The Impact of ADHD on Siblings - Brothers with ADHD

Written by David Rabiner, Ph.D.

STRATEGIES TO MANAGE DISRUPTION

Three of the 10 siblings reported that they dealt with their brother's behavior by fighting back. All 3 of these children had been diagnosed with Oppositional Defiant Disorder. Whether their aggressive behavior arose purely in response to the attacks of their ADHD sibling, or reflected other important causes as well, could not be determined.

The majority of siblings, however, responded to the situation with their ADHD brothers by learning to avoid and accommodate themselves to their brother. The process they described was a transformation of intense anger about how they were being treated, to sadness and resignation. In some children, this process appeared to result in clinical depression.

Some of the statements that children made about dealing with their sibling are really quite telling.

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"I've learned to check and see how he's feeling before I even say hi when I come home from school. If he looks upset I don't say anything because I know he will yell at me. I dread coming home sometimes."

"I've learned not to talk to him about what's important to me because he won't listen or he'll say its stupid. So, I only talk to him about what he wants to talk about and that way he won't get mad at me."
"I just try to stay out of his way most of the time and go with the flow." Overall, 10 of the 13 siblings interviewed in the study thought they were severely and negatively affected by their brother with ADHD.

IMPLICATIONS

It is important to put the results of this study into the proper perspective. As the author points out, these findings are based on a small sample of ADHD children and their siblings, and the experiences of the siblings in this study may not necessarily be representative of what many children experience. Certainly, one would expect that some children with ADHD siblings have very positive relations with their sib and within their family. One can and should not assume, therefore, that children in one's own family are necessarily having a similar set of experiences.

As noted previously, it would be helpful to consider these children's reports in comparison to what children who live with non-ADHD siblings describe. This would help differentiate what may be more typical feelings that children with siblings have from what may be unique to children who have a sibling with ADHD.

The children in this study all had brothers with ADHD. One can certainly not assume that the experience of children with a sister who has ADHD would be similar. This would be a very interesting and important issue to examine in future research.

It is also possible that children's reports of their experience may not necessarily reflect the actual reality of their situation. They may feel frequently victimized by their ADHD brother and overlooked by their parents when this is not truly the case. Certainly, it is not uncommon for children to feel they are being treated unfairly by sibs and parents, and this could certainly have contributed to what these children had to say about their situation.

These caveat aside, these data have important implications and I think need to be taken quite seriously. The description provided by the children in this study is certainly consistent with what I have observed in many of the families I have worked with.

There are several things that parents can do to minimize the likelihood of their child without ADHD having the type of experience described here. An important place to start would be to think carefully about how the experiences shared by the siblings in this study fit with what may be going on for your own children. It is difficult for any parent to recognize that one of their children is being victimized - even when it is by their other child. The parents in this study, as you recall, tended to minimize the reports of siblings and to attribute what was going on to normal sibling rivalry. The children themselves, however, had a very different perspective.

The same applies to taking a careful look at how much one is expecting a child to care for his/her sibling. These children tended to feel burdened by caretaking responsibilities when parents believed it was what siblings do for each other. Asking oneself what your own family's expectations are and whether or not they are reasonable could be quite useful. I have to say reading this provided an important wake up call to me.

Sibling reports of aggression/violence need to be taken seriously. There can be an almost reflexive reaction to deny or minimize such accounts, which can leave a child feeling very much alone and unprotected.

As difficult as it can be in busy families, making the effort to spend special time alone with the non-affected sibling can be enormously helpful. These children were reluctant to make demands of their parents because they saw them as so overburdened trying to manage their sibling. They, of course, need parental attention as well, and making sure that it is provided can go a long way to helping a child feel better about his or her situation in the family.

For health care professionals, I think these results highlight the importance of paying close attention to the siblings of a child with ADHD in an overall evaluation and treatment plan. A focus on how to maintain a reasonable family life in spite of the disruption caused by behaviors related to ADHD may be important for many families. Looking back on my own practice, I now recognize how often I failed to consider the needs and experiences of siblings as fully as may be necessary.

The impact on family members of children with ADHD, particularly on siblings, is an important but under-researched area. This qualitative study is an important initial step to learn more about this. I am concerned that the findings of this study may be disconcerting to some readers and sincerely hope that if this is the case, you are able to take positive steps to addressing issues that you feel are important.

About the author: David Rabiner, Ph.D. is a clinical psychologist, Senior Research Scientist at Duke University and expert on ADHD in children.

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