Psychosocial adaptation of siblings of autistic individuals: current evidence, controversies, and future directions

This mini review synthesizes current evidence on the psychosocial adaptation of non-autistic siblings of autistic children, adolescents, and adults. We searched PubMed, PsycINFO, and Web of Science (January 2021–March 2026) and synthesized the retrieved literature narratively along three organizing axes: ecological level, developmental stage, and the risk–resilience continuum. Existing research shows a heterogeneous profile in which vulnerability and resilience coexist: siblings may experience loneliness, anxiety, depressive symptoms, and role strain, but may also report empathy, maturity, and a strong sense of responsibility, alongside acceptance and benefit-finding. Adaptive outcomes are associated with multiple interacting factors, including the severity of co-occurring behavioral and emotional difficulties in the autistic child, sibling age and sex, parental mental health, family communication, social support, school context, and the interacting influences of gender, religiosity, and culture. Emerging interventions, particularly psychoeducational support groups, play-based sibling training, and family-oriented programs, have established feasibility, acceptability, and social validity, and a single randomized trial supports improved sibling relationship quality; established effectiveness has not yet been demonstrated. Most primary studies are cross-sectional, qualitative, or small-scale, and a substantial proportion draws on mixed neurodevelopmental, intellectual-disability, or chronic-condition samples, so autism-specific inference remains limited. Current controversies concern how to balance risk-based and strength-based framings without pathologizing ordinary ambivalence or romanticizing caregiving-related growth, how far elevated sibling risk reflects shared familial liability rather than psychosocial burden, and how cultural context reshapes sibling roles and the meaning of adaptation. Future research should prioritize longitudinal designs, culturally responsive interventions, and greater attention to preschool-aged and adult siblings to better inform family-centered pediatric psychological care.