Using neurotypical siblings as intervention agents to guide individuals with Autism Spectrum Disorders: A systematic review

Background: Siblings share a unique and long-lasting relationship. Their involvement in the upbringing of an individual with a disability may lead to long-term positive developmental outcomes. The purpose of this systematic review is to summarize existing interventions where neurotypical (NT) siblings served as intervention agents to guide their brothers/sisters with Autism Spectrum Disorder (ASD). Methods: Within this review we describe the training provided to NT siblings and how they delivered interventions to their brothers/sisters with ASD. We also summarize social validity outcomes to understand the social importance of the goals and effects as well as the social appropriateness of the intervention procedures from the perspectives of parents, siblings, and naïve observers. Results: The 16 included studies provided training of intervention strategies/skills (e.g., Stay-Play-Talk curriculum, delivering prompts and reinforcers, and giving play instructions) to NT siblings. After training, NT siblings implemented the intervention through play or other interactions with their siblings with ASD. Social validity outcomes from raters indicated the agreement on the intervention goals, appropriateness and acceptance of the procedures, and satisfaction of the behavioral changes of the included studies. Conclusion: Findings from this systematic review should be used to guide the development of appropriate training for NT siblings and inform the procedures within interventions delivery. Limitations of existing studies and areas for future consideration are discussed.