Research That Matters (January 17 - 20, 2008)

Purpose: Despite the prominence of a family systems framework in research on childhood chronic health conditions (CHC), data on the sibling relationship are limited, especially from the perspective of the sibling without the CHC (Stoneman, 2001).  However, this relationship helps form the foundation for the development of social and emotional competence (Lobato, Faust, & Spirito, 1988). Further, qualities of the sibling relationship, in particular warmth and conflict, have emerged as important predictors of adjustment for both the child with the CHC and the sibling.  The purpose of this research is to delineate individual, family, and environmental risk and protective influences on the sibling relationship in spina bifida (SB).

Methods: A convenience sample of 224 adolescent siblings of youth with SB was recruited from the Spina Bifida Association and three SB clinic sites.  Participants completed anonymous, self-report surveys that used standardized instruments to examine attitude toward illness, satisfaction with family functioning, peer social support, and select demographic factors.  Hierarchical regression analyses were performed to test predictors of (1) sibling warmth and (2) sibling conflict, after controlling for clinical (SB severity) and demographic (age difference; time living with sibling with SB) covariates.

Results: The overall model significantly predicted sibling warmth (R²= .32, F= 9.59, p < .01) and sibling conflict (R²= .22, F= 5.83, p < .01), and the set of individual, family, and environmental factors explained a significant amount of variance beyond the covariates in warmth (R²Δ= .31, F= 13.22, p < .01) and conflict (R²Δ = .08, F= 2.92, p < .01).  Specifically, sibling warmth was predicted by satisfaction with family functioning (B = 1.15, p < .001), same sex in the sibling dyad (B = 3.51, p = .005), and female gender for the sibling without SB (B = -3.83, p =.003).  In contrast, conflict in the sibling relationship was associated with low levels of family satisfaction (B = -.24, p = .004) and male gender for the sibling without SB (B = 1.74, p = .01).  Conflict was also associated with siblings who were closer in age (B = -.50, p < .001) and less severe SB (B = -.26, p = .01). 

Implications for Practice: This research identifies multi-level opportunities for social workers to mitigate risk and bolster protective influences on sibling relationships.  Male gender of the sibling without SB, less clinical severity of SB, and dyads close in age emerged as risk factors for conflict in the sibling relationship.  The health of the broader family environment carried an especially important influence on both sibling warmth and conflict.  Enhancing shared decision-making, communication, and affection in the family context is a pivotal role social workers may play.  Strengthening sibling relationships is a key component of providing family-centered services in SB.

Lobato, D., Faust, D., & Spirito, A.  (1988).  Examining the effects of chronic disease and disability on children's sibling relationships.  Journal of Pediatric Psychology, 13(3), 389-407.

Stoneman, Z. (2001).  Supporting positive sibling relationships during childhood.  Mental Retardation and Developmental Disabilities Research Reviews, 7, 134-142.