Managing Life with Autistic Children
By Charles H Geneslaw, MD
January 03, 2018
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Managing life with autistic children often tests the abilities of even the heartiest of people.  Daily schedules taken for granted by the rest of us requires persistence, patience, and planning by them.  Let’s touch briefly on issues facing siblings of autistic children.

Firstly, there are medical and mental health considerations.  While specific molecular causes of “non-syndromic” autism( i.e, not associated with some described medical/genetic condition) is uncommon, siblings have approximately 20x greater likelihood of having autism themselves (for identical twins almost 50/50).  Curiously, an older autistic sister appears a greater association than brothers.  Also note that autism is associated with “co-morbidities” like ADHD, anxiety, learning disorders and intellectual impairment, all having a tendency towards familial association.  So siblings themselves should be carefully monitored.  Considering the above, by far still the most common occurrence between 2 siblings is for one to be affected and the other unaffected.  So please keep that in mind.

The other aspect to touch upon are coping skills for the sibling.  The autistic child is going to require more attention and effort by the parent; there is no way around that.  It's so important to not allow others to be “lost in the mix.”  This is a complex situation depending on many parameters like the degree of disability in the involved child, sibling number and birth order, temperament of all living in the home, marital status and nuclear and extended family dynamics, community and school types, and parental physical and mental health(studies suggest greater influence from the mother’s status here).

There are a variety of difficulties for children living with an autistic sibling: anger, resentment, fear, embarrassment, loss, isolation.  Normal childhood play and sibling rivalry can become troubled.  Siblings can struggle with interpersonal relationships, school functioning, and use of leisure time, as well as perceived or real expectations to assume more adult caretaker roles not typically assigned to the youth of their age.

Happily, as is often the case, there can be an “upside.” Many of these kids can develop greater empathy, earlier and deeper maturity, and stronger coping skills from their home experience. Children who have a greater understanding of their sibling’s disability and receive positive reinforcement from parents and peers in their interactions with their siblings can do very well.  This can be aided by honest, open, age-appropriate communication, endeavoring to develop and maintain “normal” family life activities (restaurants, sports, vacations), providing individual and undivided parental attention(“quality time”) and “safe space” for the sibling(including toys and possessions), as well as helping that child through periods of loneliness or isolation and developing strategies to address questions and comments from peers. Counseling can be beneficial with the last 2.  As always, these can all become more fraught during adolescence.

Being proactive about siblings’ physical and mental health is a foundation for all of the above, so please give me a call.  I’m here to help.

Some of the information presented here was detailed in Pediatric News by Dr. Jeremiah Dickerson of the University of Vermont and from Indiana University’s Resource Center for Autism.  I am grateful to those sources.