A Literature Review and Case Study on the Strengths and Struggles of Typically Developing Siblings of Persons With Disabilities

Abstract

Many counselors may recognize the importance of providing treatment to a person with a disability and that person’s primary caregiver due to the strain placed on the family. However, counselors may be less aware of issues concerning nondisabled sibling(s) in such families. Siblings of persons with disabilities (SPDs) may be forgotten in the counseling process, despite the increased stressors they experience. Therefore, in this article, we (a) provide a review of the literature on typically developing SPDs, (b) highlight the positive effects of having a sibling with a disability, and (c) describe a clear approach for counseling with this population and provide a case illustration.

Keywords

disability family sibling strength struggle

Approximately 6.5% of children struggle with some form of disability (Newacheck & Halfon, 1998). The trials encountered in such families likely contribute to the unique competencies and deficiencies of each family member, including typically developing siblings of persons with disabilities (SPDs). Many counselors may recognize the importance of providing treatment to a person with a disability and that person’s primary caregiver due to the strain placed on the family (Cherry, 1989). However, counselors may be less aware of issues concerning nondisabled sibling(s) in such families. The purpose of this article is to review the literature and inform counseling practice with typically developing SPDs.

Having a sibling with special needs can have a profound family impact, including significant problems with both internalizing and externalizing behavior (Fisman et al., 1996) and heightened risk of psychological difficulties throughout childhood (Giallo, Roberts, Emerson, Wood, & Gavidia-Payne, 2014). For example, 89% of adolescent SPDs indicated others are prejudiced toward their brother or sister, 84% believed others do not know how to act when in the presence of the person with a disability, 58% reported having concealed emotions about being an SPD, and 63% avoided family activities with a preference for doing things on their own (Opperman & Alant, 2003). Each of these areas can be compounded by other demographic characteristics of SPDs, such as family financial strain.

The systemic effects of financial strain experienced by parents inevitably affect all children in the family (e.g., Thompson & Haskins, 2014). In their review of the literature, Stabile and Allin (2012) found that families of children with disabilities face higher costs in out-of-pocket expenses, especially for medical issues, higher indirect costs in terms of decreased likelihood of maternal employment (compared with families of children without disabilities) and compromised maternal health, increased marital stress, and then higher long-term costs for the child with a disability due to his or her diminished potential to acquire and maintain profitable employment. Stabile and Allin also noted that mental health problems negatively influenced the long-term effects more so than physical problems, and they concluded that overall costs (including societal contributions, with the exception of expenses covered through insurance) averaged US$30,500 per year for each family of a child with a disability. In their research summary on their study conducted in the UK, Dobson and Middleton (1998) noted that the estimated minimum costs required to raise a child with a severe disability, while allowing the child to engage the surrounding environment as completely as possible, would be 3 times more than the costs associated with a typically developing child. The increased costs are considerable and likely add stressors to the entire family unit.

In examining families in the United States, one study compared families of children with disabilities and families of children with typically developing children (Daire, Munyon, Carlson, Kimemia, & Mitcham, 2011) and found that parents of children with disabilities utilized community supports to a greater degree. Additionally, no significant differences existed in levels of individual or marital distress for parents of children with disabilities compared with those of typically developing children. One inference from Daire et al.’s study is that families of persons with disabilities must use more resources in order to simply achieve the same level of coping as families of typically developing children who have less need of such resources. For families of children with special needs, Daire and colleagues found that total child visits with professionals were 50.47 on average over 6 months, compared to 0.29 for families of typically developing children. At a minimum, this translates into time and energy expended by at least one parent to acquire the services, even if they are government subsidized, and then time and energy utilizing those services, all of which takes away from time which could otherwise be spent in different family activities with more direct involvement of all of the children in the family. This does not take into account other costs that may be associated with attending so many professional visits, such as transportation, childcare for siblings, and time away from work or other household responsibilities.

A noteworthy limitation of Daire et al.’s study is that participants were mostly White, educated at the college level or greater, and married. Nevertheless, a potential implication of this study is that, if it takes more social support to maintain equal footing when a family has a child with special needs, then families of children with special needs who are less able to navigate the infrastructure of the social support system may be more distressed at both the individual and the marital levels. Given the relative socioeconomic disparities and associated contextual stressors faced by low-income families (e.g., Karney & Bradbury, 2005), low-income families may have greater need of social support services and experience greater difficulty accessing and maintaining those services (e.g., due to inconsistency of available transportation such as when relying upon a Medicaid van).

In addition to income status, researchers noted that certain birth defects disproportionately affect specific ethnically diverse populations (National Center on Birth Defects & Developmental Disabilities, 2016). In the late 1990s, there were also disproportionate numbers of Black males, children in single-parent families, and families below the poverty level dealing with a childhood disability (Newacheck & Halfon, 1998; Parish, Rose, Grinstein-Weiss, Richman, & Andrews, 2008). Moreover, note that siblings of children with congenital disabilities are more likely to struggle with mental health concerns compared with typically developing siblings (Giallo et al., 2014), and ethnically diverse individuals are less likely to present to counseling in the first place (Clement et al., 2015). Thus, the potential compounding of factors highlights the importance of counselors being informed on the strengths and struggles of SPDs in order to build bridges to communities which may otherwise be turned off by the notion of counseling. However, the literature in major counseling journals has historically evidenced scant interest in examining this population.

In a search of counseling-related journals over approximately the past 20 years, using the search terms “sibling” and “disability,” only eight articles existed that addressed interventions, supportive activities, or referrals for siblings. Of these, only two articles provided substantive information on interventions with siblings (i.e., Bodenhorn & Lawson, 2003; Layne, 2007) and one provided information on a supportive activity for multiple families including SPDs (Lock, Hendricks, Bradley, & Layton, 2010). Counselors may naturally work with the primary caregivers to help ensure a good foundation for the family (e.g., shared parenting, strong social support). Yet, the omission of focus on the SPDs is striking because, for example, in persons with intellectual disabilities, an SPD is likely to inherit the caregiving responsibility (Greenberg, Seltzer, Orsmond, & Krauss, 1999).

Despite documented struggles experienced by SPDs (e.g., Giallo & Gavidia-Payne, 2006; Orsmond & Seltzer, 2007; Williams, 1997), their strengths have not received much scholarly attention in peer-reviewed literature. Specifically, counseling-related journals include scant information on issues concerning SPDs and effective approaches when working with SPDs and their families. Therefore, this article focuses on the strengths of SPDs and presents strategies for counselors when working with SPDs and their families.

Strength-Based Perspective for SPDs

Over the past 25 years, researchers have either examined how deficits of siblings of children with disabilities may be mitigated (Pollard, Barry, Freedman, & Kotchick, 2013) or how the siblings have fared as part of the family system (Bragg & Brown, 1992). Studies examining siblings in such families are likely to be found in journals concerned with developmental disabilities (e.g., Meadan, Stoner, & Angell, 2010; Mophosho, Widdows, & Gomez, 2009), intellectual disability (e.g., Cunningham, Glenn, & Fitzpatrick, 2000; Mazaheri et al., 2013), nursing (e.g., Graff et al., 2012; O’Brien, Duffy, & Nicholl, 2009), pediatrics (e.g., Goudie, Havercamp, Jamieson, & Sahr, 2013; Williams et al., 2003), and pediatric psychology (e.g., Lobato & Kao, 2005). A trend in literature on developmental disorders and intellectual disability has been to consider strengths of siblings as well (e.g., Cuskelly & Gunn, 2006; Hodapp & Urbano, 2007). Hodapp (2007) provided a review of the transition in the literature from a deficit-based perspective to a stress-and-coping lens. Given the interdisciplinary interest in this topic, counselors venturing outside the confines of major counseling journals have a wide array of literature to consult in preparing to help this unique population. Literature reviews external to the field of counseling prove helpful for an initial foray into a deeper understanding of the variety of SPDs. The literature discussed in this article was reviewed over nearly a decade by the first author due to interest in working with families of children born with disabilities. The methodology by which much of this review of the literature could be replicated would involve using the terms sibling and disability to search major social science research databases such as PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO, and Social Sciences Full Text (H. W. Wilson).

Sibling Struggles and Services

A literature review on risk among siblings of children with chronic illness revealed that 60% of studies indicated greater risk for maladjustment, 30% did not find a risk, and 10% found a blend of adaptive and maladaptive sequela (Williams, 1997). Additionally, a review of the literature on siblings of children with an autism spectrum disorder (ASD) indicated that siblings could be at increased risk for social and behavioral problems (Orsmond & Seltzer, 2007). Similarly, siblings of children with pervasive developmental disorders have been found to have greater levels of difficulty than siblings of children with Down syndrome (DS) and siblings of nondisabled children (Fisman et al., 1996). As far back as the 1960s, it was asserted that psychiatrists treated more brothers and sisters of disabled children than children with handicaps themselves (Poznanski, 1969). Seligman (1983) indicated factors likely contributing to sibling problems include a sense of responsibility, fear of catching the disability, anger and guilt, communication, and parental attitudes. Whereas early work from both Poznanski and Seligman appears deficit-based, a different study found that religion shapes parental attitudes in their ability to build a positive meaning about the disability (Murray, Kelley-Soderholm, & Murray, 2007). The strength-based view of such parents likely influences their children in the same direction. Taking both views into account, it is likely that counselors are going to see SPDs but also that such clients will bring unique strengths into the room with them. Moreover, Duncan (2014) noted that exploration of strengths and the activation of client resources are more fruitful therapeutic endeavors (in terms of outcomes) than is continually identifying insufficiencies and psychopathology. Consequently, it is important to tend to the strengths of SPDs while remaining informed of their difficulties.

Allison and Campbell (2015) contended that sibling relationship quality affects psychosocial skills, acknowledged the varied findings about relationships in families of persons with disabilities, and sought to study mothers’ perspectives about the effect of the disability on the sibling relationship, using SPDs closest in age to the sibling with a disability (SD). Overall, they found that SPDs had less warmth and closeness in relationship to the SD than typically developing siblings. They also found that younger children had more warmth and closeness. Lastly, they found that there was more conflict when the sibling was younger, regardless of the presence of a disability.

Using parental perceptions and self-reports, Long et al. (2013) researched the difference between Latino and non-Latino White siblings of children with an intellectual disability. The researchers concluded that the differences in communicating and expression of emotion can lead to greater risk for emotional problems among Latino SPDs. Furthermore, Welch et al. (2012) investigated whether respite services with an SD make a difference to SPDs in England. They found that SPDs reported mostly positive feedback about the effects of respite services providing a dual role in that they helped to buffer some of the negative aspects of being an SPD while they also highlighted positive aspects of being an SPD. From a conceptual perspective, Hewitt, Agosta, Heller, Williams, and Reinke (2013) wrote on experiences of families of persons with intellectual and developmental disabilities. They acknowledged that SPDs need to prepare for when they will take over care for the adult SD. The researchers noted the following concerns with regard to supporting these families: (a) tension between self-advocacy (of the SD) and allowing the family to be involved in decision-making; (b) lack of an agreed-upon definition for support of the family, noting that some consider any individual support to the SD as family support, definitions will continue to vary state by state, and often supports fail to address siblings; (c) lack of a national database regarding supports for families which could provide accurate information for each state’s supports; (d) increasing demand for supporting SDs living in the family home, noting that many states have ceiling to the amount of funding or spots available for those seeking support; (e) overdependence on federal Medicaid dollars for support for families, noting that states are seeking to limit services and enrollment and that family supports may not always be considered reimbursable services; and (f) lack of focus on adult SPDs, noting their importance as primary caregivers.

In Belgium, Moyson and Roeyers (2012) studied the perceptions of quality of life specifically related to being SPD. The final list generated had nine domains: joint activities with the SD, desired mutual understanding with the SD, private time away from the SD, acceptance of differences of the SD, forbearance with the SD’s limitations, trust in well-being of the SD (with emotions negatively affected when the SD is not well), exchanging experiences with other SPDs, social support SPDs desire from parents and any other SPDs in their households, and dealing with the outside world which can lead to a sense of comfort or discomfort. Counselors could use such a list in a session geared toward contemplation and the potential for self-efficacy among young SPDs as well as adolescent SPDs, with the clear understanding that SPDs are free to agree or disagree and come up with their own lists about quality of life.

Note the wide variety of struggles and services indicated above when it comes to addressing SPDs’ struggles which could be conceptualized as growth opportunities. Counselors may enhance their knowledge of siblings of children with disabilities by considering potential psychosocial strengths in particular, such as love, kindness, loyalty, and perseverance (Peterson & Seligman, 2004) (for a more thorough review of deficit-based literature as well as additional strengths-based information on SPDs, please see Seligman and Darling, 2007, chapter 9, Effects on Siblings).

Sibling Social Development

Mulroy, Robertson, Aibertie, Leonard, and Bower (2007) investigated parents’ perspectives regarding the impact on their children of having a sibling with either DS or Rett syndrome. They found that the main disadvantages for the siblings involved parent and personal time limitations, lack of a typical sibling relationship (such as sharing secrets), missed opportunities for socializing, unique prohibitions and constricted routines, and their parents’ emotion and helping load. The perceived benefits involved open-mindedness, compassion, maturity, patience, helpfulness, and appreciation of their own health.

Mandleco, Olsen, Dyches, and Marshall (2003) utilized a descriptive field study, specifically a comparative analysis examining correlates of parents’ understanding of family functioning and school-aged siblings’ prosocial skills and problematic conduct. The descriptive results regarding adjustment of siblings of children with disability(ies) indicated that siblings had greater self-control and cooperative/assertive conduct than the comparison group siblings. The authors noted that bivariate analysis revealed that socioeconomic status was related to both externalizing and self-control behavior of the children (with higher income negatively correlated with child externalizing and positively correlated with child self-control). The authors also reported that they did not find differences in family conflict, marital conflict, or orientation toward external locus of control when it came to the study group and the comparison group. Mandleco et al. (2003) still concluded that it is not the presence of a child with a disability that affects family adaptation so much as it is the communication patterns within families.

Cuskelly and Gunn (2006) conducted a descriptive field study, specifically investigating the adjustment of siblings of people with DS and comparing it with adjustment of siblings who did not have an SD. They indicated that a “well-adjusted child could be described as one who shows few behavioral difficulties, has high self-esteem, and who is competent in everyday activities at school and with peers” (p. 918). Mothers of children in the study group indicated a greater level of caregiving than mothers of children in the comparison group. Also, siblings in the study group of children indicated a greater level of caregiving than siblings in the comparison group.

Based on the studies indicated above, counselors may conclude that in some families of children with disability(ies), levels of self-control and cooperative/assertive conduct may be high. For example, SPDs may have high levels of sharing, helping, compliance with authority, taking initiative, self-introducing behavior, seeking information from others, and responsiveness to others. Furthermore, siblings of children with DS may exhibit high levels of caregiving behavior. Therefore, if siblings of children with disabilities present for counseling, clinicians can explore these constructs with them and perhaps have a ready base of strengths on which to build for growth.

Sibling Relationships

Cuskelly and Gunn (2003) initiated a descriptive field study specifically investigating the sibling relationships of siblings of people with DS and compared this with sibling relationships of those who did not have an SD. Siblings in the study group scored higher on empathy when they had a sibling of the same sex than did siblings in the comparison group. Siblings in the study group scored lower on unkindness than did siblings in the comparison group. Children in the study group also had higher caregiving scores than children in the comparison group.

Graff et al. (2012) conducted a qualitative study examining perspectives of adolescent siblings of children with DS and multiple health problems. Many indicated no desire to change a thing regarding their experiences, yet they acknowledged their family being affected by the needs of the child with DS and other health problems and they did not consider the sibling with DS capable of ever living independently. Overall, participants focused on positive rather than negative issues related to their experience.

Hodapp and Urbano (2007) employed a cross-sectional design descriptive field study, specifically examining the issue of “Down syndrome advantage” (p. 1018) with regard to disabilities, looking in particular at adult siblings of people with DS and adult siblings of people with ASD. Their findings were positive regarding a DS advantage, as evidenced by the following items: higher reported levels of sibling closeness and positivity, more frequent contacts with the sibling with DS, a marginally higher number of hours spent together per month, and marginally lower depressive symptoms for siblings of people with DS versus siblings of people with ASD. Additionally, only 3.2% of people with DS lost supports or services within the previous year versus 14.2% of people with ASD.

Hodapp and Urbano acknowledged that personality characteristics of people with DS versus people with ASD may have played a role in the finding of a DS advantage. They also noted that people with DS tend to have older mothers who perhaps have more parenting experience than mothers of children with ASD. Furthermore, they agree with Cahill and Glidden’s findings (1996) that families of children with DS tend to have higher incomes than families of children with other disabilities.

Smith and Cascella (2007) surveyed siblings of people with DS regarding their perspective on communication competence of the sibling with DS. The findings placed most persons with DS’s ability to communicate in a positive light, highlighting them as communicators who were “effective,” “good,” and capable of communicating “to potential” (p. 187). The authors noted that the more positive descriptions were typically used by siblings to describe persons with DS who were adults, did not have a severe intellectual disability, and did not have hearing loss.

Equipped with the information outlined above, counselors may be better able to collaboratively search for strengths in session with SPDs. Note the importance of being mindful of the diversity of struggles within the population of siblings of children with disabilities. For the purpose of this article, Hodapp and Urbano (2007) specified the importance of awareness regarding adult siblings of people with disabilities because adults with DS are living longer and likely to outlive their parents, leaving siblings to become their caretakers. This is especially pertinent for siblings of people with DS due to early onset dementia and other concurrent health problems typically occurring with DS (Zigman & Lott, 2007). Counselors can assist siblings of people with DS in recalling and leaning in to the bank of strengths contained within the DS advantage in order to navigate difficult life circumstances. For siblings of persons with ASD, counselors can explore with them strengths they may have developed in order to cope with difficulties in the sibling relationship as well as unique exceptions and the ensuing bonds that may occur when the sibling relationship overrides the potential social deficits.

Implications for Counseling Practice

In addition to using strengths, counselors working with SPDs can follow some general guidelines in their work. These guidelines can be conceived in the following steps: (a) assessing for client strengths; (b) incorporating a variety of modalities and techniques, such as play therapy, family therapy, and use of intentional questions; and (c) utilizing community resources to build family support. Below, we provide more depth to this process as well as a case example.

Parents may welcome the offer for a counselor to work with the nondisabled sibling as a form of respite care, particularly if the sibling and the counselor are engaged in child-centered play therapy, which is said to be focused on the child rather than a problem (Landreth & Sweeney, 1997). Other forms of play therapy could also be utilized to assist in working through intrapersonal and interpersonal conflicts, including filial therapy, which involves the counselor training the parents to conduct play therapy with their children (Guerney, 1964; VanFleet, 2013), or parent–child interaction therapy (Hembree-Kigin & McNeil, 2013), a combination of behavioral therapy and play therapy for parents struggling with child disciplinary concerns.

For screening clients and families, counselors have a variety of options from which to choose. For example, the Outcome Rating Scale and the Session Rating Scale (Duncan, 2014) can aid in guiding treatment through collaborative goal setting and course correcting. From a systemic lens, counselors can utilize the SCORE-15 (Stratton et al., 2014) to gather both quantitative and qualitative data on family functioning in a succinct manner. Furthermore, the counselor can engage the child/family in constructing a genogram during the first session to assess how other family members have responded to the client and also their respective relationships with the SD. Children may particularly enjoy constructing play genograms (McGoldrick, Gerson, Petry, & Gil, 2008), thus counselors should have miniatures available in liberal supply. Lastly, an activity for understanding children’s perspectives and getting on their level is the kinetic family drawing (Burns & Kaufman, 1972). This activity involves providing a child with a paper and pencil (preferably one without an eraser), with a request along the lines of “Please draw a picture of you and your family doing something together.” Afterward, the clinician can ask questions about what is happening in the picture, what individuals in the picture are thinking and feeling, as well as what will happen next. A variety of views exist on analysis with this projective technique, but a primary objective is the attempt to see the world through the child’s eyes (for a current brief overview with examples included, see McConaughy, 2013).

Simple questions about client and family functioning may prove helpful, such as What’s the best thing you’ve done lately?; Done anything that’s hard to talk about? (Followed up with) Please tell me about the hard stuff.; What’s the best thing that’s happened in your family lately?; What’s the hardest thing that’s happened?; If I ask Mom how you’ve been doing, what do you think she’ll tell me?; Do you need anything you haven’t been getting lately?; What’s one good thing about being a brother or sister to (siblings’ names)?; What’s one hard thing about being a brother or sister to (siblings’ names)?; If I were to ask him or her or them about it, what do you think he or she or they would say is good about being your sibling?; and What would he or she or they say is hard about being your sibling?

Counselors may probe and find in research and practice that siblings of children with a disability such as DS do not have a damaged relationship with the SD and may actually experience greater levels of empathy, less unkindness, and take more opportunities for caregiving than siblings of children without disabilities. These may be useful strengths upon which to build for growth in a counseling setting. A search for these strengths at the intake session may prove fruitful in terms of activating client internal resources and building a strong therapeutic alliance (Duncan, 2014; Duncan & Moynihan, 1994).

Counselors should also consider advocacy and referral opportunities. There is a wide range of events available within most communities for persons with disabilities and their family members. For example, some communities host events, such as an Advocacy Day for Access and Independence, in support of people with disabilities in general. Additionally, there are national organizations, such as the National Association for DS, with local chapters that host a Buddy Walk in support of people with DS. Involvement in such organizations may help parents, siblings, and children with disabilities develop a supportive community which may highlight the family’s strengths rather than focus on deficits.

Counselors may also be able to host events such as Don Meyer’s Sibshops (Meyer, Vadasy, & Fewell, 1985; Sibling Support Project, 2015), workshops in a low-key setting which are designed for siblings of children with disabilities. These workshops have traditionally offered information, activities, and discussions for children and parents. In particular, Sibshops can serve to combat feelings of isolation in siblings of children with disabilities, as each workshop can serve as a meeting place for them to meet others who share similar stories and struggles, an opportunity not often afforded in everyday life (Meyer, Vadasy, & Fewell, 1985). Counselors working with siblings and families of people with disabilities on a systemic level may need to regularly consult with professionals in a variety of fields, especially social workers (who may be working with the person with a disability and the primary caregiver), psychologists, and medical professionals such as developmental pediatricians and other specialists. If the counselor is working in a primary care clinic or school of medicine, then building a relationship with stakeholders at the clinic or school of medicine can help to establish a collaborative relationship which may help families of people with disabilities seeking services through the school of medicine. Following, we provide a case example to demonstrate some of the clinical strategies outlined above.

Case Example

Drawing from clinical experience working with an African American male sibling of a child with hearing loss, we will call our SPD “Mikey” and his sibling with hearing loss “Scotty.”

The family was dealing with financial difficulty at the time and living in a rough neighborhood. Scotty was a 9-year-old African American male with a history of explosive behavior to the extent that one could say if someone started something against him, he would finish it, and then some. Findings on children with hearing impairments reveal that this population has a harder time expressing themselves and making themselves understood (Fellinger, Holzinger, Sattel, Laucht, & Goldberg, 2009). Thus, a buildup of difficulty with expression could have been at play in the perception of disproportionate reactions. However, Scotty was also protective of his younger sibling Mikey.

Mikey was 5 years old and had a history of internalizing symptoms including statements of suicidality and attempts to harm himself. In the play therapy office, he also exhibited a knack for sticking with potentially frustrating activities such as a magnet matching game, a desire for reading about and understanding emotions, a penchant for hand sanitation once educated on the topic, and a wonderful ability to articulate himself.

The systemic side of counseling focused on dealing with violence between siblings and avoiding age-inappropriate media exposure such as mature video game violence. Work with their mother included implementation of special time with Mikey daily or as often as possible in order to strengthen their bond and so that he could better internalize a sense of security for when she was not around. Structural work with his sister included the agreement to cooperate with acting a little more responsible like mom instead of neglecting to feed him when she babysat. Additional structural work included seeking to aid the parental hierarchy getting into alliance with one another on media limits and on disciplinary procedures for whenever violence or other difficult behavior occurred among the children. As is perhaps the case with many identified patients, once such ideas were out in the open and some incremental shifts began to occur, Mikey began to flourish and this showed in counseling.

Mikey’s developmental maturity was actually commented on by the clinician’s supervisor during a review of the case. One example of this is when he chose a book for the clinician to read to him, My Many Colored Days (Dr. Seuss, 1996/1998). Mikey expressed how his dad told him he could howl like a wolf. When he got to the page with the wolf, that is exactly what he did when encouraged that he could do so, loudly. His latent strengths showed up in the area of organization as well. His strengths all this time were running in a stream beneath the litter of burdens on the surface. As the litter began clearing away, the beauty of the stream became clearer and clearer. While some difficulties remained, including living in a rough neighborhood, others which were within control of the family were managed in such a way so as to facilitate Mikey’s ability to grow.

Challenges

Considering the literature review and suggestions for practice outlined above, there are challenges to be addressed when working with SPDs. For example, multiple problems may often be part of the case when presenting for treatment in a community setting serving the underserved, as was the case with Mikey. Findings on child poverty and mental health concerns have been well-documented by Costello, Compton, Keeler, and Angold (2003) as well as Thompson and Haskins (2014). The challenge to the therapist is to mine for strengths even in the midst of the parental complaints about the child, family, or neighborhood. Some may argue that looking at strengths simply puts rose-colored glasses on the clinician and is merely a reaction to a deficit focus (i.e., it is the pendulum swinging the other direction rather than taking a realistic view of the client/family). However, the point of the matter is not to focus solely on strengths but rather that focusing on strengths will result in greater outcomes than simply seeking to mitigate deficits through assessment, diagnosis, and psychoeducation.

Furthermore, research is lacking on ethnically diverse SPDs, especially with regard to counseling. Thus, one of the challenges to practitioners is to apply what is currently known about SPDs in general and discover what works with each client, with an eye toward solutions.

Conclusion

Siblings of children with disabilities represent a population that has unique strengths as well as struggles, formed in the same crucible. Such a rich history makes for a potential client story saturated with love in the midst of inadequacy, dancing in the midst of disability, singing in the midst of pain, or, at a minimum, perseverance in the face of adversity.

Though historically the literature has been deficit-based, more recent literature points toward adaptive functioning of SPDs and in some cases potential positive features that come along with having an SD. Alongside the deficit-based literature necessary to explore needs, future research could include studying specific positive features of SPDs’ histories which can be called upon for advocacy efforts and day-to-day life in overcoming obstacles. Yet another possibility is that research could be conducted to probe for developmental events and patterns among flourishing SPDs. Furthermore, a pilot study could be conducted on outcomes for child-centered play therapy, filial play therapy, or parent–child interaction therapy with SPDs. Lastly, both correlational and treatment studies could be conducted with ethnically diverse SPDs in order to better inform practitioners encountering this population.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflict of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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