Research in Developmental Disabilities 62 (2017) 104–114

Contents lists available at ScienceDirect

Research in Developmental Disabilities

Sibling relationship quality and psychosocial outcomes

among adult siblings of individuals with autism spectrum
disorder and individuals with intellectual disability without
autism
Theodore S. Tomeny a,∗ , Brandi M. Ellis b , James A. Rankin a , Tammy D. Barry c
a
The University of Alabama, Department of Psychology, 505 Hackberry Ln., Box 870348, Tuscaloosa, AL, 35487, USA
b
The University of Southern Mississippi, Department of Psychology, 118 College Dr. #5025, Hattiesburg, MS, 39406, USA
c
Washington State University, Psychology Department, PO Box 644820, Johnson Tower 233, Pullman, WA, 99164, USA

a r t i c l e i n f o a b s t r a c t

Article history: Research on adult typically-developing (TD) siblings of individuals with developmental
Received 24 January 2016 disabilities remains limited, and outcomes for TD siblings appear to vary widely. For the
Received in revised form current study, 82 adult TD siblings of individuals with autism spectrum disorder (ASD) or
10 December 2016
intellectual disability (ID) completed questionnaires about themselves and their affected
Accepted 4 January 2017
sibling. Results of this study suggest that the attitudes possessed by adult TD siblings are
Number of reviews completed is 2
important to consider when understanding adult TD sibling outcomes. Specifically, data
indicate that higher levels of positive sibling relationship attitudes are related to TD sib-
Keywords: lings providing more aid/support to their sibling with a disability, along with having higher
Autism spectrum disorder
levels of general life satisfaction, and negatively related to levels of stress and depressive
Intellectual disability
symptoms among TD siblings. Consistent with previous child research, siblings of individu-
Siblings
Adults als with ASD reported fewer positive sibling relationship attitudes compared to siblings of
Relationship attitudes individuals with ID. Finally, group membership related to aid provided, depressive symp-
toms, and stress of TD siblings indirectly through sibling relationship attitudes. Overall,
results indicate that sibling relationship attitudes may be particularly important to con-
sider when conceptualizing sibling relationships when one sibling has an intellectual or
developmental disability.
© 2017 Elsevier Ltd. All rights reserved.

What this paper adds

This study helps to fill gaps in the literature on adult typically-developing (TD) siblings of individuals with developmental
disabilities by identifying a potential predictor of sibling outcomes: sibling relationship attitudes. The results of this paper
indicate that TD siblings of individuals with ASD may possess less positive attitudes about their sibling relationships com-
pared to TD siblings of individuals with ID without ASD. Moreover, sibling relationship attitudes were associated with TD
sibling outcomes (e.g., stress, depressive symptoms, life satisfaction) and amount of support that TD siblings provide their
affected sibling. Due to rising rates of diagnoses and a healthcare system already in crisis with regard to care for adults
with developmental disabilities, siblings likely will be increasingly charged with assuming care after parents are no longer

∗ Corresponding author.
E-mail addresses: theodore.s.tomeny@ua.edu (T.S. Tomeny), brandi.ellis@eagles.usm.edu (B.M. Ellis), jarankin1@crimson.ua.edu (J.A. Rankin),
tammy.barry@wsu.edu (T.D. Barry).

http://dx.doi.org/10.1016/j.ridd.2017.01.008
0891-4222/© 2017 Elsevier Ltd. All rights reserved.
 T.S. Tomeny et al. / Research in Developmental Disabilities 62 (2017) 104–114 105

able. Thus, clinicians must be ready to assist TD siblings in this role, and improving attitudes and views about the sibling
relationship may be one approach to consider.

1. Introduction

According to the United States Census Bureau, data collected in 2010 indicated that 0.4% of the population (i.e., about 1.2
million adults) had intellectual disability (ID), whereas the estimated U.S. prevalence of autism spectrum disorder (ASD) is
1 in 68 children or roughly 1.5% of the population (Baio, 2014). Moreover, a significant portion of individuals with ASD also
have co-occurring ID (e.g., Levy et al., 2010). These numbers alone are noteworthy, but it also is important to consider that
each individual’s disability is likely to impact their family members. Having a family member with a developmental disability
(DD) places unique demands on those within the family unit and may have implications for the outcomes and functioning
of all those involved (McHale & Gamble, 1989; Roper, Allred, Mandleco, Freeborn, & Dyches, 2014; Tozer & Atkin, 2015). It
would seem that those closely connected to individuals with a DD may require support services themselves, substantially
raising the number of individuals needing services related to any given disability.

2. Sibling relationships

Generally, siblings seem to have strong and persistent influence over one another’s development, life choices, outcomes,
and functioning compared to individuals fulfilling other roles in a person’s life. As Cicirelli (1995) observed, sibling rela-
tionships span a greater expanse of time than most relationships—including parents-child and spousal—rendering sibling
relationships generally the longest lasting relationships in a person’s life. The longevity of this particular familial relation-
ship and the far-reaching nature of disability underscore the importance of understanding the outcomes and functioning of
typically-developing (TD) siblings of individuals with a DD. Further, healthy functioning and positive outcomes in TD siblings
is particularly relevant to the disabled sibling because, as adults, many TD siblings may assume the primary caregiver role
once parents can no longer do so (Coyle, Kramer, & Mutchler, 2014).

3. Adult siblings provision of aid/support

Adult siblings of individuals with a DD often play important, supportive roles to their siblings with DD (Atkin & Tozer,
2014). Most adult siblings in this population indicate that they desire to be involved in the care of their sibling (Tozer & Atkin,
2015), with many expecting to provide assistance in the future if they are not already doing so (Burke, Fish, & Lawton, 2015).
Relatedly, TD siblings have expressed difficulty in balancing the demands of caring for their own family, caring for their
aging parents, and being consistently involved with their siblings with ASD (Tozer & Atkin, 2015). Duignan and Connell’s
(2015) study suggests that caring for an individual with ASD can alter the home environment in ways that result in negative
effects on siblings’ social relationships. Many TD siblings expect to assume greater caregiving roles when their parents get
older (Coyle et al., 2014), especially if they have a closer relationship with their sibling (Burke, Taylor, Urbano, & Hodapp,
2012; Heller & Kramer, 2009). Thus, consideration of adult sibling relationships is of particular interest when assessing the
outcomes and functioning of adult siblings of individuals with a DD.

4. Adult sibling relationships and developmental disabilities

Little research considers the importance of sibling relationships in this population (Hastings & Petalas, 2014), particularly
in adults (Ferraioli & Harris, 2009). Adult siblings of individuals with a DD have unique sibling relationships as compared to
similar but younger sibling dyads (Orsmond, Kuo, & Seltzer, 2009), adult siblings of individuals with other types of diagnoses
(e.g., psychiatric, chronic health conditions), and TD sibling dyads (e.g., Hodapp & Urbano, 2007). Whereas the closeness of
sibling relationships appears to fluctuate in typical sibling dyads (Orsmond et al.), closeness of siblings when one has a DD
appears more stable over time (Orsmond & Seltzer, 2007). Thus any social and emotional difficulties related to a lack of
closeness in the early sibling relationship may continue into adulthood (Orsmond & Seltzer, 2007). Furthermore, TD siblings
of individuals with a DD who report positive, rewarding, close sibling relationships also tend to have good health and perceive
benefits of being a sibling to a brother/sister with disabilities (Hodapp & Urbano, 2007; Hodapp, Urbano, & Burke, 2010).
Although mostly unexplored in adults, childhood sibling relationship quality predicts psychosocial adjustment outcomes in
adulthood (Dunn, Slomkowski, Beardsall, & Rende, 1994; Waldinger, Vaillant, & Orav, 2007). Considering the longevity and
impact of this relationship, it is critical to assess adult sibling relationships in families of individuals with a DD.

5. Consideration of group differences

Research concerning the functioning and outcomes of TD siblings of individuals with DDs when compared to siblings
within typical dyads appears inconsistent, with some siblings exhibiting positive outcomes (Macks & Reeve, 2007), some
negative outcomes (Gold, 1993; Verté, Roeyers, & Buysse, 2003), and some no differences (Di Biasi et al., 2015; Tomeny,
Barry, & Bader, 2012). As suggested by Seltzer, Greenberg, Orsmond, and Lounds (2005), these inconsistencies in TD siblings’
outcomes may be dependent upon their siblings’ type of DD. Rossiter and Sharpe’s (2001) meta-analysis suggests that
106 T.S. Tomeny et al. / Research in Developmental Disabilities 62 (2017) 104–114

Fig 1. Conceptual model of indirect effect between group membership and TD sibling outcomes through sibling relationship attitudes.

the type of disability and its severity are what influence the effects of the disability on the TD siblings. Caroli and Sagone
(2013) found that youth TD siblings (ages 13–18 years) of individuals with ASD had more negative social attitudes toward
their disabled siblings and more negative emotions than did TD siblings of individuals with Down syndrome (DS) or ID.
Alternatively, TD siblings of children with DS have reported higher levels of relationship quality and social support within
the sibling relationship (Pollard, Barry, Freedman, & Kotchick, 2013) and viewed their sibling more positively (Mandleco and
Webb, 2015) than TD siblings of children with ASD.
The limited research on adults suggests that TD siblings of individuals with ASD experience more depressive symptoms
and poorer health compared to TD siblings of adults with DS (Hodapp & Urbano, 2007). Further, TD siblings of adults with
ID report more positive affect, closeness, and compassion in the sibling relationship compared to siblings of adults with ASD
(Orsmond & Seltzer, 2000). Though few, these studies support the need for further investigation of differences in sibling
outcomes according to disability type, particularly among adults.

6. Current study

Given the substantial number of individuals in the U.S. with a DD, the longevity of sibling relationships (Cicirelli, 1995),
and the unique demands placed upon the families of individuals with a DD (McHale & Gamble, 1989; Roper et al., 2014;
Tozer & Atkin, 2015), it is important to examine the functioning and outcomes of TD siblings of individuals with a DD.
Research displaying the differential effects of ID and ASD on TD siblings’ functioning warrants further examination of group
differences. Because most studies to date have focused on differences in youth siblings of individuals with various mental
disabilities, the current study aims to build upon current literature by examining similar factors among adult siblings of
individuals with DD.
First, it was expected that sibling relationship quality would predict amount of aid/support provided by TD siblings, TD
sibling life satisfaction, and depressive, anxiety and stress symptoms in TD siblings over and above demographic correlates
(Hypothesis 1). Second, we hypothesized that TD siblings of those with ASD would report significantly lower levels of positive
sibling relationship attitudes compared to siblings of individuals with ID without ASD (Hypothesis 2). We then conducted
exploratory post hoc analyses based on results from Hypotheses 1 and 2 that examined indirect effects between group
inclusion (ASD vs. ID) and TD sibling outcomes through sibling relationship attitudes (Fig. 1).

7. Method

7.1. Participants

As part of a larger study, 82 TD siblings of individuals with either ASD or ID without ASD provided data about themselves
and their sibling with a disability. The ASD group was composed of 45 TD siblings ages 18–62 (M = 29.42, SD = 11.08; 82% were
female) and siblings with ASD ages 18–52 (M = 26.49, SD = 8.55; 20% were female). The ID without ASD group (referred to as
the ID group) was composed of 37 TD siblings ages 19–61 (M = 36.30, SD = 13.07; 86% were female) and siblings with ID ages
19–55 (M = 35.24, SD = 12.71; 49% were female). Those within the ID group were of mixed etiology and had disorders such
as Down Syndrome, Cerebral Palsy, Fragile X, and intellectual disability not otherwise specified. Across both groups, 4.67
years was the average absolute value of sibling age differences and 63% of respondents were older than their sibling with a
disability. The racial distribution of the overall sample was 88% Caucasian, 4% Hispanic, 4% Asian, 1% African-American, and
4% other. Thirty-two percent of TD siblings reported making over $100,000 annually, 42% reported being married, and 38%
described themselves as never married or living alone.
Few respondents (i.e., four) described themselves as the primary caregiver of their sibling. However, across both groups,
43% reported providing direct care [defined as “assistance with activities of daily living (e.g., grooming, feeding, household
chores)”] at least once per month (15% reported daily direct care), 51% reported providing transportation at least once per
month (15% reported daily transportation assistance), 28% reported providing financial assistance at least once per month
(13% reported providing daily financial assistance), and 40% reported running errands for their sibling at least once per
month (16% reported performing daily errands).
 T.S. Tomeny et al. / Research in Developmental Disabilities 62 (2017) 104–114 107

7.2. Measures

7.2.1. Demographic and diagnostic questionnaire

TD siblings provided demographic data (e.g., age, gender, ethnicity, marital status, income, level of education) about
themselves and their sibling with a DD, along with information about their siblings’ diagnosis (e.g., specific diagnosis, age of
diagnosis, who made the diagnosis) via a demographic and diagnostic questionnaire. Amount of aid/support provided by TD
siblings to their sibling with a DD was measured via this questionnaire: a Total score was calculated by summing responses
to five questions on a 5-point Likert scale (0 = none to 4 = daily or almost daily) about amount of direct care, transportation,
financial assistance, errands completed, and “other” care provided.

7.2.2. Depression anxiety and stress scale

The Depression, Anxiety, and Stress Scale (DASS; Lovibond & Lovibond, 1995) is a 21-item self-report measure of distress.
Using a 0 (Did not apply to me) to 3 (Applied to me very much, or most of the time) scale, respondents rate how much each item
applied to them during the previous week. The DASS provides a Total scale and Depression, Anxiety, and Stress subscales.
Scale scores are calculated by multiplying the sum of scores by two to allow for comparisons to the 42-item version of the
DASS per Lovibond and Lovibond (1995). Example items from the DASS include “I found it difficult to relax” and “I was unable
to become enthusiastic about anything.” The DASS has shown appropriate convergent validity and internal consistency in
previous research (Lovibond & Lovibond, 1995), and coefficient alphas for the current sample ranged from 0.80 to 0.91 for
the subscales.

7.2.3. Lifespan sibling relationship scale

The Lifespan Sibling Relationship Scale (LSRS; Riggio, 2000) is a self-report adult measure of sibling relationship quality
and attitudes. The LSRS aims to provide an overall assessment of relationship quality by measuring affective, cognitive, and
behavioral components of a sibling relationship (Riggio, 2000). Respondents report on current and retrospective attitudes,
and they were asked to think about their sibling with a disability when completing this measure. The LSRS is composed of 48
items on a 5-point Likert scale from 1 (Strongly disagree) to 5 (Strongly agree) and higher scores indicate more positive attitudes
about the sibling relationship. The LSRS produces six subscale scores that measure affective, behavioral, and cognitive
characteristics of sibling relationships during childhood and adulthood. Example items include: “My sibling is a good friend”
and “My sibling and I often helped each other as children.” The LSRS also produces a Total score, which was of interest for
the current study. Previous psychometric research suggests that the LSRS shows appropriate validity and reliability, and this
validity appears to remain stable across the lifespan (Riggio, 2000). The LSRS Total scale produced a coefficient alpha of 0.96
for the current sample, indicating good internal consistency.

7.2.4. Satisfaction with life scale

The Satisfaction with Life Scale (SWLS) is a brief 5-item measure of overall life satisfaction (Diener, Emmons, Larsen, &
Griffin, 1985). Respondents are asked to rate the extent to which they agree with each statement using a 7-point Likert scale
from 1 (Strongly Disagree) to 7 (Strongly agree). Example items include: “I am satisfied with my life” and “The conditions of
my life are excellent.” The total scale produced a coefficient alpha of 0.89, suggesting good internal reliability for the current
sample, consistent with previous research (Diener et al., 1985).

7.3. Procedure

Data were collected following approval from the University Institutional Review Board and provision of electronic consent
by each participant. TD siblings were recruited via organizations associated with developmental disabilities. TD siblings
who agreed to participate were sent a link to a secure survey website on which study questionnaires were stored and
completed. Seventy-three percent of those TD siblings who accessed the survey completed the study. After consent, TD
siblings completed a Demographic and Diagnostic form, the DASS, the LSRS, and the SLS. TD siblings were instructed to
consider their sibling with a DD when answering questions about their sibling relationship and interactions.

8. Results

Less than 0.01% of data was missing at the item-level; the mean of the items on respective scales was imputed to replace
missing data according to Harrell (2001). Group differences among variables of interest are listed in Table 1. Intercorrelations
of the variables of interest are listed in Table 2.

8.1. Control variables

Possible control variables for Hypothesis 1 and the post hoc analyses were determined using zero-order correlations
between the possible control variables and the criterion variables for the total sample (Table 3). TD sibling depression was
negatively correlated with TD sibling income and marital status (dichotomized: 0 = living alone, 1 = living with a significant
108 T.S. Tomeny et al. / Research in Developmental Disabilities 62 (2017) 104–114

Table 1
Group Means and Group Differences among Variables of Interest.

Groups

Total Sample (N = 82) ASD (n = 45) ID (n = 37)

Variables M SD M SD M SD F d

DASS Depression 8.57 8.54 8.80 8.16 8.28 9.08 0.08 0.06
DASS Anxiety 5.56 6.64 5.42 7.02 5.73 6.24 0.13 0.05
DASS Stress 11.67 8.02 11.89 7.87 11.41 8.29 0.00 0.06
Total Aid 5.49 4.80 5.00 4.85 6.08 4.73 0.93 0.23
SLS Total 25.40 6.84 24.73 6.55 26.22 7.19 3.06 0.22
LSRS Total 161.62 32.81 153.45 31.82 171.55 31.63 7.55** 0.57

Note. ASD = autism spectrum disorder; ID = intellectual disability (without autism); DASS = Depression, Anxiety, and Stress Scale; Aid = Amount of aid/support
provided by TD sibling; SLS = Satisfaction with Life Scale; LSRS = Lifespan Sibling Relationship Scale. Group differences between ASD and ID were examined
using ANCOVA with propensity score as a single covariate (analyses were repeated with individual covariates; results remained unchanged).
**
p < 0.01.

Table 2
Correlations among Variables of Interest for Total Sample.

1. 2. 3. 4. 5. 6.

1. DASS Depression – 0.60** 0.66** 0.09 −0.36** −0.28*

2. DASS Anxiety – 0.65** 0.21 −0.15 −0.07
3. DASS Stress – 0.18 −0.16 −0.13
4. Total Aid – 0.03 0.41**
5. SLS Total – 0.31**
6. LSRS Total –

Note. DASS = Depression, Anxiety, and Stress Scale; Aid = Amount of aid provided by TD sibling; SLS = Satisfaction with Life Scale; LSRS = Lifespan Sibling
Relationship Scale; SD = Standard deviation.
**
p < 0.01.
*
p < 0.05.

Table 3
Correlations between Possible Control Variables and Criterion Variables (Total Sample).

Criterion Variables

Possible Control Variables DASS Dep. DASS Anxiety DASS Stress Total Aid SLS Total LSRS Total

Sib w/ Dis Age −0.09 −0.13 −0.01 0.07 −0.16 −0.003

Sib w/ Dis Gender −0.16 −0.15 −0.15 −0.13 −0.04 −0.10
Sib w/ Dis Birth Order 0.03 −0.03 .26* 0.22* 0.13 0.18
Distance from Sib w/ Dis −0.05 −0.03 −0.11 0.42** −0.08 0.19
TD Sibling Gender −0.003 −0.06 −0.06 −0.16 −0.004 −0.003
TD Sibling Age −0.12 −0.15 0.00 0.19 −0.01 0.11
TD Sibling Birth Order 0.08 0.06 −0.06 0.12 −0.11 0.07
TD Sibling Race (Dich.) −0.05 −0.05 0.06 −0.31** 0.14 −0.21
TD Sibling Education −0.08 −0.06 0.05 −0.09 −0.08 0.05
TD Sibling Income −0.25* −0.37** −0.26* −0.13 −0.05 −0.18
Childhood Family Size 0.16 0.07 0.17 0.19 −0.06 0.07
TD Sib Marital Stat (Dich) −0.31** −0.19 −0.12 −0.01 0.11 0.007
Age Disc. (Abs. Value) −0.03 −0.01 −0.08 0.23* 0.26* 0.19

Note. Sib w/ Dis = Sibling with a disability; TD = Typically-developing; Dich = Dichotomized; Abs. Value = Absolute Value; DASS = Depression, Anxiety and
Stress Scale; SLS = Satisfaction with Life Scale; Aid = Amount of aid provided by TD sibling; LSRS = Lifespan Sibling Relationship Scale. Race coded as
0 = nonwhite, 1 = white; Marital status coded as 0 = living alone, 1 = living with a significant other. * p < 0.05.

other). TD sibling anxiety and stress were also negatively associated with TD sibling income, and TD sibling stress was posi-
tively associated with birth order of siblings with DD. Aid/support was positively correlated with age discrepancy (absolute
value), distance between siblings, and birth order of siblings with DD and was negatively correlated with TD sibling race
(dichotomized: 0 = nonwhite, 1 = white). As such, TD sibling income, TD sibling marital status, birth order of siblings with DD,
age discrepancy, distance between siblings, and TD sibling race were included as covariates when their respective criterion
variables were examined for Hypothesis 1 and post hoc analyses.
Because the ASD and ID groups were not matched on demographic variables, independent samples t-tests were conducted
to examine group differences in possible confounds for Hypothesis 2 (Table 4). Results revealed that the two groups differed
in gender of sibling with a disability (coded 1 = male, 2 = female), t(80) = 2.79, p = 0.007, TD sibling age, t(80) = 2.54, p = 0.01, TD
sibling birth order, t(80) = 3.28, p = 0.002, and number of people in their household during childhood, t(79) = 2.74, p = 0.009. In
order to maximize statistical power via conservative use of degrees of freedom (Cepeda, Boston, Farrar, & Strom, 2003) when
examining group differences, propensity scores were calculated according to procedures outlined by Rosenbaum and Rubin
 T.S. Tomeny et al. / Research in Developmental Disabilities 62 (2017) 104–114 109

Table 4
Group Means and Group Differences of Possible Covariates.

Groups

Total Sample (N = 82) ASD (n = 45) ID (n = 37)

Possible Control Variables M SD M SD M SD t d

Sib w/ Dis Age 30.44 11.43 26.49 8.55 35.24 12.71 3.58** 0.81
Sib w/ Dis Gender 1.33 0.47 1.20 0.41 1.49 0.51 2.79** 0.62
Sib w/ Dis Birth Order 2.37 1.18 2.29 0.90 2.46 1.46 0.62 0.14
Distance From Sib w/ Dis 2.24 1.22 2.29 1.27 2.19 1.16 −0.37 0.08
TD Sib Gender 1.84 0.37 1.82 0.39 1.86 0.35 0.53 0.11
TD Sib Age 32.52 12.43 29.42 11.08 36.30 13.07 2.54* 0.57
TD Sib Birth Order 1.93 1.03 1.60 0.84 2.32 1.11 3.28** 0.73
TD Sib Race (Dich) 0.88 0.33 0.84 0.37 0.92 0.28 1.05 0.24
TD Sib Education 5.93 0.84 5.91 0.82 5.95 0.88 0.19 0.05
TD Sib Income 7.14 2.01 7.00 2.21 7.31 1.74 0.70 0.16
Childhood Family Size 5.12 1.47 4.71 0.82 5.64 1.90 2.74** 0.64
TD Sib marital status (Dich) 0.56 0.50 0.56 0.50 0.57 0.50 0.11 0.02
Age Discrepancy (Abs. Value) 4.67 4.29 4.71 4.97 4.62 3.34 −0.10 0.02

Note. ASD = autism spectrum disorder; ID = intellectual disability (without autism); Sib w/ Dis = sibling with disability; TD Sib = typically-developing sibling;
Dich = dichotomized; Abs. Value = absolute value; Gender coded as 1 = male, 2 = female; Race coded as 0 = nonwhite, 1 = white; Marital status coded as
0 = living alone, 1 = living with a significant other.
**
p < 0.01.
*
p < 0.05.

Table 5
Results of Multiple Regression Analyses of Sibling Relationship Attitudes Predicting Aid/Support Provided by TD Siblings, TD Siblings’ Life Satisfaction, and
Depression, Anxiety, and Stress in TD Siblings (Total Sample).

Criterion Variables

Predictor Variables Total Aid SLS Total Depression Anxiety Stress

Model 1
Age Discrepancy (Abs. Value) 0.17 0.26* – – –
Distance from Sib w/ Dis 0.34** – – – –
Sib w/ Dis Birth Order 0.18 – – – 0.25*
TD Sibling Race (Dich) −0.18 – – – –
TD Sibling Income – – −0.18 −0.37** −0.27*
TD Sibling Marital Stat (Dich) – – −0.28* – –
R2 (df) 0.28 (4,77)*** 0.07 (1,80)* 0.14 (2,78)** 0.14 (1,79)** 0.13 (2,78)**

Model 2
Sibling Relationship Attitudes 0.27** 0.27* −0.31** −0.14 −0.23*
R2 (df) 0.07 (1,76)** 0.07 (1,79)* 0.09 (1,77)** 0.02 (1,78) 0.05 (1,77)*

Note. Abs. Value = absolute value; Sib w/Dis = sibling with disability; TD = Typically-developing; Race coded as 1 = white, 0 = nonwhite; Marital Status coded
as 0 = living alone, 1 = living with a significant other. Standardized beta-weights reported for each predictor. Degrees of freedom reported in parentheses
following each R2 value. Dashes indicate that control variables are not applicable for respective analyses.
***
p < 0.001.
**
p < 0.01.
*
p < 0.05.

(1983). The aforementioned variables were entered into a binary logistic regression as predictors of group membership
(ASD vs. ID), and the probability scores from these logistic regressions were saved and served as a single covariate when
examining group differences. Although the groups also differed on age of siblings with a DD, this variable was not included
as a covariate due to its strong association with TD sibling age (r = 0.88, p < 0.001).

8.2. Hypothesis 1

Hypothesis 1 (that sibling relationship attitudes would predict amount of aid provided by TD siblings, TD sibling life
satisfaction, TD sibling depression, TD sibling anxiety, and TD sibling stress across the whole sample) was tested via a
series of multiple regression analyses (Table 5). Statistically determined covariates (Table 3) were entered in Step 1 of
their respective analyses. Sibling relationship attitudes were entered in Step 2. Positive sibling relationship attitudes were
positively associated with aid provided by TD siblings, F(5, 76) = 7.65, p = 0.01, R2 = 0.07, and TD sibling life satisfaction,
F(1, 79) = 6.31, p = 0.01, R2 = 0.07. Alternatively, positive sibling relationship attitudes were negatively associated with TD
sibling depression, F(3, 77) = 9.33, p = 0.003, R2 = 0.09, and stress, F(3, 78) = 4.78, p = 0.03, R2 = 0.05. Sibling relationship
attitudes did not predict TD sibling anxiety, F(2, 78) = 1.69, p = 0.20, R2 = 0.02.
110 T.S. Tomeny et al. / Research in Developmental Disabilities 62 (2017) 104–114

8.3. Hypothesis 2

Hypothesis 2 (that TD siblings of individuals with ASD would have significantly lower levels of positive sibling relationship
attitudes compared to TD siblings of individuals with ID) was examined via an analysis of covariance. On average, TD siblings
of individuals with ASD (M = 153.45, SD = 31.82) reported significantly fewer positive sibling relationship attitudes compared
to TD siblings of individuals with ID (M = 171.55, SD = 31.63) while holding gender of siblings with a disability, TD sibling age,
TD sibling birth order, and childhood family size constant. Analyses were conducted twice (with separate covariates and
with the propensity scores as a single covariate); each analysis yielded significant group differences: F(1,75) = 7.07, p = 0.01,
when using separate covariates, F(1,78) = 7.55, p = 0.01, when using the propensity score.

8.4. Exploratory post hoc analyses

Given the group differences in sibling relationship attitudes and the relations between sibling relationship attitudes and
outcomes in TD siblings, we explored whether an indirect pathway exists between group membership (ASD vs. ID) and
(1) aid provided by, (2) life satisfaction, (3) depression, and (4) stress in TD siblings through sibling relationship attitudes.
Although a total effect between group membership and outcomes in TD siblings was not found, a total effect between the
predictor and the criterion variable is not a precursor for determining meaningful indirect effects (Hayes, 2013). Despite the
lack of evidence of a direct relation, it could be that TD sibling group membership relates to outcomes in TD siblings in an
indirect way through group differences in sibling relationship attitudes.
Indirect effects (i.e., the product of the effect for the path between group membership and sibling relationship attitudes
and the effect for the path between sibling relationship attitudes and each criterion variable; i.e., path a X path b; Hayes, 2013)
were examined using bootstrapping methods to estimate bias-corrected asymmetric confidence intervals (CIs) of the indirect
effects with 5000 resamples with replacement. A CI not inclusive of zero indicates a significant indirect effect (Preacher &
Hayes, 2008). These bootstrap analyses were conducted using Hayes’s (2013) PROCESS macro tool for SPSS. Aforementioned
propensity scores were entered as a control variable to account for group differences in demographic variables during each
analysis. Additional control variables were entered based on their bivariate relations with each respective criterion variable
(Table 4). Specifically, siblings with a DD birth order, geographic distance between siblings, TD sibling race (dichotomized:
1 = Caucasian, 0 = non-Caucasian), and the age difference between siblings (absolute value) were entered as control variables
when predicting amount of aid provided. Age difference between siblings (absolute value) and age of siblings with a DD
served as control variables when predicting TD sibling life satisfaction. When predicting TD sibling depression, TD sibling
marital status (dichotomized: 1 = living with a significant other, 0 = living alone) and TD sibling income were entered as
control variables. When predicting TD sibling stress, birth order of siblings with a DD and TD sibling income were entered
as control variables.
Fig. 2 displays the indirect effect of group membership (coded 0 = ID, 1 = ASD) through sibling relationship attitudes when
predicting aid provided by TD siblings (Panel A), TD sibling depression (Panel B), and TD sibling stress (Panel C). The point
estimate of the indirect effect was −0.93 (95% CI [−2.26, −0.22]) when predicting TD sibling aid, 2.00 (95% CI [0.52, 4.53])
when predicting TD sibling depression, and 1.52 (95% CI [0.25, 3.61]) when predicting TD sibling stress. No indirect effect
was found when predicting TD sibling life satisfaction −1.16 (95% CI [−3.0, 0.004]). The negative coefficients between group
membership and sibling relationship attitudes reflect the Hypothesis 2 findings (that TD siblings of those with ID report
higher levels of positive sibling relationship attitudes compared to TD siblings of those with ASD).
For these three TD sibling outcomes (aid, depression, stress), three additional post-hoc analyses were conducted to
examine indirect effects of group membership on sibling relationship attitudes indirectly through each of the TD sibling
outcomes. Despite the total effect of group membership on sibling relationship attitudes, none of the indirect effects through
the TD sibling outcomes were significant. These additional analyses further bolster our confidence in the directionality of
the indirect effect.

9. Discussion

In this study, we found that TD siblings of individuals with ASD reported fewer positive attitudes about their sibling
relationship compared to TD siblings of individuals with ID. Across the whole sample, sibling relationship attitudes accounted
for significant variance over and above demographic covariates in amount of aid/support provided by TD siblings, in TD sibling
life satisfaction, and in TD sibling depressive symptoms and stress. Specifically, results suggested that more positive sibling
relationship attitudes were related to increased levels of aid provided and life satisfaction and lower levels of depressive
symptoms and stress. Despite the challenges related to caring for a sibling with a disability described in previous research
(Dunigan & Connell, 2015; Tozer & Atkin, 2015), TD siblings in our sample who expressed more positive attitudes about their
sibling relationships also provided higher levels of aid to their sibling, described being more satisfied with life, and reported
fewer depressive and stress symptoms.
TD siblings of those with ASD reported significantly fewer positive sibling relationship attitudes. Multiple studies have
compared child siblings of those with ASD to those with Down Syndrome and other intellectual disabilities, and several
differences have been observed. For example, siblings of children with ASD often describe their sibling’s disability as stress-
ful and as having a negative impact on the sibling relationship (e.g., Petalas, Hastings, Nash, Dowey, & Reilly, 2009; Ross
 T.S. Tomeny et al. / Research in Developmental Disabilities 62 (2017) 104–114 111

Fig. 2. Mediated outcomes on TD sibling aid/support provided (panel A), depression (panel B), and stress (panel C) showing indirect effects of group
membership through sibling relationship attitudes. Note: Propensity scores were entered as a control variable for all three panels to account for group
differences in demographic characteristics. For panel A, birth order, race (dichotomized: 1 = white, 0 = nonwhite), geographic distance, and sibling age
difference (absolute value) were additional covariates. For panel B, TD sibling marital status (dichotomized: 1 = living with significant other, 0 = living
alone) and TD sibling income were additional covariates. For panel C, birth order and TD sibling income were additional covariates. Unstandardized
regression coefficients are reported. Statistics in brackets show the total effect of the predictor on the outcome; statistics in parentheses show the direct
effect of the predictor on the outcome, after controlling for the indirect effect of the mediator. Each indirect effect (depicted above each curved, dashed
arrow) was significant based on an asymmetric 95% confidence interval with 5000 resamples with replacement (Hayes, 2013).
112 T.S. Tomeny et al. / Research in Developmental Disabilities 62 (2017) 104–114

& Cuskelly, 2006; Sage & Jegatheesan, 2010) and on their relationships with friends (Petalas et al., 2009). TD siblings of
individuals with ASD also report lower levels of nurturance, intimacy, and prosocial behavior toward their sibling with ASD
and increased internalizing problems when compared to those with DS (Fisman, Wolf, Ellison, & Freeman, 2000; Kaminsky
& Dewey, 2001). Alternatively, siblings of those with DS do not report the aforementioned psychoscial problems as fre-
quently (Kaminsky & Dewey, 2002), report higher levels of relationship quality and more social support within the sibling
relationship (Pollard et al., 2013), and more overall positive views about their sibling’s disability (Mandleco & Webb, 2015).
Many have suggested that there is something different about living with an individual with ASD compared to living with
individuals with other, similar disorders (Fisman et al., 2000; Kaminsky & Dewey, 2001; Mascha & Boucher, 2006). The core
deficits in social functioning inherent in ASD often create interpersonal challenges, and these difficulties likely extend to
sibling relationships (Kaminsky & Dewey, 2001; Orsmond & Seltzer, 2000). The results of the current study suggest that
these distinct characteristics of ASD sibling relationship dyads appear to extend into adulthood.
Finally, multiple indirect pathways through sibling relationship attitudes were identified. These results indicate that
there is an indirect effect of group membership on amount of aid provided and TD sibling depressive symptoms and stress
through sibling relationship attitudes. Specifically, results indicate that TD siblings of those with ASD may be at greater risk
for depression and stress and for providing less aid/support due to lower levels of positive sibling relationship attitudes.
Again, these results support the notion that siblings of individuals with ASD are at greater risk for negative outcomes when
compared to siblings of individuals with ID (Hodapp & Urbano, 2007; Orsmond & Seltzer, 2000) and that these effects may be
explained, at least in part, by sibling relationship attitudes. In contrast, group membership did not demonstrate an indirect
effect on life satisfaction through sibling relationship attitudes, perhaps because life satisfaction is a global, positive outcome.
Previous research indicates that time spent with siblings with developmental disabilities may often be spent providing
instrumental support rather than engaging in close emotional and interpersonal sibling relationship behaviors (Burbidge &
Minnes, 2014). The unique nature of these relationships may leave TD siblings feeling unsatisfied, particularly TD siblings of
individuals with ASD given that those affected with ASD may be even less likely to reciprocate prosocial behavior. Neverthe-
less, these indirect pathways indicate that sibling relationship attitudes may be a particularly salient point of intervention.
According to the current results, improvements in sibling relationship attitudes may lead to reductions in depression and
stress and increases in amount of aid provided, particularly among TD siblings of individuals with ASD.

9.1. Limitation and future research

Several limitations should be considered when interpreting these results. The sample is relatively small and data were
collected in a way that may have led to sampling bias, thus reducing the generalizability of results. The relatively wide sibling
age range could confound the findings due to differences in experiences of young adults versus middle-age adults. However,
age of TD siblings was statistically accounted for given the significant differences between the groups and its relation with
criterion variables. In addition, data indicate that some of the TD siblings may have lived with both their parents and their
sibling with a disability; this may have introduced error given differences related to varied living arrangements. Moreover,
a large segment of the sample was female and previous research indicates that sisters may interact with siblings with
disabilities differently compared to brothers (Burke et al., 2012; Cridland, Jones, Stoyles, Caputi, & Magee, 2015; Orsmond &
Seltzer, 2000,2009). Finally, many of the respondents were recruited via organizations that provide support for those with
disabilities and their families. Thus, the current sample’s representation of the broader population may be less than optimal.
The study’s cross-sectional design also limits conclusions that can be drawn. Larger, more diverse longitudinal studies
that yield contemporaneous data early in childhood and later in life are necessary for achieving a more accurate assessment
of sibling functioning. Also, directionality and temporal relations among these variables cannot be determined. Although
sibling relationship attitudes were theorized as a predictor in the current analyses, the relations between the variables of
interest may be in the opposite direction. For example, it may be that those siblings who provide high levels of aid to their
sibling with a disability or who are generally satisfied in life may then experience more positive attitudes about the sibling
relationship. However, we have higher confidence in the directionality of the indirect effects given that diagnoses (i.e., group
membership) were likely determined, in most cases, when siblings were children and given that the tests for an indirect effect
when reversing sibling relationship attitudes with TD sibling outcomes in the model were all not significant. Additionally,
diagnoses of the siblings with disabilities were not independently confirmed, and standardized measures of disability,
behavior problems, and adaptive functioning were not performed—all of which are additional domains that may influence
sibling relationship attitudes and outcomes in TD siblings. Future research would be strengthened by direct assessment of
the affected individuals so that diagnoses are confirmed and more thorough information about the characteristics of the
siblings can be gathered. Finally, data from multiple informants (e.g., multiple siblings, parents) would allow for a more
comprehensive view of the constructs of interest.

9.2. Conclusions

Although developmental disability diagnostic classifications rarely change, the results of this study suggest that the
attitudes possessed by TD siblings are important to consider when understanding adult sibling outcomes. Specifically, data
suggest that higher levels of positive sibling relationship attitudes are related to TD siblings providing more aid/support to
their sibling with a disability, along with higher levels of general life satisfaction. More positive sibling relationship attitudes
 T.S. Tomeny et al. / Research in Developmental Disabilities 62 (2017) 104–114 113

also appear associated with lower levels of stress and depressive symptoms among TD siblings. Consistent with previous
child research (e.g., Mandleco & Webb, 2015), siblings of individuals with ASD report fewer positive sibling relationship
attitudes compared to siblings of individuals with ID without ASD. Finally, given the indirect effects of group membership on
aid/support provided, depressive symptoms, and stress through sibling relationship attitudes, sibling relationship attitudes
may be a salient point of intervention, particularly for siblings of individuals with ASD. Although prior changes in public
policy would be needed, clinicians working with adult siblings of those with ASD may be able to work with clients to improve
their attitudes about the sibling relationship when targeting other psychosocial outcomes. Despite this study’s limitations,
the results provide promising clues for improving our understanding of adult sibling relationships when disabilities are
involved.

Funding

This work was not supported by any funding agencies, and the authors have no conflicts of interest to report.

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