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Salutogenesis and the Wellbeing of Siblings of Individuals with Autism Spectrum Disorder: Contribution of Involvement, Resistance Resources, and Loneliness

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Title: Salutogenesis and the Wellbeing of Siblings of Individuals with Autism Spectrum Disorder: Contribution of Involvement, Resistance Resources, and Loneliness
Language: English
Authors: Ayelet Siman-Tov (ORCID 0000-0002-9237-8400)
Source: Child & Youth Care Forum. 2025 54(3):635-658.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 24
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Health Promotion, Well Being, Siblings, Autism Spectrum Disorders, Coping, Family Involvement, Self Efficacy, Psychological Patterns, Social Isolation
DOI: 10.1007/s10566-024-09833-5
ISSN: 1053-1890
1573-3319
Abstract: Background: According to family systems theories, the family is an inter-connected social unit, where dysfunction, disability or illness in one family member may affect the rest of the family. Research indicates that the presence of an individual with autism can influence the functionality of the various subsystems, including siblings. Objective In light of salutogenic approaches, which focus on factors promoting health and effective coping, the study examined the relations between the involvement, personal resources (sense of coherence, self-efficacy), and loneliness of siblings of individuals with autism with their wellbeing. Methods: Participants included 116 siblings of individuals with autism between the ages of 18-50, who completed self-report questionnaires. Results: Results indicated that siblings who are more involved in the lives of their siblings with autism perceive their sense of coherence and self-efficacy as higher, and their loneliness as lower, and further report higher levels of wellbeing. The study emphasizes the contribution of the resource of a high sense of coherence for predicting lower loneliness and better wellbeing for siblings of individuals with autism. Similarly, a shared contribution of self-efficacy and sense of coherence emerged for feelings of wellbeing. Conclusions: In light of the results, it is recommended to develop interventions based on a joint approach between the pathogenic and salutogenic approaches towards promoting health. Integrating these approaches can contribute to the promotion of the salutogenic and holistic direction of siblings of individuals with autism and to the research of emotional, social, and environmental factors towards the typically-developing siblings' coping ability.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1471273
Database: ERIC
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  Value: <anid>AN0185155352;5jr01jun.25;2025May16.03:44;v2.2.500</anid> <title id="AN0185155352-1">Salutogenesis and the Wellbeing of Siblings of Individuals with Autism Spectrum Disorder: Contribution of Involvement, Resistance Resources, and Loneliness </title> <p>Background: According to family systems theories, the family is an inter-connected social unit, where dysfunction, disability or illness in one family member may affect the rest of the family. Research indicates that the presence of an individual with autism can influence the functionality of the various subsystems, including siblings. Objective: In light of salutogenic approaches, which focus on factors promoting health and effective coping, the study examined the relations between the involvement, personal resources (sense of coherence, self-efficacy), and loneliness of siblings of individuals with autism with their wellbeing. Methods: Participants included 116 siblings of individuals with autism between the ages of 18–50, who completed self-report questionnaires. Results: Results indicated that siblings who are more involved in the lives of their siblings with autism perceive their sense of coherence and self-efficacy as higher, and their loneliness as lower, and further report higher levels of wellbeing. The study emphasizes the contribution of the resource of a high sense of coherence for predicting lower loneliness and better wellbeing for siblings of individuals with autism. Similarly, a shared contribution of self-efficacy and sense of coherence emerged for feelings of wellbeing. Conclusions: In light of the results, it is recommended to develop interventions based on a joint approach between the pathogenic and salutogenic approaches towards promoting health. Integrating these approaches can contribute to the promotion of the salutogenic and holistic direction of siblings of individuals with autism and to the research of emotional, social, and environmental factors towards the typically-developing siblings' coping ability.</p> <p>Keywords: Family Systems; Autism; Siblings; Self-efficacy; Coherence; Psychology and Cognitive Sciences Psychology Medical and Health Sciences Public Health and Health Services</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <hd id="AN0185155352-2">Introduction</hd> <p>The diagnosis of a child with Autism Spectrum Disorder (ASD) is described as a stressful event that can serve as a crisis and disturbance in the family throughout their lives (Siman Tov & Kaniel, [<reflink idref="bib79" id="ref1">79</reflink>]; Hastings et al., [<reflink idref="bib43" id="ref2">43</reflink>]). According to family-systems approaches, the family is a system constructed from the parental and the sibling subsystems, which are dependent on each other and develop through dynamic interaction between them (Turnball et al., [<reflink idref="bib91" id="ref3">91</reflink>]). As such, disturbances within the family can upset the existing balance and create change within the family system. Numerous studies have focused on how parents cope with having children with ASD (e.g., Lee, [<reflink idref="bib51" id="ref4">51</reflink>]; Shapiro & Accardo, [<reflink idref="bib73" id="ref5">73</reflink>]; Sharabi & Marom-Golan, [<reflink idref="bib74" id="ref6">74</reflink>]). Yet, in recent years, it is seen as increasingly important to relate to typically-developing siblings of individuals with ASD as central research subjects, with an emphasis placed on various aspects of their lives with their sibling with ASD (e.g., Bontinck et al., [<reflink idref="bib13" id="ref7">13</reflink>]; Casale et al., [<reflink idref="bib16" id="ref8">16</reflink>]; Harris & Glasberg, [<reflink idref="bib39" id="ref9">39</reflink>]; Hasting, [<reflink idref="bib40" id="ref10">40</reflink>]). The current study highlights the sibling subsystem by focusing on typically-developing siblings of individuals with ASD. The salutogenic approach centers on factors that promote health and the way in which people cope with and respond to particular situations and how to steer them towards better health. In this light, the study examined variables that contribute to siblings' wellbeing.</p> <hd id="AN0185155352-3">Theoretical Background</hd> <p>From a family systems perspective, the family is a dynamic social system, based on relations and social-communication interactions needed for the development of its members. As an inter-connected social unit, dysfunction, disability or illness in one family member may affect the rest of the family (Friedman et al., [<reflink idref="bib32" id="ref11">32</reflink>]). ASD, characterized by basic deficiencies in social communication and the development of mutual social interactions (APA, [<reflink idref="bib3" id="ref12">3</reflink>]), can cause stress in one of the elements that serve as a basis for the normal development and functioning of the family as a system. Studies exploring the impact of the presence of the individual with ASD on the family provide support for situations of chronic stress, which can affect the functioning of all family members, including siblings (Siman Tov, [<reflink idref="bib80" id="ref13">80</reflink>]; Hastings et al., [<reflink idref="bib43" id="ref14">43</reflink>]; Kaminsky & Dewey, [<reflink idref="bib49" id="ref15">49</reflink>]; Shapiro & Accardo, [<reflink idref="bib73" id="ref16">73</reflink>]; Turnbull & Turnbull, [<reflink idref="bib91" id="ref17">91</reflink>]).</p> <p>This study is also rooted in the salutogenic theory to promoting health, which was developed by Antonovsky ([<reflink idref="bib5" id="ref18">5</reflink>]), and proposed as an alternative to the pathogenic approach. The innovation of the salutogenic approach lies in its attempt to identify the sources of a person's health as opposed to the pathogenic approach that investigates the sources of disease (Antonovsky, [<reflink idref="bib5" id="ref19">5</reflink>]; Or et al., [<reflink idref="bib60" id="ref20">60</reflink>]; Sagy, [<reflink idref="bib69" id="ref21">69</reflink>]). The theory suggests flexibly relating to stressful situations, including situations defined as illness, and seeing them not as pathogenic sources but as drivers of health-promoting resources (Or et al., [<reflink idref="bib60" id="ref22">60</reflink>]). In light of the challenges that siblings of individuals with ASD must contend with, the current study explores resources that promote the wellbeing of typically-developing siblings of individuals with ASD.</p> <hd id="AN0185155352-4">Sibling Relationships</hd> <p>Sibling relationships are among the longest-lasting bonds in the life of an individual, and fills a meaningful role in siblings' social, emotional, and cognitive development (Allison & Campbell, [<reflink idref="bib2" id="ref23">2</reflink>]; Davies et al., [<reflink idref="bib21" id="ref24">21</reflink>]). Siblings serve as a source of support, help, love, friendship for each other, as well as role models and basis for social comparison, and foster experience with social skills such as Theory of Mind, and the development of empathy, which are implemented in other social relations. Being a sibling also helps in the development of one's personal identity, allows for coping with interpersonal situations, stressful events and crises, and provides ways to solve problems (Dirks et al., [<reflink idref="bib26" id="ref25">26</reflink>]; Jambon et al., [<reflink idref="bib48" id="ref26">48</reflink>]; Song & Volling, [<reflink idref="bib84" id="ref27">84</reflink>]). Sibling relations receive a unique meaning when one of the siblings has ASD.</p> <p>ASD is characterized by impaired communication and social interactions, as well as repetitive patterns of activity and interests (APA, [<reflink idref="bib3" id="ref28">3</reflink>]). These challenges are often expressed in difficulty creating eye contact, understanding social cues and reciprocity in relationships, inappropriate social behavior, pragmatic difficulties with language, and in non-verbal gestures for communication and difficulties with language (APA, [<reflink idref="bib3" id="ref29">3</reflink>]; Baron-Cohen, [<reflink idref="bib10" id="ref30">10</reflink>]). An important contributor to the nature of the relations between typically-developing siblings and their siblings with ASD is the level of functionality of the sibling with ASD. The functionality of children with ASD is quite variable, and is generally established in accordance with the level of support required for the diagnosed individual -- the level of dependence of the individual with ASD on others to provide their basic needs, and the oversight needed to avoid risky behaviors and the extent of the educational and behavioral needs (APA, [<reflink idref="bib3" id="ref31">3</reflink>]). The greater the number of symptoms the individual has, the lower their level of functioning and the greater support needed (Level 3). In line with the APA ([<reflink idref="bib3" id="ref32">3</reflink>]), there are generally three levels of functionality: low (greatest number of symptoms and support needed, Level 3), medium (Level 2), and high (Level 1). Studies have found that the lower the level of functioning of the sibling with ASD, including acute symptoms and more difficult behavioral problems, the greater the difficulties with adjustment faced by the typically-developing siblings (Benson & Karlof, [<reflink idref="bib11" id="ref33">11</reflink>]; Hastings, [<reflink idref="bib40" id="ref34">40</reflink>], [<reflink idref="bib41" id="ref35">41</reflink>]; Hastings & Petalas, [<reflink idref="bib42" id="ref36">42</reflink>]; Petalas et al., [<reflink idref="bib64" id="ref37">64</reflink>]). For example, emotional and behavioral difficulties were found amongst typically-developing siblings of individuals with low-functioning ASD, as expressed by excessive concern and expressions of aggression towards the sibling with ASD and feelings of embarrassment stemming from difficulties explaining ASD (Mascha & Boucher, [<reflink idref="bib56" id="ref38">56</reflink>]). Additionally, it was found that severe and public behavior problems of individuals with low functioning ASD predicted behavior problems amongst typically-developing siblings (Hastings, [<reflink idref="bib41" id="ref39">41</reflink>]), and negatively impacted their wellbeing (Sikora et al., [<reflink idref="bib78" id="ref40">78</reflink>]), and the sibling relations (Petalas et al., [<reflink idref="bib64" id="ref41">64</reflink>]). In contrast, when siblings with ASD showed fewer behavior problem, their typically-developing siblings reported better sibling relations and more positive emotions towards them (Braconnier et al., [<reflink idref="bib14" id="ref42">14</reflink>]; Hastings & Petalas, [<reflink idref="bib42" id="ref43">42</reflink>]; Orsmond & Seltzer, [<reflink idref="bib61" id="ref44">61</reflink>]).</p> <p>Typically-developing siblings of individuals with ASD have primarily been examined as an at-risk group (Bontinck et al., [<reflink idref="bib13" id="ref45">13</reflink>]; Kaminsky & Dewer, [<reflink idref="bib49" id="ref46">49</reflink>]; Rivers & Stoneman, [<reflink idref="bib65" id="ref47">65</reflink>]; Tsai et al., [<reflink idref="bib88" id="ref48">88</reflink>]). The aim of the current study was to examine variables that may contribute to the wellbeing of adult siblings of individuals with ASD, through the lens of family systems approaches, and from the salutogenic perspective that views the strengths and resources that contribute to their mental wellbeing (Siman Tov, [<reflink idref="bib80" id="ref49">80</reflink>]; Antonovsky, [<reflink idref="bib5" id="ref50">5</reflink>]). These variables include sibling involvement, self-efficacy, sense of coherence, and loneliness.</p> <hd id="AN0185155352-5">Sibling Involvement</hd> <p>The diagnosis of a child with ASD impacts all the individuals within the family system and leads to a new definition of roles within the family (Turnball et al., [<reflink idref="bib91" id="ref51">91</reflink>]). It was found that brothers and sisters of individuals with ASD are involved in the lives of their sibling throughout the life cycle and at different developmental stages (Tozer et al., [<reflink idref="bib87" id="ref52">87</reflink>]). At times, even in childhood, siblings need to fill a parental role (parentification) that is accompanied with a heavy responsibility that is not necessarily appropriate for the development stage that they are in (Hooper et al., [<reflink idref="bib46" id="ref53">46</reflink>]; Tomeny et al., [<reflink idref="bib86" id="ref54">86</reflink>]). Siblings' involvement in adolescence includes support and emotional and physical help focused on their parents (e.g., housework), alongside supporting and helping their sibling with disability, including general support, coordinating between various therapists, representation of legal rights, planning free time, and involvement in their social lives (Sharabi & Siman-Tov, [<reflink idref="bib75" id="ref55">75</reflink>]; Hall & Rossetti, [<reflink idref="bib38" id="ref56">38</reflink>]; Tomeny et al., [<reflink idref="bib86" id="ref57">86</reflink>]). As they get older, and towards the possibility of their becoming the primary caretakers in the lives of their sibling with ASD, siblings' involvement is accompanied by challenged focusing on future plans (Sharabi & Siman-Tov, [<reflink idref="bib75" id="ref58">75</reflink>]; Nuttall et al., [<reflink idref="bib58" id="ref59">58</reflink>]). In a study that examined the perceptions of siblings with and without disability (ASD and Down Syndrome), it was found that siblings of individuals with developmental disabilities related a positive and close emotional sibling relationship, and a broader variety of shared activities (Rossetti et al., [<reflink idref="bib67" id="ref60">67</reflink>]).</p> <hd id="AN0185155352-6">Psychological Resources of Siblings of Individuals with ASD</hd> <p>The term "resources" relates to the skills, abilities, the actual means and powers inherent in each individual in the family system and in the community that helps the individual cope with stressful situations (Hobfoll, [<reflink idref="bib45" id="ref61">45</reflink>]). Studies reveal that there is a broad range of resources that the family uses to cope with having a children with ASD or other developmental disabilities. Among these are family cohesion, sense of coherence, self-esteem, locus of control, self-efficacy, and social support (Siman Tov & Kaniel, [<reflink idref="bib79" id="ref62">79</reflink>]; Al-Yagon & Margalit, [<reflink idref="bib1" id="ref63">1</reflink>]; Benzies et al., [<reflink idref="bib12" id="ref64">12</reflink>]; Higgins & Pearce, [<reflink idref="bib44" id="ref65">44</reflink>]; Pallant & Lae, [<reflink idref="bib62" id="ref66">62</reflink>]). Of these, it was found that self-efficacy and sense of coherence are essential in the family's adjustment to the presence of a child with ASD.</p> <hd id="AN0185155352-7">Self-Efficacy</hd> <p>Self-efficacy is defined as the belief or confidence an individual has in their ability to cope with challenging situations, and to implement the required behaviors to create the desired outcome (Bandura, [<reflink idref="bib7" id="ref67">7</reflink>], [<reflink idref="bib9" id="ref68">9</reflink>]; Dickson, [<reflink idref="bib23" id="ref69">23</reflink>]). Individuals with higher levels of self-efficacy tend to see problems as challenges rather than threats, experience less stress when engaging in challenges, and in general, experience a sense of capability when performing a task (Črnčec et al., [<reflink idref="bib19" id="ref70">19</reflink>]). Self-efficacy plays a meaningful role in a person's feeling of mental wellbeing (Fry et al., [<reflink idref="bib33" id="ref71">33</reflink>]). It can contribute to an optimistic outlook, motivation, positive health and mental wellness, and a reduction of negative symptoms such as anxiety and depression (Ciarrochi et al., [<reflink idref="bib18" id="ref72">18</reflink>]; Gabmin & Swiecicka, [<reflink idref="bib34" id="ref73">34</reflink>]). Self-efficacy has also emerged as an important resource for the functioning of families with children with disabilities. For instance, self-efficacy predicted the adjustment of families with children with serious disabilities (Benzies et al., [<reflink idref="bib12" id="ref74">12</reflink>]), and helped them cope with stressful situations (e.g., Tsibidaki, [<reflink idref="bib90" id="ref75">90</reflink>]). Particularly in relation to typically-developing siblings, self-efficacy was lower amongst siblings of a child with ASD compared to a sibling of a typically-developing child (Habelrih et al., [<reflink idref="bib37" id="ref76">37</reflink>]). Other research indicates that aspects relating to adjustment, such as interpersonal ability and maternal attitudes, significantly related to self-efficacy (O'Kane Grisson & Borkowski, [<reflink idref="bib59" id="ref77">59</reflink>]), highlighting the importance of this variable.</p> <hd id="AN0185155352-8">Sense of Coherence</hd> <p>Sense of coherence is a central variable in Antonovsky's ([<reflink idref="bib5" id="ref78">5</reflink>], [<reflink idref="bib6" id="ref79">6</reflink>]) salutogenic model. A sense of coherence is defined as a personality tendency that guides a person and contributes to their coping with stress. It is a resource that describes a worldview as a "general cognitive orientation," which is expressed in the tendency to view the world as a logical and reasonable place, not chaotic, which can be emotionally and behaviorally managed. Sense of coherence is comprised of three inter-related aspects, which include cognitive, behavioral, and foundations, referred to as comprehensibility, manageability, and meaningfulness, respectively (Sagy & Antonovsky, [<reflink idref="bib70" id="ref80">70</reflink>]). A person with a strong sense of coherence will perceive the world as organized, predictable, and understandable. They will feel that there is meaning to the events in their life, and will learn to evaluate them as appropriate challenges for coping and investment of energy and effort. They will perceive themselves as capable and able to rely on themselves of others. Studies reveal a significant positive relation between a strong sense of coherence and mental health, which is expressed in psychological adjustment, a feeling of satisfaction from life, and wellbeing, amongst others. A weak sense of coherence is related to negative symptoms, mental distress, anxiety, and depression amongst parents of individuals with ASD (Kaniel & Siman -Tov, [<reflink idref="bib50" id="ref81">50</reflink>], Siman Tov, [<reflink idref="bib80" id="ref82">80</reflink>]; Mak et al., [<reflink idref="bib54" id="ref83">54</reflink>]). There is minimal research on sense of coherence amongst siblings of individuals with ASD, but a high sense of coherence was found to significantly relate to siblings' adjustment (Smith et al., [<reflink idref="bib82" id="ref84">82</reflink>]).</p> <hd id="AN0185155352-9">Loneliness</hd> <p>While resources may be available to siblings to help cope with difficult situations, they may also experience loneliness. Loneliness is an unpleasant, subjective feeling, which has emotional, mental, and behavioral expressions that stem from the gap between a person's current social relationships and their expectations from them (Margalit, [<reflink idref="bib55" id="ref85">55</reflink>]). Parents of children with disabilities reported high levels of loneliness (Woodgate et al., [<reflink idref="bib93" id="ref86">93</reflink>]), and similar impacts were found for the sibling subsystem. For instance, siblings of individuals with ASD reported negative feelings between them: anger, blame, loneliness, confusion, sadness, concern, and anxiety, alongside a sense of obligation towards the sibling with ASD (Kaminsky & Dewey, [<reflink idref="bib49" id="ref87">49</reflink>]; Petalas et al., [<reflink idref="bib64" id="ref88">64</reflink>]; Tsamparli et al., [<reflink idref="bib89" id="ref89">89</reflink>]). Siblings of individuals with ASD are aware of the difficulties their siblings face in forming social connections, and consequently, take upon themselves the role of being a friend (Tomeny et al., [<reflink idref="bib86" id="ref90">86</reflink>]). This complexity can negatively impact on the typically-developing siblings' social lives and can increase their feeling of loneliness (Shivers et al., [<reflink idref="bib77" id="ref91">77</reflink>]; Tsamparli et al., [<reflink idref="bib89" id="ref92">89</reflink>]). The current study explored how loneliness relates with typically-developing siblings' mental wellbeing.</p> <hd id="AN0185155352-10">Wellbeing</hd> <p>Wellbeing is defined as the level of an individual's cognitive judgment and global evaluation of their quality of life, relates to the existence of positive factors, and not solely on the absence of negative factors (Diener, [<reflink idref="bib24" id="ref93">24</reflink>]; Diener et al., [<reflink idref="bib25" id="ref94">25</reflink>]; Viet & Ware, 1983; Diener et al., [<reflink idref="bib25" id="ref95">25</reflink>]). This integrated and inclusive judgment of one's life is influenced by their available resources (Diener et al., [<reflink idref="bib25" id="ref96">25</reflink>]). Research reveals that the presence of an individual with ASD on typically-developing siblings' wellbeing can have both a positive and negative impact on wellbeing. Some studies indicate negative symptoms such as stress and that siblings are at-risk for psychological and developmental difficulties including behavior problems, adjustment issues, emotional problems, and elevated levels of anxiety and depression compared to those without a sibling with ASD (Murrin et al., [<reflink idref="bib57" id="ref97">57</reflink>]). Other studies indicate that siblings of individuals with ASD showed maturity, adaptability, and effective coping skills (Macks & Reeve, [<reflink idref="bib53" id="ref98">53</reflink>]; Smith et al., [<reflink idref="bib82" id="ref99">82</reflink>]), and that a positive attitude towards sibling relationships was associated with high levels of support and life satisfaction and lower levels of depressive symptoms (Tomeny et al., [<reflink idref="bib85" id="ref100">85</reflink>]). Still other studies did not find significant differences in anxiety and depression and adjustment between siblings of an individual with ASD and those without (Rodgers et al., [<reflink idref="bib66" id="ref101">66</reflink>]; Shivers et al., [<reflink idref="bib76" id="ref102">76</reflink>]). This study aims to gain greater clarity on the wellbeing of typically-developing siblings of individuals with ASD.</p> <hd id="AN0185155352-11">Study Aims & Hypotheses</hd> <p>The current study utilized a family systems approach to shed light on the sibling subsystem, and a salutogenic perspective to explore variables associated with siblings' wellbeing. Specifically, the study examined the relations between the involvement of siblings of individuals with varying levels of ASD functioning, their resources (self-efficacy, and sense of coherence), and their feelings of loneliness with their wellbeing. Similarly, the ability of these variables (involvement, resources, and loneliness) to predict typically-developing siblings' wellbeing was explored. The following hypotheses are based on these primary aims:</p> <p></p> <ulist> <item> A relation will be found between the involvement of siblings of individuals with ASD and loneliness, such that higher involvement will relate to lower loneliness.</item> <p></p> <item> A relation will be found between the involvement of sibling of individuals with ASD and wellbeing, such that greater involvement will be associated with higher wellbeing and lower distress.</item> <p></p> <item> A relation will be found between the personal resources of siblings of individuals with ASD and loneliness, such that higher levels of self-efficacy and sense of coherence will be associated with lower levels of reported loneliness.</item> <p></p> <item> A relation will be found between the personal resources of siblings of individuals with ASD and wellbeing, such that higher levels of self-efficacy and sense of coherence will be associated with higher wellbeing and lower distress.</item> <p></p> <item> A relation will be found between loneliness reported by siblings of individuals with ASD and wellbeing, such that lower levels of loneliness will be associated with higher levels of wellbeing and lower distress.</item> </ulist> <p>Regarding the variables' predictive ability to siblings' wellbeing, there is little existing research, and thus no specific direction was formulated. As such, these variables were examined using two primary questions, which were examined in two stages:</p> <p></p> <ulist> <item> To what extent do involvement and personal resources (self-efficacy and sense of coherence) contribute to the explanation of the variance in loneliness of siblings of individuals with ASD?</item> <p></p> <item> To what extent do involvement, resources (efficacy, coherence, and loneliness contribute to the explanation of the variance of wellbeing of siblings of individuals with ASD?</item> </ulist> <hd id="AN0185155352-12">Method</hd> <p></p> <hd id="AN0185155352-13">Participants</hd> <p>Participants in the study included 116 Jewish-Israeli siblings of individuals with ASD, ranging in age from 18 to 50 (<emph>M</emph> = 27.41, <emph>SD</emph> = 6.16). Overall, there were more sisters (66.4%) than brothers (33.6%). Chi-square analysis revealed no significant differences between sisters and brothers of individuals with ASD in terms of socioeconomic status, χ² = 2.77, <emph>p</emph> >.05. A majority of the participants (56.5%) reported an average socioeconomic level, 37.4% reported an above-average level, and 6.1% reported a below-average level. In terms of the siblings with ASD, 78% of them were male, and 22% were female. Their ages ranged between 14 and 42. All the siblings with ASD were diagnosed according to Israeli guidelines (Israel Ministry of Health, [<reflink idref="bib47" id="ref103">47</reflink>]), meaning, that they were evaluated by both a psychiatrist and a clinical psychologist, who agreed on the diagnosis of ASD. Further, the diagnosis included a level of functionality, which is in line with the APA ([<reflink idref="bib4" id="ref104">4</reflink>], [<reflink idref="bib3" id="ref105">3</reflink>]) guidelines, such that Level 1 = high functionality, Level 2 = medium functionality, and Level 3 = low functionality. Participants were asked to report on their sibling with ASD's functionality according to the diagnosis; of the siblings, functionality was reported to be 49.1% with low functionality (Level 3) and 50.9% with high functionality (Level 1). No siblings were reported to be medium functionality (Level 2).</p> <hd id="AN0185155352-14">Measures</hd> <p></p> <hd id="AN0185155352-15">Demographic Questionnaire</hd> <p>This questionnaire was constructed for the purposes of the current study. Participants were asked about themselves (e.g., sex, number of siblings) and their siblings with ASD (e.g., sex, age, level of diagnosed functionality). Participants were asked to self-report their SES as one of the following: significantly below the average, below the average, average, above the average, and significantly above the average. Of interest was the participants' subjective view of where they stand economically, rather than using various economic criteria. Overall, more than half (56.5%) identified themselves subjectively as being from an average socioeconomic level, 37.4% reported an above average level, and 6.1% reported a below-average level. Regarding their siblings' ASD functioning, participating siblings reported in line with the assessment diagnosing their siblings. That is, as part of the diagnosis by both the psychiatrist and clinical psychologist, the report details level of functionality, according to the DSM criteria, such that Low = Level 3, Medium = Level 2, High = Level 1. We asked the participating siblings to report the functionality that was included in the diagnostic report. All the participants reported their siblings as either low or high functionality, with no medium functionality reported. The questionnaire also included three items related to siblings' involvement, ranked on a scale of 1 (not at all) to 5 (always): (a) level of active involvement in their sibling with disability's life: "How would you define your level of personal involvement in the care of and providing active help to your sibling with a disability?"; (b) involvement in the search for information: "I make sure to be updated on relevant information about my siblings' functioning, development, rights, and innovations"; (c) involvement in the search for possible treatments to promote the sibling with ASD: "To what extent do you explore additional options for treatment and promoting your brother/sister?".</p> <hd id="AN0185155352-16">Self-efficacy (Chen et al., 2001)</hd> <p>This questionnaire was developed in Hebrew and English and validated by Chen et al. ([<reflink idref="bib17" id="ref106">17</reflink>]), and used in other Israeli samples (e.g., Davidson et al., [<reflink idref="bib20" id="ref107">20</reflink>]). Self-efficacy was examined using an eight-item questionnaire, where participants marked their level of agreement with each item on a scale ranging from 1 (agree very little) to 5 (agree very much). Items described the individual's belief in their ability to perform tasks (e.g., "When faced with difficult tasks, I believe I can perform them"). Higher scores reflect a higher level of self-efficacy. Internal reliability was Cronbach's 𝛼 = 0.85 in previous studies (Davidson et al., [<reflink idref="bib20" id="ref108">20</reflink>]) and 𝛼 = 0.83 in the current study.</p> <hd id="AN0185155352-17">Sense of Coherence Scale (Antonovsky, 1987)</hd> <p>Since its original publication, it has been translated to multiple languages, used and found reliable and valid in more than 20 countries and multiple ethnicities and cultures (Antonovsky, [<reflink idref="bib6" id="ref109">6</reflink>]; Erikson & Lindstrom, [<reflink idref="bib28" id="ref110">28</reflink>], [<reflink idref="bib29" id="ref111">29</reflink>], [<reflink idref="bib30" id="ref112">30</reflink>]; Lindstrom & Erikson, [<reflink idref="bib52" id="ref113">52</reflink>]). Participants' sense of coherence was measured using a 29-item questionnaire, which includes items relating to three aspects -- understandability (e.g., "Does it happen that you have a feel that you don't know what exactly is going to happen?"), manageability (e.g., "Does it happen that you have emotions that you are not certain you can control"), and meaningfulness ("Do you have a feeling that there is not much meaning to what you are involved in in your daily life?").</p> <p>Participants are asked to rank items on a scale ranging from 1 (very little) to 7 (very much), which are then averaged. Higher scores indicates a stronger SOC. Inter-item reliability ranged from Cronbach's 𝛼 = 0.88 to 0.91 in previous studies (Antonovsky, [<reflink idref="bib6" id="ref114">6</reflink>]) and 𝛼 = 0.91 in the current study.</p> <hd id="AN0185155352-18">Loneliness Scale (de Jong Giervald & Van Tilburg, 2006)</hd> <p>The Hebrew adaptation (Einav et al., [<reflink idref="bib27" id="ref115">27</reflink>]) of de Jong Geirvald and Van Tilburg's ([<reflink idref="bib22" id="ref116">22</reflink>]) loneliness scale was used. Participants are asked to respond to nine items that relate to two different aspects of loneliness -- emotional loneliness (3 items, e.g., "I feel I'm missing something when I don't have a close, true friend"), and social loneliness (6 items, e.g., "I miss not having enough people around me"). Items are ranked on a scale ranging from 1 (often applies) to 3 (rarely applies). Higher scores reflect a higher level of loneliness. Internal reliability was Cronbach's 𝛼 = 0.82 in previous studies (Einav et al., [<reflink idref="bib27" id="ref117">27</reflink>]) and 𝛼 = 0.85 in the current study.</p> <hd id="AN0185155352-19">Wellbeing: Mental Health Inventory (Veit & Ware, 1983; Hebrew: Florian & Drori, 1990)</hd> <p>To assess participants' wellbeing, a mental health inventory was used. This inventory was originally designed by Veit and Ware ([<reflink idref="bib92" id="ref118">92</reflink>]) and validated within an Israeli population in Hebrew in 1990. This 38-item questionnaire relates to feelings of mental wellbeing (e.g., "To what extent are you happy or satisfied from your personal life") and distress (e.g., "How often do you feel lonely") over the past month. Items are ranked on a scale ranging from 1 (all the time) to 6 (never). The overall score serves as a Mental Health Index, with two subscales -- mental wellbeing and mental distress. For the current study, only the mental wellbeing subscale was used, with internal reliability at Cronbach's 𝛼 = 0.93.</p> <hd id="AN0185155352-20">Procedure</hd> <p>Participants were recruited via social media and through organizations that focus on individuals with disabilities. Surveys were distributed electronically, and included a consent form. All participants completed an informed consent form confirming that their responses would be anonymous and that their participation was voluntary. The study followed all ethical guidelines of the country and was approved by the ethical board at Institution (Kibbutzim College of Education, Technology and the Arts).</p> <hd id="AN0185155352-21">Data Analysis</hd> <p>Initial analyses were conducted including descriptive statistics and reliability for the above-described measures. All initial statistical measures such as skewness, kurtosis, etc. were normal, and no significant outliers were found in the data. Sex was coded male/female (0/1), and functionality was coded either low (Level 3) or high (Level 1), in line with the diagnostic report. No siblings were reported as being medium functionality (Level 2).</p> <p>To examine the research questions and hypotheses, Pearson correlations were conducted first. To examine the contribution of the predictor variables (participants' age and sex, sibling with ASD's functionality, involvement, self-efficacy, sense of coherence to the variance in loneliness and then to wellbeing (where loneliness was a predictor), hierarchical regressions were run with variables entered in five steps as follows. In Step 1, personal characteristics (participants' sex, age, sibling with ASD's functionality) were entered. In Step 2, the three involvement measures (life, information, treatment) were entered, and in Step 3, the personal resources of self-efficacy and coherence were entered. In Step 4, the interactions were entered simultaneously and the significant interactions of Sex X Self-efficacy and Functionality X SOC, are reported. The same was true for the following regression (predicting wellbeing), where interactions were entered simultaneously in Step 5, and only interactions that significantly contributed to variance in wellbeing are reported here.</p> <hd id="AN0185155352-22">Results</hd> <p></p> <hd id="AN0185155352-23">Correlations between Study Variables</hd> <p>The correlations between predictor variables and each of the dependent variables was examined via Pearson correlations. These correlations, along with the means and standard deviations of the relevant variables are presented in Table 1.</p> <p>Table 1 Descriptives & Pearson correlations between study variables</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2"><p>Variable</p></th><th align="left"><p>Level of involvement</p></th><th align="left"><p>Involvement in the search for information</p></th><th align="left"><p>Involvement in the search for treatment options</p></th><th align="left"><p>Self-efficacy</p></th><th align="left"><p>Sense of coherence</p></th><th align="left"><p>Loneliness</p></th><th align="left"><p>Wellbeing</p></th></tr><tr><th align="left"><p>1</p></th><th align="left"><p>2</p></th><th align="left"><p>3</p></th><th align="left"><p>4</p></th><th align="left"><p>5</p></th><th align="left"><p>6</p></th><th align="left"><p>7</p></th></tr></thead><tbody><tr><td align="left"><p>1</p></td><td align="left"><p>------</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>2</p></td><td align="left"><p>0.61***</p></td><td align="left"><p>------</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>3</p></td><td align="left"><p>0.68***</p></td><td align="left"><p>0.64***</p></td><td align="left"><p>------</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>4</p></td><td align="left"><p>− 0.02</p></td><td align="left"><p>0.09</p></td><td align="left"><p>0.07</p></td><td align="left"><p>------</p></td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>5</p></td><td align="left"><p>0.09</p></td><td align="left"><p>0.11</p></td><td align="left"><p>0.14</p></td><td align="left"><p>0.35***</p></td><td align="left"><p>-----</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>6</p></td><td align="left"><p>0.03</p></td><td align="left"><p>− 0.15</p></td><td align="left"><p>0.03</p></td><td align="left"><p>− 0.30***</p></td><td align="left"><p>− 0.50***</p></td><td align="left"><p>------</p></td><td align="left" /></tr><tr><td align="left"><p>7</p></td><td align="left"><p>0.18*</p></td><td align="left"><p>0.30***</p></td><td align="left"><p>0.20*</p></td><td align="left"><p>0.52***</p></td><td align="left"><p>0.59***</p></td><td align="left"><p>− 0.56***</p></td><td align="left"><p>------</p></td></tr><tr><td align="left"><p><italic>M</italic></p></td><td align="left"><p>2.08</p></td><td align="left"><p>3.62</p></td><td align="left"><p>2.50</p></td><td align="left"><p>3.30</p></td><td align="left"><p>4.57</p></td><td align="left"><p>1.54</p></td><td align="left"><p>54.84</p></td></tr><tr><td align="left"><p><italic>SD</italic></p></td><td align="left"><p>0.97</p></td><td align="left"><p>0.85</p></td><td align="left"><p>1.13</p></td><td align="left"><p>0.48</p></td><td align="left"><p>0.81</p></td><td align="left"><p>0.46</p></td><td align="left"><p>10.98</p></td></tr></tbody></table> </ephtml> </p> <p>*<emph>p</emph> <.05, ***<emph>p</emph> <.001</p> <p>From Table 1 it can be seen that in terms of sibling involvement, significant positive correlations were found between the three measures of involvement. At the same time, no significant correlations were found between involvement and personal resources (efficacy, coherence), nor with loneliness. Significant positive correlations were found between the three involvement measures and wellbeing, such that higher levels of involvement were associated with greater wellbeing. Regarding personal resources, self-efficacy and sense of coherence significantly positively correlated with each other, and significantly negatively correlated with loneliness. That is, higher levels of personal resources was associated with lower levels of loneliness. In terms of the relations between personal resources and loneliness with wellbeing, significant positive relations were found so that higher levels of resources and lower loneliness were associated with greater wellbeing.</p> <p>The age of the participants was examined in relation to the study variables. Significant negative correlations were found between age and involvement in the search for treatment (<emph>r</emph> = −.19, <emph>p</emph> <.05), with older participants less involved in treatment. A significant positive correlation was found between age and sense of coherence (<emph>r</emph> =.20, <emph>p</emph> <.05), with older participants having higher levels of coherence. Results showed that 41% of the variance in loneliness and 61% in wellbeing was explained by the study variables (see Tables 2 and 3 respectively).</p> <p>Table 2 Hierarchical regression explaining variance of loneliness amongst siblings of individuals with ASD</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2"><p>Step</p></th><th align="left" rowspan="2"><p>Variables</p></th><th align="left" colspan="5" /></tr><tr><th align="left"><p>B</p></th><th align="left"><p>Std Err.</p></th><th align="left"><p>Beta</p></th><th align="left"><p><italic>R</italic><sup>2</sup></p></th><th align="left"><p>ΔR<sup>2</sup></p></th></tr></thead><tbody><tr><td align="left"><p>1</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.02</p></td><td align="left"><p>0.02</p></td></tr><tr><td align="left" /><td align="left"><p>Sex</p></td><td align="left"><p>− 0.08</p></td><td align="left"><p>0.09</p></td><td align="left"><p>− 0.09</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Functionality</p></td><td align="left"><p>− 0.05</p></td><td align="left"><p>0.09</p></td><td align="left"><p>− 0.05</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Age</p></td><td align="left"><p>− 0.01</p></td><td align="left"><p>0.01</p></td><td align="left"><p>− 0.06</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>2</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.07*</p></td><td align="left"><p>0.05*</p></td></tr><tr><td align="left" /><td align="left"><p>Sex</p></td><td align="left"><p>− 0.09</p></td><td align="left"><p>0.09</p></td><td align="left"><p>− 0.09</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Functionality</p></td><td align="left"><p>− 0.07</p></td><td align="left"><p>0.09</p></td><td align="left"><p>− 0.07</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Age</p></td><td align="left"><p>− 0.01</p></td><td align="left"><p>0.01</p></td><td align="left"><p>− 0.07</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - life</p></td><td align="left"><p>0.02</p></td><td align="left"><p>0.07</p></td><td align="left"><p>0.04</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - information</p></td><td align="left"><p>− 0.17</p></td><td align="left"><p>0.07</p></td><td align="left"><p>− 0.328</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - treatment</p></td><td align="left"><p>− 0.09</p></td><td align="left"><p>0.06</p></td><td align="left"><p>− 0.218</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>3</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.34***</p></td><td align="left"><p>0.27***</p></td></tr><tr><td align="left" /><td align="left"><p>Sex</p></td><td align="left"><p>− 0.11</p></td><td align="left"><p>0.08</p></td><td align="left"><p>− 0.11</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Functionality</p></td><td align="left"><p>− 0.08</p></td><td align="left"><p>0.08</p></td><td align="left"><p>− 0.09</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Age</p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.01</p></td><td align="left"><p>0.04</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - life</p></td><td align="left"><p>0.01</p></td><td align="left"><p>0.06</p></td><td align="left"><p>0.03</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - information</p></td><td align="left"><p>− 0.16</p></td><td align="left"><p>0.06</p></td><td align="left"><p>− 0.29**</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - treatment</p></td><td align="left"><p>− 0.12</p></td><td align="left"><p>0.05</p></td><td align="left"><p>− 0.29*</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Efficacy</p></td><td align="left"><p>− 0.10</p></td><td align="left"><p>0.08</p></td><td align="left"><p>− 0.10</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>SOC</p></td><td align="left"><p>− 0.28</p></td><td align="left"><p>0.05</p></td><td align="left"><p>− 0.49***</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>4</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.41***</p></td><td align="left"><p>0.07***</p></td></tr><tr><td align="left" /><td align="left"><p>Sex</p></td><td align="left"><p>− 0.13</p></td><td align="left"><p>0.08</p></td><td align="left"><p>− 0.14</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Functionality</p></td><td align="left"><p>− 0.03</p></td><td align="left"><p>0.08</p></td><td align="left"><p>− 0.03</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Age</p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.01</p></td><td align="left"><p>− 0.06</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - life</p></td><td align="left"><p>0.01</p></td><td align="left"><p>0.05</p></td><td align="left"><p>0.02</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - information</p></td><td align="left"><p>− 0.13</p></td><td align="left"><p>0.06</p></td><td align="left"><p>− 0.23*</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - treatment</p></td><td align="left"><p>− 0.12</p></td><td align="left"><p>0.05</p></td><td align="left"><p>− 0.29*</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Efficacy</p></td><td align="left"><p>− 0.08</p></td><td align="left"><p>0.08</p></td><td align="left"><p>− 0.09</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>SOC</p></td><td align="left"><p>− 0.26</p></td><td align="left"><p>0.05</p></td><td align="left"><p>− 0.46***</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Sex X Self-efficacy</p></td><td align="left"><p>0.09</p></td><td align="left"><p>0.03</p></td><td align="left"><p>− 0.21*</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Functionality X SOC</p></td><td align="left"><p>− 0.10</p></td><td align="left"><p>0.04</p></td><td align="left"><p>− 0.20*</p></td><td align="left" /><td align="left" /></tr></tbody></table> </ephtml> </p> <p>Note. Sex and Age refer to the participants, while Functionality (low/high) refers to the siblings with ASD. SOC = sense of coherence *<emph>p</emph> <.05, **<emph>p</emph> <.01, ***<emph>p</emph> <.001</p> <p>Table 3 Hierarchical regression explaining variance of Wellbeing amongst siblings of individuals with ASD</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2"><p>Step</p></th><th align="left" rowspan="2"><p>Variables</p></th><th align="left" colspan="5" /></tr><tr><th align="left"><p>B</p></th><th align="left"><p>Std Err.</p></th><th align="left"><p>Beta</p></th><th align="left"><p><italic>R</italic><sup>2</sup></p></th><th align="left"><p>ΔR<sup>2</sup></p></th></tr></thead><tbody><tr><td align="left"><p>1</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.01</p></td><td align="left"><p>0.01</p></td></tr><tr><td align="left" /><td align="left"><p>Sex</p></td><td align="left"><p>0.44</p></td><td char="." align="char"><p>2.20</p></td><td align="left"><p>0.02</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Functionality</p></td><td align="left"><p>0.95</p></td><td char="." align="char"><p>2.20</p></td><td align="left"><p>0.04</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Age</p></td><td align="left"><p>− 0.18</p></td><td align="left"><p>0.17</p></td><td align="left"><p>− 0.10</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>2</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.10*</p></td><td align="left"><p>0.09*</p></td></tr><tr><td align="left" /><td align="left"><p>Sex</p></td><td align="left"><p>0.03</p></td><td char="." align="char"><p>2.17</p></td><td align="left"><p>− 0.00</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Functionality</p></td><td align="left"><p>1.77</p></td><td char="." align="char"><p>2.19</p></td><td align="left"><p>0.08</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Age</p></td><td align="left"><p>− 0.12</p></td><td align="left"><p>0.17</p></td><td align="left"><p>− 0.07</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - life</p></td><td align="left"><p>− 0.11</p></td><td char="." align="char"><p>1.56</p></td><td align="left"><p>0.01</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - information</p></td><td align="left"><p>4.00</p></td><td char="." align="char"><p>1.63</p></td><td align="left"><p>0.31*</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - treatment</p></td><td align="left"><p>0.02</p></td><td char="." align="char"><p>1.35</p></td><td align="left"><p>0.00</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>3</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.54***</p></td><td align="left"><p>0.44***</p></td></tr><tr><td align="left" /><td align="left"><p>Sex</p></td><td align="left"><p>0.32</p></td><td char="." align="char"><p>1.58</p></td><td align="left"><p>0.01</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Functionality</p></td><td align="left"><p>1.31</p></td><td char="." align="char"><p>1.62</p></td><td align="left"><p>0.06</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Age</p></td><td align="left"><p>− 0.31</p></td><td align="left"><p>0.12</p></td><td align="left"><p>− 0.17*</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - life</p></td><td align="left"><p>0.31</p></td><td char="." align="char"><p>1.13</p></td><td align="left"><p>0.03</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - information</p></td><td align="left"><p>3.11</p></td><td char="." align="char"><p>1.18</p></td><td align="left"><p>0.24*</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - treatment</p></td><td align="left"><p>0.82</p></td><td align="left"><p>0.98</p></td><td align="left"><p>0.08</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Efficacy</p></td><td align="left"><p>7.44</p></td><td char="." align="char"><p>1.70</p></td><td align="left"><p>0.33***</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>SOC</p></td><td align="left"><p>6.70</p></td><td char="." align="char"><p>1.00</p></td><td align="left"><p>0.49***</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>4</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.59***</p></td><td align="left"><p>0.05***</p></td></tr><tr><td align="left" /><td align="left"><p>Sex</p></td><td align="left"><p>− 0.43</p></td><td char="." align="char"><p>1.50</p></td><td align="left"><p>0.02</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Functionality</p></td><td align="left"><p>0.73</p></td><td char="." align="char"><p>1.53</p></td><td align="left"><p>0.03</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Age</p></td><td align="left"><p>− 0.29</p></td><td align="left"><p>0.12</p></td><td align="left"><p>− 0.17*</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - life</p></td><td align="left"><p>0.40</p></td><td char="." align="char"><p>1.07</p></td><td align="left"><p>0.04</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - information</p></td><td align="left"><p>2.05</p></td><td char="." align="char"><p>1.15</p></td><td align="left"><p>0.16</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - treatment</p></td><td align="left"><p>0.01</p></td><td align="left"><p>0.96</p></td><td align="left"><p>0.00</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Efficacy</p></td><td align="left"><p>6.78</p></td><td char="." align="char"><p>1.60</p></td><td align="left"><p>0.30***</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>SOC</p></td><td align="left"><p>4.81</p></td><td char="." align="char"><p>1.07</p></td><td align="left"><p>0.36***</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Loneliness</p></td><td align="left"><p>-6.80</p></td><td char="." align="char"><p>1.83</p></td><td align="left"><p>− 0.28***</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>5</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.61***</p></td><td align="left"><p>0.02*</p></td></tr><tr><td align="left" /><td align="left"><p>Sex</p></td><td align="left"><p>− 0.39</p></td><td char="." align="char"><p>1.47</p></td><td align="left"><p>− 0.03</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Functionality</p></td><td align="left"><p>0.63</p></td><td char="." align="char"><p>1.50</p></td><td align="left"><p>0.03</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Age</p></td><td align="left"><p>− 0.25</p></td><td align="left"><p>0.12</p></td><td align="left"><p>− 0.14</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement – life</p></td><td align="left"><p>0.36</p></td><td char="." align="char"><p>1.05</p></td><td align="left"><p>0.03</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - information</p></td><td align="left"><p>1.90</p></td><td char="." align="char"><p>1.13</p></td><td align="left"><p>0.15</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Involvement - treatment</p></td><td align="left"><p>0.04</p></td><td align="left"><p>0.94</p></td><td align="left"><p>0.00</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Efficacy</p></td><td align="left"><p>7.07</p></td><td char="." align="char"><p>1.55</p></td><td align="left"><p>0.31***</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>SOC</p></td><td align="left"><p>4.88</p></td><td char="." align="char"><p>1.05</p></td><td align="left"><p>0.36***</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Loneliness</p></td><td align="left"><p>-6.84</p></td><td char="." align="char"><p>2.79</p></td><td align="left"><p>− 0.29***</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Age X Self-efficacy</p></td><td align="left"><p>-1.71</p></td><td align="left"><p>0.72</p></td><td align="left"><p>− 0.15*</p></td><td align="left" /><td align="left" /></tr></tbody></table> </ephtml> </p> <p>Note. Sex and Age refer to the participants, while Functionality (low/high) refers to the siblings with ASD. SOC = sense of coherence *<emph>p</emph> <.05, **<emph>p</emph> <.01, ***<emph>p</emph> <.001</p> <p>To explain variance in loneliness, variables were entered into the regression in four steps as follows. In Step 1, personal variables were entered (participants' sex, age, and sibling with ASD's functionality– high vs. low functioning). In Step 2, the three involvement measures were added, while in Step 3, the personal resources were added (efficacy, coherence). In Step 4, the contribution of interactions between the demographic variables and study variables were examined. Variables were force entered in the first three steps, whereas in Step 4, interactions were entered based on their significance. Table 2 presents these results.</p> <p>It can be seen in Table 2 that the personal variables did not significantly explain the variance in loneliness. The involvement variables explained 5% of the variance. Amongst the three involvement variables, a significant contribution was found for involvement in the search for information and the search of alternative treatments. The negative beta for this measure indicates that higher levels of these types of involvement predicted lower levels of loneliness. The personal resources entered in Step 3 explain 27% of the variance. Between the two measures entered, a significant contribution was only found for Sense of coherence. The negative beta for this measure indicates the higher levels of coherence predicts lower levels of loneliness. In the fourth and final step, the contribution of interactions between the variables was examined. A significant contribution was found for two interactions: participants' Sex X Self-efficacy and for sibling with ASD's Functionality X participants' Sense of Coherence. This contributed an additional 7% to the explanation of variance. Figures 1 and 2 present these interactions.</p> <p>Graph: Fig. 1 Relations between self-efficacy and loneliness amongst Brothers and Sisters of Individuals with ASD</p> <p>Graph: Fig. 2 Relations between sense of coherence and loneliness amongst siblings of individuals with autism with high vs. low functionality</p> <p>From Fig. 1 it is evident that for brothers of individuals with ASD, there is a negative relation between self-efficacy and loneliness, such that higher levels of efficacy are associated with lower reported loneliness (<emph>r</emph> = −.21, <emph>p</emph> <.05). In contrast, amongst sisters, no significant result was found for this relation (<emph>r</emph> =.10, <emph>p</emph> >.05).</p> <p>From Fig. 2 it can be seen that amongst siblings of individuals with ASD with both high and low functionality, a significant relation was found between sense of coherence and loneliness. In both groups, the greater the sense of coherence, the lower the reported loneliness, with this relation higher amongst siblings of individuals with low functioning ASD (<emph>r</emph> = −.18, <emph>p</emph> <.05, <emph>r</emph> = −.49, <emph>p</emph> <.001 for high and low functionality, respectively).</p> <p>A similar hierarchical regression was conducted to explain the variance in wellbeing. Variables were entered in five steps, as follows. In Step 1, the individual variables were entered (participants' sex and age, and siblings' functionality – high vs. low). In Step 2, the three variables of involvement were entered (involvement in treatment, in the search for information, and in the search for alternative treatments). Step 3 included the personal resources of self-efficacy and sense of coherence. Step 4 entered the loneliness variable. In the final step (Step 5), the contributions of the interactions between personal/demographic variables and study variables were entered. In the first four steps, the variables were force entered, whereas interactions were entered based on their significance. Table 3 shows the results of the regression.</p> <p>As can be seen in Table 3, results showed that overall, the variables explained 61% of the variance in wellbeing. Further, a significant contribution was not found for the personal characteristics in explaining the variance in wellbeing. The three involvement variables contributed 9% to the explanation of the variance. Of the three variables, only involvement in the search for information was significant, with more involvement associated with greater wellbeing. The personal resource variables (efficacy, coherence) contributed 44% to the explanation of the variance. Both variables made a significant contribution, such that higher levels of either variable predict higher levels of wellbeing. Loneliness added an additional 5% to the explanation of variance, with a negative beta indicating that the greater the level of loneliness, the lower the level of wellbeing. In the last step, where the interactions were added, a significant interaction was found only for participants' Age X Self-efficacy, which contributed an additional 2% to the explained variance. Figure 3 presents this interaction.</p> <p>Graph: Fig. 3 Relations between age and wellbeing amongst participants with low/high self-efficacy</p> <p>As can be seen in Fig. 3, amongst younger participants, there was a positive relation between self-efficacy and wellbeing (<emph>r</emph> =.32, <emph>p</emph> <.001), such that greater self-efficacy was associated with greater wellbeing. In contrast, amongst older siblings, a lower and non-significant relation was found (<emph>r</emph> =.12, <emph>p</emph> >.05).</p> <hd id="AN0185155352-24">Discussion</hd> <p>The current study utilized a family systems perspective to delve into the sibling subsystem, examining siblings of individuals with ASD, through a salutogenic lens. Specifically, the study examined the wellbeing of the typically developing siblings, focusing on how their strengths and resources contribute to their wellbeing (Siman Tov, [<reflink idref="bib80" id="ref119">80</reflink>]; Antonovsky, [<reflink idref="bib5" id="ref120">5</reflink>]). Results from the correlations and the first steps of the regression analyses revealed that siblings who are more involved in the lives of their siblings with ASD, who perceive their levels of self-efficacy and sense of coherence as higher, and their loneliness as lower, report higher feelings of wellbeing. Further, when predicting loneliness, brothers with higher self-efficacy reported lower loneliness, while this was not found for sisters. These results support other studies that found positive relations between involvement and adjustment (Rossetti et al., [<reflink idref="bib67" id="ref121">67</reflink>]), positive relations between self-efficacy and higher sense of coherence with siblings' wellbeing (Habelrih et al., [<reflink idref="bib37" id="ref122">37</reflink>]; O'Kane Frisson & Borkowski, [<reflink idref="bib59" id="ref123">59</reflink>]; Simth et al., [<reflink idref="bib82" id="ref124">82</reflink>]), and to studies finding negative relations between loneliness and wellbeing (Tsamparli et al., [<reflink idref="bib89" id="ref125">89</reflink>]), as well as differences between brothers and sisters (e.g., Siman-Tov & Sharabi, [<reflink idref="bib81" id="ref126">81</reflink>]). Looking at these results as a whole, it appears that active involvement by typically-developing siblings in the lives of their siblings with ASD exposes them to joint interactions. Mutual experiences are important in building self-efficacy, in strengthening a sense of coherence, reducing feelings of loneliness, and in achieving a sense of mental well-being (Grove et al., [<reflink idref="bib36" id="ref127">36</reflink>]; Peebles & Mendaglio, [<reflink idref="bib63" id="ref128">63</reflink>]).</p> <p>The study also examined the contribution of the variables of involvement, self-efficacy, and sense of coherence to loneliness, and how personal resources (efficacy, coherence) and loneliness predict typically-developing siblings' wellbeing. Additionally, the regression analysis revealed that amongst those with siblings with low and high functionality, the greater the sense of coherence, the lower the reported loneliness, with this relation higher amongst siblings of individuals with low functioning ASD. According to the salutogenic model for promoting health, the source of adaptive coping is in a sense of coherence, which is a personality tendency that reflects basic beliefs in oneself and the world. These beliefs touch on the comprehensibility of the world, the ability to manage stressful situations, and the meaning attributed to events. Similarly, the salutogenic model proposes that those with a stronger sense of coherence cope more effectively with the emotions that accompany stressful situations. They are more aware of their emotions and able to recognize them, and accept them (Antonovsky, [<reflink idref="bib5" id="ref129">5</reflink>], [<reflink idref="bib6" id="ref130">6</reflink>]. This ability allows them to cope better with recognizing problems (rather than avoiding or deflecting them), and in regulating the accompanying emotions. Additionally, this approach considers that a person with a stronger sense of coherence has a broader pool of coping mechanisms, and better changes of selecting the most appropriate mechanism for the specific source of the stress (Antonovsky, [<reflink idref="bib5" id="ref131">5</reflink>]). In line with the model, the study's results support the relation between sense of coherence and the siblings' sense of loneliness, and may provide them with cognitive, emotional, and motivational strength to evaluate the sources of stress as less threatening and more challenging, recognize unpleasant emotions that accompany stressful situations and accept them, and identify effective coping methods that help them cope with challenging stressful situations. It can be hypothesized that siblings with a strong sense of coherence have a broader range of coping mechanisms that allows them to select the most appropriate method to regulate their emotions and can help them reduce their feelings of loneliness (Antonovsky, [<reflink idref="bib5" id="ref132">5</reflink>], [<reflink idref="bib6" id="ref133">6</reflink>]). These findings are supported by studies showing that those with a higher sense of coherence were found to cope more effectively with stresses and regulate negative emotions, and have higher wellbeing (Pallant & Lea, [<reflink idref="bib62" id="ref134">62</reflink>]; Soderfeldt et al., [<reflink idref="bib83" id="ref135">83</reflink>]). It was similarly found that individuals with a low sense of coherence had a reduced ability to cope with stress and regulate negative emotions (Yinga et al., [<reflink idref="bib95" id="ref136">95</reflink>]). A stronger sense of coherence was also related to the use of more effective coping strategies (Pallant & Lea, [<reflink idref="bib62" id="ref137">62</reflink>]).</p> <p>An additional finding indicates the contribution of involvement to the prediction of their loneliness, such that greater involvement in the search for information and identifying alternative treatment approaches for the sibling with ASD predicted lower levels of loneliness. Siblings' involvement may strengthen their feeling of belonging and commitment, and the value of their actions towards their sibling with ASD. The willingness to contribute to another from the desire to improve and simplify their lives is good for the individual themselves, and provide both sides with the experience of deep human partnership, compassion, which can reduce feelings of loneliness and distress (Germer & Siegel, [<reflink idref="bib35" id="ref138">35</reflink>]).</p> <p>The study's results show that the more siblings are involved, have a higher sense of self-efficacy and sense of coherence, and lower levels of loneliness, their sense of wellbeing is predicted to be higher. These results support previous studies that found positive relations between involvement and adjustment (Rossetti et al., [<reflink idref="bib67" id="ref139">67</reflink>]), between higher self-efficacy and sense of coherence with wellbeing (Habelrih et al., [<reflink idref="bib37" id="ref140">37</reflink>]; O'Kane et al., [<reflink idref="bib59" id="ref141">59</reflink>]; Smith et al., [<reflink idref="bib82" id="ref142">82</reflink>]), and a negative relation between loneliness and wellbeing amongst siblings of individuals with ASD (Tsamparli et al., [<reflink idref="bib89" id="ref143">89</reflink>]). Examining the findings between the variables from the family systems perspective, regarding relations and interactions in the sibling subsystem, seems to hint at a dynamic that operates in a circular manner with the variables feeding each other in promoting the wellbeing of the typically-developing siblings. Specifically, their involvement strengthens their sense of belonging and commitment and provides them with value and justification for their actions. In this way, the family systems and salutogenic perspectives complement each other to further the understanding of siblings of individuals with ASD.</p> <p>Sense of coherence as an orientation and worldview acts as a kind of organizing framework that provides siblings with the motivation and internal and external coping resources, and serves as an important factor in the way that siblings explain various situations in their lives. This explanation creates an openness to ways of acting and allows flexibility and choice in appropriate coping methods. High self-efficacy in siblings, which expresses the belief and confidence in their ability to cope with challenges and complex situations contributes to individuals' perspectives of judgment and evaluation that they will successfully perform actions that will bring about a desired result (Bandura, [<reflink idref="bib8" id="ref144">8</reflink>]; Schwarzer, [<reflink idref="bib72" id="ref145">72</reflink>]).</p> <p>From the salutogenic perspective, sense of coherence is the key to effective coping with stresses and promoting health and wellbeing. The meaningfulness aspect of sense of coherence serves as a motivational factor that provides the individual a goal, direction, motivation, and purpose to act. When a person has a meaningful goal that propels them and a clear purpose, they are ability to cope with frustration, effort, and challenge. An inner commitment to a goal that has personal meaning for the person provides a sense of self-sufficiency and control over life and raises the levels of mental well-being essential to the individual and their contribution to the benefit of others (Cantor, [<reflink idref="bib15" id="ref146">15</reflink>]; Ryff & Singer, [<reflink idref="bib68" id="ref147">68</reflink>]). In line with this approach, it may be that a stronger sense of coherence of siblings of individuals with ASD provides them with the purpose for their actions for their siblings and serves as a broad platform for the application of their elf-efficacy and its realization.</p> <p>The results showed that amongst brothers, there was a negative relation between self-efficacy and loneliness, such that higher levels of efficacy are associated with lower reported loneliness, whereas no significant result was found for this relation amongst sisters. Previous studies demonstrated differences in coping styles between men and women, with women focusing more on emotions as well as seeking and receiving social support, with men tending to focus on cognitive problem-solving and less searching for social support (Sarason & Sarason, [<reflink idref="bib71" id="ref148">71</reflink>]; Siman-Tov & Sharabi, [<reflink idref="bib81" id="ref149">81</reflink>]; Yee & Schulz, [<reflink idref="bib94" id="ref150">94</reflink>]). These differences may in turn, relate to their feelings of efficacy and loneliness. Having fewer people to rely on for support and sharing your experiences may be associated with the brothers feeling less efficacy in coping with having a sibling with ASD, and feeling greater loneliness compared to sisters.</p> <p>It was found that self-efficacy is the characteristic that allows control over cognitive abilities that leads to behaviors to emerge from strength into action and control over emotional and motivational sources required to turn potential to behavior (Bandura, [<reflink idref="bib9" id="ref151">9</reflink>]). The integration of these two resources contributes to their sense of wellbeing. As a result of these processes (and their explanations of various situations), a cycle is created that encourages the siblings to be involved in the lives of their sibling with ASD, and allows them to reduce the sense of loneliness and promote their mental wellbeing.</p> <hd id="AN0185155352-25">Limitations</hd> <p>The study's results are limited by a number of aspects. First, the study relied on the typically-developing siblings' perspectives regarding their lives with a sibling with ASD. Future studies should explore these relationships from the perspectives of parents, professionals, and the siblings with ASD themselves in order to convey a broader, more well-rounded view. Additionally, the study relied on self-report questionnaires, which may be subject to social desirability. Utilizing other methods of data collection, particularly qualitative approaches, may facilitate a deeper exploration of siblings' involvement and triangulate the results of the current study with other findings. Lastly, the current study relied on a cross-sectional view of siblings' reports. The study was conducted with Jewish Israelis, but it is important to gather data from other sectors, including the Arab sector within Israeli society. Additionally, future studies should extend the current study by examining siblings with ASD at all levels of functionality, including medium (Level 2).</p> <hd id="AN0185155352-26">Conclusions & Implications</hd> <p>The study's importance lies in raising awareness to and the importance of siblings of individuals with ASD as a unique subsystem within the family system, and the need to strengthen their personal resources. The study's theoretical contribution is in expanding the knowledge base on the resources that contribute to typically-developing siblings' wellbeing. In recent years, there is evidence of additional research into resilience, which aims to combine the pathogenic and salutogenic approaches, and to focus on research into reciprocal relations between risk factors and protective, i.e., salutogenic factors (Sagy, [<reflink idref="bib69" id="ref152">69</reflink>]). The current study highlights the contribution of the resource of a sense of coherence in promoting siblings' wellbeing. The implications of the study's findings are in the development of programs to promote health that will integrate between the approaches. This kind of integrative approach can contribute to the salutogenic and holistic orientation without abandoning the study of emotional, social, and environmental factors on the specific topic of siblings of individuals with ASD's coping. Programs can be developed that first assess and evaluate personal resources, facilitate the identification of people who are at-risk, have weak or low protective resources, which can then serve as the basis for individualized intervention programs, with the aim of addressing the various needs of siblings of individuals with ASD and strengthening their resources. At the same time, it is recommended to develop therapeutic models that are focused on the community and educational and welfare systems, and to develop interaction programs to support these siblings throughout the lifecycle, in the spirit of the salutogenic approach. This proposes methods of looking at and operative to create a foundation for the ability to cope and be resilient in life.</p> <hd id="AN0185155352-27">Funding</hd> <p>There are no organizations that may gain or lose financially through the publication of this manuscript.</p> <hd id="AN0185155352-28">Data Availability</hd> <p>The author takes responsibility for the integrity of the data and the accuracy of the data analysis.</p> <hd id="AN0185155352-29">Declarations</hd> <p></p> <hd id="AN0185155352-30">Ethics Approval</hd> <p>Research involving human participants. The study was approved by the ethics committee of Kibbutzim College of Education, and the study was performed in accordance with the ethical standards of the Helsinki Declaration and its amendments and Israeli research ethical standards.</p> <hd id="AN0185155352-31">Consent to Participate</hd> <p>Informed consent was obtained from all individual participants included in the study and data was deidentified and aggregated for analysis.</p> <hd id="AN0185155352-32">Employment</hd> <p>The author does not have any recent, present or anticipated employment by any organization that may gain or lose financially through the publication of this manuscript.</p> <hd id="AN0185155352-33">Financial Interests and Non-Financial Interests</hd> <p>The author has no relevant financial or non-financial interests to disclose. The author declares that <emph>there are no interests</emph> that go beyond financial interests that could impart bias on the work submitted for publication such as professional interests, personal relationships or personal beliefs (amongst others). There are no positions on the editorial board, advisory board or board of directors or other types of management relationships like writing and/or consulting for educational purposes; expert witness; mentoring relations; and so forth.</p> <hd id="AN0185155352-34">Conflict of Interest</hd> <p>The authors do not have any competing interests with the Editorial Board members. The author certify that she has no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Salutogenesis and the Wellbeing of Siblings of Individuals with Autism Spectrum Disorder: Contribution of Involvement, Resistance Resources, and Loneliness
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Ayelet+Siman-Tov%22">Ayelet Siman-Tov</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-9237-8400">0000-0002-9237-8400</externalLink>)
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  Label: Source
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  Data: <searchLink fieldCode="SO" term="%22Child+%26+Youth+Care+Forum%22"><i>Child & Youth Care Forum</i></searchLink>. 2025 54(3):635-658.
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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 24
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Health+Promotion%22">Health Promotion</searchLink><br /><searchLink fieldCode="DE" term="%22Well+Being%22">Well Being</searchLink><br /><searchLink fieldCode="DE" term="%22Siblings%22">Siblings</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Coping%22">Coping</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Involvement%22">Family Involvement</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Efficacy%22">Self Efficacy</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+Patterns%22">Psychological Patterns</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Isolation%22">Social Isolation</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10566-024-09833-5
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1053-1890<br />1573-3319
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: According to family systems theories, the family is an inter-connected social unit, where dysfunction, disability or illness in one family member may affect the rest of the family. Research indicates that the presence of an individual with autism can influence the functionality of the various subsystems, including siblings. Objective In light of salutogenic approaches, which focus on factors promoting health and effective coping, the study examined the relations between the involvement, personal resources (sense of coherence, self-efficacy), and loneliness of siblings of individuals with autism with their wellbeing. Methods: Participants included 116 siblings of individuals with autism between the ages of 18-50, who completed self-report questionnaires. Results: Results indicated that siblings who are more involved in the lives of their siblings with autism perceive their sense of coherence and self-efficacy as higher, and their loneliness as lower, and further report higher levels of wellbeing. The study emphasizes the contribution of the resource of a high sense of coherence for predicting lower loneliness and better wellbeing for siblings of individuals with autism. Similarly, a shared contribution of self-efficacy and sense of coherence emerged for feelings of wellbeing. Conclusions: In light of the results, it is recommended to develop interventions based on a joint approach between the pathogenic and salutogenic approaches towards promoting health. Integrating these approaches can contribute to the promotion of the salutogenic and holistic direction of siblings of individuals with autism and to the research of emotional, social, and environmental factors towards the typically-developing siblings' coping ability.
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  Data: As Provided
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  Data: 2025
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  Label: Accession Number
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  Data: EJ1471273
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1471273
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      – Type: doi
        Value: 10.1007/s10566-024-09833-5
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 24
        StartPage: 635
    Subjects:
      – SubjectFull: Health Promotion
        Type: general
      – SubjectFull: Well Being
        Type: general
      – SubjectFull: Siblings
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Coping
        Type: general
      – SubjectFull: Family Involvement
        Type: general
      – SubjectFull: Self Efficacy
        Type: general
      – SubjectFull: Psychological Patterns
        Type: general
      – SubjectFull: Social Isolation
        Type: general
    Titles:
      – TitleFull: Salutogenesis and the Wellbeing of Siblings of Individuals with Autism Spectrum Disorder: Contribution of Involvement, Resistance Resources, and Loneliness
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            NameFull: Ayelet Siman-Tov
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          Dates:
            – D: 01
              M: 06
              Type: published
              Y: 2025
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