The Play Experience for Siblings of Children with Autism

RESEARCH QUESTION: This study used a modified Photovoice methodology to explore the experience of play for typically developing (TD) children with a sibling with autism spectrum disorder (ASD).

RATIONALE: Play is critical for a child’s health and development, yet most research does not illuminate the child’s perspective. Research has shown that siblings are one of the first and most important peer influences on a child and that the way they play is likely to have an impact on their physical, cognitive, social, and emotional development. Research has shown a discrepancy between parents’ and siblings’ perceptions of the TD–ASD sibling relationship as well as the social and emotional effects of having a sibling with ASD.

This study provided siblings with the opportunity to share their play experience on their own terms. The findings provide information for therapists who work with children with ASD to consider ways of including their TD siblings in therapy and help parents understand their children’s play experience.

DESIGN: A descriptive qualitative study using a modified Photovoice methodology

PARTICIPANTS: Purposive and snowball sampling was used to recruit 4 TD children ages 9–11 yr (3 boys, 1 girl) who had a younger sibling with ASD receiving services from a local pediatric occupational therapy clinic.

METHOD: Children were given 1 wk to take pictures of their play using a disposable camera. The participants met to discuss the photos in a focus group session. The interview questions used were developed on the basis of the Photovoice methodology.

ANALYSIS: Thematic analysis was conducted of the photos and transcriptions. Trustworthiness was established using an audit trail, peer review, investigator triangulation, and member checking.

RESULTS: Theme 1: Participants’ experience of play was diverse and supported by parent involvement. Participants engaged in spontaneous and structured play that was physical, creative, and skilled with various playmates including their sibling.

Theme 2: Participants demonstrated acceptance, tolerance, and understanding of their younger sibling. They expressed a variety of emotions and attitudes about their sibling and were able to interpret and adapt to their sibling needs. The results indicated positive play interactions.

DISCUSSION: The findings of this study show that the play experience of siblings of children with autism has similarities to and differences from the play experiences recorded in a previous Photovoice study. TD siblings were more likely to engage in pretend play alone or with friends than with their younger sibling with autism. The dearth of pretend play is not surprising given the existing research regarding the restrictive and repetitive play of children with autism. Physical play was shown to be common with their sibling, matching previous research indicating a preference for sensorimotor play.

Our results indicate that TD siblings may have more positive play experiences with their ASD sibling than parents may perceive. This study shows that an older TD sibling is capable of knowing ways to help and play with their younger sibling with autism, that they can be an expert on the wants and needs of their younger sibling, and that they are capable of using Photovoice as a way of expressing themselves.

IMPACT STATEMENT: Occupational therapists (OTs) can rely on TD siblings’ expertise in treatment interventions, thereby better integrating the family into therapy services. OTs can benefit from knowing that play between TD and ASD siblings is typically sensorimotor play, to further educate the family and foster relationships between siblings. Photovoice was found to be a suitable research method for eliciting the narrative of children ages 9–11 yr.