Keeping siblings in view
They are often the considerate ones, the inconspicuous ones, the sensible ones. And that is exactly why they easily slip out of view.
In almost every longer counseling conversation the sentence comes up at some point: “And then there’s our eldest — she always gets the short end of it.” Usually a pause follows, and then tears.
Siblings of neurodivergent children often develop remarkable consideration. They put their own needs aside, make themselves small when the air at home gets thin, and function impeccably at school. That is exactly why they do not stand out — and exactly why they need attention.
This is not an accusation against you. It is simple arithmetic: if one child needs a great deal of support, less remains for the other. That cannot be organized away, but it can be shaped.
What really helps siblings
None of this takes much time. It takes reliability.
Their own time, reliably
Ten minutes a day that definitely happen do more than a big outing that keeps getting postponed. What matters is the reliability, not the duration.
Explaining, age-appropriately
Children notice anyway that something is different. If nobody names it, they invent their own explanations — and those often include their own guilt. A simple explanation lifts that burden.
Allowing negative feelings too
Anger at the sibling, embarrassment in front of friends, the wish for a normal family — all of this is normal and may be said without being corrected.
Not making them a co-parent
Consideration yes, responsibility no. A sibling may help, but should not be in charge. Holding that line is the adults' job.
Read on in the Mika Guide
In the Mika Guide you will find conversation prompts for siblings — and one preparation story for the moment a new baby joins the family.
Explaining what is going on
Words for different ages — without a lecture on diagnosis and without glossing over.
Shaping time together
Small, reliable rituals that work even on full days.
When others help
Grandparents, godparents, friends: how others can make one-to-one time possible.
“A New Baby Sibling”
A preparation story to read aloud when a new baby joins the family.
The app is free; the first section of this module is free to read, the deeper content belongs to Mika+ (one-time €19.99, £19.99 in the UK).
“And what if we want another child?”
This question comes up in almost every consultation, and almost always at the very end. I will answer it here as precisely as I can.
The number. When one child is autistic, the likelihood is higher for a sibling born afterward than in the general population. The largest study on this followed 1,605 such siblings from their first months of life to their third birthday. The result: about 20 % — roughly one child in five.
What this does not mean. It does not mean your next child has a 20 % chance of being autistic. This number applies to a large group of families, not to yours. For your individual child there is no probability that can be calculated — there is only a child who either is autistic or is not. And read from the other side: in about four out of five cases the sibling is not autistic.
What shifts the number. A few things are known:
- Boy or girl. Among boys the share is higher (about 25 %) than among girls (about 13 %).
- How many children are affected. If one child is already autistic, the share is about 21 %; if two or more are, about 37 %.
- Whether the first autistic child is a girl. Then the share is higher (about 35 %) than with a boy (about 23 %). The reason is likely that girls are on average diagnosed later and less often — so it takes more before a diagnosis is made.
And what the number does not measure. It comes from research projects that deliberately accompany families with an autistic child and examine the children closely. Looking closely finds more. In large register analyses, which only count who received a diagnosis, the figures are lower. Both are correct — the 20 % is the number for “closely examined,” not for “will be noticed.”
What I would tell families facing this decision. First: this number is an argument for attention, not against another child. Second: if you have a second child, you already know a great deal — and you will notice early if something runs differently. Noticing early is an advantage, not a reason to worry. Third: genetic counseling can make sense if several diagnoses come together in your family or if another condition is in question. It is counseling, not a test — and no one has to arrive there with a decision made.
What this decision is not. It is not an arithmetic problem. Whether you want another child has to do with your strength, your circumstances and your wish — and no number decides that for you. If you would like to talk it through without anyone having an opinion about it, I am here for that.
Source: Ozonoff et al., Familial Recurrence of Autism, Pediatrics 2024 (1,605 children, 18 sites) — see the knowledge base.
When more is needed
If a sibling withdraws persistently, complains of stomach or headaches, drops off at school or seems conspicuously grown-up, that is a signal. Sibling groups, school psychology services or a child therapy assessment can bring relief.
You do not have to absorb this alone — and you are not to blame for this situation existing.
Would you like to talk about it?
If you feel a sibling is currently getting too little, let us look together at what is realistically possible in your everyday life.