A WORKSHOP ON
ADJUSTMENT BEHAVIORS
AND ATTACHMENT
PATTERNS IN SIBLINGS OF
AUTISTIC CHILDREN
By
Yashwanthi Sharan
Mirji

Contents
•
Autism Spectrum Disorder
• Stress in Families
• Sibling Relationships
• Impact of Autism on Siblings’ Relationship
•
Sibling Stress and Adjustment Behaviors
•
Attachment Theory
•
Types of Attachment
•
Adult Attachment Patterns
• Correlation between Adjustment behaviors and Attachment
Patterns
• Questions & Answers
• Breathing and Relaxation techniques
• References

Autism Spectrum Disorder
What is Autism?
•
Autism Spectrum Disorder (ASD) is a group of complex developmental disabilities.
• Also known as “Autism” this spectrum disorder occurs in varying degrees from “full blown” autism to a mild version of autism.
(Center for Disease Control and Prevention 2012)

Autism Spectrum Disorder
• Autism Spectrum Disorder (ASD) is a group of complex developmental disabilities that is characterized by;
• significant impairments in social interactions
• communication skills
• behavioral challenges
(CDC 2012)
• The Diagnostic and Statistical
Manual of Mental Disorders, 4th ed. (DSM-IV-TR) lists the Autism
Spectrum Disorder as a Pervasive
Developmental Disorder.

Pervasive Developmental
Disorder
•
•
•
•
•
•

The Diagnostic Criterion….
•
The diagnostic criterion for Autistic disorder 299.00 in the
DSM-IV-TR is based on the presence of six or more of the twelve symptoms across three major areas:
• qualitative impairment in social interaction
• qualitative impairments in communication
• restricted, repetitive, and stereotyped patterns of behavior, interests, and activities (APA, 2000, p.75).
•
According to the website ( www.dsm5.org
2012) there will be a new category called Autism Spectrum Disorder in the new DSM-V.
•
This will incorporate several previously separate diagnoses, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (2012).

Prevalence of ASD
•
Autism Spectrum Disorder (ASD) has been on the rise at an alarming rate in the United States for the past decade.
•
In March 2012 the Centers for Disease Control and
Prevention (CDC), released their latest records that estimated 1 in 88 children in the United States are diagnosed with Autism.
• A big jump from the report they released in 2009 when it was estimated that 1 in every 110 children were diagnosed with autism, which is a 23% increase in just a couple of years (Center for Disease Control and Prevention 2012).

Symptoms of ASD
•
The symptoms of ASD vary significantly depending on the developmental level and chronological age of the child, and in some cases may include an additional comorbid diagnosis of mental retardation (also referred to as intellectual disability).
•
The symptoms of ASD may range from mild challenges for someone on the high functioning end of the spectrum to more severe behavioral symptoms, such as hyperactivity, impulsivity, aggressiveness, self-injurious behaviors and temper tantrums that interfere with everyday life.
(Lyons, Leon, Phelps and Dunleavy 2010)

Symptoms of ASD
•
Parenting a child with ASD can be stressful and psychologically distressing for some parents when compared to parents of typically developing children.
•
Diagnosis of autism, the severity of the autistic symptoms and the behavior problems are a strong predictor of parental stress.
(Lyons et al. 2010)

Stress in Families
Raising a child with disability is one of the ultimate stressors parents face. Parents of children with ASD have been found to experience more stress and adjustment problems than parents of children with Down syndrome (Gousmet 2006).

Stress in Families
•
The effects of having an autistic child does impact parents as well as the rest of the family members.
• The ambiguity of their child’s diagnosis and child’s impairments with social interactions makes it “extremely difficult” and “frustrating” for the parents.
(Gupta and Singhal 2005)

Stress in Families
•
Parents feel deprived of the simple pleasures of parenthood when the child with ASD is unresponsive and does not show affection nor form any attachment towards them.
•
This creates a lot of tension and parental anxiety resulting in negative psychological effects when compared to parents of children with other developmental disabilities .
(Gupta and Singhal 2005)

Stress in Families……
•
Parents of autistic children are at a higher risk for depression, social isolation and marital distress. Some parents go through deep sadness and feelings of inadequacy, anger and guilt.
•
Mothers of autistic children are significantly affected, as they are the primary caregivers who handle the brunt of the caring for the child.
• Mothers were more open to admitting that their emotional wellbeing was affected by the lack of the emotional expressiveness by the autistic child. They were resentful that they had to miss work and perform below their normal level and sometimes do part-time work.
Gupta and Singhal (2005)

Stress in Families
•
There is a great need for one parent to always be available to deal with the autistic child’s problems.
•
Considerable pressure is placed on the mother to restrict her career and get more involved in the autistic child’s special schooling, interventions, speech therapies and behavior programs putting a strain on the family finances.
(Gupta and Singhal 2005).

Stress in Families
•
Parents who are the primary caregivers of the autistic child, are very involved in meeting the autistic child’s needs.
•
They do not have time to arrange extracurricular activities for their typically developing children.
•
There is a considerable amount of stress associated with the family’s finances that are budgeted to aid the needs of the autistic child’s therapies making it difficult for them to pay for extracurricular activities for the typically developing children.
(Barak-Levy et al. (2010)

Stress in Families
The mothers reported significantly higher levels of stress, impaired family functioning, job and career adjustments, lack of time for personal activities and marital strain. The common theme of concerns reported by the mothers was; the impact of the ASD child has on their typically developing children.
(Meirsschaut, Roeyers and Warreyn 2010).

Stress in Families
•
Mothers reported a significantly lower sense of self-efficacy about parenting a child with ASD.
•
They expressed the guilt of “not doing enough”, not having enough time and giving enough attention to the typically developing child when compared to the amount of time they spent on being actively involved with the ASD child.
• The stress and depression evoked by the challenges of raising an ASD child, also effects the stress and depression of raising their typically developing child.
(Meirsschaunt et al. 2010)

Stress in Families
•
Parents with high self-efficacy beliefs interpret the difficult behavior of their children as a challenge to their parenting skills, where as parents with low self-efficacy beliefs are likely to perceive the difficult child as a threat to their limited parenting skills.
•
Maternal depression restricts parental competence indirectly by undermining the mother’s self-efficacy beliefs.
(Meirsschaunt et al. 2010)

Stress in Families
• The autistic child’s unpredictable behavior is another major stress causing factor, the child’s aggressiveness and temper tantrums have an impact on the entire family.
• The family has anxieties about the autistic child’s meltdown episodes in public situations
(for example: at the shopping mall, grocery stores or a relative’s house) often leave them feeling embarrassed and stigmatized.
•
Parents limit their social lives and avoid attending social events together as a family.
They isolate themselves within their own safe and familiar environment.
(Gray 1993)

Stress in Families
• Families are complex systems that are influential, as well as interactive.
• The causative influences flow through one variable to influence another variable.
• The stress of having to care for the autistic child, taking them to several different therapy appointments may create conflict between spouses, leaving very little time for the typically developing children.
•
Parents get anxious and may lose their temper and take it out on the typically developing child.
• This might cause resentment and anger towards the autistic sibling and the typically developing child may completely avoid their sibling.
(Stoneman 2005)

Sibling Relationships
The U.S. Department of Health and Human Services defines sibling relationship as, children who typically require a biological parent in common. Other types of sibling relationships include full siblings, half siblings, step siblings, foster children in the same family, orphanage mates or group home mate, children of the partner or former partner of the child’s parent and other close relatives or non-relatives living in the same household (2006).

Sibling Relationships
• the relationship between brothers and sisters is important and unique because it begins very early in life and is often the longest lasting relationship, longer than the ties to parents, spouses or children.
• Siblings usually share genetic characteristics; the common environmental influence allows them to grow up with similar personality traits, views and attitudes.
(Martins, 2007)

Sibling Relationships
• Some of the factors that make this relationship complex is the gender, age, birth order, home and school environments and characteristics of parents, their interpersonal relationships, as well as other members in the family that play a role in the development of the sibling relationship (Watkins 2008).
• Intimacy between siblings translates into an opportunity for providing emotional and instrumental support for one another.
• When they engage in pretend play or have a conflict, this plays an important role in understanding others points of views.
(Howe and Recchia 2006)

Sibling Relationships
•
•

Sibling Relationships
•
Siblings are the most important source of emotional support to each other; they serve as role models and play as buddies, and influence social and cognitive learning in the sibling relationship.
• Parents are the primary agents of socialization; the parent-child relationship plays a significant role in the sibling relationship.
(Neale 2003)

Sibling Relationships
•
Birth order can influence the development of pro-social skills in younger children; they learn by imitation of their older siblings who take the role of teachers and sometimes as leaders.
• Older siblings who model positive pro-social skills (e.g. helping, sharing) rather than aggressive and violent behavior were able to influence positive peer relationships outside the home.
•
When the parents are stressed and emotionally unavailable to meet the needs of the children, the sibling adapt and take the role of the parent and take care of the other siblings.
(Watkins 2008)

Sibling Relationships

• Petalas, Hastings, Nash, Dowey and Reilly (2009) explain that siblings growing up with an autistic child in the family experience relationships that are unique and challenging.
• The complexity of the ASD is what makes the difference in the experiences.
• Research indicates siblings who have an autistic brother or sister experience internalizing and externalizing behavior problems.
• There is also research that reports siblings have a positive relationship with their autistic brother or sister.
Petalas et al. (2009)

Impact of Autism on Siblings
Relationship

Impact of Autism on Siblings
Relationship
Petalas et al. (2009) conducted a study….
•
Twenty-two siblings who have an autistic brother or sister were interviewed.
•
This study was conducted to explore the knowledge and awareness typically developing siblings had of their relationship with the autistic child in the family.
•
Petalas et al. (2009) lists the experiences of the typically developing siblings: the self-injurious, aggressive behaviors, obsessive behaviors and the tantrums of the ASD child impact the siblings in negative ways.
(Petalas et al. 2009)

Impact of Autism on Siblings
Relationship
• The siblings experience anger and frustration when the family’s recreational activities/outings are often interrupted by the autistic child having a meltdown.
•
The siblings perceived this as interference in family time.
•
Siblings experience a range of emotions, such as feeling anxious, anger and even embarrassment.
(Petalas et al. 2009)

Impact of Autism on Siblings
Relationship
•
Siblings report feeling anxious and stigmatized when they have to explain their sibling’s condition to their peers or even strangers.
•
In the process of coping with the embarrassment of the ASD child, the siblings often felt lonely and become socially isolated.
• They also felt angry and upset by the prejudices of their peers.
• Siblings clarified that not everything was negative in their relationship with the ASD child in the family.
(Petalas et al. 2009)

Impact of Autism on Siblings
Relationship
• Petalas et al. (2009) explains that typically developing siblings accepted the
ASD child’s impairments and acknowledged that their sibling is not in control of his or her actions.
• They report feeling proud of their ASD sibling of everything they accomplish and enjoy the sibling relationship.
• Petalas et al. (2009) highlight the fact that siblings, who had a greater understanding of their brother or sister’s autism spectrum disorder and experienced positive reactions from parents and peers towards the autistic child, were said to display positive behaviors towards their autistic sibling.
(Petalas et al. 2009)

Impact of Autism on Siblings
Relationship

Impact of Autism on Siblings
Relationship
•

Impact of Autism on Siblings
Relationship
•
Parents and caregivers have to be mindful of this and help the siblings cope in the following ways
• Teach Siblings Open Communication Most children talk openly with their parents about how they feel about having an autistic sibling, but some do not, they keep their feelings to themselves and feel guilty about how they feel towards the autistic child. They watch and learn how the parents deal with their feeling and emotions. Listening to what siblings have to say will encourage them to communicate about their autistic sibling.
• Explain ASD to Siblings in Simple Terms - Siblings need to be educated about their sibling’s autism spectrum disorder. It’s important for them to learn how to play and get along with ASD children. It’s crucial to explain to them that they did not cause it and they cannot “catch it” or get it later in life.
Parents and caregivers should be calm, use simple words and explain how the autistic child is getting treatment.

Impact of Autism on Siblings
Relationship
• Focus on Treating Each Child Fairly - Typically developing siblings at some point are going to complain that their parents/caregivers are not being “fair”. They believe that their parents let the ASD child get away with something they would be punished for, or they cannot do something because of their autistic sibling. Parents are advised to treat each child fairly according to his wants and needs.
• Allow Independence and Individual Time for Siblings - Siblings as well as parents and caregivers need time for their own activities and friends.
Parents can set aside some alone time with just the sibling, so they get to feel special and loved.
• Help Siblings Get Support - Siblings of children with ASD feel embarrassed and are concerned that their friends do not understand the autistic sibling and will tease them. It is helpful for siblings to meet other children, who have ASD siblings to understand they are not alone and that there are other kids out there who know exactly how they feel.
(The Resource Guide for Families of Children with Autism Spectrum
Disorder 2011)

Impact of Autism on Siblings Relationship
• Kaminsky and Dewey (2001), hypothesized that siblings of children with autism would report differences in their relationship when compared to siblings of children with Down syndrome.
• The siblings of autistic children reported less pro-social behavior, less intimacy and less nurturance when compared to siblings of Down syndrome children.
• Siblings of autistic children felt this way because children with autism lack communication and social skills and their limitations in cognitive functioning impede their ability to initiate a conversation.
•
Autistic children’s inability to dialogue with their typically developing siblings and their incapacity to understand another person’s views and feelings, as well as express their own thoughts and feelings, may have been the basis for the unresponsiveness to their siblings’ emotions.
• Typically developing siblings also reported great admiration for their sibling with ASD; they were less competitive and quarreled less with their autistic siblings, as they felt less inclined to fight with a child with disability.
(Kaminsky and Dewey 2001)

According to Stoneman (2005)
•
Typically developing siblings are expected by their parents to act responsibly and help out with chores around the house.
•
Siblings are expected to take on child-care responsibilities and watch over the autistic child.
•
Parents expect the typically developing sibling to take on a mature, dominant role and help teach and play with the autistic child, regardless if they are older or younger, than the autistic child.
(Stoneman 2005)

Impact of Autism on Siblings
Relationship
•
Watkins (2008), writes that the perceived differential treatment by the parents greatly influences the relationship between the typically developing sibling and the autistic child throughout life.
• When parents show preferential treatment for one sibling and the other sibling gets less affection and is treated with a different set of rules, sibling aggression, sibling rivalry, resentment and alienation is noticeable in the relationship.
(Watkins 2008)

Sibling Stress and Adjustment
Behaviors
According to Benson and Karlof (2008)
• Some studies have indicated that siblings were negatively impacted and some showed that the siblings were well adjusted.
•
One of the reasons for this contradiction could be due to the variations of methods used, as well as using comparison groups with developmental disabilities other than ASD.
•
Benson and Karlof (2008) did a study on social, emotional and behavioral adjustment of siblings who have an autistic brother or sister in the family.
• They looked into parental distress and family climate, as these are some factors known to impact the sibling relationships of autistic children.
(Benson and Karlof 2008)

Sibling Stress and Adjustment
Behaviors
Benson and Karlof (2008)
• explain parental distress as: stress between parents, marital problems, health problems, financial problems and unemployment.
• All are indicative of siblings developing emotional, as well as behavioral problems.
•
Siblings of autistic children are particularly vulnerable to this type of stress that can be associated with depression and anxiety.
• Family climate is another factor that plays an important role in the process of sibling adjustment.
(Benson and Karlof 2008)

Sibling Stress and Adjustment
Behaviors
•
Benson and Karlof (2008) defines family climate as: relationships between family members that promote feelings of cohesion among parents, siblings and the other members.
•
They explain that the positive relations between the parents and other members in the family can create an environment that will promote the emotional wellbeing and social competence.
• The symptom severity of the ASD child’s is directly related to parental stress, as well as adjustment difficulties of typically developing sibling. This research also shows that siblings, who perceive parental favoritism, experienced various negative adjustment problems.
(Benson and Karlof 2008)

Sibling Stress and Adjustment
Behaviors
•
Meyer, Ingersoll and Hambrick (2011) conducted a study on autism severity affecting the sibling adjustment on a daily basis.
•
The results indicated that ASD symptom severity does affect the sibling’s adjustment, it is also influenced by the mother’s depressive symptoms when they have a more severely affected autistic child.
• The typically developing siblings notice the behavior problems, such as aggression and acting out by the child with autism, to be problematic and embarrassing in their daily lives.
(Meyer et al. 2011)

Sibling Stress and Adjustment
Behaviors
According to Meyer et al. (2011)
• a parent who is significantly depressed may be less effective in balancing the demands of multiple children with different developmental needs and may be unable to effectively parent them and provide them with the emotional support they need.
(Meyer et al. 2011)

Sibling Stress and Adjustment
Behaviors
•
According to Meyer et al. (2011) mothers who experience depressive symptoms have less energy to monitor the ASD child closely, which may lead to negative behaviors and aggression towards the typically developing sibling.
• They may not be able to attend to the typically developing sibling’s social/emotional needs as well.
• The limitation of this study does indicate that this study cannot be generalized to all families with ASD children, as the data was collected from mothers who were depressed and this depression could affect their evaluation of the ASD child and typically developing child’s behavior.
(Meyer et al. 2011)

Sibling Stress and Adjustment
Behaviors
•
A study conducted by Petalas et al. (2012) on the sibling relationship between the autistic child and the typically developing child found that, the relationship played an important role in sibling development and sibling adjustment, as they are both connected.
• The authors explain that when the ASD child with behavior problems did not display warmth, intimacy and friendly behavior towards his or her siblings this resulted in internalizing and externalizing behavior in the typically developing siblings.
• There was an increase in conflict resulting in behavior problems in young children and adolescents negatively impacting the sibling relationship.
(Petalas et al. 2012)

Sibling Stress and Adjustment
Behaviors
• According to Macks and Reeve (2007), siblings of autistic children are more likely to experience several stressors, which include changes in family roles, restructuring of the family functioning and activities, and loss or absence of parental attention.
• They are at risk for experiencing problems of psychological adjustment when they experience feelings of guilt or, shame brought on by the negative evaluations of their peers when their autistic sibling displays unusual behavior.
• Typically developing siblings are resentful when they are unable to invite friends over to their house; they deal with the possibility of being embarrassed by the autistic child’s unpredictable behavior.
•
Siblings of an autistic child feel that their parents treat them unfairly.
(Macks and Reeve 2007)

Sibling Stress and Adjustment Behaviors
•
Macks and Reeve (2007) report parents often spend most of their time and attention on the autistic child, while the siblings are often expected to do more household chores and physically care for the autistic child.
• There are multiple demographic risk factors, such as number of siblings in the family, the gender; birth order of the typically developing siblings, as well as the socioeconomic status, significantly predicted psychosocial and emotional adjustment of siblings of autistic children.
•
Just having an autistic sibling may not be a risk factor by itself, as they can have a positive influence on the typically developing sibling. However, when multiple demographic risk factors are present, the typically developing siblings experience emotional and psychological difficulties.
(Macks and Reeve 2007)

Sibling Stress and Adjustment
Behaviors
•
Macks and Reeve (2007) explains that in large families parents are less likely to overburden individual siblings with childcare responsibility. The siblings can relate to and learn from other typically developing siblings. Another variable that was taken into consideration was birth order of the siblings.
• They found that older siblings have greater difficulty with feeling and behaviors.
• On the other hand, they reported that siblings of autistic children are well rounded and have positive self-concept, high levels of social competence and a healthy behavioral adjustment.
•
A possible explanation for this contradiction is, siblings of autistic children are often more mature than their peers.
(Macks and Reeve 2007)

Sibling Stress and Adjustment
Behaviors
•
Macks and Reeve (2007) explained that siblings of autistic children have a higher level of maturity and this leads to improved behavior, better social skills, improved academic performance and an overall positive self-concept.

Sibling Stress and Adjustment
Behaviors
•
Kaminsky and Dewey (2002), conducted a study to see if feelings of loneliness, social support and social demographic factors were related to psychosocial adjustment in siblings of autistic children when compared to siblings of children with
Down syndrome and siblings of normally developing children.
•
The results indicated that siblings of all groups reported low mean levels of loneliness.
•
They reported higher level of social support from parents, peers, close friends and teachers.
•
The overall correlations showed that higher levels of social support were associated with lower levels of loneliness and better adjustment with the autistic siblings.
(Kaminsky and Dewey 2002)

Sibling Stress and Adjustment
Behaviors
•
Kaminsky and Dewey (2002) pointed out that siblings of autistic children whose parents participated in support groups displayed fewer internalizing and externalizing adjustment problems
• Siblings who attend support groups are exposed to information about autism and have the opportunity to interact with other siblings of autistic children who attend these support groups.
•
They reported that siblings of autistic children who came from large families felt less embarrassed about their autistic siblings and reported fewer feelings of burden regarding their siblings.
(Kaminsky and Dewey 2002)

Sibling Stress and Adjustment
Behaviors
•
Having other non-disabled siblings and other family members was an important source of social support to the typically developing siblings.
•
Children who were younger than the child with the disability were inclined to feel more rejecting towards their sibling than older siblings. They had different experiences than the older siblings, and these may have a unique effect on their psychosocial adjustment.
•
They report that children younger than their siblings with autism show more adjustment problems.
(Kaminsky and Dewey 2002)

Sibling Stress and
Adjustment Behaviors
•
Hasting (2003) hypothesizes that this might be related to the fact that older children have had a period of time to develop attachment relationships with their parents before the sibling with autism was born (2003).

Attachment Theory

What is Attachment?
Attachment is a specific and confined relationship between a child and a caregiver that is involved with making the child safe, secure and protected. Attachment is where the child uses the primary caregiver as a secure base from which to explore and return for safety and as a source of comfort when they need it.
(Benoit 2004)

Attachment…
Benoit (2004) writes:
Parents play many different roles in the lives of children, including teacher, playmate, disciplinary, caregiver and attachment figure. Of all these roles, their role as an attachment figure is one of the most important in predicting the child’s later social and emotional outcome
(2004 p. 541).

Attachment….
Cornell and Hamrin (2008) write,
• attachment between a child and the primary caregiver is a biological function that enhances proximity and protects the child from dangers.
•
The caregiver is most often the mother or any consistent caretaking figure that can provide the needs of the infant.
•
The attachment behavior is observed when the infant uses smiling, crying, reaching, grasping and other behaviors to engage the caregiver, and the caregiver responds by giving the infant what is needed.
• Attachment plays an essential role in survival of the species; it’s how infants learn to connect and interact with each other as they learn social norms (2008).

Attachment…
• Cornell and Hamrin (2008) also explain that it’s through attachment that infants learn that they are worthy and loveable and the world will respond to their needs.

Attachment Theory
• 1907- 1990
• John Bowlby was a British psychologist.
•
He was influenced by
Freud/Lorenz
• He is considered to be the father of
Attachment Theory.
• He coined the term Attachment

Attachment Theory
•
John Bowlby, a psychologist, was the first to research the concept of attachment.
•
Bowlby shared his psychoanalytic view that early experiences in childhood have an important influence on the development and behavior later in life.
(Bretherton 1992)

Attachment Theory
• Bowlby theorized that children develop attachment to the caregiver, who takes care of them during the initial years, even if the caregiving is poor.
•
Bowlby believed that early experiences of infant/caregiver relationships, as well as attachment styles in early childhood, have an important influence on the development and behaviors later in life.
(Newton 2008)

Attachment Theory
• According to Sable (1992), emotional bonds, which form between individuals, have implication on their relationships and mental health throughout life.
• He states that psychological health is related to the positive quality of attachment the individual has experienced in the past as well as present.
• Psychological distress is perceived as distortion of the attachment behavior system.
•
Symptoms of anxiety, depression and anger reflect the internalization of adverse affection experiences that have diverted developmental pathways away from adaptive functioning towards dysfunction.
(Sable 1992)

Attachment Theory
•
Bowlby developed a framework for explaining the development of pathological anxiety and depression.
•
According to Bowlby, the event of separation is followed by a sequence of responses: the initial protest of distress and anxiety is followed by despair or depression, which is followed by detachment.
(Sable 1992)

Attachment Theory
According to Pistole (1989)
• Bowlby’s theory suggests the goal of attachment as instinctively determined proximity to the attachment figure.
• The desire to be near the people the infant is attached to.
•
If the caregiver is not able to maintain proximity, the caregiver may be perceived as inaccessible, and in this case the infant experiences separation anxiety.
• The child displays behaviors, such as crying and actively searching for the attachment figure and resists to being comforted by others.
• Returning to the attachment figure for comfort and safety in the face of fear or threat is referred to as a safe haven or a secure base where the attachment figure acts as a base of security from which the child can explore the surrounding environment.
(Pistole 1989)

Attachment Theory
The four key components of Attachment Theory.

Attachment Theory
• According to Bowlby the individual’s sense of safety and security is derived from maintaining a bond with an accessible and responsive caregiver.
• When the child perceives a threat to the caregiver’s availability, they most likely will feel anxious and angry and, if the disruption in the availability of the caregiver continues, this results in feelings of sadness and despair affecting the attachment bond.
(Cassidy and Shaver 2008)

Attachment Theory
• Bowlby explains that older children and adults perceive threat to caregiver availability when there is disruption in communications, prolonged absences, emotional disengagement and signals of rejection.
• Disruptions in communication results in feelings of anxiety, anger and sadness similar to what is noticed in younger children when they experience separation form their caregiver.
• Children derive their sense of security from the way they appraise their attachment figure’s availability.
• Bowlby’s way of explaining “ready accessibility” being able to establish a security in a child; the caregiver could be physically accessible but
“emotionally absent.” Bowlby stresses the fact that a child needs to experience a parent who is not only accessible but also responsive.
(Cassidy and Shaver 2008)

Attachment Theory
•
Born in 1913-1999
• Mary Ainsworth was a
Canadian Psychologist
•
Expanded on John
Bowlby’s work of attachment.
• Devised “Strange
Situations” in order to investigate the different attachment styles in infants.

Attachment Theory
• In the 1970s, psychologist Mary Ainsworth expanded on Bowlby’s findings on attachment and the concept of parent as a secure base.
• Ainsworth conducted her research on the mother/child relationship and how the behaviors of the mother were affected by the quality of attachment.
• Ainsworth not only confirmed Bowlby’s idea that attachment system is not based upon feeding but instead on protecting the child to guarantee the survival of the gene pool; she explains that smiling, vocalization and proximity to the mother was quite prominent among infants that it was easy to spot the mother based upon the child’s behavior alone.
(Newton 2008 p. 12)

Attachment Theory
• Ainsworth researched the “Strange Situation”.
• This study focused on gradually increasing an infant’s stress to activate the biological attachment system so that it can be seen and measured.
• When a child is stressed she/he will naturally seek the caregiver for protection, soothing and reassurance.
•
When the child experiences mild to moderate stress, his/her behavior will reflect their expectations of what they have already learned from their caregiver about the caregiver’s availability (p. 13).
• Newton (2008) explains that this is a learned behavior; the child knows when care will be given and when care will not be given. It’s by examining any difference in expectations that Strange Situation studies can determine the quality of a child’s attachment to her caregiver.
• The primary attachment figure for an infant is the person that the child prefers, or seeks out when stressed, sick, or needs soothing.
(Newton 2008)

Attachment Theory
• Ainsworth perceived that an infant’s confidence can increase with the mother’s responsiveness and sensitivity towards him/her.
•
On the other hand, the mother’s insensitivity and nonresponsiveness can lead to the infant feeling rejected.
(Cassidy and Shaver 2008)

Types of Attachment Theory
•
Ainsworth found four attachment styles in children:
•
Secure
• insecure-avoidant
• insecure-resistant
• disorganized attachment style.
(Cassidy and Shaver 2008)

Attachment Theory
•
When infants are about six months of age, they begin to anticipate responses from their caregivers when they are distressed.
• Caregivers who consistently respond to the infant’s distress in sensitive
“loving” ways, such as picking the infant up promptly and reassuring the infant, makes the infant feel secure.
• The infant comprehends that it is all right for them to express negative emotion, which will elicit comforting from the caregiver.
• This is the infants “organized” strategy to feel “secure” when they are feeling distressed.
•
Ainsworth codes them as having secure attachment.
• Infants with secure attachments approach the caregiver and maintain contact but are also able to return to play.
• This occurs in 55% of the general population.
(Benoit 2004)

Attachment Theory
•
Connors (2011) writes that parents who are psychologically healthy are said to have securely attached children, and securely attached infants use their attachment figures to help them control their distress, whereas children who are insecurely attached have to find ways to control affect as they don’t have any sensitive attachment figure close by.

Attachment Theory
•
Caregivers, who consistently respond to the infants distress in an insensitive or “rejecting” ways, such as ignoring, ridiculing or getting annoyed with the infant causes the infant, to get distressed.
• The strategy for dealing with this is also “organized,” but they avoid the caregiver when distressed and minimize displaying negative emotions in the presence of the caregiver. In this attachment pattern, the child’s strategy towards the rejecting caregiver is to avoid the caregiver in times of need.
• This avoidant tactic is “insecure,” because it increases the risk of developing adjustment problems.
• Ainsworth codes them as infants with insecure-avoidant attachment; they fail to approach caregivers and appear oblivious when the caregiver returns.
Instead they remain focused on the toys avoiding the caregivers.
•
This occurs in 23% of the general population.
(Benoit 2004)

Attachment Theory
•
Connors (2011) writes that these infants must attempt to reduce anguish by defocusing from the attachment figure, whose rejection is so predictable, and they grow up to be dismissing adults.

Attachment Theory
Insecure-resistant attachment
• Caregivers who respond to infants in inconsistent, unpredictable and
“involving” ways such as expecting the infant to worry about the caregiver’s needs or by intensifying the infant’s distress or even being overwhelmed, causes the infant distress.
•
The strategy for dealing with this distress is for the infant to display extreme negative emotion to get the attention of his/her inconsistent caregiver.
• These infants display exaggerated distress, resistant responses, and anger, and they hope that this response is not missed by the inconsistently responsive caregiver.
• This resistant strategy is “insecure” as it is associated with an increased risk for developing social and emotional maladjustment.
• Ainsworth codes them as infants with insecure-resistant or insecureambivalent attachment, these infants are extremely distraught by separations and do not get pacified easily; they display anger and resistance to caregivers.
• This occurs in about 8% of the general population.
(Benoit 2004)

Attachment Theory
Insecure-resistant attachment cont…
• Connors (2011) writes that infants who are insecure-resistant must develop conditional strategies that will allow them to stay in close proximity to a problematic caregiver. The mothers/caregivers of these infants were warm at times but were mostly unpredictable, inconsistent and insensitive.
• Infants who are insecure-resistant display an intense neediness and emotionality in order to get the attention they want from their self-absorbed parents as they are not sure if they will get the attention this time.
(Connors 2011)

Attachment Theory
Disorganized-disoriented attachment
• Certain infants and children are exposed to certain forms of distorted parenting that are quite unusual.
•
Caregiving styles that are “frightening” dissociated, sexualized behaviors displayed by caregivers during interactions with their children and not limited to when the child is distressed.
• These caregivers have history of unresolved trauma such as post-traumatic stress disorder or even domestic violence.
• In this situation, infants are disorganized when distressed, they display misdirected, contradicting behaviors.
• They freeze from uneasiness and even fear the parent. The infants with disorganized attachment are unable to find a solution to fear and distress so the infants display bizarre contradictory behavior.
• Disorganized attachment in infancy and early childhood is seen as a strong predictor of serious maladjustment in childhood.
(Benoit 2004)

Attachment Theory
Disorganized-disoriented attachment cont…
• According to Benoit (2004), disorganized attachment is connected to internalizing and externalizing problems in early school years. Children who have disorganized attachment have low self-esteem and poor peer relations/interactions (2004).
•
Connors (2011) explains that infants of disorganized attachments are in a dilemma because their parents are their source of security, as well as the source of fear and distress.
• The mothers are said to behave in a distressing and disciplinary ways, arousing strong affect in their children but doing nothing to lessen it.
• Disorganized infants lack coherent strategy for managing frightening caregivers and overwhelming affects.
• Their disorganization has been linked to aggression, dissociation and over controlling behavior from their parents.
(Connors (2011)

Attachment Theory
• The” internal working model “as referred to by Bowlby and Ainsworth is used to describe the internally encoded attachment experience a child has with the primary caregiver.
• Infants steadily develop internal representations of the self as worthy or not worthy of care and attention, and others as trustworthy and available or not available based on the type of caregiving they have experienced (Connors 2011).
• The internal working models are the cognitive representations of the child’s early experiences that act as a guide to help them to interact with others in their social world.
• The quality of these working models can vary, as they are believed to be based on each individual infant’s experiences with his or her primary caregiver (Marchand, Schedler and Wagstaff 2004) .

Attachment Theory
Adult Attachment Patterns
• Attachment relationships continue to be important throughout the lifespan.
•
Childhood attachment patterns are said to have a direct link to the intimate, romantic relationships we have as adults.
•
Adults seeking long-term relationships identify responsive caregiving qualities, such as attentiveness, warmth and sensitivity.
•
Certain adults develop relationships with partners who confirm their existing beliefs about attachment relationships.
(Fraley 2010)

Attachment Theory
Adult Attachment Patterns cont…
• Secure adults are more satisfied in their relationships and seem comfortable with intimacy and their own emotions.
•
As adults they seem to have relationships characterized by longevity, balance, trust, commitment and interdependence.
They use their partners as a secure base from which to explore the world and are more likely to be supportive and provide support to their distressed partners.
(Fraley 2010)

Attachment Theory
Adult Attachment Patterns cont…
• Children who are insecure will approach their parents with fear and anxiety, seeking closeness but then withdraw due to fearful avoidance.
•
Fearfully-avoidant adults adjust poorly because of their defensive nature; they minimize attachment with others and, due to their lack of trust, cover up their true feeling of vulnerability.
• The dismissing-avoidant adults use their defensive strategies to cope with their problems.
(Fraley 2010)

Attachment Theory
Adult Attachment Patterns cont
• Dismissing-avoidant adults minimize the impact of interpersonal events; they don’t remember much about their childhood and divulge brief facts making it sound as normal as possible.
• Avoidant adults prefer low levels of dependence, commitment and display of affection in their relationships.
• They minimize the significance of relationships and prefer to be extremely involved with work.
• Adults rated as avoidant or dismissing are always stressed, they are prone to somatic disorders and are likely to use alcohol for tension relief.
•
Infants who are ambivalent or resistant are said to be preoccupied as adults.
(Connors 2011)

Attachment Theory
Adult Attachment Patterns cont…
• Connors (2011) also explains that disorganized or unresolved adults continue to be significantly affected by unresolved trauma.
•
They show lapses in reasoning and collaborative discourse.
•
Adults with a disorganized attachment style are clearly associated with significant psychopathology, including dissociative disorders, criminal convictions and violent behaviors (2011).

Attachment Theory
Adult Attachment Patterns cont…
• According to Fraley (2010), attachment theory was originally adapted for the ecology of infancy but it continues to influence behavior, thoughts and feelings in adulthood.
•
The differences in attachment styles are shaped by variations in experiences with parents and caregivers in early childhood that in turn, shapes the individual’s attachment style as an adult.
• Fraley (2010) refers to a simple questionnaire that was developed by
Hazan and Shaver (1987) and used to measure attachment styles.
• Hazan and Shaver (1987) asked their subjects to read three paragraphs
(listed below) and indicate which paragraph best characterized the way they think, feel and behave in close relations.

Attachment Theory
Read the three paragraphs (listed below) and indicate which paragraph best characterizes the way you think, feel and behave in close relations.
• A. I am somewhat uncomfortable being close to others; I find it difficult to trust them completely, difficult to allow myself to depend on them. I am nervous when anyone gets too close, and often, others want me to be more intimate than I feel comfortable being.
•
B. I find it relatively easy to get close to others and am comfortable depending on them and having them depend on me. I don't worry about being abandoned or about someone getting too close to me.
• C. I find that others are reluctant to get as close as I would like. I often worry that my partner doesn't really love me or won't want to stay with me.
I want to get very close to my partner, and this sometimes scares people away.

Attachment Theory
•
•
•
•
Hazan and Shaver found that
•
60% of the adults classify themselves as secure.
• 20% describe themselves as being avoidant
• And only about 20% rate themselves as anxious-resistant.
(Hazan and Shaver 1987)

Sibling attachment patterns to parents
•
Gousmett (2006) conducted studies on the attachment of siblings of autistic children to their parents.
•
Positive, secure attachments to parents and caregivers is crucial from birth to 2 years in order for the child to develop a strong sense of self that aids in forming healthy relationships with other people.
• Secure attachment process can become disrupted by the presence of a brother or sister with special needs such as autism or Down syndrome.
• A child who has already spent time with the mother and developed a secure base may begin to feel a sense of abandonment as the mother begins to spend more time with the child with special needs.
(Gousmett 2006)

Sibling attachment patterns to parents
•
Typically developing children who see their mother spending more time with their autistic sibling and notice that they have less energy for them and rest of the family, begin to develop a sense of abandonment and their sense of self begins to suffer.
• They perceive the autistic sibling to be more important than they are, they receive more attention from their mother.
• The parent can tolerate any type of externalizing behavior from the child if they already have a secure attachment, but if there is an autistic child in the family the parent tends to be more depressed and stressed and can react differently.
(Gousmett 2006)

Sibling attachment patterns to parents
According to Cassidy and Shaver (2008)
• the infant-mother attachment security is associated with less sibling conflict.
•
The study they conducted showed the infant-mother attachment security was also related to positive treatment of and from the older sibling.
•
They agree that the quality of the sibling relationships stems from secure attachment to the mother/caregiver, which seems to be consistent with the attachment theory
(2008).

Is there a correlation between adjustment behaviors and attachment patterns?
•
Levy-Wasser and Katz (2004) examined the connection between birth order, attachment styles and adjustment behaviors in families with typically developing children who have siblings with intellectual disabilities.
• Older siblings have a greater amount of responsibility placed on them, and they are accountable for helping and caring for the sibling with the disabilities when the parents are not around.
•
It is understood that older siblings have a better control of situations and have the capacity to cope.
•
As older siblings, they have had a period of time in their lives being a part of a normal family environment(2004).

Is there a correlation between adjustment behaviors and attachment patterns?
•
Children, who are younger than the sibling with intellectual disabilities, have a greater risk of maladjustment.
•
They face the challenge of understanding the older sibling’s unusual behaviors and feel the need to compete for parental attention.
• Typically developing younger siblings are born into emotionally loaded environments that play a major role in their emotional growth and stability.
• Insecurity in attachment provides a base for the development of an anxious and unstable personality.
• They hypothesized that the infant-mother attachment role is a potentially important variable mediating the birth order status of the siblings and their adjustment patterns.
(Levy-Wasser and Katz 2004)

Is there a correlation between adjustment behaviors and attachment patterns?
•
Typically developing children born before the sibling with intellectual disabilities were born into a normative family, and had an opportunity to establish a secure attachment style.
•
This secure attachment style acts as a buffer against the pressures of having a sibling with intellectual disabilities, thereby allowing for better adjustment.
• In case of the typically developing child born after the sibling with intellectual disabilities, it was assumed that there would be less potential for a secure attachment as the parents would be busy providing maximum support for the child with disabilities and therefore, are not emotionally and practically available to deal with the other children in the family.
(Levy-Wasser and Katz 2004)

Is there a correlation between adjustment behaviors and attachment patterns?
•
Results indicate contrary to the expectations, the presence of the child with intellectual disabilities in the family did not negatively affect the sibling adjustment to the attachment style.
•
The reason for these results could have been that the typically developing siblings may have internalized cognitive models of trust, which they experienced when their parents were sensitive and caring towards them.
• The siblings may have developed positive adjustment behaviors by watching their parents cope with the realities of having a disabled child in the family.
•
Therefore this confirms that positive attachment style demonstrates overall better adjustment, because attachment style is an indicator of the emotional and social profile of the individual as well as of family functioning. (Levy-Wasser and
Katz 2004)

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Reference
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Barak-Levy, Y., Goldstein, E., & Weinstock, M., (2010). Adjustment characteristics of healthy siblings of children with autism. Journal of Family Studies, 16, 155-164. Retrieved
September 15, 2012 from http://jfs.e-contentmanagement.com/
Benoit, D., (2004). Infant-parent attachment: Definition, types, antecedents, measurements and outcomes. Pediatrics and Child Health, 9(8), 541-545. Retrieved November 4, 2012 from http://www.paediatricsandchildhealthjournal.co.uk/
Benson, P. R., & Karlof, K. L. (2008). Child, parent, and family predictors of latter adjustment in siblings of children with autism. Research in Autism Spectrum Disorders, 2, 583-600. doi:10.1016/j.rasd.2007.12.002
Beyer, J. (2009). Autism spectrum disorders and sibling relationships: Research and strategies Education and Training in Developmental Disabilities, 44(4), 444-452. Retrieved September
15, 2012 from http://daddcec.org/Publications/ETADDJournal.aspx
Bretherton, I. (1992). The origins of attachment theory: John bowlby and mary ainsworth. Developmental Psychology, 28(5), 759-775. Retrieved September 21, 2012 from http://www.apa.org/pubs/journals/dev/index.aspx
Cassidy, J., & Shaver, P. R, (2008). Handbook of Attachment Theory, Research, and Clinical Applications (2nd ed.). Spring Street, New York: A Division of Guilford Publications, Inc.
Center for Disease Control and Prevention (2012). Autism spectrum disorder (ASD’s). Retrieved August 20, 2012 from http://www.cdc.gov/ncbddd/autism/hcp-dsm.html
Connors, M. E., (2011). Attachment theory: A “secure base” for psychotherapy integration. Journal of Psychotherapy Integration, 21(3), 348-362. doi: 10.1037/a0025460
Cornell, T., & Hamrin, V. (2008). Clinical interventions for children with attachment problems. Journal of Child and Adolescent Psychiatric Nursing, 21(1), 35-47.Retrieved August 29,
2012 from http://www.wiley.com.libproxy.csun.edu/bw/journal.asp?ref=1073-6077
DSM-V, (2012). American Psychiatric Association. Retrieved October 10, 2012 from http://www.dsm5.org
Fraley, C. R., (2010). A brief overview of adult attachment theory and research. University of Illinois. Retrieved November 4, 2012 from http://internal.psychology.illinois.edu/~rcfraley/links.htm
Gousmett, S. L., (2006). Families of children with developmental disabilities: Family environment, social support and sibling well-being. University of Canterbury. Retrieved October 15,
2012 from http://ir.canterbury.ac.nz/bitstream/10092/1340/1/thesis_fulltext.pdf
Gray, D. E., (1993). Perceptions of stigma: the parents of autistic children. Sociology of Health & Illness, 15(1), 102-120. Retrieved September 11, 2012 from http://www.blackwellpublishing.com/shil_enhanced/
Gupta, A., & Singhal, N. (2005). Psychosocial support for families of children with autism. Asia Pacific Disability Rehabilitation Journal 16(2), 62-83. Retrieved September 2, 2012 from http://dcidj.org/
Hastings, R. P. (2003). Behavioral adjustment of siblings of children with autism engaged in applied behavioral analysis early intervention programs: The moderating role of social support.
Journal of Autism and Developmental Disorders 33(2), 141-150. Retrieved September 11, 2012 from http://www.springer.com/psychology/child+&+school+psychology/journal/10803
Howe, N., & Recchia, H. (2006). Sibling relations and their impact on children’s development. Encyclopedia on Early Childhood Development. Center of Excellence for Early Childhood
Development. Retrieved October 5, 2012 from http://www.child-encyclopedia.com/documents/Howe-recchiaANGxp.pdf
Kaminsky, L. & Dewey, D. (2001). Siblings relationships of children with autism. Journal of Autism and Developmental Disorders, 31(4), 399-410. Retrieved September 11, 2012 from http://www.springer.com/psychology/child+&+school+psychology/journal/10803
Kaminsky, L. & Dewey, D. (2002). Psychosocial adjustment in siblings of children with autism. Journal of Child Psychology and Psychiatry, 43(2), 225-232. Retrieved September 15,
2012 from http://www.springer.com/psychology/child+&+school+psychology/journal/10803
Levy-Wasser, N. & Katz, S. (2004). The relationship between attachment style, birth order, and adjustment in children who grow up with a sibling with mental retardation. The British
Journal of Developmental Disabilities, 50(99), 89-98. Retrieved October 1, 2012 from http://maneypublishing.com/index.php/journals/jdd/
Lyons, A. M., Leon, S. C., Rocker Phelps, C. E., & Dunleavy, A. M. (2010). The impact of child symptom severity on stress among parents of children with ASD: The moderating role of coping styles. Journal of Child and Family Studies, 19, 516-524. doi: 10.1007/s10826-009-9323-5

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Reference
Macks, R., & Reeve, R. E. (2007). The adjustment of non-disabled siblings of children with autism. Journal of Autism and Developmental Disorders, 37, 1060-1067. doi:
10.1007/s10803-006-0249-0
Marchand, J. F., Schedler, S., & Wagstaff, D. A. (2004). The role of parents’ attachment orientations, depressive symptoms, and conflict behaviors in children’s externalizing and internalizing behavior problems. Early Childhood Research Quarterly, 19, 449-462. doi: 10.1016/j.ecresq.2004.07.003
Martins, M. P. (2007). Siblings of individuals with autism: Perceptions of the sibling experience, psychological functioning, and the developmental tasks of young adulthood. The State University of New Jersey Retrieved September 21, 2012 from http://il.proquest.com.libproxy.csun.edu/en-
US/catalogs/databases/detail/pq_psychology_journ.shtml
Mascha, K., & Boucher, J. (2006). Preliminary investigation of a qualitative method of examining siblings’ experiences of living with a child with ASD. The British
Journal of Developmental Disabilities, 52(1), 19-28. Retrieved September 11, 2012 from http://maneypublishing.com/index.php/journals/jdd/
Meirsschaut, M., Roeyers, H., & Warreyn P. (2010). Parenting in families with a child with autism spectrum disorder and a typically developing child: Mothers’ experiences and cognitions. Research in Autism Spectrum Disorders 4, 661-669. doi: 10.1016/j.rasd.2010.01.002
Meyer, K. A., Ingersoll, B., & Hambrick D. Z. (2011). Factors influencing adjustment in siblings of children with autism spectrum disorders. Research in Autism
Spectrum Disorders 5, 1413-1420. doi: 10.1016/j.rasd.2011.01.027
Neale, C. W., (2003). Perceived sibling compatibility and the effects of personality. University of Georgia Retrieved September 15, 2012 from http://www.fcs.uga.edu/ss/docs/neale_cheryl_w_200312_ms.pdf
Newton, R. P., (2008). The Attachment Connection (1st ed.). Oakland, CA: New Harbinger Publications, Inc.
Petalas, M. A., Hastings, P. R., Nash, S., Downey, A. & Reilly, D. (2009). “I like that he always shows who he is “: The perceptions and experienced of siblings with a brother with autism spectrum disorder. International Journal of Disability, Development and Education 56(4), 381-399. doi: 10.1080/10349120903306715
Petalas, M. A., Hastings, R. P., Nash, S., Hall, L. M., Joannidi, H., & Downey, A.(2009).Psychological adjustment and sibling relationships in siblings of children with autism spectrum disorder: Environmental stressors and the broad autism phenotype. Research in Autism Spectrum Disorders 6, 546-555. doi: 10.1016/j.rasd.2011.07.015
Pistole, M. C. (1989). Attachment: Implications for counselors. Journal of Counseling & Development 68 190-193. Retrieved August 15, 2012 from http://www.counseling.org/Publications/Journals.aspx
Resource Guide for Families of Children with Autism Spectrum Disorder, Rhode Island Department of Health. (2011) Retrieved September 12, 2012 from http://www.health.ri.gov/publications/guidebooks/2011ForFamiliesOfChildrenWithAutismSpectrumDisorders.pdf
Sable, P. (1992). Attachment theory: Application to clinical practice with adults. Clinical Social Work Journal 20 (3), 271-283. Retrieved September 20, 2012 from http://www.springer.com/psychology/psychology+general/journal/10615
Sable, P. (2004). Using attachment theory in clinical practice with adults. Clinical Social Work Society. Retrieved September 20, 2012 from http://clinicalsocialworksociety.org/docs/continuing_education/AttachmentTheoryClinicalPractice.pdf
Stoneman, Z. (2005). Siblings of children with disabilities: Research themes. American Association on Mental Retardation 43(5), 339-350. Retrieved October 15, 2012 from http://www.aamr.org/news/news_item.cfm?OID=1590
U.S. Department of Health and Human Services, Administration for Children and Families. (2006). Retrieved September 12, 2012 from http://www.childwelfare.gov/pubs/siblingissues/siblingissues1.cfm
Watkins, S. (2008). The joys and complexities of sibling relationships. Adoption.com. Retrieved October 22, 2012. http://library.adoption.com/articles/the-joys-andcomplexities-of-sibling-relationships.html

Image Reference (In The order they appear)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Image 1: Dr. Manny: Autism diagnosis in danger? FOX News Network, LLC. (2012) Retrieved November 17, 2012 from http://www.foxnews.com/health/2012/01/23/drmanny-autism- diagnosis-in-danger/
Image 2: Could Childhood Immunizations Cause Autism?, Working Nurses.com. (2012) Retrieved November 17, 2012 from http://www.workingnurse.com/articles/Could-Childhood-Immunizations-Cause-Autism
Image 3: What Is Autism, Asperger’s and PDD?, McCray Psychological Services, Inc. ( 2012) Retrieved November 17, 2012 from http://mccraypsychological.com/#wrap
Image 4: Healthy Minds Healthy Lives, American Psychiatric Association. (2010) Retrieved November 17, 2012 from http://apahealthyminds.blogspot.com/2010/12/coping-with-stress-in-america.html
Image 5: How to Stop Temper Tantrums, HubPages Inc. (2012) Retrieved November 01, 2012 from http://tamron.hubpages.com/hub/Stop-Temper-Tantrums
Image 6: How to Identify Autism, National Nursing Review: Nursing Study Resources and Health Tips (2011). Retrieved November 01, 2012 from http://nationalnursingreview.com/2011/03/how-to-identify-autism/
Image 7: Finding a Treatment that’s Right for Your Family, Help with Autism (2011) Retrieved November 17, 2012 from http://www.helpyourautisticchildblog.com/date/2011/05/
Image 8: Autism Unraveling the mystery, Cable News Network, CNN U.S. (2009) Retrieved November 17, 2012 from http://edition.cnn.com/2008/HEALTH/conditions/07/08/autism.refugee.mom/index.html
Image 9 : Study Claims Depressed Moms Disturb Their Babies' Sleep, National Sleep Foundation (2012) Retrieved November 17, 2012 from http://pedzzz.blogspot.com/2012/04/study-claims-depressed-moms-disturb.html
Image 10: The Homeschool Post, Does Child-Rearing Have To Be Stressful? (2011). Retrieved November 11, 2012 from http://hsbapost.com/2011/07/19/does-childrearing-have-to-be-stressful/
Image 11: Autism Mom Meme, (2012). Retrieved November 17, 2012 from http://balancingthebucket.blogspot.com/
Image 12: How to Handle Tantrums in Autistic Children, eHow (2012). Retrieved October 11, 2012 from http://www.ehow.com/how_7828674_handle-tantrums-autistic-
Image 13: Real Advice For Real Life, Families Online Magazine (2012). Retrieved November 11, 2012 from http://www.familiesonlinemagazine.com/nanny/sibling-squabbles.html
Image 14: Rewards-for-children, Toy Queen (2012). Retrieved November 11, 2012 from http://www.toyqueen.com/tag/pretend-play
Images 15: The Key Characteristics of Play, Seriously!! Kids (2012). Retrieved October 01, 2012 from http://www.seriouslykids.com.au/2012/01/the-key-characteristics-of-play/
Images 16: Effective Discipline for Sibling Rivalry. eHow (2012) Retrieved November 11, 2012 from http://www.ehow.com/info_12002595_effective-discipline-siblingrivalry.html
Images 17: Better Parenting, Parenting Tips For Raising Successful Kids (2012). Retrieved October 11, 2012 from http://www.betterparenting.com/ways-to-reduce-rivalry-and-improve-sibling-relationships/
Image 18: The Inevitable Sibling Rivalry with Twins (2011) Retrieved November 11, 2012 from http://franpitre.com/wp-content/uploads/2011/10/FranPitreSiblingRivalry.jpg

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Image Reference (In The order they appear)
Image 19: 4 Ways Parents Can Positively Impact Sibling Relationships, Parent Coaching for Autism (2012). Retrieved November 05, 2012 from http://parentcoachingforautism.com/wp-content/uploads/2010/10/fightingsiblings-300x198.jpg
Image 20: Siblings of autistic kids at higher risk. Press TV (2011). Retrieved November 11, 2012 from http://previous.presstv.ir/photo/20110815/mortazavi20110815082952140.jpg
Image 21: The Impact of Autism on Siblings. Scholastic Inc (2012). Retrieved November 11, 2012 from http://www.scholastic.com/parents/files/4613/3173/8668/autism.gif
Image 22: Helping Siblings Cope, About Kids Health (2012). Retrieved November 10, 2012 from http://www.aboutkidshealth.ca/En/Assets/afr_am_girl_baby_mom1_6289_EN.jpg
Image 23: Special needs kids gain benefit from siblings, Examiner.com (2010). Retrieved October 12, 2012 from http://www.examiner.com/images/blog/wysiwyg/image/jess_and_jay_08_sized.jpg
Image 24: Handling Sibling Rivalry, Childology.in (2012). Retrieved November 05, 2012 from http://www.childology.in/images/Parenting/Sibling-Rivalry.jpg
Image25: Warring parents affect kids' sleep, Bennett, Coleman & Co. Ltd (2012). Retrieved November 12, 2012 from http://timesofindia.indiatimes.com/photo/9469746.cms
Image 26: Sibling Rivalry –It never ends Chapters in love (2012). Retrieved November 12, 2012 from http://chaptersinlove.com/wp-content/uploads/2012/05/Sibling-Rivalry.jpg
Image 27: Autistic Kids: The Sibling Problem, Time Inc. (2012). Retrieved November 21, 2012 from http://img.timeinc.net/time/daily/2007/0712/360_autism_siblings_1221.jpg
Image 28: John Bowlby, Maternal Deprivation Theory, Simply Psychology (2007) Retrieved November 21, 2012 from http://www.simplypsychology.org/monotropy.gif
Image 29: Attachment Parenting, Skinny Cap With Two Sugars, (2012). Retrieved November 21, 2012 from http://skinnycapwithtwosugars.files.wordpress.com/2012/07/138645.jpg
Image 30: Information for families of children with autism, Partington Behavior Analysis (2012) Retrieved November 21, 2012 from http://www.partingtonbehavioranalysts.com/uploads/1310518228_Family_21790432.png
Image 31: Play developmental games with your baby, She knows parenting, (2007) Retrieved September 11, 2012 from http://cdn.sheknows.com/articles/mother-with-laughing-baby.jpg
Image 32: John Bowlby, Real magick.com (2012). Retrieved November 11, 2012 from http://www.psicoterapiaintegrativa.com/therapists/images/John_Bowlby.jpg
Image 33: Attachment Styles, About.com Psychology (2012). Retrieved September 11, 2012 from http://0.tqn.com/d/psychology/1/0/-/4/attachment2.jpg
Image 34: A Brief Overview of Adult Attachment Theory and Research, (2010) Retrieved November 10, 2012 from http://internal.psychology.illinois.edu/~rcfraley/fig1.jpg
Image 35: Mary Ainsworth - Psychology's Feminist Voices (2010). Retrieved November 10, 2012 from http://www.feministvoices.com/assets/Women-Past/Ainsworth/Ainsworth1web.jpg
Image 36: Attachment Theory - About.com (2012). Retrieved November 10, 2012 from http://0.tqn.com/d/psychology/1/G/j/E/caregivers.jpg
Image 37: two-dimensional model of individual differences in adult attachment, University of Illinoi (2010). Retrieved November 10, 2012 from http://internal.psychology.illinois.edu/~rcfraley/measures/2d.jpg
Image 38. Jeremy C Wilson (2012) Retrieved November 20, 2012 from http://www.jeremycwilson.com/wp-content/uploads/2010/01/Questions_And_Answers.jp
Image 39 : Relaxation Techniques The Guide to Relaxation (2012) Retrieved November 20, 2012 from http://www.theguidetorelaxation.com/wpcontent/uploads/2010/02/feature-12.jpg