THE FORGOTTEN SOULS - SIBLINGS OF CHILDREN WITH ATTENTION DEFICIT DISORDER

Attention Deficit Disorder (ADD) is a condition that affects multiple areas of a child's life, and the impact of ADD on the families of such children is often profound. While vast research energies and most professional interventions focus on the child with ADD or the parents, his/her siblings are often the forgotten souls amidst major storms and day-to-day adjustments which occur in the family. White scant research attention has been paid to these children, it is my own clinical impression that such siblings often suffer greatly in such families, or at best, often make tremendous sacrifices and contributions which are inadequately noticed or acknowledged. It is my hope that better understanding of these siblings by parents and professionals may lead to more thorough acknowledgment of their contributions, better education for them about ADD, and more careful assessment of their psychological needs including the possible need for psychotherapeutic intervention.

Siblings of children with ADD are required to adjust to a myriad of special circumstances in their home lives. What often adds to their burden, as it does for all the family members, is the fact that ADD often goes undiagnosed for many years. During the years prior to its recognition there is often a strong sense of confusion in the family, with many feelings that remain unexpressed or unresolved. Self-esteem often suffers during these years. Even after ADD is recognized, many complications remain. The child with ADD, for instance, may be held to different standards of behavior than the siblings. The child with ADD usually requires extra attention from parents, whether it be around homework or guidance around other issues. Even if the ADD child is being disciplined by a parent, that child is still the recipient of parental attention, which may be experienced as a loss by the sibling.

In direct interactions among the children, the siblings of children with ADD must learn to adjust to a sibling who may be moody, bossy, volatile, or inconsistent. If the sibling is younger, he/she may be the displaced target for a great deal of anger carried by the ADD child. This may lead to feeling terrorized by the older sibling, and the sibling may be physically abused by the older child with ADD as well. If the sibling is older, he/she may have to deal with a younger sibling who is embarrassing, petulant, or irresponsible with borrowed possessions.

On the positive side, children with ADD are often lively, curious, and exciting to be around. This may provide many benefits for siblings and parents alike. Even the experience of helping a sibling who has learning problems or social problems to overcome can be a very rewarding experience.

Basically the task of development for siblings of ADD children requires them to deal with a similar range of feelings faced by the parents and the children who have ADD. They will experience anger at the frustrations and deprivations which they encounter as an inevitable consequence of their sibling's condition. They will feel sad that their family has these struggles. They may feel guilt as a survivor, or guilt for feeling pleased that they are not afflicted with ADD. They also may feel anxiety that accompanies confusion about what is really going on with their sibling and family. If these children can be encouraged to express such feelings and to accept them as normal reactions to life's unpredictable events and circumstances, the feelings can be handled and development can proceed apace.

What is more worrisome is when the feelings are not processed and also when there are dysfunctional behavioral patterns that persist. For instance, when siblings express their distress by provoking the child with ADD into misbehavior and then taking joy in their punishment, they will incur feelings of guilt on an ongoing basis. This kind of scapegoating can be very subtle.

I remember several families in which a well-behaved younger child often said something especially sweet or heralded his own positive accomplishments just moments after the parents had reprimanded the older ADD child.

This kind of one-upsmanship is very common, and parents often unwittingly support it. I believe that such "model" children are not only trying to show up their ADD siblings, but are also hoping to restore their sense of balance and hopefulness in the family.

Another common pattern may evolve in which an older sibling tries to help "parent" a younger ADD sibling. This role often develops from an older child's frustration that the parents are not adequately controlling the ADD child. The older child's disappointment in the parents may be "acted out" in excessive harshness or humiliation aimed at the child with ADD. Such older children may become demoralized and depressed themselves since their efforts to "shape up" their sibling are always fruitless.

Another common developmental problem arises when a younger child has been the brunt of an ADD child's anger and frustration. Such younger siblings may evolve into quiet and sensitive children who try to create no waves in a family already over stressed. Underneath this facade might exist deep feelings of anger, self doubt, and depression. Such children may become masters at accommodation, finding it difficult to express their own needs or wants.

Of course there are countless other adaptations that is to notice patterns and personality traits that seem especially rigid. Children who display these signs require help to identify and express their feelings while the family needs to change the interactional patterns that seem to generate those feelings.

Clearly, with proper education and support many families, including the siblings, are very successful at coping with ADD. There is a sense of pride and confidence that cornes with mastering any challenge in life, and such positive feelings can certainly develop in siblings of children with ADD when their contributions are recognized and their feelings and emotional needs are taken seriously.

Barton S. Herskovitz, M.D. is a child psychiatrist in private practice in Needham, MA. He has special interests in family therapy and in Attention Deficit Disorder. He is also Director of The Haida Center, which offers evaluation, counseling, as well as groups for parents and siblings of children with ADD/LD as well as for the children themselves who are struggling with learning disabilities and/or ADD. The Haida Center is located in Needham, offering some services in Newton as well.