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Effective Practices in Intervention: Including Siblings

When I first started my pediatric private practice, I went into the homes of families to provide therapy. While not necessarily aware of the research around family-centered practice, it just made sense to me to include the entire family in my sessions as much as possible. After all, I was a guest in their house, and it did not feel right to ask them to keep their other children away while I was “playing” with the child with the speech-language delay.

What I learned later is that research shows better treatment outcomes when using a family-centered framework. This includes working with the family unit to ensure the well-being of all family members, which includes not only the caregivers, but siblings too. Siblings often get overlooked and can feel left out as their brother or sister seemingly gets all of the fun and attention from the therapist. Caregivers too can find themselves caring for and attending to the needs of their child with special needs that they too can overlook their other child or children.

I found that siblings could be of great help to me as the therapist, as well as could keep their sister or brother motivated in the session. Including siblings in the therapy process not only helps the non-affected child but can also strengthen the bond between siblings. Plus, siblings can be a great asset as they can act as a language model, a play-model and have the benefit of already having a relationship with their brother or sister. They can also help you by promoting generalization and carry-over, as well as can off load some of the burden from caregivers.

While the thought on including siblings in therapy sessions may feel daunting, it does not have to be. Whether siblings are older or younger than the child you are treating, there are some simple ways to include them.

Give the sibling a role.

Activities that include a sibling are more likely to be fun and motivating! Provide the sibling with directions and model what you want them to do. Their role can be as simple as modeling a target skill or word, helping get therapy materials out, playing while you talk to the caregiver or helping to clean up. Whatever role(s) you assign, be sure to provide them with a lot of praise for being a good helper.

Teach them how to provide reinforcement.

Let them know what their brother or sister is working on and coach them how and when to deliver reinforcement. After all siblings are typically each other’s first best friend, play-partner and as such can be a great cheerleader!

Create simple games for them to take turns.

Siblings can be great at practicing social skills and taking turns appropriately can help siblings get along better during therapy and outside of therapy session. So, setting up simple games for them to take turns can be a lot of fun and can provide excellent models for them to imitate. Additionally, siblings tend to be less judgmental which can take so much stress out of the situation.

Help them carry-over skills worked on.

Share desired outcomes with siblings, so that they can then help carry over the goals at home, in school, and throughout their day-to-day interactions. Siblings are around each other for stretches of the day, and regularly play and interact with their sibling far more than other children or parents, so this is the critical tool that we can take advantage of to support progress at home and in other environments outside of therapy!

Interestingly, some of the siblings that I have included in therapy sessions years ago have grown up to become therapists themselves. So, instead of having siblings wait in the waiting room or engage themselves in another room of the house while you work with their brother or sister, challenge yourself to include them in your therapy sessions. Together we can support them to feel included, helpful and useful to their sibling’s progress and success in life. This will also enhance their lifelong bond and create new paths for educational activities and fun memories they’ll share together! And who knows, maybe it will spark a career path interest for them as well.


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