Children with ASD and Their Siblings: A Global Analysis and a Micro-Analysis of Dyadic Interactions

Background:

It is well accepted that siblings’ interactions in childhood are important for typical social development (Dunn, 2007). Social interaction is a fundamental challenge in Autism Spectrum Disorder (ASD), and therefore studies on sibling interactions when one of them has ASD are highly important. Still, these studies are rare (Knott et al., 2007; Bontinck et al., 2018).

An exploratory sequential mixed methods design (Creswell & Plano-Clarck, 2018) was used in the present study to explore sibling interaction among children with ASD in great detail.

Objectives:

To characterize interactions between children with ASD and their older typically developing (TD) siblings.

Methods:

Twenty-eight sibling dyads in middle childhood, in which the younger sibling has ASD (see table 1), were video-recorded in their homes playing a game of their choice. The observations were analyzed in an exploratory approach, guided by open-ended questions. In a circular process, based on data and literature from relevant fields, a system was developed for coding and analyzing the interactions. The code was found to be reliable (Kappa=0.703-1.00), and was implemented in a software program for the analysis of behavioral observations (INTERACT). All observations were coded on a global and a micro-analytic level, and data were analyzed to address a set of research questions regarding the characteristics of the dyadic interaction, among them: what activities were chosen? What was the set-up for the interaction? What was the most prevalent engagement state of the child with ASD, and how collaborative was the playing? What predicts the behavior of each sibling (affect, frequency and quality of actions, and scaffolding by the TD sibling)?

Results:

The siblings demonstrated a wide range of game choices and play levels (from sensory-motor to symbolic-imaginary). They tended to play on the floor, facing each other or angled, thereby best supporting eye-contact. Children with ASD demonstrated a coordinated symbol-infused joint engagement state during 70% of interaction time. About half of the ASD siblings demonstrated notable episodes of symbol-infused joint engagement states even without eye contact.

Interactions were mostly positive. The most frequent actions demonstrated by both siblings were play-related, then pro-social for TD siblings, and low-level (incomplete/unclear) actions for ASD children.

Both siblings were involved in coordinated play 82.45% of the time. They were also coordinated in the expression of affect (rs=0.751, p<0.01).

The number of pro-social, play-related, discourse, imitation, and agonistic actions of the ASD sibling was predicted by the number of actions of the same kind by the TD sibling (see table 2).

The level of adaptive behavior function of the ASD sibling predicted the degree of scaffolding by the TD sibling (χ2=4.509, df=1, p<0.05; Nagelkerke-R2=0.32).

Conclusions:

The findings indicate sensitivity and coordination between the siblings, and explain recent findings on better outcomes among children with ASD who have TD siblings, in comparison to only children (Ben-Itzchak, Zukerman & Zachor, 2016). This study challenges the assumption of negative influence underlying much research on children with ASD and their siblings (Stoneman, 2005). The benefits of at-home play with a familiar, better-abled, non-didactic partner are emphasized.