In brief
Siblings of children with autism experience a lot, both good and hard. A meta-analysis found, on average, more social, emotional and behavioural difficulties than among siblings of children without autism (an average finding, not a judgement about an individual child; effect size not checked by us). [1] Differences between individual families can be large; older reviews also describe studies without any difference. [4] In one study, social support was linked to better outcomes for siblings. [3] Siblings mainly need attention, age-appropriate explanations and time of their own.
This English translation was produced with AI assistance and has not yet been independently reviewed.
What studies show
A 2023 meta-analysis evaluated 24 studies. On average, siblings of children with autism had more adjustment difficulties than siblings of children without autism in all three areas examined: social, emotional and behavioural. [1] We have not checked how large the differences are; we only know the summary of the study. Fewer difficulties were seen in older siblings, in sisters or female siblings, and in siblings who were older than the child with autism. This is an average finding across studies and says nothing about the individual child. [1]
The research is not uniform. A review from 2013 (14 articles) describes studies with poorer adjustment, but also studies without any difference and indications of positive effects of growing up with a sibling on the autism spectrum. The author notes that the samples mostly combined children and adolescents and that precise conclusions are therefore difficult. [4]
Why siblings are affected so differently
A study of 168 children with autism (grouped by support-need profiles, reports from parents and siblings) found that how siblings were doing was linked to characteristics of the child with autism. Siblings of children with the most complex support needs reported a less warm relationship, but not more problems of their own. The most problems of their own and more conflict in the relationship were instead shown by siblings of children with a mild symptom profile and high daily-living skills who themselves had many behavioural and emotional difficulties. [2]
In a 2012 study that compared families with a home-based ABA programme with control families, social support was linked to better outcomes for siblings in all groups examined. The main finding of the study was that the programme brought neither clear disadvantages nor advantages for the siblings. A link does not mean that support was the cause of the better outcomes. [3]
What parents can do
The 2021 S3 guideline (expired on 23.03.2026 according to the overview of the DGKJP [6]) recommended considering the whole family including siblings when making decisions about therapy and support. [5, Rec. 6, Ch. C.3.2] The following suggestions come from practice and are not proven to be effective; none of the cited studies tested them:
- Explain what autism is, in age-appropriate language and again and again, because questions change with age.
- Plan exclusive time with each sibling, even if it is only short, fixed moments.
- Allow feelings: anger, shame, jealousy or worry are normal and may be spoken about.
- Do not overburden: siblings should not permanently take on the role of carers.
- Use outside support, for example friendships, grandparents or sibling groups, where available.
What do we know – what is still open?
Found repeatedly
- On average, more adjustment difficulties among siblings of children with autism (meta-analysis of 24 studies; effect size not checked). [1]
Older picture: inconsistent
- A 2013 review describes studies with poorer adjustment, with no difference and with positive effects. [4]
Limited evidence
- In one study, social support was linked to better outcomes for siblings (a link, not a demonstrated effect). [3]
Open
- Which specific services demonstrably help siblings, and how well international studies transfer to Germany.
Sources and literature
- Park HR, Moon H, Kim YS, Karkar Esperat TM, Lee J. A meta-analysis on adjustment difficulties in siblings of children with and without autism spectrum disorder. International Journal of Special Education 2023;38(1):16–33. https://doi.org/10.52291/ijse.2023.38.2 – Meta-analysis
- Rixon L, Hastings RP, Kovshoff H, Bailey T. Sibling adjustment and sibling relationships associated with clusters of needs in children with autism: a novel methodological approach. Journal of Autism and Developmental Disorders 2021;51(11):4067–4076. https://doi.org/10.1007/s10803-020-04854-0 – Study
- Cebula KR. Applied behavior analysis programs for autism: sibling psychosocial adjustment during and following intervention use. Journal of Autism and Developmental Disorders 2012;42(5):847–862. https://doi.org/10.1007/s10803-011-1322-x – Study
- Green L. The well-being of siblings of individuals with autism. ISRN Neurology 2013;2013:417194. https://doi.org/10.1155/2013/417194 – Review article
- DGKJP, DGPPN et al. S3-Leitlinie Autismus-Spektrum-Störungen, Teil 2: Therapie. AWMF 028-047, 2021. – Guideline (in German); validity expired on 23 March 2026 according to the DGKJP overview [6]
- DGKJP: Aktuelle Leitlinien (Übersicht mit AWMF-Registernummer und Gültigkeitsdatum). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
You might also be interested in
Knowledge articleParents & family
My child has been diagnosed with autism – what next?
Knowledge articleParents & family
Talking to your child about their diagnosis
Knowledge articleParents & family
Family life with a child on the autism spectrum
Knowledge articleParents & family
Strain and the parents’ relationship
Found a mistake?
If something is factually wrong, out of date or unclear, let us know. You do not have to give any personal details.