14 May I LIKE THAT HE ALWAYS SHOWS WHO HE IS: THE PERCEPTIONS AND EXPERIENCES OF SIBLINGS WITH A BROTHER WITH AUTISM SPECTRUM DISORDER.
I Like That He Always Shows Who He Is: The perceptions and experiences of siblings with a brother with autism spectrum disorder.
Please summarized the article and then critique the phenomenology approach that used and the data analysis the strengths and weaknesses, and take a reflective stance on how the applied study moderates the students understanding of the chosen tradition.
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International Journal of Disability, Development and
Education
ISSN: 1034-912X (Print) 1465-346X (Online) Journal homepage: http://www.tandfonline.com/loi/cijd20
“I Like That He Always Shows Who He Is”: The
perceptions and experiences of siblings with a
brother with autism spectrum disorder
Michael A. Petalas , Richard P. Hastings , Susie Nash , Alan Dowey & Deirdre
Reilly
To cite this article: Michael A. Petalas , Richard P. Hastings , Susie Nash , Alan Dowey & Deirdre
Reilly (2009) “I Like That He Always Shows Who He Is”: The perceptions and experiences of
siblings with a brother with autism spectrum disorder, International Journal of Disability,
Development and Education, 56:4, 381-399, DOI: 10.1080/10349120903306715
To link to this article: http://dx.doi.org/10.1080/10349120903306715
Published online: 13 Nov 2009.
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International Journal of Disability, Development and Education
Vol. 56, No. 4, November 2009, 381399
ISSN 1034-912X print/ISSN 1465-346X online
© 2009 Taylor & Francis
DOI: 10.1080/10349120903306715
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“I Like That He Always Shows Who He Is”: The perceptions
and experiences of siblings with a brother with autism
spectrum disorder
Michael A. Petalas*a, Richard P. Hastingsa, Susie Nasha, Alan Doweyab, and Deirdre
Reillya
aSchool of Psychology, Bangor University, Bangor, UK; bWrexham Child Health Centre,
Wrexham, UK
I01245TCOMn06aIrt.i.J03iyeAc1gD049rlh0io.n-0naP8r9a0eaA e0t1a&l2lit/P 2noa01A Xle4dnF0atr3 ar93sa Ft(la0i@l4 prcna8Ja9lrsoc4leni1iiun5vcs2rt.ie)0nss/rg9a1pml04o 3o6o3f5l .0D-a36ci47.su6a1kbX5i l(iotyn,l iDnev) elopment and Education
Semi-structured interviews were used to explore the perceptions and experiences of
eight typically developing siblings in middle childhood who had a brother with autism
spectrum disorder (ASD). The interviews were analysed using interpretative
phenomenological analysis (IPA). The analysis yielded five main themes: (i) siblings
perceptions of the impact of their brothers condition on their lives, (ii) siblings
perceptions of the attitudes of others, (iii) siblings tolerance and acceptance towards
their brothers, (iv) positive attitudes and experiences, and (v) siblings views on support
for themselves and their brothers. These exploratory findings can be used to inform
future larger scale studies and quantitative research. Initial implications for practice
focus on issues related to enhancing the development of support services for siblings of
children with ASD.
Keywords: autism; Aspergers syndrome; families; qualitative research; siblings
Introduction
Parents of children with autism spectrum disorder (ASD) often report increased stress
compared to parents of children with another disability or typically developing children
(Abbeduto et al., 2004; Duarte, Bordin, Yazigi, & Mooney, 2005; Hastings, Daley, Burns,
& Beck 2006; Herring et al., 2006; Koegel et al., 1992; Rodrigue, Morgan, & Geffken,
1990; Weiss, 2002). Hence, there has been interest in whether some siblings in a family
environment that includes a child with ASD, and possibly a parent under considerable
stress, might also be at risk for adjustment difficulties.
In terms of how siblings adjust to living and growing up with a brother or sister with
autism, there are mixed findings. Some researchers report that children with a brother or
sister with autism are at a higher risk for internalising and externalising behaviour problems
(Fisman et al., 1996; Fisman, Wolf, Ellison, & Freeman, 2000; Gold, 1993; Hastings,
2003a; Rodrigue, Geffken, & Morgan, 1993; Ross & Cuskelly, 2006; Verte, Royers, &
Buysse, 2003; Wolf, Fisman, Ellison, & Freeman, 1998) and for impoverished sibling and
peer relationships (Bägenholm & Gillberg, 1991; Hastings 2003a; Kaminsky & Dewey,
2001) compared to siblings of children with another disability or typically developing children.
Other researchers suggest that siblings of children with autism may not be at increased
risk for such difficulties (Hastings 2007; Kaminsky & Dewey, 2002; Mates, 1990;
Pilowsky, 2004). Furthermore, in a number of studies positive outcomes have been
*Corresponding author. Email: M.A.Petalas@liverpool.ac.uk
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382 M. A. Petalas et al.
reported, such as better sibling emotional and behavioural adjustment (Hastings, 2003b),
more positive perceptions of sibling relationships with their brothers and sisters with autism
(Royers & Mycke, 1995), and higher social competence (Ferrari, 1984) and self-concept
(Macks & Reeve, 2007), when compared to siblings of children with another disability or
with normative data.
Research focusing on siblings has generally started with research questions that explicitly
or implicitly assume that growing up with a brother or sister with ASD is a stressful
experience that can lead to emotional and behavioural difficulties. Not only is the evidence
contradictory, but respondents in research are typically parents reporting on siblings
adjustment rather than the siblings themselves. Siblings personal accounts of their circumstances
might reflect aspects of their appraisal process that form an integral component of
their coping efforts (Lazarus & Folkman, 1984). McHale, Sloan, and Simeonson (1986),
interviewed 30 siblings of children with autism, 30 siblings of children with an intellectual
disability and 30 siblings of typically developing children aged between 6- and 15-yearsold,
about their sibling relationships and their perceptions of their siblings. Overall, reports
from all three groups were positive. Data from individual children, however, revealed that
while some children expressed positive views of their siblings with a disability, others
described their relationships in very negative terms. In the groups of siblings of children
with autism and with intellectual disability, negative sibling relationships were associated
with worries about the future of the child with a disability, perceived parental favouritism
and feelings of rejection toward the child with a disability. On the other hand, siblings
greater understanding of their brothers or sisters disability, and perceived positive
reactions from parents and peers towards the child with a disability, were related to more
positive sibling relationships.
In a replication of the McHale et al. study, Bägenholm and Gillberg (1991) interviewed
20 siblings of children with autism, 20 siblings of children with intellectual disability and
20 siblings of typically developing children between the ages of five and 20-years, using
the same semi-structured interview format with the added domain of siblings self-perceptions.
All three groups of siblings expressed positive views, but siblings of children with
autism were relatively more negative in their accounts of their relationships, reported more
problems with their siblings behaviour, and expressed greater concerns for their siblings
future. These children also reported feeling more lonely than siblings of children with
intellectual disability and typically developing children.
These studies using sibling self-reports derived quantitative data from semi-structured
interviews. It was not their aim to provide the detail and wealth of information that can be
found in verbatim interview data (Smith, Harre, & Langenhove, 1995). Qualitative research
methods allow the researcher to focus on issues that are meaningful to the participants,
without the constraints of predetermined categories, therefore allowing for the emergence
of different perspectives (Barbour, 2000). Given the diversity of perceptions and adjustment
of siblings of children with ASD, these aspects of the siblings experience lend themselves
to exploration via qualitative methods. In one of the few recent qualitative studies on
the experiences of siblings of children with autism, Benderix and Sivberg (2007) conducted
face-to-face interviews with 14 siblings aged between 5- and 29-years-old from five families.
The interview transcripts were analysed via content analysis (Burnard, 1991) and
yielded seven categories of siblings experiences: (i) having a sense of responsibility, (ii)
feeling sorry for their sibling with autism, (iii) dealing with abnormal behaviour, (iv) feeling
empathy for their sibling with autism, (v) expressing hope and anticipating relief
through respite, (vi) experiencing violent behaviour, and (vii) a negative impact on
siblings peer relationships. Also using content analysis, Mascha and Boucher (2006)
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Siblings with a Brother with ASD 383
interviewed 14 siblings between the ages of 11- and 18-years using a semi-structured
format. In general, these siblings reports were positive. Where there were negative reactions,
these related to the behaviour problems of the child with autism and feelings of
embarrassment in the typically developing siblings.
In an earlier qualitative investigation, Dellve and colleagues (2000) interviewed 15
sisters between the ages of 12- and 18-years who had a brother with deficits in attention
motor control and perception (DAMP) and/or Aspergers syndrome. The analysis of the
data was performed via a constant comparative method for grounded theory (Glaser &
Strauss, 1991). These authors found that where siblings possessed increased knowledge and
understanding of their brothers disability this was associated with less embarrassment in
relation to the child with a disability and greater acceptance of their circumstances. Some
siblings described a marked sense of responsibility and striving for a close relationship with
their brothers, while others were attempting to distance themselves from the family and
gain independence.
There is a dearth of siblings accounts of their experiences in families where there is a
child with ASD. Existing samples either span the childhood and adolescent years in toto ,
or focus on adolescent siblings exclusively. Minimal research attention has been paid to the
experiences of siblings of children with ASD in middle childhood and preadolescence. In
a home observational study, child siblings of children with ASD spent on average 40
minutes out of every hour in mutual interaction (Knott, Lewis, & Williams, 1995). At this
stage, siblings are an important part of each others emotional support network (Harris &
Glasberg, 2003) and sibling conflict may increase (Kim, McHale, Wayne, & Crouter,
2006). This is also the time when the sibling relationship becomes more egalitarian
(Buhrmester & Furman, 1990; Dunn, 1992) and has been shown to predict stability of relationship
quality longitudinally between siblings (McHale, Kim, & Whiteman, 2006), as
well as with peers (Updegraff, McHale, & Crouter, 2002). The conflicting research findings
on sibling well-being (Orsmond & Seltzer, 2007), scarcity of information directly from
siblings and lack of clarity regarding how siblings experience life as children in a family
with a child with ASD, give grounds for employing a qualitative method of analysis that
captures detailed accounts of siblings subjective experiences. Therefore, the aim of the
present study was to investigate, using a qualitative method based on phenomenology, the
perceptions and lived experiences of typically developing siblings, in middle childhood,
who were growing up with a brother with ASD.
Method
Methodological Approach
Interpretative phenomenological analysis (IPA: Smith, Jarman, & Osborn, 1999) was the
chosen method of analysis in this investigation. IPA deliberately seeks to capture the richness
and diversity of participants accounts by uncovering the central themes that emerge
from the participants talk (Jarett, Payne, Turner, & Hillier, 1999). In this respect, the
participant is seen as an expert on his or her personal experience. Herein, IPA is used to
capture the experience of siblinghood where there is a child with ASD as it is understood
by the typically developing sibling.
In addition to the meaning offered by the participants accounts, IPA recognises the
dual aspect of analysis as the investigator also engages in an interpretative relationship with
the interview data. Direct access to the personal meaning offered by the participant is not
achievable without acknowledging the influence of the researchers personal conceptions;
this interpretative activity is therefore a necessary component in IPA (Smith et al., 1999).
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384 M. A. Petalas et al.
IPA methodology typically involves small (N typically = 6 8), somewhat homogenous
samples, which allows for in depth examination of participants accounts, although samples
have varied from single case studies to 30 participants (Brocki & Wearden, 2006). Additional
researchers are often involved in credibility checks to ensure that the emerging
themes are internally coherent and grounded in the transcripts (Elliott, Fisher, & Rennie,
1999). Furthermore, treatments such as seeking consultation from the participants on the
accuracy of the findings, discussion within the research team, peer review and the use of
reflective practice via a reflexive journal (Smith, 2003) can also be utilised to aid verification
and consistency, and ensure the quality of the findings (Carradice, Shankland, & Beail,
2002). The data interpretation in this study was facilitated by group discussions within the
research team, and a credibility check of themes conducted by a co-author.
Participants
The participant recruitment process was facilitated by a local parent group, a local school
for pupils with ASD, a local branch of a national disability charity, and also through advertisement
in a local newspaper and the UK National Autistic Society (NAS) web site. The
inclusion criteria for the study were that there was a child in the family with a formal diagnosis
of ASD between five and 17-years-of-age and a typically developing sibling between
the ages of eight and 17-years, and families resided in or around the area local to the University
of Bangor. Families were asked to volunteer to participate. Twenty-two siblings with
a brother with ASD who met the inclusion criteria for the study were interviewed. The
present study reports on a subsample of eight biological siblings with a brother with ASD,
who were selected based on the childrens age (middle childhood age 912 years; M =
11.19 years, SD = 1.32). There were three brothers and five sisters of males with ASD.
Three siblings were younger, four were older and one was a twin of the child with ASD.
Two children, one male, one female, were biological siblings, from the same household,
with a brother with Aspergers syndrome. All of the siblings interviewed in the research
were aware of their brothers diagnosis. The number of children in the participants homes
ranged from two to five (M = 2.87; SD = .83; mode = 3). The ages of the boys with ASD
ranged from eight to 17-years (M = 11.99 years, SD = 2.83). Three boys had a diagnosis of
ASD with associated intellectual disability and five boys had a diagnosis of Aspergers
syndrome. Apart from one child with ASD who had an additional diagnosis of ADHD, the
rest of children did not have any comorbid neurological or psychiatric diagnoses. Seven
boys with ASD lived in the family home, while one child with ASD was living away from
home.
Instrument
The semi-structured interview was developed through multiple discussions with the
research team about the items and structure of the interview schedule. The interview schedule
was first piloted with one sibling whose interview is not included in this analysis. The
pilot interview resulted in some minor changes to the interview format. A number of items
were omitted (e.g. “Can you catch autism from someone else?”), one item was added
(“What advice would you give to other brothers/sisters of siblings with autism?”) and the
interview was organised into two main areas described below. The interview schedule
included a number of warm-up questions aiming to put the participant at ease before
moving on to the substantive areas, as well as subsidiary questions and prompts should a
sibling have difficulty discussing a particular topic. The two main areas covered by the
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Siblings with a Brother with ASD 385
interview schedule were: (1) siblings knowledge and perception of their brothers ASD
(for example, “How would you describe autism to someone who had never heard it
before?” “How would things be different for [name of brother with ASD] if he/she didnt
have autism?”), and (2) siblings perceptions and experiences of their relationships with
their brothers with ASD (for example, “Tell me what its like to be ____s brother/ sister?”
“What advice would you give to other brothers/sisters of siblings with autism?”).
Procedure
Ethical approval was granted by the University of Bangor Ethics Committee prior to
commencing the participant recruitment process. Written consent was obtained from the
parent(s), verbal consent was obtained from the participating sibling prior to commencing
the interview, and where applicable the child with ASD was also asked to consent to their
personal information being discussed between the researcher and their typically developing
brother/sister. Information on the aims of the research and the potential topics that would
be discussed during the interview was provided via an information sheet (including a childfriendly
version) linked to the consent form, which the participating families received a
number of days prior to the interview. During the interview, the participant was allowed to
lead the discussion. At the end of the process participants were given the opportunity to
provide their feedback, including thoughts and feelings, about the interview process, and
raise any additional topics. Participants were given the choice of being interviewed in their
home (n = 7), or at the researchers base (n = 1). Interviews were conducted face-to-face
and on average lasted 21 minutes (range 14.1342.51 mins). The transcripts of the interviews
amounted to 70 single-spaced pages of data. All participants reported positively on
the interview experience and none requested that the interview be terminated prematurely.
A copy of the interview schedule is available from the corresponding author.
Data Analysis
Each interview was audio-recorded and subsequently fully transcribed. Initially, the first
author listened to and read through the transcript a number of times to become familiar
with the interview content. Following this, the transcripts were read line-by-line noting
comments (e.g., preliminary interpretations, summaries of meaning) on the left hand side
of the transcript. The transcripts were reread and themes emerging from the data were
noted on the right hand side of the transcript until the interviewer was satisfied that all
relevant data had been extracted from the transcript. This process was then repeated for
each transcript. An initial list of themes relating to the siblings experiences was drawn up
by grouping comments that clustered together, and a list of relevant verbatim quotes
corresponding to these themes was created using a spreadsheet programme. The emerging
themes were grouped together and a master list of themes was developed. The credibility
check and the process for validating and themes involved a co-author reading each
transcript, the list of themes and quotes, and the master list of themes, to ensure that the
themes in the master list were grounded in the data and none had been omitted. Discussion
among the authors resulted in minor changes to the presentation and description of
the themes. A final master list of five themes emerged through this process, by collapsing
themes across the various sets. The themes are discussed below and illustrated with verbatim
quotes from the interviews. For purposes of confidentiality, all names have been
changed. When providing extracts from the interviews “…” is used to indicate words
omitted to shorten a quote.
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386 M. A. Petalas et al.
The interpretative facet of this research was inevitably influenced by the authors
diverse and convergent characteristics. The research team consisted of two doctoral
students who have worked with children with ASD in a caring and educational capacity,
two researchers in the field of families with children with a developmental disability, and a
clinical psychologist working in services for people with autism. In this sense, the analysis
and discussion of the results represents an integration of care, research and clinical perspectives,
so the recognition of the authors interpretative roles led to concerted efforts to ensure
that interpretation was firmly grounded in the data.
Results
Five main themes emerged from the process described above. The first theme represents
siblings perceptions of the impact of their brothers condition on their lives. The second
theme describes siblings perceptions of others attitudes and the influence that these attitudes
have on the siblings. The third theme illustrates the siblings tolerance towards their
brothers with ASD, while the fourth theme presents positive attitudes and experiences in
the participants lives with their brothers. The final theme refers to various sources of
support that the participants identified as helpful, or supports they would like to receive.
Theme 1. Living with a Brother with ASD: Siblings accounts of the impact on
themselves and their families
Growing up with a brother who has ASD is an experience unique to each sibling, ASD in
itself is a particularly complex disorder, given its multi-factorial nature, and it may differ
from one individual to the next. Accounts of the perceived impact of their brothers disability
varied greatly across the siblings, as did their responses to the challenges they faced. The
children spoke about the typically negative impact of having a brother with ASD on themselves,
their families, as well as on their brother with ASD. Children spoke about the disruption
in their daily lives caused by their brothers peculiar or aggressive behaviour, the
concessions they made, and the atypical roles some have had to assume. Lizzy reflected on
care-taking responsibilities for her brother with ASD despite being the younger sister: “I
never feel like the youngest, even when I was small … I suppose I learnt how to take care
of people just like if I had a younger brother”.
Elliott had resigned himself to interacting little with others and had forgone attention
from his parents and others because of what he perceived as his brothers needs. Elliott
spent time in his room with his brother, reducing the contact he had with others:
Elliott: Well I keep on looking out for him, which I dont really mind but he doesnt
interact much so Ive pretty much taken to staying in my room most of the
time. He wants a lot of attention. I just try and keep my distance from most
people.
Interviewer: How come?
Elliott: I dont know, Oscar deserves most of the attention because he cant understand
what its like to have no attention and I dont mind staying in my room.
Maddie struggled with her brothers idiosyncratic and eccentric habits that often meant
not being able to get to sleep until late. Maddie described how she had to deal with her
brothers disruptive behaviour by taking a problem-focused approach:
Hes loud and very awkward, and when its night time and hes got like a book, even when the
lights are out and he makes these funny little noises, so I cant get to sleep until nine or ten. …
Jakes loud and he wont stop running into my bedroom when were talking; and then he just
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Siblings with a Brother with ASD 387
wants to play with us all the time. I get very irritated and I cant get him out. Thats why I have
a lock on my bedroom door now.
Four siblings spoke about having to face physically and verbally aggressive behaviour
from their brother with ASD in the home. These behaviours were often reported as
unprovoked:
When like you play with something, Jack he comes along because he wants to put it in a little
order; and he absolutely takes it off you. And say you just walk off and just go and sit in the
sitting room and go and watch TV, he just comes in and starts chucking things at you … he
just chucks things at you, shouts at you, screams at you.
Kevin described how his brothers tantrums and aggression had been difficult for him
in the past and continued to have a considerable negative impact on his life. Despite this,
Kevin made an effort to understand the reasons that might lie behind his brothers challenging
behaviour:
Say if he is in a bad mood, and he takes it out on me, like he hits me, or throws something at
me, or calls me names, you know, it can affect me. When I was in primary, he did take it out
on me quite a lot and at school I felt, I wouldnt be in a good mood because of what happened
that morning. Its mainly in the mornings that he will start a tantrum, because he doesnt like
how, he thinks we all rush to get to school, and he doesnt like how we rush about, and he gets
frustrated about that.
Kevin went on to give an account of the disruption that his brothers behaviour often
caused to family life by making references to his parents and the emotions he experienced
as a result:
I feel quite angry, because he has spoiled a day, which we were all enjoying to that point. I feel
quite sad because my Mum and Dad spend that money on us, and then he has to go and spoil
it by having a tantrum.
Having a family member with ASD also impacted on family recreational activities and
spending family time together was a luxury seldom enjoyed by many of the children. This
in turn resulted in perceived restricted opportunities for the siblings. Eddie spoke about the
disruption and constant pace that the family experienced during outings: “We cant go to
many places, and when we go to town, we cant stop and look at something, we always have
to go”.
Eddie also talked about how certain situations could prompt difficult behaviour from
his older brother with ASD:
Interviewer: … Would you have any advice to give any other younger brothers, like yourself,
who have an older brother like Isaac?
Eddie: Dont wind him up, or hell hurt you, and dont take him to a lot of shops …
Because when he sees something he wants, and he cant have it, he wont go
out of the shop.
Theme 2. Others Reactions: Implications for siblings
Having a sibling with ASD came with more than just the immediate demands of the condition.
Siblings often reported prejudice and misunderstanding in addition to having to
answer questions and combat the ignorance of others. As a result of a lack of understanding
and negative attitudes on the part of strangers and friends, they experienced a range of
emotions. The participants described feeling angry, embarrassed and anxious. This resulted
in providing explanations to others on the part of some, and silence and withdrawal from
others.
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388 M. A. Petalas et al.
Some siblings spoke about other childrens attitudes toward their brothers, and the
difficulties associated with reactions from peers:
Its quite annoying because they dont see Jack for who he really is; they just see a big person
thats got Aspergers and [who] is really annoying. (Leah)
Most of my friends are fine but its quite hard when people act different around him because
hes autistic. I like when people just see him as a person. (Lizzy)
To some, social awkwardness and embarrassment were regular occurrences:
It can be quite embarrassing because they just want to go to my room and lock themselves in,
because none of my other friends have got autistic brothers and sisters, so they just get freaked
out by Jake sometimes. (Maddie)
Others, like Leah, reported feeling rejected as a result of negative peer reactions to their
brother with ASD:
Interviewer: Whats it like for you, Leah, when your friends meet Jack?
Leah: Its like they dont really like me any more, because they see Jack as someone
they dont really want to know.
For one participant, Kevin, feelings of embarrassment often turned to frustration and
anger. This occurred in situations where Kevin believed stigmatising and discriminating
behaviour of an unsympathetic member of the public had been demonstrated. Kevin
perceived onlookers as lacking the necessary understanding and etiquette required when a
child with ASD acts in a way that is out-of-the-ordinary or when the child is out of
control.
… People look at us in funny ways, so if another family has a tantrum, but theres nothing
wrong about them, nobody would look at them in a funny way, must be like sort of not
getting treated with respect as everybody else should, just because its a family with autism.
… So if he starts swearing or starts kicking, you know, its quite embarrassing because
people might think, oh, you know, their mother or father taught him to do that, so its quite
embarrassing to me to think that people sort of disrespecting my family and me and my
brother.
The children spoke about the curiosity that their brothers condition provoked in peers.
They also spoke about providing an explanation of the condition to others:
Just sometimes they sort of well, when you make new friends they ask whats wrong with
him and I have to explain it. And they get used to it when they get to know him. You tell them
more about it, and you tell them stories and stuff. (Lizzy)
In addition, the attitudes of others led some children to remain silent and guarded about
their siblings. In Elliotts case this response followed a negative experience of teasing by
peers:
Interviewer: How come youve decided to not talk with other people about Oscar?
Elliott: Because I tried it once in primary and they started to make fun of my brother
so I didnt want that to happen again.
Kevin expressed his unwillingness to talk about personal issues, and discussed his anxiety
about his friends who did not understand the reality of having a brother with ASD:
I dont really speak about what has happened in the house with him. … I dont know how my
friends would take it [talking about having a brother with ASD], you know, if they would
understand, or if they would think that, the house doesnt really sound at all nice, sounds a bit
like a madhouse.
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Siblings with a Brother with ASD 389
Theme 3. Acceptance and Wanting Change
Particularly evident in this study were the siblings views that conveyed a sense of acceptance
toward their brothers with ASD. Many children acknowledged their siblings for
who they were, and perceived the disability as an inseparable part of them. They clearly
stated their positive acceptance of their brothers. Dylans views did not deviate from what
he perceived to be normal and his acceptance
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