ABCs of Child Psychiatry

Real info about children's mental health

Sibling Fights: More Than Just Kid Stuff

The common fighting between sibs may be more harmful than we thought.

Brothers and sisters fighting with each other is exceedingly common, and these conflicts often get chalked up to typical sibling interactions, or even a rite of passage that can toughen kids up.  A new study from the journal Pediatrics, however, finds evidence that there may be real mental health consequences to these battles.

The study comes from the National Survey of Children’s Exposure to Violence.  In this national probability sample, over 3500 children and adolescents participated in a telephone interview from phone numbers selected randomly.  Items taken from questionnaires were used to examine mental health problems as well as three types of aggression occurring by siblings in the previous year: psychological (feeling bad or scared due to a sibling’s verbal attacks), property (forcibly taking or destroying something), and physical aggression. 

While not explicitly reported in the study (which means I had to add up a couple items appearing in the text), it appears that 40% of children and adolescents experienced sibling aggression of some form.  Furthermore, those who did were found to have higher mental health distress than those who did not report such sibling conflict.  The effect of “mild” physical aggression (i.e. did not involve a weapon or lead to injury) seemed to be particularly difficult for younger children less than 10 years old.  Cumulative effects were found for those experiencing greater amounts of sibling aggression and those who experienced both peer and sibling aggression.

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The authors summarized their results by saying that there are real negative effects on children from sibling aggression that should not be dismissed as typical and benign.  They advocated that current anti-bullying campaigns should consider adding sibling aggression as a target of their interventions.

This study is a wake-up call, warning us not to view sibling aggression as a benign part of growing up.  Some of these aggressive siblings might benefit from their own psychiatric evaluation, with effective treatment (no I don't just mean medications) having positive effects not only for that child but for other family members as well. 

While interesting, the study would have been strengthened by providing more information about the rates and severity of various types of aggression as well as how big the effect of this aggression was on family members.  In addition, the study does not control for genetic factors.  It may be that shared genes contribute both to a child's mental health problems and his or her sibling's aggression and it just looks like the sibling’s aggression is driving the stress in that child’s brother or sister. Association studies like this can’t adequately address cause and effect.

Finally, what do we make of the rate of 40% of child and adolescent subjects reporting some sort of sibling aggression in the past year?  This rate seems fairly low and casts some doubt for me on how questions were asked.  Upon reading this information, many people's first reaction (including myself) may be something like, "C'mon, siblings are gonna fight from time to time.  I turned out alright." Eliminating all sibling conflict seems to be a tall order in my view, and more information on what things can really lead to feelings of fear and intimidation would be useful.

Reference

Tucker CJ, et al.  Association of sibling aggression with child and adolescent mental health.  Pediatrics 2013; 132:79-84.

Follow me on Twitter @PediPsych and like the PediPsych page on Facebook. 

David Rettew, M.D., is a child psychiatrist at the University of Vermont and author of Child Temperament: New Thinking about the Boundary between Traits and Illness.

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