Including Siblings in Therapy Over Winter Break

In about eight weeks, the kids on your caseload will walk into winter break sessions with company. Brothers and sisters are home all day, sitting on the couch during telehealth, peeking around the door during a home visit, asking what the bubbles are for. Including siblings in therapy for a session or two can turn that crowd into an asset, as long as the sibling stays a brother or sister and never becomes a junior therapist.

What the research says about including siblings in therapy

Sibling-mediated intervention has a long, small and promising literature. The Association for Science in Autism Treatment describes behavioral sibling training as teaching a sibling to prompt, model and reinforce play and social communication, usually at home. ASAT reports gains in targeted social and play skills for autistic children, plus more confidence and enjoyment and less frustration for siblings. ASAT also flags real limits: sibling roles varied widely across studies, and few studies followed families long term.

Shivers and Plavnick's systematic review in the *Journal of Autism and Developmental Disorders* found no standard method for bringing siblings into treatment. One frequently cited study, Tsao and Odom (2006), trained siblings to support social interaction with young autistic children, and a published commentary by Reichle summarized the results as modest effects. The honest read for clinicians: worth trying, with clear goals and realistic expectations.

Guest, not co-therapist

Including siblings in therapy should never turn a sibling relationship into a treatment plan. A sibling who is asked to run trials, deliver reinforcement or correct errors can start to feel responsible for progress, and that weight lands on a kid who may already feel overlooked. Our parent post on glass children covers how easily siblings fade into the background.

ASAT recommends assessing the sibling's assent at the start and checking it again throughout. In practice, assent means asking the sibling directly, accepting a no without disappointment, and letting a yes change to a no halfway through.

Age-appropriate roles for siblings

Match the job to the sibling's age and interest, not to the session goal:

• Preschool siblings: play partner. Roll the ball back, take a turn with the bubbles, be silly with the puppets. No instructions beyond "play with us."
• Early elementary siblings: game buddy. Take turns in a simple board game, hold the second puppet, model a request like "more blocks, please" when it is their turn anyway.
• Older siblings and teens: helper by invitation. Show a favorite game, help build the obstacle course, or learn one simple strategy, such as waiting before helping. Keep the role optional and short.

Across ages, the sibling should be doing something fun for its own sake. If the activity would bore the sibling without the therapy angle, pick a different activity.

How to plan a sibling session over break

Including siblings in therapy works best when everyone knows the plan ahead of time. A simple sequence for a winter break home visit or telehealth session:

1. Ask the family first. Check with caregivers a week ahead, ask which siblings will be home and whether a joint session fits the family right now.
2. Ask the sibling, in kid language. "Want to play with us for part of today? You can stop anytime." Respect the answer.
3. Pick one shared activity. Choose a game both kids already enjoy, such as a ball ramp, a cooking task or a building project, so nobody is learning two new things at once.
4. Give the sibling one simple job. One job, like taking turns or modeling one phrase, is plenty. Skip prompting hierarchies, data and corrections.
5. Cap the joint time. Ten to fifteen minutes is usually enough. End while both kids are still having fun, then finish solo work.
6. Thank the sibling for being there, not for performing. "I loved playing with you today" lands better than "Great job helping your brother."

Add the joint time as a picture step in the visual schedule so the autistic child knows when the sibling joins and when the sibling leaves.

Notice the sibling's own needs

Including siblings in therapy also gives you a short window into how the sibling is doing. A 2023 narrative review by Godara and colleagues of eight studies with 247 siblings found that support groups were the most common intervention for siblings of autistic children, with generally positive results for autism knowledge, self-concept and coping. The authors also called the evidence base early and limited by small samples.

Sibshops are one widely available option: peer groups that mix games and guided discussion for school-age siblings, connected to the national Sibling Support Project. Stanford Medicine Children's Health notes more than 550 Sibshops worldwide. Keeping a local Sibshop or sibling group on your family resource list costs nothing and gives caregivers a concrete next step. Our post on supporting sibling relationships is a good share for parents who want more.

Fold siblings into the break plan

A sibling session fits naturally into your holiday break regression plan, because the sibling is home for the same two weeks the routine wobbles. Including siblings in therapy, done lightly, can leave families with one more shared game to play when you are not there.

VizyPlan was built by an autism dad and an autism mom who is a licensed speech-language pathologist so families can show "play with my sister" as a picture step in the day, right next to everything else.

Share VizyPlan with your families so the whole household can see the winter break plan. Families can try it free for a week. If it helps, they can keep going for $6.99/month or $59.99/year.

VizyPlan was built by an autism dad and an autism mom who is a licensed speech-language pathologist who needed something that did not exist. Explore VizyPlan.