings.html.

Tarter, L. (2012). Family functioning and coping styles: A Parent’s perspective of raising a child with autism. (Psy.D, Alliant international School of Psychology).1-177.

Smith, M., Segal, J., & Hutman, T. (2013, December). Helping children with autism: Treatment strategies and parenting tips. Retrieved from http://www.helpguide.org/mental/autism_help.htm.

State Public Broadcasting. (2010, November 19). Autism and Sibling Relationships. YouTube. Retrieved April 2, 2014, from https://www.youtube.com/watch?v=O4D7kXC-wVY&list=WLv15k1LdXrAALPk7xeJgwjGEDaGfU.

Winfrey, O. (2012, October 3). Oprah Winfrey Show - April 5, 2007 - Segment on Autism & Siblings, featuring Andrew Marshall. YouTube. Retrieved April 1, 2014, from https://www.youtube.com/watch?v=-hKvDDjVfUI&list=WLv15k1LdXrAALPk7xeJgwjG.

Wood Rivers, J. (1998). Siblings relationships when a child has autism. (Master's thesis, The University of Georgia, Athens, Georgia, Georgia, United States).

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