Dissertations, Theses, and Capstone Projects

Date of Degree

9-2024

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Emily Jones

Committee Members

Valentina Nikulina

Veronica J. Hinton

Holly Weisberg

Theodore S. Tomeny

Subject Categories

Clinical Psychology

Keywords

autism, siblings, naturalistic developmental behavioral intervention

Abstract

Relationships between children with autism and their non-autistic siblings are often characterized by great warmth, empathy, and affection. However, because of core deficits in social-emotional reciprocity, autistic children and their siblings often experience difficulties with communication, play, and associated mental health problems. Interventions aimed at improving relationships in these sibling dyads historically have involved teaching non-autistic children to behave similarly to interventionists for autistic siblings, and support groups for children with broad chronic illnesses. More recent interventions have shifted focus to improvement of play between siblings, and support groups for siblings of children with autism spectrum disorder. Some are naturalistic developmental behavioral interventions (NDBIs) that utilize traditional behavioral intervention methods, bolstered by natural environment teaching, and tailored to learners’ developmental skill level.

SIBS Club at Queens College was the first program to investigate results of a randomized controlled trial comparing mental health outcomes for non-autistic siblings who underwent a 10-week support group consisting of standardized psychoeducation and provision of emotional coping strategies, to those who underwent a 10-week control group (Jones et al., 2020). Further interventions conducted by SIBS Club personnel (Kryzak & Jones, 2017; Weisberg et al., 2024) have focused on the individual tailoring of behavioral interventions to improve prosocial relationship behavior in siblings through use of the Stay, Play, Talk curriculum (English et al., 2005) and self-management. The current research examined two experimental NDBIs tailored for three autistic children and their non-autistic siblings, and one group-based intervention implemented through SIBS Club that combined emotional support, psychoeducation, and behavioral skills training for non-autistic siblings. The three research questions we pursued included:

Experiment 1 Research Question: What are the effects of a simple behavioral intervention (prompting and reinforcement) on social skills (sharing) in two autistic children and their non-autistic sisters?

Experiment 2 Research Question: What are the effects of a complex behavioral intervention (behavioral skills training and self-management with video-based modeling and feedback) on social conversation skills (initiating conversation, asking questions, reciprocity) in an autistic boy and his non-autistic sister?

Experiment 3 Research Question: What are the differential effects of three group intervention packages (social attention only control group, support group, support group combined with behavioral interventions) on the psychological well-being of non-autistic siblings of autistic children?

Experiment 1 examined use of behavioral interventions – most-to-least prompting and positive reinforcement – to teach autistic children and non-autistic siblings to share toys, the first study to our knowledge to effectively utilize identical interventions for both siblings. Experiment 2 extended these findings by using identical behavioral interventions (i.e., behavioral skills training and self-management) with an autistic child and his non-autistic sister to improve upon conversation skills. Experiment 2 is limited in that its experimental design is incomplete, as the study was discontinued due to changes in participant availability before the clinician was able to fade intervention supports and examine independent skill acquisition. However, intervention supports led to improvements in both participants’ conversation skills. As toy sharing, initiation of conversations, question-asking, and conversational reciprocity are pivotal prosocial behaviors, we view them as reflecting improved sibling relationships. Experiment 2 also improved upon naturalistic and developmental aspects of behavioral interventions, thereby increasing likelihood of generalized outcomes, and best tailoring target behaviors to children’s developmental skill levels, increasing likelihood of effective initial (and later associated) acquisition. Experiment 2 also leaves room for improvement in these areas, however. We suggest future research address the gaps still present in Experiment 2, by optimizing natural environment teaching and developmental individualization (e.g., Vineland-3; Sparrow et al., 2016). Furthermore, both Experiments 1-2 are limited in their external validity due to small sample sizes, and by their sole focus on behavioral outcomes. Experiment 3 combined behavioral training procedures, similar to those used in Experiments 1-2, with a support group for siblings of children with autism. The support group consisted largely of introduction to other children, identification as part of a group of children with autistic siblings, psychoeducation about autism, and provision of emotional coping strategies. As such, the intervention addressed emotional, cognitive, and behavioral outcomes in non-autistic siblings. The preliminary results of this pilot study revealed trending changes in internalizing and externalizing symptomatology, coping skills, and perceptions of sibling relationship quality in the group of children receiving a combination of support and training, compared to those who participated in a support group only, or in an attention-only control group (Jones et al., 2020).

Overall, these three studies demonstrate ways of improving behavioral interventions and group-based supports for relationships between autistic and non-autistic siblings. Experiments 1 and 2 demonstrate how clinicians can utilize identical intervention methods for both autistic and non-autistic children, and we use these data to discuss ways of improving naturalistic and developmental aspects of behavioral interventions. Experiment 3 reveals promising preliminary data from a pilot comparison of psychological outcomes in siblings of autistic children. All three studies are limited in sample size, and thus external validity. However, we outline suggestions for future research to continue to examine individual and group-based interventions addressing emotional, cognitive, and behavioral relationship outcomes for autistic children and their siblings.

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