It is important for parents to also give attention to their healthy children, supporting them in their emotional reactions and promoting their development and adaptation. Although current research suggests that siblings do appear to experience negative effects from an ill sibling, serious psychopathol-ogy or behavioral problems have generally not been identified (Barlow and Ellard 2006; Sharpe and Rossiter 2002).

In all studies sibling problems were rated as more problematic in parent reports compared with sibling self-reports. Sharpe and Rossiter (2002) found a modest negative effect in siblings resulting in greater amounts of depression, lower self-concept, and poorer overall psychological functioning as well as difficulties with peer relationships. These negative effects were greater among siblings living with children whose illness required complex daily treatment regimens. Barlow and Ellard (2006) noted an increased frequency of anxiety and posttraumatic stress symptoms as well as school absences. Nevertheless, many siblings appeared to cope adequately, and some were noted to demonstrate significant resilience and empathy as a result of their experience of living with an ill sibling.

Given the current state of research, including the absence of longitudinal studies and the mixed populations studied, it is best to view siblings of chronically ill children as an "at risk" group requiring assessment and monitoring by their parents. However, these youngsters may demonstrate significant strengths that will prove valuable to them in their lives based on their unique childhood experience.

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