Preschool Peer Relationships in Younger Siblings of Children with ASD

Background: Peer competence and friendships are major developmental achievements in middle-childhood and are related to emotional well-being and academic skills. Peer relationships in preschool provide opportunities to develop the skills required for these achievements. By school-age, children with ASD demonstrate fewer reciprocal friendships and poorer peer competence than same-age peers. However, little is known about peer relationships in preschool-age children with ASD. Younger siblings of children with ASD may be at risk for poor peer competence and friendships due to higher rates of ASD (~20%) and other developmental and psychiatric conditions (~25%), but no empiric studies have yet described peer relationships in this high-risk (HR) population. Caregivers play an important role in promoting peer competence during preschool, but it is not yet known to what extent having an older sibling with ASD may impact early peer relationship development in this high-risk group.

Objectives: We examined 1) peer relationships in preschool-aged HR vs low-risk (LR) younger siblings, 2) factors associated with poorer peer relationships, and 3) peer relationship support activities among caregivers with an older child with ASD (HR) vs typical development (LR).

Methods: Data include 70 HR (16 ASD-pos; 54 ASD-neg) and 36 LR participants enrolled in the Infant Brain Imaging Study at 6 or 12 months with peer relationships measured during preschool (age 3-5). Diagnosis (based on DSM-IV-TR) and language ability (Expressive and Receptive Language, Mullen Scales) were directly assessed by research reliable clinicians across 4 sites at age 3-5 or at 24 months for 20 HR-ASD-neg children assessed only by questionnaire at age 3-5. Peer relationships (Peer Social Contact Questionnaire; Guralnick, 1997), and problem behavior (Internalizing and Externalizing scales, CBCL) were assessed through parent-report at preschool age.

Results: The HR-ASD-pos group had significantly fewer peer playmates than the HR-ASD-neg and LR-neg groups (F(2,103)=7.80, p<.001) and lower quality peer interactions than HR-ASD-neg group (F(2,79)=4.66, p<.05). Half of ASD-pos preschoolers had no playmates vs 20% of HR-ASD-neg and 20% of LR. HR-ASD-pos children with no peers had higher internalizing and externalizing behavior than those with peers, and HR-ASD-neg and LR groups. Caregivers of HR-ASD-pos children reported significantly greater stress while monitoring play (F(2,77)=4.82, p<.05) and greater need to directly facilitate peer play interactions (F(2,76)=4.20, p<.05). HR-ASD-neg and LR caregivers did not differ regarding stress while monitoring or facilitating.

Conclusions: Children with ASD already demonstrate precursors to poor peer competence and friendship outcomes by preschool, with fewer playmates and lower quality peer relationships. Having an older sibling with ASD does not increase caregiver stress or monitoring demands during younger sibling playdates. Importantly, arranging playdates is no more difficult for caregivers of preschoolers with ASD, caregivers with an older sibling with ASD (HR-ASD-neg) or caregivers with only typically developing children (LR). However, caregivers of preschoolers with ASD report increased stress while monitoring playdates as compared with HR-neg and LR caregivers. The preschool years may be well-suited for implementing parent-delivered interventions to support the development of peer competence in younger siblings of children with ASD and to reduce caregiver stress while monitoring play.