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Psychosocial adaptation of siblings of children with chronic medical illnesses

Tritt, G.S. & Esses, L. (1991, April). Psychosocial adaptation of siblings of children with chronic medical illnesses. American Journal of Orthopsychiatry, 58(2), 211-218.


According to Tritt and Esses, "Theory and research concerning chronic medical illness in children focus predominantly on the stresses and adaptations of the patient and parents; the adjustment of siblings has largely been overlooked." Tritt and Esses research the impact of a chronic illness on the siblings of the ill child. They sought to affirm the theory that "all family members are affected when a child becomes chronically ill." In assuming this task, Tritt and Esses also recognized that there could be positive effects for some siblings.

Tritt and Esses studied fifty-four siblings. The index group consisted of twenty-seven siblings who were from families with a chronically ill child; the remaining twenty-seven siblings—the control group—were from families with healthy children. The chronically ill children studied had diabetes, juvenile rheumatoid arthritis, or gastrointestinal dysfunctions. These illnesses were chosen because "they are not life-threatening, require prescribed medications and treatments, and frequently require parental involvement in ongoing care."

Through a series of four tests, the behavioral and emotional adjustments of the siblings were assessed. One test, the Behavior Problem Checklist (BPC), contained a series of items in which the parents rated the siblings. Secondly, the Self-Appraisal Inventory (SAI) attempted to define the self-concept of each sibling. Next, the What I Think and Feel Questionnaire (WITF) sought to determine the anxiety level of each sibling. Finally, the Kleins Sibling Questionnaire was implemented only with the index group. This interview questionnaire captured their "thoughts and feelings about the impact of chronic illness on them and their families."

Tritt and Esses found little statistically that related the "chronic illness in children and their siblings’ emotional adjustment. Perhaps most importantly, no significant differences in self-concept were found between the two groups." The only notable difference between the two groups emerged in the behavioral adjustment of the siblings of ill children, as experienced by their parents.

Qualitatively, Tritt and Esses found some interesting results. Through the interviews with these siblings, they found that "over one-half of the siblings felt that the ill child received special treatment. This was the case more often with those siblings of children with diabetes, because the treatment is more regimented than the other diseases." Tritt and Esses also found that many of the siblings carried some resentment toward the ill child due to the difference in the amount of responsibilities they held. When the question was raised "who in the family do you think is most unhappy because of your brother’s or sister’s illness?", these siblings thought that they themselves were the most unhappy.

Overall, the information from this article affirmed the theories that siblings of chronically medically ill children "are affected by the illness in some adverse ways and raise concerns regarding the potential for psychosocial difficulties for children with the target group." However, Tritt and Esses found that further research was necessary before drawing any definite conclusions about the relationship between childhood chronic illnesses and the adjustment of the siblings.


  1. Is there anyone in your youth group who has a chronic illness or has a family member afficted with a chronic illness? If so, how does the child or sibling emotionally adjust to the situation? Behaviorally?
  2. What is the role of a youth worker in this situation? How can you balance the needs of the ill child and the healthy sibling?
  3. Does the youth worker have a responsibility to the parents of the sick child? What are those responsibilities?


This article should encourage youth leaders to be aware of the effects of chronic medical illness on the members of his or her family. In dealing with adolescents, it is essential that teachers, youth leaders, and parents become educated on the expected adjustments of chronically ill children and their siblings.