Winter 2025 Issue

Supporting Siblings
By Sue Coyle, MSW
Social Work Today
Vol. 25 No. 1 P. 20

A child’s mental health can impact those around them, including siblings.

An estimated 82% of children have a sibling, and while every sibling relationship is unique, even within the same family, there is no discounting the impact siblings can have on one another. In childhood, in particular, siblings are often first friends and first enemies, teaching each other valuable lessons about coexisting, sharing, disagreeing, and more. In fact, researchers conducting a 2014 literature review on sibling relationships noted that “Siblings’ extensive contact and companionship during childhood and adolescence—increasingly outside the direct supervision of parents or other adults—provides ample opportunity for them to shape one another’s behavior and socioemotional development and adjustment.”1

Thus, it is no surprise that when one sibling experiences a crisis or has a longer-term health concern, their brothers and sisters are impacted, as well. Such an impact may be most commonly thought of in connection with chronic illnesses, such as childhood cancer, and intellectual/developmental disabilities, such as Down syndrome. However, any long- or short-term health concern can have lasting effects on a sibling, and that includes mental health.

Recognizing that the sibling of a child with mental health concerns is struggling is something that can be easily missed. After all, identifying the mental health needs of a child is in and of itself challenging. “Mental health concerns, especially for children, can be really tricky and misunderstood. It can be much more difficult to diagnose a child with a mental health condition than it is an adult. It’s an underserved and underrecognized population of kids themselves who have mental health concerns. When we stop to consider the impact of mental health conditions on siblings, we realize this is an even less addressed population,” says Emily Holl, LMSW, director of the Sibling Support Project, a national program for the siblings of individuals with developmental, health, and mental health needs.

However, just because it’s difficult doesn’t mean it isn’t necessary. Those working with children and families should work to support—either themselves or through referrals—the needs of siblings, allowing them to be seen and heard.

Potential Impact
How a child’s mental health disorder or mental health crisis impacts their siblings will vary depending on the sibling. But it will most certainly affect them. “A child’s mental health can have profound effects on their siblings, often leading to shifts in family dynamics. When one child struggles, siblings might experience feelings of anxiety, confusion, or even resentment, as they try to understand behaviors they don’t fully grasp,” explains ViAnna Gordon, LSW, assistant director of care management at Circle of Care for Families and Children of Passaic County in New Jersey. “This dynamic can sometimes lead siblings to feel emotionally distressed, confused about their role or as though their own needs are overlooked while caregivers focus on the child in crisis.”

That feeling of being overlooked has led some siblings to identify with the term “glass child.” First used in a sibling context by Alicia Maples during a TEDx San Antonio Talk in 2010, the glass child concept describes siblings of children with special needs as being strong but “made of glass because when parents look at them, they look right through them,” Holl says.

Through that feeling of invisibility, there may also be resentment. “When family life revolves around the needs of one person, it is understandable that the siblings feel resentful of the time, the attention, all of the resources that go into supporting that child,” Holl notes. “For children, fairness is everything. It can be difficult for young siblings to understand the difference between fairness—each child getting the same things—and equity, which is about each child getting what they need as an individual.”

Emily Rubin, MA, LICSW, social worker, and faculty member at Harvard Medical School and UMass Chan Medical School, adds that siblings may experience a litany of other responses to their brother or sister’s mental illness, including:

• “a pervasive sense of confusion due to the affected child’s unpredictable behavior or rapidly shifting moods;

• concerns about safety, including the safety of other family members;

• shame or embarrassment, which can manifest as not wanting to be seen in public with the affected child; and

• parentification, meaning that the sibling takes on adult responsibilities before they are developmentally ready to do so.”

How these responses manifest, again, varies, depending on the child, their age, and their own abilities. However, it is not uncommon for siblings to demonstrate behaviors that are outside of what is typical for them.

Gordon notes that “some of the behaviors include aggressive behavior, substance use, peer social disruption, depression, and isolation or school refusal.” These behaviors may start in isolation and be infrequent. However, if the child’s needs are not addressed, the behaviors may grow in prevalence and intensity.

Gordon adds that it is not uncommon at Circle of Care for the siblings of the child first treated to reach a point where they, too, are seeking services. “We often have siblings. One or two may come in, and eventually, the rest of the siblings in the home end up getting to our level of care.”

Addressing Needs
Addressing the needs of the sibling in these situations should start with information. A sibling knows when their brother or sister is experiencing an issue or a change and has the right, when that issue impacts them all, to understand it as best they can.

“The sibling experience really does parallel the parent experience,” Holl says. “They need information about the condition. Children don’t have access to professionals and other resources that parents do. If they’re lucky, they’re getting information from their parents. All too often, that doesn’t happen for the most loving reason. Parents want to protect them, and sometimes they don’t know how to talk about the diagnosis. Siblings are left with a lot of questions. They piece together an understanding based on what they observe. Sometimes, those puzzle pieces don’t go together so naturally when there’s a mental health condition involved.”

Talking to a child in an age-appropriate way about their sibling’s mental illness can open the door to questions, concerns, and fears that the child has. It also lets the child know that moving forward, they can come to the parent to discuss what is happening and how they feel about it.

“Not talking about it doesn’t mean it’s not real. Everyone is experiencing the situation in their own way. By not talking about it, parents unintentionally send the signal that it’s not okay to ask questions,” Holl says.

Within that conversation, it is important for parents or providers to address the concept of fairness that Holl previously mentioned. The needs of the child with a mental health condition may mean that they get more family resources. While that may not feel equal to the sibling. It can be equitable.

“I always tell people that fair does not mean equal,” says LaKisha Hoffman, MSW, senior director of school and community programs at the Child Mind Institute in the San Francisco Bay area. She says that she uses the analogy of needing glasses. Someone with 20/20 vision is not going to get a pair of glasses, but the child who can’t see clearly is. They need the glasses to be able to see in the same way their sibling already does. The same may be true of time and other resources when one child is struggling with their mental health.

Siblings of children with mental health needs must also have the opportunity to focus on themselves, their own relationships within the family and outside of it, and their changing needs. “Create space,” Hoffman says.

“It’s really, really important to do check-ins. If I’m a parent, I need to do a check-in. I need to do one-on-one quality time. I think it’s really great to talk about overall wellbeing. You have to be able to really validate your kids’ strengths and figure out what the areas are that they need support in. Even if you do small things where you take a walk with that kid after dinnertime and you ask them questions to figure out what is needed,” Hoffman says, it can be really powerful.

And don’t minimize their feelings. If they express an emotion or need, it should be heard in a way that is supportive and understanding. “It’s important for siblings’ feelings to be validated rather than minimized. Validation from a trusted adult may sound like, ‘I can understand why you feel so angry at your brother for calling you names.’ This is a different message than minimizing or reprimanding a sibling, which may sound like, ‘You should be mature enough to handle your brother’s outbursts.’ When the sibling realizes that the trusted adult understands how challenging life can be for the sibling and values the sibling enough to reflect back on what they’ve heard, it sets the stage for ongoing conversation and support,” Rubin says.

Sibling Support Groups
In addition to siblings finding support from parents and other trusted adults, siblings can also turn to specific support groups. Academicians, such as Rubin, have found that children benefit greatly from having the opportunity to interact with peers going through similar experiences.

“The research I conducted over a decade showed that an effective sibling group setting allows siblings to feel safe, understood, and not alone. The key factors are establishing and upholding basic ground rules so all participants feel safe and heard; utilizing trained mental health clinicians to facilitate the group; engaging the siblings with group activities that resonate with them; providing support at a time of day that does not conflict with school or afterschool activities; and, ideally, providing concurrent support to parents/guardians of the affected child, in a separate group,” Rubin explains.

Support groups can be found throughout the country, hosted or sponsored by different organizations and programs. For example, the Sibling Support Project is best known for its Sibshops—workshops where siblings of children with disabilities and health concerns can meet each other, receive information and peer support, and have fun. “We train organizations around the world on how to run Sibshops,” Holl says, who explains that Sibshops are not clinical or a form of therapy. “Usually, at the first Sibshop a child attends, they arrive unsure and timid. By the end, they are bouncing off the walls and asking when they can come back. It’s a very gratifying experience.”

Fostering Relationships
Addressing the needs of the sibling(s) can also mean addressing the sibling relationship. There is no hard and fast rule that says siblings need to be best friends or spend all their time together, but it is still important to foster a relationship that is open and understanding. That can be difficult when one child is struggling with their mental health.

“Sometimes the behavior of the child with a mental health condition can be unsupportive of a positive sibling relationship,” Holl says. “Sometimes, because of the mental health condition, a child might be aggressive or aloof or indifferent. With any kind of behavior that is not desirable to a brother or sister, it can be hard to understand why their sibling is behaving this way.”

Hoffman recommends working to find something that siblings can share—an interest that may bring them together even if they do it separately. “Family time as a unit is really valuable. What is it that we can do together that does not create conflict? Sometimes, that’s doing an art project together. Sometimes, that’s cooking. It really depends on the family.”

However, Holl cautions, parents and providers also need to be aware of a sibling’s boundaries. Yes, supporting a positive relationship is important but so is recognizing when that relationship needs a break.

“I had a mom reach out to me not long ago,” Holl recalls. “She has three daughters, and the middle daughter has mental health concerns. Mom said her other daughters try to be good sisters to her. But the oldest one got tired of being a punching bag. The youngest is getting to that point. Mom wanted to know how to salvage these relationships and help her daughters understand that their sister didn’t mean to hurt them. I said, I understand, and I also think it’s important to recognize your daughters’ experiences of this relationship. They’ve both gotten physically and emotionally hurt. Regardless of the reason, that impact is real. They are responding by setting healthy boundaries to protect themselves.”

Parental Needs
Much of the support discussed thus far, however, rests on the shoulders of the parents. That can be hard.

“Families face substantial challenges in balancing the needs of all their children, especially when one child has mental health concerns. Allocating time and energy effectively becomes a primary challenge. Parents may find themselves stretched thin, leading siblings to feel neglected or to believe their needs aren’t being met,” Gordon says.

Hoffman agrees, stressing the importance of parents finding a way to take care of themselves. “You can’t pour from an empty cup,” she says. “Parents need to be well.”

This is often easier said than done, of course. Fortunately, it’s also where social workers can play a key role. Throughout this journey, social workers are present, whether supporting the child with a mental health concern or being a trusted adult for the sibling at school and in the community.
For the parents, social workers can offer a safe space for communication while also being a resource for finding additional services.

What is available to families may vary depending on location, as well as what the families are able to afford. While there are many free-of-charge services, others are fee-based. Therapy copays may be affordable when one child is receiving counseling but not when family counseling and other individual sessions are added in as well. Social workers should speak with parents about the family’s needs and capabilities when preparing to make referrals.

Gordon recommends family therapy, educational resources from organizations such as the National Alliance on Mental Illness and Mental Health America, Youth Mental Health First Aid training, and much like for siblings, parent support groups.

With the right resources, the whole family, from the child with a mental health concern to their parents and their siblings, can feel supported.

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.

Reference
1. McHale SM, Updegraff KA, Whiteman SD. Sibling relationships and influences in childhood and adolescence. J Marriage Fam. 2012;74(5):913-930.