Abstract
Siblings of children with neurodevelopmental disorders (ND) are at increased risk of mental health problems. The burden on families of children with ND is exacerbated in low-income countries with limited health services and dependency on informal care systems. Yet, there is little research on family impacts of ND in non-Western settings, and no evidence-based interventions for siblings. We examined initial outcomes and feasibility of a manual-based intervention for siblings and parents of children with ND, called SIBS, delivered in Cambodia. SIBS has promising evidence from an open trial in Norway. We delivered eight groups for 52 siblings (M age = 12.7 years, SD = 2.7; 44.0% female) and 56 caregivers (M age = 43.5 years, SD = 8.5; 61.1% mothers) of 54 children with ND at the only public child mental health clinic in Cambodia. We aimed to improve sibling and parent mental health and family communication. The SIBS intervention comprises three separate sibling/parent group sessions and two joint sibling-parent dialogue sessions. Parent-reported mental health scores for siblings were higher than sibling self-report. Parent mental health problems at baseline were high, with no difference between mothers and fathers. There was significant improvement in parent mental health and parent-rated mental health for siblings from baseline to 4-month post-intervention (effect sizes d = 0.44 to 0.52). There was no change in sibling-reported mental health or family communication. Sibling- and parent-rated user satisfaction was high. We conclude that the SIBS intervention showed promise in Cambodia. However, revision of the communication component is needed.
Highlights
Siblings of children with neurodevelopmental disorders (ND) are at increased risk of mental health problems
In the current study we address this gap, by evaluating initial outcomes and feasibility of a brief group intervention for siblings and parents of children with ND developed in Norway, when delivered in Cambodia
Mother-rated mental health was significantly associated with mother-rated mental health for siblings and mother-rated communication with siblings
Summary
Siblings of children with neurodevelopmental disorders (ND) are at increased risk of mental health problems. Siblings of children with ND (siblings) experience multiple burdens These include extra care responsibilities; worries and confusion; reduced coping, resilience, and social support; and impaired family communication (Murphy et al 2017; Tudor and Lerner 2015; Vermaes et al 2012). Existing interventions typically involve sibling groups, and some studies have documented positive outcomes of sibling interventions on mental health symptoms, stress, self-esteem, social support, and sibling relations (Smith and Perry 2005; Phillips 1999; Williams et al 2003). These findings are important, existing studies have limitations, and none have sufficient methodological quality to qualify as “well-established” or “probably efficacious” (McKenzie Smith et al 2018; Tudor and Lerner 2015). The intervention is based on a theoretical framework for resilience development in children, focused on the importance of relations (i.e., the dyadic dialogue component) and sense of competence (i.e., understanding of the ND and related challenges; Sommerschild 1998)
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