Journal of Child and Family Studies (2020) 29:583–591

https://doi.org/10.1007/s10826-019-01570-x

ORIGINAL PAPER

Sibling Relationship and Friendship in Adolescents with Autism

Spectrum Disorder
1
Fiorenzo Laghi ●
Antonia Lonigro2 Susanna Pallini3 Graziana Marziano1 Roberto Baiocco1
● ● ●

Published online: 19 September 2019

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Abstract
Objectives The study was designed to compare sibling and best friend relationships engaged by adolescents with autism
spectrum disorder (ASD).
Methods Twenty adolescents with ASD, aged 15–18 years ((M = 16.80, SD = 0.95), and their typically developing (TD)
siblings (n = 20), aged 18 to 24 years (M = 20.05, SD = 1.67), were recruited for the current study. Behaviors underpinning
attachment, caregiving and affiliative systems were evaluated as well as negative interaction behaviors in sibling relation-
ships and friendships. Non-parametric statistical analyses (the Wilcoxon signed-ranks test and the Mann–Whitney U-test)
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were carried out to verify the differences in sibling and best friend relationships.
Results Adolescents with ASD referred a higher presence of negative interaction behaviors in sibling relationships com-
pared to friendships. However, when mixed and non-mixed friendships were distinguished, the descriptions of typically
developing (TD) siblings and (TD) best friends overlapped for caregiving behaviors, revealing as both of them were
depicted as a source of support and comfort by adolescents with ASD. A lower presence of behaviors underpinning
attachment, caregiving and affiliations characterized relationships with best friends with disability compared to TD best
friends.
Conclusion This study highlighted that TD siblings provided a strong support for their siblings with ASD. The same role
was also played by TD best friends.
Keywords Autism spectrum disorder Sibling relationships Friendship Behavioral system theory
● ● ●

Deficits in social communication, social interaction and (Bauminger and Kasari 2000; Lasgaard et al. 2009). The
difficulties in functioning levels characterizing Autism key features of ASD, such as the presence of few shared
Spectrum Disorder (ASD) strongly concern parents for interests with others, the occurrence of highly routinized
negative implications that these impairments may have on and stereotypical behaviors, and the inability to adequately
social life for their daughters and sons with ASD at all ages. initiate and respond to both verbal and non-verbal social
Several studies have broadly demonstrated how students cues (for details, see American Psychiatric Association
with ASD are more often neglected or rejected by their 2013) make very infrequent to view a student with ASD as
classmates (Laghi et al. 2018a; Ochs et al. 2001), experi- a central or popular figure in the classroom (Chamberlain
encing more frequently feelings of loneliness at school et al. 2007; Leslie and Billingsey 2010; Di Maggio et al.
compared to their typically developing (TD) peers 2016; Laghi et al. 2016a, 2016b, 2018c). Nevertheless,
students with ASD have major difficulties to meet their
friends outside the school context (Kuo et al. 2013; Ors-
mond et al. 2004) and maintain a close friendship over time
* Fiorenzo Laghi
fi[email protected]
(Rowley et al. 2012). Even when students with ASD make
same-aged friends, the self-perceived quality of their
1
Department of Developmental and Social Psychology, Sapienza friendships is often lower than those referred by their TD
University of Rome, via dei Marsi 78, 00185 Rome, Italy counterparts (Calder et al. 2013).
2
Department of Human Sciences, Università Europea di Roma, Researchers agree that among children and adolescents
Rome, Italy with ASD high levels of cognitive skills, in particular a
3
Department of Education, University of Rome Tre, Rome, Italy good intellectual functioning and well-developed
584 Journal of Child and Family Studies (2020) 29:583–591

language abilities, constitute a protective factor which 2009; Tomeny et al. 2012), highlighting how the natural
may compensate a part of deficits in social cognition shift between intimacy, fun and emotion sharing on the
(e.g., theory of mind skills), thus allowing people with one side, and conflict, treat and tease on the other side is
ASD to spontaneously interact with other people in a common to all sibling relationships, with or without a
more socially complex and co-regulated way (Bauminger person with ASD (Brody 2004). As argued by McHale
et al. 2010; Lonigro et al. 2014; Sigman and Ruskin et al. (2012), positive sibling relationship behaviors (e.g.,
1999). Moreover, when students with ASD interact with helping, teaching, caring) and negative sibling relation-
TD friends (e.g., mixed dyads) they engage more fre- ship ones (e.g., teasing, arguing, undermining) are not
quently in more advanced social behaviors (e.g., eye two opposite poles of the same continuum, but they can
contact with smile) than they do when they interact with co-exist. In the same way, opposite emotions may be felt
other disabled students (e.g., non-mixed dyads). Overall, by TD siblings. They often refer a great sense of
in mixed friendships, both partners, including children admiration for their disabled siblings for challenges that
and adolescents with ASD, are more responsive to one they must cope with every day (Kaminsky and Dewey
another and exhibit a greater positive social orientation 2001; Laghi et al. 2018b; Petalas et al. 2009) as well as
than in non-mixed dyads (Bauminger et al. 2008). In a feelings of embarrassment for problem behaviors (e.g.,
previous study, Bauminger-Zviely et al. (2014) found physical aggression, self-injury, tantrums) displayed by
that during recess time, which occurred between struc- siblings with ASD in public (Mascha and Boucher 2006).
tured activities, preschoolers with ASD who held good Recently, Tomeny et al. (2017) have argued that less-
cognitive abilities conversed spontaneously with their advanced social abilities held by individuals with ASD
friends, displayed higher levels of social complexity, often encourage TD siblings to provide care for them.
fewer pragmatic pitfalls, and more adequate interactions The Behavioral System Theory (Furman and Wehner
than they did when they interacted with non-friends. 1994), which is premised on Attachment Theory (Ains-
In the family context, the core symptoms of ASD may worth 1989; Bowlby 1969; Pace et al. 2016) and Sulli-
sometimes make parenting and siblinghood challenging vanian Theory (Sullivan 1953), constitutes a good lens to
(Benderix and Sivberg 2007; Higgins et al. 2005; Ludlow observe and understanding the quality of interactions
et al. 2012; Sikora et al. 2013). Several studies have among siblings and friends, respectively. A behavioral
broadly documented how raising children with ASD may system is a goal-corrected system which is finalized to
hamper everyday activities due to the core symptoms of maintain a relatively steady state between the individual
ASD, such as the difficulty in managing unexpected and the environment, thus warranting survival. In close
changes (e.g., using a different street to go home). relationships, three behavioral systems are activated,
Among parents of children with ASD minor levels of whose degrees may vary by the type of relationship (e.g.,
parental self-efficacy and elevated levels of parenting friends, siblings). The Attachment System aims at
stress have been often observed compared to families maintaining some degree of proximity to an attachment
with TD daughters and sons (Karst and Van Hecke 2012). figure in order to gain comfort and security (Bowlby
It must be considered that the lifelong burden places not 1969). Two different kinds of behavior characterize the
only on parents but also on siblings of children with attachment system: Seeking the other out as a safe haven
ASD. While several studies dealing with the impact of when upset or distressed, and using the other person as a
having a child with ASD on parents have been carried out secure base to engage in exploratory behaviors. Con-
(Martins et al. 2015; Thomas et al. 2018), the same ceptualized as reciprocal to the attachment system, the
cannot be said for the impact on TD siblings who have a Caregiving System refers to behaviors finalized to pro-
sibling with ASD (Cicirelli 1995; Petalas et al. 2015; vide comfort and security to the other person by either
Rivers and Stoneman 2003; Stoneman 2005). Never- providing a safe haven or a secure base (George and
theless, the findings provided by recent studies have not Solomon 2008). Finally, the Affiliative System is based
led to a shared agreement among researchers (McHale on humans’ biological predisposition to interact with
et al. 2012, 2016; Walton and Ingersoll 2015). If on the others for protection and co-operative food-sharing
one hand, a poorer quality of interactions has been opportunities (e.g., companionship).
observed in sibling relationships of individuals with ASD The purpose of the current study was to compare sibling
compared to TD siblings or sibling pairs where one has and best friend relationships as described by adolescents
another disability (Hodapp and Urbano 2007; Mascha with ASD. We hypothesized that among sibling relation-
and Boucher 2006; Orsmond and Seltzer 2007), on the ships, behaviors underpinning the attachment system
other hand, no differences have been found between would prevail among siblings with ASD whilst those
different kinds of sibling pairs (Angell et al. 2012; relating to the caregiving system would be more engaged
Dempsey et al. 2012; Diener et al. 2015; Petalas et al. by TD siblings, without excluding the presence of negative
Journal of Child and Family Studies (2020) 29:583–591 585

interactions. When friendships are considered, we hypo- to TD siblings if they were interested in participating at a
thesized that behaviors underlying the attachment system support group for sibling of adolescents or young adults
would be less present among non-mixed friendships ado- with ASD.
lescents (e.g., Autism Spectrum Disorder, Intellectual
Disabilities) compared to mixed ones. We were also Measures
interested in verifying the role of gender in friendships,
hypothesizing to confirm in adolescence the same trend The Italian adaptation of network of relationships
observed in past studies on childhood (for details, see Dean inventory: behavioral systems version
et al. 2014).
The Italian adaptation of network of relationships
inventory: behavioral systems version (NRI-BSV; Fur-
Method man and Buhrmester 2009; Dellagiulia et al. 2011) is a
pencil-and-paper questionnaire comprising 25 items. It is
Participants finalized to evaluate 8 features of close relationships. In
details, 2 scales evaluate attachment behaviors: (a) par-
The sample included 40 participants: 20 adolescents with ticipant seeks safe haven (e.g., “How do you seek out this
ASD and 20 TD siblings. Participants with ASD (16M and person when you’re upset?”), and (b) participant seeks
4F) ranged in age from 15 to 18 years (M = 16.80, SD = secure base (e.g., “How much does this person
0.95), with average intelligence quotient (IQ total score, M = encourages you to try new things that you’d like to do but
104,15, SD = 5.34; range: 90–110). The diagnosis of each are nervous about?”). Two scales assess caregiving
participant with ASD had been assured, prior to the inclu- behaviors: (a) participant provides safe haven “e.g.,
sion in the study, by experienced psychiatrists and psy- “How much does this person turn to you for comfort and
chologists using gold standard diagnostic instruments for support when s/he is troubled about something?”), and
ASD. TD siblings (13F and 7M) ranged in age from 18 to (b) participant provides secure base (e.g., “How much do
24 years (M = 20.05, SD = 1.67). All of the TD siblings in you encourage this person to try new things that s/he
the research were older than their siblings with ASD, and would like to do but is nervous about?”). The compa-
they were biological siblings to the children with ASD. Two nionship scale evaluates affiliative behaviors (e.g., “How
point three years (SD = 1.65) was the average absolute much do you and this person spend free time together?”).
value of sibling age differences (range equaled 1–8 years). Moreover, this instrument allows us to assess negative
interaction scales, namely conflict (e.g., “How much do
Procedure you and this person get upset with or mad at each
other?”), antagonism (e.g., “How much do you and this
We recruited participants in this study by distributing person hassle or nag one another), and criticism (e.g.,
information sheet about the study to local organizations and “How much do you and this person say mean or harsh
centers that provided services to adolescents and young things to each other?). Items measure the extent to which
adults with ASD. The eligibility requirements were (1) to features occur in the relationship across a five-point
have a certified diagnosis of autism spectrum disorder, (2) Likert format, from 1—Little or None—to 5—The most.
the absence of intellectual disability, and (3) the participa- Eight scores are computed, one for each scale, by aver-
tion of one of their TD siblings. All of the participants lived aging the corresponding items. Moreover, 2 second-order
in the family home. factors may be computed. Support factor is obtained by
Approval from the University Institutional Review Board averaging affiliation, attachment and caregiving scales,
was obtained before data were collected for the current whereas Negative Interaction is derived by averaging
study. Participants with ASD and their TD siblings were conflict, antagonism, and criticism scales. The NRI-BSV
independently evaluated at a research laboratory at the has been successfully used in both clinical and non-
Faculty of Medicine and Psychology (Sapienza University clinical studies, in the Italian context too, providing good
of Rome) by a team of clinical psychologists with the evidence dealing with its validity (for details, see Della-
supervision of the first author and took approximately giulia et al. 2011).
35 min to complete. In the current study, we administered the NRI-BSV to
Application consisted of the participants fulfilling the both adolescents with ASD and their TD siblings, respec-
questionnaires in a quiet research laboratory, after informed tively. For friendship, the NRI-BSV was only administered
consent was acquired from both participants and their to adolescents with ASD. Thus, we had information on
parents if they were under eighteen-year-old. After friendship only through the point of view provided by
administering the questionnaires, the experimenters asked adolescents with ASD.
586 Journal of Child and Family Studies (2020) 29:583–591

Friendship with the best friend the best friend. All statistical analyses were performed with
SPSS 24 for Windows.
The most shared definition of best friend was adopted to
formulate the questions. As described in previous studies
(for details, see Baiocco et al. 2014), best friend is defined Results
as someone with whom one shares the closest kind of
friendship, excluding intimate or sexual activities. The Convergence among Reporters: Differences
questions deal with the existence of a best friend (e.g., “Do between Adolescents with ASD and Their Siblings
you have a best friend?”), the best friend’s noun and gender
(e.g., “What is her/his name?”), the duration of best The Wilcoxon signed-ranks test showed statistically sig-
friendship (e.g., “How long has she/he been your best nificant differences for Seeks secure base, and Conflict,
friend?”), and the characteristics of best friend (e.g., “Can where adolescents with ASD reported higher scores than
you tell me about some of your best friend?). The last their siblings; TD siblings reported higher scores for Pro-
question was structured to explore the possibility that best vides safe haven, and Provides secure base than their ASD
friend had a diagnosis of ASD. A confirmation was asked to sibling, as reported in Table 1.
siblings of adolescents with ASD because they knew their
best friends, thus constituting a reliable source. Best Friend Relationship

Data Analyses All participants with ASD nominated a best friend who
were 16 to 22 years of age (M = 18.40, SD = 1.57); for
Due to the small number of sibling pairs, a continuous female adolescents with ASD (n = 4) the majority of their
normal distribution could not be assumed. Thus, non- best friends were same sex (3F and 1M); for male adoles-
parametric statistical analyses were used. The Wilcoxon cents with ASD (n = 16) 13 was same sex friend and 3 were
signed-ranks test was carried out to analyze the mean-level different sex. Fisher’s exact test was used because the
differences between participants with ASD and their sib- number of observations in the cells of the contingency table
lings in the evaluation of their relationship. For adolescents was less than 5, pointing out no cross-gender best friendship
with ASD, pair-wise comparisons with Wilcoxon signed- differences (p = 0.06). Of these, 11 relationships involved
rank were used to verify whether there were differences in best friends with an ASD diagnosis, and 9 relationships
scale and subscale scores among different types of rela- involved best friends without ASD diagnosis. Fisher’s exact
tionships (sibling vs. best friend). Mann–Whitney U-tests test pointed out no gender differences (p = 0.28). The
were computed to examine group differences (presence or mean duration of friendship, expressed in months, was
absence of a cross gender friendship) in relationship with 62.60 (SD = 44.72; range: 4–192). Sixty-point one year

Table 1 Sibling relationship differences between adolescents with ASD and their TD siblings: descriptive statistics and
significant effects
Sibling relationship quality Report of adolescents with ASD TD siblings Significant value
N = 20 N = 20
M SD Alpha M SD Alpha Z p

Scales
Seeks safe haven 2.72 1.11 0.90 2.10 0.89 0.88 −1.86 0.06
Seeks secure base 2.95 1.02 0.88 2.05 1.16 0.90 −2.56 0.01
Provides safe haven 2.18 1.07 0.89 2.85 1.30 0.88 −1.95 0.05
Provides secure base 2.68 1.17 0.90 3.40 1.05 0.87 −2.05 0.04
Companionship 2.98 1.08 0.88 2.95 0.88 0.88 −0.53 0.60
Conflict 3.02 0.72 0.89 2.43 0.58 0.85 −2.61 0.01
Criticism 2.47 1.07 0.83 2.05 0.80 0.86 −1.21 0.23
Antagonism 2.82 0.83 0.82 2.60 0.94 0.88 −0.83 0.41
Factors
Support 2.70 0.86 0.90 2.67 0.79 0.88 −0.46 0.65
Negative Interaction 2.77 0.82 0.86 2.36 0.61 0.87 −1.42 0.16
Journal of Child and Family Studies (2020) 29:583–591 587

Table 2 Sibling and best friend relationship differences as described by adolescents with ASD: descriptive statistics and
significant effects
Relationship quality by adolescents with ASD TD siblings Friends Significant value
M SD Alpha M SD Alpha Z p

Scales
Seeks safe haven 2.72 1.11 0.90 2.62 1.26 0.90 −0.20 0.84
Seeks secure base 2.95 1.02 0.88 2.95 1.14 0.88 −0.10 0.92
Provides safe haven 2.18 1.07 0.89 2.57 1.24 0.89 −0.97 0.33
Provides secure base 2.68 1.17 0.90 2.90 1.29 0.88 −0.95 0.34
Companionship 2.98 1.08 0.88 3.47 1.18 0.87 −1.43 0.15
Conflict 3.02 0.72 0.89 1.60 0.68 0.88 −3.85 0.00
Criticism 2.47 1.07 0.83 1.48 0.61 0.86 −3.50 0.00
Antagonism 2.82 0.83 0.82 1.37 0.51 0.82 −3.88 0.00
Factors
Support 2.70 0.86 0.90 2.90 1.07 0.88 −1.06 0.29
Negative Interaction 2.77 0.82 0.86 1.48 0.54 0.86 −3.89 0.00

(SD = 1.50) was the average absolute value of age differ- Companionship, and Criticism than adolescents who
ences (range equaled 0–5 years). reported a best friend with an ASD diagnosis, as reported in
Table 3. Similar results were obtained for second order
Differences in Relationship: Sibling and Best Friend factor Support.

To investigate differences in relationship (sibling vs. best

friend), we conducted the Wilcoxon signed–ranks test on Discussion
NRI-BSV dimensions, comparing sibling and best friend
evaluations. The analysis revealed significant differences The present study contributes to the research literature
only for Conflict, Criticism, and Antagonism, where ado- dealing with social relationships in ASD. The use of
lescents with ASD reported higher scores for sibling rela- behavioral systems to compare sibling relationships and
tionship than best friend relationship. Similar results were friendships represents the novel aspect of our investigation.
obtained for second order dimension, Negative interaction, The first aim of the present study was to analyze similarities
as reported in Table 2. and differences in sibling relationships, considering the
perspective of both siblings, with ASD and with a typical
Differences in Best Friend Relationship: Same and development. It is very interesting to notice that com-
Cross Gender plementary behavioral systems were activated. Whether
behaviors relating to caregiving system prevailed among
We performed Mann–Whitney U-tests to verify the differ- TD siblings, behaviors dealing with attachment system were
ences for evaluating best friend relationship, considering more reported by siblings with ASD as well as conflict. TD
two different groups (same or different sex of best friend). siblings described their sibling relationships in terms of a
No significant differences were found for cross-gender reliable base from which their own siblings with ASD
friendship. depart to explore the environment and engage in new
activities. In details, they referred to display support and
Differences in Best Friend Relationship: Best Friend encourage their siblings with ASD to try new plays or
with or without an ASD Diagnosis activities and pursue their goals. Moreover, TD siblings
described their role of a safe haven where their siblings with
Additionally, we performed Mann–Whitney U-tests to ASD may return in case of danger or when they are trou-
verify the differences for evaluating best friend relationship bled, worried or upset to receive support and comfort.
(with or without an ASD diagnosis). Significant differences In a reciprocal way, adolescents with ASD confirmed the
were found for type of friendship. Adolescents with ASD role of support provided by their TD sisters and brothers,
who reported a TD best friend obtained higher scores for particularly for seeking secure base. Thus, TD siblings seem
Seeks safe haven, Seeks secure base, Provides secure base, to play a role in the improvement of autonomy and
588 Journal of Child and Family Studies (2020) 29:583–591

Table 3 Best friend with or without an ASD diagnosis: descriptive statistics and significant effects
Relationship quality with Best friend with a TD best friend Significant value
best friend diagnosis of ASD (N = 9)
(N = 11)
M SD M SD U p

Scales
Seeks safe haven 1.91 0.76 3.48 1.24 13.5 0.01
Seeks secure base 2.36 0.77 3.67 1.14 14.5 0.01
Provides safe haven 2.09 0.94 3.15 1.37 26.5 0.08
Provides secure base 2.24 0.87 3.70 1.30 17 0.01
Companionship 3.03 1.01 4.00 1.21 19 0.02
Conflict 1.55 0.70 1.67 0.69 43 0.60
Criticism 1.27 0.65 1.74 0.46 24 0.03
Antagonism 1.30 0.55 1.44 0.47 39.5 0.40
Factors
Support 2.33 0.67 3.60 1.08 13 0.01
Negative Interaction 1.37 0.59 1.62 0.49 32 0.17

independence for their siblings with ASD. However, this documented by past investigations with school-aged chil-
issue leads us to ascertain whether the role assumed by TD dren (Dean et al. 2014). When adolescents with ASD
sibling may have a cost for them because they might engage described their social relationships, they referred higher
in a caregiver role that usually reserves to parents. This risk levels of negative interactions—including conflict, criticism
should not be neglected but it needs to be further considered and antagonism—in sibling relationships compared to
in research. Tomeny et al. (2017) have recently argued on friendships. It is reasonably to think that the great number of
the risk of parentification among TD siblings of brothers hours that siblings spend together may expose them a higher
and sisters with ASD, distinguishing sibling-focused par- likelihood of conflicts and quarrels compared to time spent
entification from parent-focused parentification. According with best friends. Interestingly, when a fine-grained analysis
their results, the latter form appeared to be more likely was carried out distinguishing among two types of friend-
predictive of anxiety and depression among TD siblings. ships, the descriptions of sibling relationships and mixed
Future research should further examine the impact of par- friendships by adolescents with ASD overlapped, high-
entification by TD siblings on their mental health and social lighting how TD siblings and TD best friends represent a
conduct, extending the interest towards the relation between secure base or a safe haven for adolescents with ASD in
different forms of parentification and the activation of order to carry out their daily activities. Furthermore, the
behavioral systems by TD siblings. interactions with TD best friends were depicted by adoles-
Interestingly, negative aspects of sibling relationships cents with ASD using behaviors underpinning affiliation
were highlighted only by siblings with ASD, who described and attachment behavioral systems, revealing how in mixed
higher levels of conflict compared to those reported by TD interactions both partners—TD best friends and adolescents
siblings. It is well documented that TD siblings, particularly with ASD—offered and received support more than in non-
if they are older than disabled siblings, are prone to develop mixed interactions. This finding is consistent with previous
a sense of duty, responsibility and commitment towards investigations examining the differences between social
their siblings with ASD because of the challenges and dif- interactions in mixed and non-mixed friendships (Bau-
ficulties that they must face every day (Cridland et al. 2016; minger et al. 2003, 2008; Bauminger-Zviely et al. 2014). It
Tozer et al. 2013). Perhaps, this support role displayed by is well documented that mixed friendships are more similar
TD siblings and overall difficulties that they have to face in to typical friendships compared to non-mixed ones. In
quality of siblings of children with ASD might obscure mixed friendships, children and adolescents with ASD are
minor conflicts that occur daily (e.g., how much they and involved in co-regulated social exchanges, displaying
their siblings with ASD disagree). However, it must be said greater positive social orientation, more advanced receptive
that this is only our hypothesis and future studies need to language abilities and responsiveness than in non-mixed
test this possibility. In regard to friendship, our results friendships (Bauminger et al. 2008). However, in mixed
showed that adolescents with ASD socialized with same- friendships higher levels of criticism were described by
gender peers, thus confirming the trend which was adolescents with ASD compared to non-mixed friendships.
Journal of Child and Family Studies (2020) 29:583–591 589

As for sibling relationships, the bonds with TD friends Publisher’s note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
appeared to confirm that positive and negative aspects may
co-exist in the same relationship. As argued by McHale and
colleagues (2012), behaviors regarding helping, caring,
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