How to Support Siblings of Children with Special Needs

Johnny has leukemia. He has been hospitalized. His third grade class holds a bake sale, and purchases T-shirts. They come to hospital and rally around him. His older sister proudly wears her matching T-shirt in support.

Henry has severe depression. He is in the hospital. Henry lies to his friends about where he is, and his brother is confused and ashamed, shutting down in school.

The stigma surrounding mental illness is real. A child or teen going through the mental illness is not the only one affected. Families and siblings also experience a secondary crisis. It is important that we not only support the impacted child, but consider the implications for other siblings who are also struggling as the family attempts to cope.

How can we support siblings of a child with mental illness?
When considering how to support the sibling of a child with mental illness, it is important to think about the ongoing nature of the behavioral health challenge the child is experiencing. Is the problem new? Is this an ongoing and chronic situation? Was there an acute crisis event? These are important questions to ask when supporting the siblings.

Brand new or acute events are scary for families and lead to a great deal of confusion regarding the system and the “right” steps to take.

Long-term and chronic problems can lead to families giving up hope and feeling downtrodden.

Other factors to consider include:

• The nature of the symptoms the patient is experiencing. Is the child going through the behavioral health problem acting out? Isolating? Harming themselves? The nature of these behaviors can have different impacts on the sibling.
• Parent-reactions and the home environment. Younger children are much more likely to react strongly to adult emotion. Older children can be negatively influenced by changes to their routine and schedule.
• Other life stressors. Food insecurity, domestic violence or parent conflict can negatively affect the experience of the sibling.

Mental illness and its impact on a family are difficult to navigate. The best approach is to keep open communication. Talk to the patient’s sibling in words they can understand. For example, “Your sister’s brain is making her mind and feelings get all tangled up. If she had the choice, she would not want to feel this way.”

Consider using these techniques to keep communication going:

1. Encourage the sibling to share their thoughts. For example, “Have you told your mom that you are worried about your sister?” or “Maybe we could tell your dad together that you miss getting to go to baseball practice during your brother’s appointments.”
2. Validate what the sibling is saying. Don’t try to minimize their feelings or change their mind. For example, “Wow, that must be scary.” Or, “It must be hard being so mad all the time.”
3. Reflect back what they tell you. For example, “Your sister hasn’t acted happy in months and you have felt very alone.”
4. Consider creating a plan. This way, if their sibling does something “scary,” they know how to communicate:
   • What they are feeling
   • Who they will talk to about it
   • How they will say it
   • Things they will do to help themselves feel better.

Remember that mental illness is often a life-long journey and there is no “magic pill.” Treatment is an ongoing process.

The National Alliance on Mental Illness offers support groups for family members of those with behavioral or mental illness. For  more information on the Big Lots Behavioral Health Services at Nationwide Children's Hospital, click here.