Resilience and vulnerability in siblings of children with chronic illness or disability

The focus of this research is the stress placed on a child when a sibling in the family has a chronic illness or disability, and analysis of what factors may buffer this stress and be associated with well child resilience in the face of family illness. Several major studies from other countries (Cadman, Boyle, & Offord, 1988; Houtzager, Grootenhuis, Caron & Last, 2005; Laufersweiler-Plass, Rudnik-Schoneborn, Zerres, Backes, Lehmkuhl & von Gontart, 2003; Sharpe & Rossiter, 2002; Williams, Williams, Graff, Hanson et al., 2002) suggest that there may be deleterious outcomes for well children in such families, for example higher rates of anxiety, depression, aggressive behaviour and rule breaking behaviour. However there is a lack of clarity about the processes which lead to these negative outcomes. The current study had two major research aims. The first was to describe social, family and personal characteristics of a group of well children with siblings who have a chronic illness or disability. The second aim was to examine relationships between adjustment problems in these well children and factors relating to the family (income, number of children in family, respite availability and utilisation), parents (stress, parenting style, maternal education, access to support) and children (ill child behaviour, amount of care required, well child age, well and ill child participation in social activities). Adjustment in well-children (n=102) was assessed using child self report, child projective and parent rating measures. Parents rated well children with ill siblings as significantly higher in externalising and internalising behaviour than age and gender matched population norms. Children did not rate their behaviour problems higher than norms but did indicate quite high rates of emotional problems on a projective (drawing) test. Parent-rated behaviours of well children were associated with parental, family and ill child variables, including (high) parental stress (daily hassles), (low) family income and (high) ill child internalising and externalising behaviours. Relationships between the well child's perception of having a sibling with a chronic illness or disability and various parent, child and family variables were also explored. Well children who listed more negative (than positive) attributes about having a sibling with a chronic illness were more aggressive and rule breaking in their behaviour. Well children with emotional problems, as assessed by the child family drawings, did not differ significantly from children without emotional problems in any of the parent, child or family variables however both the emotional problems index and the use of scribble drawings were associated with several measures of well child maladjustment. The results were discussed in terms of family systems and resilience theory. Implications for well children and their families including practical applications for existing interventions which target well children, ill siblings and parents were discussed and ideas for future directions for interventions to improve outcomes for well siblings were presented.