J Autism Dev Disord (2007) 37:1060–1067
DOI 10.1007/s10803-006-0249-0
ORIGINAL PAPER
The Adjustment of Non-Disabled Siblings of Children
with Autism
Ryan J. Macks Æ Ronald E. Reeve
Published online: 27 October 2006
Ó Springer Science+Business Media, LLC 2006
Abstract This study compared the psychosocial and
emotional adjustment of siblings of children with
autism and siblings of non-disabled children. In
addition, differences between self and parent reports,
as well as various demographic characteristics were
examined. Fifty-one siblings of children with autism
and 35 siblings of non-disabled children, between the
ages of 7 and 17, along with one parent of each sibling,
participated. Results indicated that the presence of a
child with autism appears to enhance the psychosocial
and emotional development of non-disabled siblings
when demographic risk factors are limited. However,
the presence of a child with autism appears to have an
increasingly unfavorable impact on the non-disabled
sibling as demographic risk factors increase.
Keywords Families
Children with autism
Autistic
children
Psychosocial adjustment and development
Introduction
Autism is a severe developmental disorder that
presents a particularly difficult challenge for the
R. J. Macks (&)
Division of Developmental and Behavioral Pediatrics, MLC
4002, Cincinnati Children’s Hospital Medical Center, 3333
Burnet Avenue, Cincinnati, OH 45229-3039, USA
e-mail: Ryan.Macks@cchmc.org
R. E. Reeve
Curry Programs in Clinical and School Psychology,
University of Virginia, 405 Emmet Street, Charlottesville,
VA 22904-4261, USA
123
family unit (Gray & Holden, 1992; Kaminsky &
Dewey, 2002; Wolf, Noh, Fisman, & Speechley, 1989).
Having a family member with any illness, handicap, or
disability may be challenging, but the unique
combination of impairments associated with autism
and related disorders may place family members at an
especially high risk for psychological difficulties
(Glasberg, 2000; Holmes & Carr, 1991; Morgan,
1988). Autism presents extreme variation in ability
and behavior, which magnifies the effects on the family.
Specifically, the greater complexity, unpredictability,
and inexplicability of autism places the family at greater
risk for poor psychological adjustment (Rodrigue,
Geffken, & Morgan, 1993). Additionally, Bebko,
Konstantareas, and Springer (1987) reported that
there is more stress in families of children with autism
than in families with children who have other
disabilities. There is a greater disruption of family
functioning, more upset and disappointment about the
child with a handicap, and fewer recreational activities
and vocational possibilities.
Given the ways in which children with autism have
been shown to affect their family, it seems only logical
to assume that these effects pertain to their siblings.
Studies have shown that the characteristic of a child
with a disability that is most clearly related to poorer
sibling adjustment is the severity of the disability. It has
also been shown that ambiguous disabilities are
associated with poorer sibling outcome. These points
are particularly relevant to siblings of children with
autism, given the severity and ambiguity of their
disorder (Bristol, 1984; Gold, 1993; McHale,
Simeonsson, & Sloan, 1984).
Surprisingly, the impact that a child with autism may
have on the psychosocial and emotional adjustment of
J Autism Dev Disord (2007) 37:1060–1067
siblings has been largely unexplored (Gray, 1998;
Kaminsky & Dewey, 2002). Among the studies that
have been completed, results have been inconsistent.
Some studies have reported poor adjustment, higher
rates of depression, and poor social competence for
siblings of children with autism (Bagenholm &
Gillberg, 1991; Gold, 1993). However, other studies
have reported siblings of children with autism are
typically well-adjusted, with positive self-concepts and
good social competence (Ferrari, 1984; Mates, 1990).
The common assumption made by most researchers is
that the siblings of children with autism will be
more likely to experience problems of psychological
adjustment than will siblings of non-disabled children.
Researchers in this area have listed several stressors that
the siblings of children with autism may experience,
including changes in family roles, restructuring of the
family’s functioning and activities, loss or absence of
parental attention, feelings of guilt, a sensation of shame
often brought on by the negative evaluation of their peer
group, and perplexity at the bizarre behavior that
children with autism may display (Randall & Parker,
1999).
Some research has found that siblings are often
resentful of the child with autism because of the
resulting restrictions on family activities and the time
and resources that have to be expended on them.
These siblings are also frequently embarrassed by the
child with autism for their inappropriate public
behavior. Additionally, the siblings often resent not
being able to invite friends to their home, and if they
do, must deal with the possibility of being embarrassed
by the misbehavior of the child with autism (Gray,
1998).
Perhaps the most obvious reason why siblings may
be negatively affected is because of the great deal of
parental time, energy, attention, and resources that the
child with autism requires. Howlin (1988) found that
many of these siblings felt that they did not receive the
same amount of parental attention as the child with
autism. These siblings often report feeling as though
they are treated unfairly by their parents because the
child with autism is held to a lower standard.
Furthermore, due to the greater amount of parental
time and attention that children with autism require,
siblings are often expected to do more household
chores and physically care for the child with autism
(Randall & Parker, 1999).
In contrast to the aforementioned findings, other
studies have reported that siblings of children with
autism are well-rounded with positive self-concepts,
high levels of social competence, and healthy academic
and behavioral adjustment (Ferrari, 1984; Gold, 1993;
1061
Mates, 1990; McHale, Sloan, & Simeonsson, 1986,
Rodrigue et al., 1993). Kaminsky and Dewey (2002)
found that siblings of children with autism were not at
inflated risk for adjustment difficulties and did
not display deficits in social competence. Similarly,
Rodrigue, Morgan, and Geffken (1992) found that
siblings of children with autism did not differ
significantly from siblings of non-disabled children
with regard to perceived competence and social/
behavioral adjustment. Furthermore, although the
siblings of children with autism had more internalizing
and externalizing behavior problems when compared to
siblings of non-disabled children, their average scores on
both dimensions fell within the normal range. A few
studies have even reported that siblings of children with
autism fare better than siblings of non-disabled children
with respect to self-concept and the overall quality of
the sibling relationship (Berger, 1980; McHale et al.,
1986).
Several studies have reported that psychosocial and
emotional adjustment of siblings of children with
disabilities is largely dependent upon the number of
siblings in the family, the socioeconomic status of the
family, and the gender and birth order of the non-
disabled sibling (Farber, 1968; Ferrari, 1984; Gold,
1993; Gath, 1974; Mates, 1990; Schwirian, 1976). Mates
(1990) reported that research on siblings of children
with disabilities indicates that females and siblings from
two-child families are at a greater risk for poor
adjustment. Other studies have supported the finding
that siblings who live in families with more than two
children are more likely to be well-adjusted than are
siblings living in two-child families (Ferrari, 1984; Gath,
1974; Kaminsky & Dewey, 2002). The explanation for
this effect states that, in larger families, parents are less
likely to overburden individual siblings with childcare
responsibilities and high expectations. Furthermore,
these siblings have a ‘‘normal’’ brother or sister to
whom they can relate and compare themselves (Mates,
1990).
Other family variables are important to consider as
well. Older siblings appear to have greater difficulty
with feelings, behaviors, and coping abilities.
Additionally, older siblings showed higher rates of
internalizing and externalizing behavior problems
(Rodrigue et al., 1992).
However, like most of the research concerning
siblings of children with autism, there are some studies
that contradict the finds of those just mentioned. Some
researchers have reported that family size, birth order,
and the gender of the non-disabled sibling were not
related to adjustment (Gold, 1993; Mates, 1990; McHale
et al., 1986; Rodrigue et al., 1993).
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1062
One potential explanation for the lack of consistency
within this area of research is the different types of
measures that have been used. Most researchers have
used parent reports while others have used self-reports.
Parent reports appear to yield different results than do
sibling self-reports (Ferrari, 1984; Lobato et al., 1987).
It appears that parents, particularly mothers, rate non-
disabled siblings as being more aggressive, depressed,
and having a higher overall level of pathology than the
siblings rate themselves (Gold, 1990; Lobato et al.,
1987). Consequently, the value of collecting data from
multiple informants, for research purposes, has been
stressed, but has not been widely practiced (Compas,
Howell, Phares, Williams, & Giunta, 1989; Offord,
Boyle, Flemming, Blum, & Grant, 1989).
Given the lack of consistency among previous
research studies related to siblings of children with
autism, the researcher hypothesized that there would
be no significant differences between the experimental
and comparison groups on the Piers–Harris, CDI-S
(Children’s Depression Inventory-Short Form ), or
BASC–PRS (Behavior Assessment System for
Children–Parent Rating Scales). In accordance with
previous research studies in which some consistent
findings have occurred, the researcher also predicted
that non-disabled siblings from both the experimental
and comparison groups would score better on the
Piers–Harris Children’s Self-Concept Scale, CDI-S, and
BASC–PRS if they: were male, had more than one
sibling, were younger than the child with autism, and
came from a family with a high SES level. Additionally,
the researcher hypothesized that a significant
interaction effect would occur between the
demographic characteristics and the child’s scores on
the various report measures. It was predicted that the
interaction effect would be significantly larger for
siblings of children with autism than for siblings of
non-autistic children.
Methods
Participants
Fifty-one families with an autistic child were recruited
for this study. The participants from each family
included one parent and one non-disabled sibling who
was between the ages of 7–17. The age of the child with
autism was not considered during the recruitment
process. However, all of these children had a diagnosis
of autism as opposed to other autism spectrum disorders
such as Asperger’s syndrome, Pervasive Developmental
Disorder, or high functioning autism.
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J Autism Dev Disord (2007) 37:1060–1067
In two-parent families, the parents decided between
themselves which of the two would participate. When
families had more than one non-disabled child, the
participating child was the one who was closest in age
to the child with autism. Thirty-six families with
children who do not have autism or any other
developmental disabilities were also included as a
comparison group. These families had to have a
minimum of two children, with at least one child
being between the ages of 7–17. If there were multiple
children in a family who were between the ages of 7–
17, one child was randomly selected by the researcher
for participation. As well, one parent of each child was
also included in the study. All of the participating
parents from both the experimental and comparison
groups were mothers.
Families with children with autism were recruited
from special day schools in suburban areas in Maryland
(The Ivymount School) and Virginia (The Virginia
Institute of Autism, Mathew’s Center for Visual
Learning, and New Horizons). Families with children
with autism in residential schools were not recruited.
For the comparison group, families of children who do
not have autism or any other developmental
disabilities were recruited from Baltimore County
Public Schools in Maryland and Fluvanna County
Public Schools in Virginia. Demographic breakdowns
of the experimental and comparison groups, for SES
and the number of siblings in the family can be found
in Table 1. Information about birth order in relation to
the sibling with autism and gender can be found in
Table 2.
All participating families were informed that they
would automatically be entered in to a random
drawing for cash prizes. Three families were selected
to receive a cash prize.
Table 1 SES and number of siblings for experimental and
comparison groups
Demographic variable n M SD
SES (Experimental) 51 2.76a 1.12
SES (Comparison) 36 2.67b .72
Number of sibs (Experimental) 51 1.35 .77
Number of sibs (Comparison) 36 1.36 .59
a
This score means that the average SES level for the
experimental group fell in-between the annual income ranges
of $26,000–50,000 and $51,000–75,000
b
This score means that the average SES level for the
comparison group fell in-between the annual income ranges of
$26,000–50,000 and $51,000–75,000
J Autism Dev Disord (2007) 37:1060–1067 1063

Table 2 Birth order and gender data for experimental and
comparison groups
Demographic variable Experimental Comparison
Birth order
Younger 24 18
Older 27 18
Gender
Male 21 16
Female 30 20
Measures
All participating children were asked to complete the
Children’s Depression Inventory-Short Form (CDI-S)
(Kovacs, 1992) and the Piers–Harris Children’s Self-
Concept Scale (Piers, 1984). All participating parents
were asked to complete the Behavior Assessment
System for Children–Parent Rating Scales (BASC–
PRS) with respect to the participating non-disabled
child. Additionally, parents were asked to complete a
demographic questionnaire, asking them to indicate
their gender; the gender, age, and birth order of
the participating child; their approximate annual
household income (by indicating an income range in
increments of $25,000); the total number of children in
the family; and a space for comments by the non-
disabled child.
Procedures
To recruit participants through a school, a recruitment
letter was sent home to the parents of each child with
autism by a school administrator. Each letter was
accompanied by a self-addressed, stamped index card.
The parents were instructed to write their name, phone
number, and address on the card and mail it back to
the examiner if they wished to participate.
When a completed index card was received, the
examiner called the family to explain their role in the
study and verify the family’s desire and willingness to
participate. Once a family agreed to participate, a
packet was sent to their home. The packet contained a
cover letter explaining the proper procedure for filling
out each questionnaire and returning it in the self-
addressed stamped envelope. The packet also included
one demographic questionnaire, one BASC–PRS, one
CDI-S, and one Piers–Harris Children’s Self-Concept
Scale.
Results
Several Analysis of Variance (ANOVA) procedures
were performed to compare the scores of siblings of
children with autism and siblings of non-disabled
children on the CDI-S, Piers–Harris, and BASC–
PRS. To control for Type I error rate for multiple
comparisons, the significance level was set at .01 for all
analyses. Prior to running the ANOVA’s, a
Multivariate Analysis of Variance (MANOVA) was
performed to justify performing the ANOVA’s. A
MANOVA for the total scores of each questionnaire
was significant, Wilkes Multivariate F(4,82) = 6.50,
P < .01. MANOVA’s were then performed for the
factor scores of each questionnaire. A MANOVA for
the Piers–Harris factor scores was significant, Wilkes
Multivariate F (7,79) = 20.29, P < .01. A MANOVA
for the BASC–PRS factor scores was also significant,
Wilkes Multivariate F (4,82) = 4.39, P < .01.
An ANOVA did not reveal any significant
differences between the experimental and comparison
groups on the CDI-S, F (1,85) = 1.60, P > .05. There
also were no significant differences between these
groups on the BASC–PRS (see Table 3). However, an
ANOVA revealed that the experimental group scored
significantly higher than the comparison group on the

Table 3 ANOVA for BASC

Measure df SS MS F P
total and factor scores
Total
Between groups 1 1684.64 1684.64 6.70 .011
Within groups 85 21364.97 251.35
Externalizing
Between groups 1 731.85 731.85 3.99 .049
Within groups 85 15579.56 183.29
Internalizing
Between groups 1 136.94 136.94 .81 .370
Within groups 85 14335.29 168.65
Adaptive skills
Between groups 1 54.89 54.89 .60 .440
Within groups 85 7765.46 91.36

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1064 J Autism Dev Disord (2007) 37:1060–1067

Table 4 ANOVA for Piers–

Measure df SS MS F p
Harris total and factor scores*
P < .01 Total
Between groups 1 1046.66 1046.66 9.06* .003
Within groups 85 9816.40 115.49
Behavior
Between groups 1 703.69 703.69 9.65* .003
Within groups 85 6195.82 72.89
Intellectual & School status
Between groups 1 820.91 820.91 10.06* .002
Within groups 85 6936.15 81.60
Physical appearance
Between groups 1 309.05 309.05 3.43 .068
Within groups 85 7663.18 90.16
Anxiety
Between groups 1 775.95 775.95 8.15* .005
Within groups 85 8096.40 95.25
Popularity
Between groups 1 1.34 1.34 .01 .908
Within groups 85 8407.93 98.92
Happiness & Satisfaction
Between groups 1 183.76 183.76 2.90 .092
Within groups 85 5386.29 63.37

Piers–Harris Total score as well as the Piers–Harris the BASC–PRS Adaptive Skills factor. For the
Behavior, Intellectual and School Status, and Anxiety comparison group, no significant correlations were
factor scores (see Table 4). found (see Table 5).
A risk scale composite was created to compare the Following the Pearson correlations, Fisher Z-values
cumulative effect of various demographic characteris- were calculated to compare the risk scale correlations
tics on children from both the experimental and between the experimental and comparison groups.
comparison groups. Based on the findings from the Significant Z-values were found for the CDI-S, the
previously mentioned research studies that examined Piers–Harris Total score, the Piers–Harris Physical
demographic variables with respect to siblings of Appearance, Popularity, and Happiness and
children with disabilities, the demographics that were Satisfaction factors, and the BASC–PRS Adaptive
considered to place a child more at risk for social, Skills factor (see Table 6).
emotional, and scholastic difficulties included being a
male, coming from a family of low SES, only having Table 5 Correlations between the risk scale and the
one sibling, and being older than the child with autism. questionnaires for the experimental and comparison groups
Demographic characteristics that were found to Measure Risk scale Risk scale
decrease a child’s risk included being female, coming (experimental) (comparison)
from a family of high SES, having more than one CDI-S .64** .22
sibling, and being younger than the child with autism. Piers–Harris total –.71** –.31
A child received one point for each demographic risk PH behavior –.55** –.31
factor that applied to them, meaning that total scores PH intellectual & –.57** –.23
school status
ranged from 0–4. PH physical –.74** –.26
Once the risk scale was completed for each child, appearance
Pearson Correlations were performed to examine the PH anxiety –.56** –.28
relationship between the experimental and comparison PH popularity –.72** –.28
PH happiness & –.70** –.29
group’s risk scale and the CDI-S, Piers–Harris, and satisfaction
BASC–PRS. BASC total .26 –.12
For the experimental group, a significant positive BASC externalizing .22 .12
correlation was found between the risk scale and the BASC internalizing .22 .17
BASC adaptive skills –.63** –.12
CDI-S. Significant negative correlations were found
between the risk scale and the Piers–Harris Total * P < .01
score, all of the Piers–Harris factor scores, as well as ** P < .001

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Table 6 Fisher Z–values comparing the risk scale correlations
between the experimental and comparison groups
Measure Z P
CDI-S 2.37*
Piers–Harris total 2.51
PH behavior 1.32
PH intellectual & school status 1.83
PH physical appearance 3.03*
PH anxiety 1.53
PH popularity 2.74*
PH happiness & satisfaction 2.52*
BASC total 1.71
BASC externalizing .46
BASC internalizing .23
BASC adaptive Skills 2.75*
* P < .01
Discussion
Siblings of children with autism appeared to have
a more positive self-concept than did siblings of
non-disabled children, as indicated by the scores on
the Piers–Harris. They were much more likely to have
a positive view of their behavior, intelligence,
scholastic performance, and anxiety than were
siblings of non-disabled children. These children also
had a more positive view of their overall personal
characteristics in comparison to siblings of non-
disabled children.
There are various possible explanations for the
responses by these groups. One possibility is that on
self-report measures, siblings of children with autism
compare themselves to their autistic sibling. It would
only be natural to assume that these children would
view themselves favorably in such a comparison.
Another possible explanation for these results could
be that there is a difference in the level of maturity.
Gray (1998) noted that siblings of children with autism
are often more mature than their peers. Perhaps this
maturity leads to improved behavior, better social
skills, and improved academic performance, thereby
increasing their overall self-concept.
It should be noted that, while siblings of children
with autism scored significantly better than the norms
on the self-report measures of self-concept and
depression, siblings of non-disabled children still
scored in the average range on these measures.
Therefore, this discrepancy between the groups was
not a result of a misrepresented comparison group but
by a seemingly well-adjusted experimental group.
Interestingly, although significant differences were
not found between the experimental and comparison
groups on the BASC–PRS, parents of children with
autism viewed the siblings’ social and emotional
1065
adjustment somewhat more negatively than did
parents who did not have any children with autism.
This discrepancy suggests that, in families of children
with autism, parents have markedly different views
.009
.006
from the non-disabled sibling, regarding the ways in
.093 which siblings’ psychosocial and emotional adjustment
.034 are affected by the children with autism.
.001 Perhaps parents spend so much time attending to
.063
.003
the needs of the child with autism that they really do
.005 not have an accurate view of the sibling’s social and
.044 emotional functioning. Another possible explanation
.323 for the discrepancy is that parents may project any
.409
.003
frustrations that they may have because of their child
with autism on to their non-disabled child. It is also
possible that if a child with autism causes a parent a
good deal of stress, the parent may then assume that
the sibling is also experiencing the same amount of
stress.
The discrepancy between the self-report and parent
report measures is very important when considering
that most studies done on siblings of children with
autism have used only a single type of respondent.
These results support an assertion made earlier: when
studying siblings of children with autism, it is
advisable for the examiner to use multiple types of
respondents.
When multiple demographic risk factors were
examined with the risk scale composite, they
significantly predicted psychosocial and emotional
adjustment for siblings of children with autism but
not for siblings of non-disabled children. This finding
suggests that demographic characteristics are more
likely to impact a sibling of a child with autism than a
sibling of a non-disabled child. In fact, results from
the Piers–Harris suggest that having a sibling with
autism may not be a risk factor in and of itself, and
that children with autism may even have a positive
influence on the life of the non-disabled sibling.
However, when multiple demographic risk factors are
present, it becomes more difficult for the non-disabled
sibling to deal with the child with autism, both
emotionally and psychologically. Hence, the
presence of a child with autism appears to have an
increasingly negative effect on the non-disabled
sibling as the number of demographic risk factors
increase.
This finding may help to explain why there has been
a lack of consistency among past studies. Perhaps those
studies that were reporting positive influences of
children with autism on their siblings were using a
sample of children who were not exposed to multiple
demographic risk factors. Alternatively, those studies
that were reporting negative influences of children with
123
1066
autism on their siblings may have used samples of
children who did experience multiple demographic risk
factors.
One limitation of this study was the small sample
size for the both the experimental and comparison
groups. Due to limited funding, the recruitment of
participants was limited. A second limitation was that
families of children with autism in residential facilities
were not included. Therefore, the results of this study
should not be generalized to all siblings of children
with autism, but rather, only to siblings of children with
autism who live at home. A third limitation of this
study is that the families for the experimental group
were recruited from specialty day schools for children
with autism and other disabilities. Therefore, the
families in this study all had community resources
available to them and were taking advantage of these
resources to some extent. Fourth, all of the
participating parents were mothers and consequently,
these findings do not necessarily apply to fathers.
Finally, for future reference it would like be easier to
compare self and parent report measures that are
designed with the same intention. For example, it may
be better to compare self report from and Achenbach
versus parent report of an Achenbach, rather than
comparing a Piers–Harris to a BASC–PRS.
This study supports the assertion that future studies
on this topic should include multiple respondents and
should examine various demographic characteristics.
Some other demographics that could be examined are
race, religion, marital status, and the gender of the
child with autism. Additionally, siblings are likely to
be the closest relatives of individuals with autism and
are expected to take over a supervisory/management
role of the death of their parents (Bigby, 1997).
Hence, research on adult sibling relationships would
help clinicians be better able to prepare siblings for
the tasks that lie ahead.
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