Background: Worldwide, 78,000 children develop type 1 diabetes annually with European cases increasing every year. In the United States, 215,000 children under 20 years of age have type 1 diabetes and over 6.5 million adults with either type 1 or type 2 diabetes need daily administration of insulin. Misunderstanding the complexity of diabetes management on the part of health care providers can affect their attitudes and negatively affect patient outcomes. The purpose of this descriptive qualitative study was to explore family nurse practitioner and undergraduate nursing students' perceptions of diabetes management while using an insulin pump in order to more effectively prepare them to understand the complexities of diabetes management faced by patients with diabetes and, therefore, provide better patient care. Methods: Nurse practitioner and undergraduate students, who participated in a week long diabetes simulation experience, were asked to participate. Consents were obtained allowing analysis of journals detailing their experiences. The journals were analyzed for common themes according to qualitative methodology. Results: Three themes emerged from the data: 1) handling self-management issues, 2) living with an insulin pump, and 3) gaining an appreciation for those who live with diabetes. Self-management subthemes included making dietary changes and monitoring blood glucose levels. Making dietary changes included carbohydrate counting, eating a balanced diet, and not snacking all day. Issues related to the monitoring of blood glucose levels included the pain of poking their fingers, difficulty getting enough blood, forgetting to check blood glucose, and not wanting to check blood glucose in front of people. Living with an insulin pump subthemes included learning where to wear the pump, having the pump get in the way, interfering with daily activities, including changing clothes or using the bathroom, interfering with intimacy, and having to change the needle site. Subthemes of gaining an appreciation for those who live with diabetes included having empathy for patients related to complying/not complying with treatment regimes, understanding the inconveniences of required lifestyle changes, and obtaining support from others having the same experience. Conclusions: Diabetes requires many lifestyle changes. Study participants cited an increased understanding of the hassles and inconvenience of living with diabetes, particularly dietary changes, monitoring blood glucose, and living with an insulin pump. Undergraduate and graduate nursing students caring for patients with diabetes would benefit from a similar simulation experience in order to gain an understanding of the complexity of diabetes management and learn ways to help their patients. Nursing faculty should consider implementing a similar simulation experience in their curriculum.

Newbery awards are conferred annually on books recognized as having made the most distinguished contribution to children's literature; these books reach a wide audience, and their depictions of characters with disabilities can influence children's perceptions and attitudes toward individuals with disabilities. Eight Newbery Medal and Honor books chosen from 2010 to 2019 were identified as portraying 11 main or supporting characters with a disability. Six disabilities were represented: emotional disturbance, deafness, specific learning disability, speech/language impairment, orthopedic impairment, and traumatic brain injury. Applying the Rating Scale for Quality Characterizations of Individuals with Disabilities in Children's Literature, we found most of the characterizations positive in personal portrayal, social interactions, and sibling relationships. Exemplary practices were also found in these books. We encourage school professionals to select books carefully to share with their students.

Parents of children with autism spectrum disorders (ASD) are at risk for having higher stress and lower marital quality than other parents. Survey data regarding respite care, marital quality, and daily hassles and uplifts were obtained from 101 mother-father dyads who were together raising at least one child with ASD (total # of children = 118). Number of hours of respite care was positively related to improved marital quality for both husbands and wives, such that a 1-h increase in weekly respite care was associated with a one-half standard deviation increase in marital quality. This relationship was significantly mediated by perceived daily stresses and uplifts in both husbands and wives. More respite care was associated with increased uplifts and reduced stress; increased uplifts were associated with improved marital quality; and more stress was associated with reduced marital quality. The number of children in the family was associated with greater stress, and reduced relational quality and daily uplifts. Results suggest policymakers and practitioners should develop supports for providing respite for families raising children with ASD.

Based on the Dyches and Prater (2000) guidelines, characterizations and plots in 34 eligible children's books published during 1999-2003 were evaluated; 36 characterizations are discussed in detail in terms of each guideline. Results showed that, compared to a previous study (Dyches, Prater, & Cramer, 2001), characters with developmental disabilities made more deliberate choices, were educated in more inclusive settings, were more accepted in their communities, and served in more helping roles; and more commonly the disability was only one of many character traits. Also a wide age spectrum was portrayed, and several characterizations represented people from minority races or cultures. Over half of the characters with DD had autism spectrum disorders, and almost half of those characters had Asperger syndrome.

AIM: To explore if young people with higher and lower levels of metabolic control of type 1 diabetes have different perceptions about their lives and illness. BACKGROUND: Adolescence through emerging adulthood is a developmental stage made more challenging when the person has type 1 diabetes. Little research has investigated if individuals with high and low levels of metabolic control in this age group perceive their disease differently. DESIGN: Qualitative descriptive. METHODS: In this study, 14 participants, ages 11-22 years were interviewed in 2008 about their perceptions of living with type 1 diabetes. Through a process of induction, major themes were identified. RESULTS/FINDINGS: Participants with high and low metabolic control levels reported similar themes related to reactions of others, knowledge about type 1 diabetes, and believed healthcare providers used authoritarian interactions. However, high metabolic control level participants believed type 1 diabetes would be cured; had negative initial responses to being diagnosed; rarely received parental support in managing their diabetes; and were negligent in self-care activities. Participants with low metabolic control levels did not believe a cure was imminent or have negative responses to being diagnosed; received parental support in managing diabetes; and were diligent in self-care activities. CONCLUSION: Nurses should give information to young people with type 1 diabetes beyond initial diagnosis and help and support this age group learn appropriate ways to manage their disease, develop positive relationships with healthcare professionals, and participate in interactions with others their age successfully managing type 1 diabetes.

There has been an increasing emphasis on multicultural issues as they relate to service and education provided to those with developmental disabilities such as autism. Research is just beginning to be conducted and disseminated on prevalence variability. The current study reports trends in the educational classification for multicultural students with autism. Results indicate that identification rates have increased for all racial/ethnic categories except for those who are Hispanic.

This study examined sibling relationships in families raising children with autism, Down syndrome, orthopedic conditions, and diabetes. Parents from 108 families independently completed the 28-item Schaefer Sibling Inventory of Behavior. Parents rated siblings as very empathetic, fairly often kind and involved, and rarely avoidant. Mothers rated sibling empathy higher than fathers did and older siblings more avoidant than younger siblings. Fathers rated male siblings kinder than female siblings; they also rated siblings of children with Down syndrome or autism more kind and involved than siblings of children with orthopedic conditions or diabetes. Sibling intervention efforts should consider these findings and be individualized according to the need of each child and family.

To develop independence and self-responsibility in students With autism, traditional intervention techniques have focused on the acquisition of academic learning and adaptive skills of language and communication and the reduction of behavior problems. The critical question is, Will these traditional foci of intervention Work for multicultural students With autism? These students have triple-layered problems'they are culturally different, they may be linguistically different, and they have an exceptionality that is loaded With behavioral repertoires. Apparently, these challenges make it imperative for general and special education practitioners to look for Ways to educate multicultural learners With autism. In this article, the authors present culture-specific strategies for meeting the educational needs of students With autism. In addition, they relate these strategies to current efforts to prepare teachers and other professionals to assist students and their families.

Thirty-one adults with type 1 diabetes participated in this qualitative study to explore reasons why they were willing (had an open attitude) or unwilling (had a closed attitude) to disclose diabetes-related information to others. Participants (61.3% female, mean age 38.48 years, mean duration of diabetes 21.94 years, 100% white) answered open-ended questions about living with type 1 diabetes. Interviews were transcribed verbatim and coded to identify major patterns that emerged in the data. Reasons for open attitudes included support from others, confidence and feeling comfortable, feeling normal despite diabetes, seeking to educate, and feeling that it was not a major concern to share information with others. Reasons for closed attitudes included fear of discrimination, misunderstanding from others, embarrassment and shame, and feeling that it was not a major concern to share information. A higher number of participants reported open attitudes after diagnosis than at initial diagnosis; a lower number of participants reported closed attitudes after diagnosis than at initial diagnosis. Professionals should consider effective forms of type 1 diabetes'related education to reduce diabetes misconceptions and discrimination against diagnosed individuals. This may help individuals feel more open and willing to adhere to and seek assistance with their diabetes-related self-care.

Authors of this qualitative descriptive study interviewed 21 adolescent siblings of children with Down syndrome (DS) who also had additional health problems rated as requiring extensive care by parents. Analysis revealed positive/negative aspects of the experience; however, participants emphasized the positive rather than negative experiences and focused more on the fact that the child had DS rather than health problems requiring additional care. Most said they would not change anything about their experience and did not believe the child with DS would ever live independently. They did, however, acknowledge their family was affected by the caregiving needs of the child which often required extra vigilance or specific care depending on the health problem. Information gained can help improve understanding of adolescent sibling perceptions about living with a child with DS who also requires additional care because of ongoing health problems so more appropriate and individualized nursing interventions can be provided.

Online instruction is a growing method of delivering course content in higher education. However, little research has been conducted regarding the effectiveness of such instruction for pre-service teachers, in both general education and special education, who will teach students with disabilities. In this chapter we briefly review the literature regarding online instruction as it relates to pre-service special education. Then we describe our involvement with the Brigham Young University PT3 grant, our personal development in using technology in our courses, the development and refining of an Introduction to Special Education course, and contributions made by our students. Recommendations for future study and practice are provided.

Although a large body of literature exists supporting the relationship between positive parenting and child outcomes for typically developing children, there are reasons to analyze separately the relevant literature specific to children with developmental disabilities. However, that literature has not been synthesized in any systematic review. This study examined the association between positive parenting attributes and outcomes of young children with developmental disabilities through meta-analytic aggregation of effect sizes across 14 studies including 576 participants. The random effects weighted average effect size was r = .22 (SE = .06, p < .001), indicative of a moderate association between positive parenting attributes and child outcomes. Publication bias did not appear to be a substantial threat to the results. There was a trend for studies with more mature parents to have effect sizes of higher magnitude than studies with young parents. The results provide support for efforts to evaluate and promote effective parenting skills when providing services for young children with disabilities.

The professional literature provides ample evidence that individuals with autism exhibit a myriad of unusual social, communication, and behavioral patterns of interactions that present challenges to their families and service providers. However, there is a dearth of quality works on multicultural issues regarding autistic spectrum disorders. In this article, we explore issues surrounding autism and multiculturalism, with the intent not to provide answers but to raise questions for further examination. We focus our discussions on two primary issues: autism within cultural groups and multicultural family adaptation based on the framework of pluralistic societies in which some cultural groups are a minority within the dominant culture. We found differences in prevalence rates across races for autism and little information regarding how multicultural families adapt to raising a child with autism. Further, students with multicultural backgrounds and autism are challenged on at least four dimensions: communication, social skills, behavioral repertoires, and culture. Future research in these areas is clearly warranted.

As many children first encounter individuals with developmental disabilities (DD) through characters in children's literature, these individuals must be depicted authentically. Using descriptive analyses, we evaluated 38 books written for children and adolescents (11 picture books, 17 chapter books) for their portrayals of characters with developmental disabilities, comparing the portrayals against those published in three previous studies. All books considered were eligible for the 2018 Dolly Gray Children's Literature Award. Data were analyzed regarding personal portrayal, social interactions, and exemplary practices. Results indicated that most characters portrayed have ASD (80%) and the majority are male (65%). Generally, characters with DD are portrayed positively and realistically, but many remain static throughout the stories. They engage in positive social relationships and are included in integrated settings. Implications for educators, authors/publishers, and researchers are provided.

Successfully working with children with special needs is a unique challenge ' but so is effectively working with their parents, siblings, and other family members. This helpful and engaging first edition text helps the reader understand every aspect of collaborating with and communicating with families of children with disabilities, from offering skills and strategies for success, to outlining the legal and ethical implications of educators' work with special needs families. Timely and thorough, Working With Families Of Children With Special Needs takes a close look at the individual needs of different families, including families struggling with aging special needs students, families with diverse backgrounds, and families with differing perspectives on special needs education. In addition, the text provides the reader with an array of helpful learning tools and aids.

The perspective of children with developmental disabilities regarding what is important is not fully understood due to limited means by which accurate data are collected. Many researchers rely upon teachers, parents, and siblings to provide information regarding the lives of children with developmental disabilities. This study differs from most because primary informants were 15 school-aged individuals with disabilities who took snapshots of that which they reported to be important to them. Their ability to take pictures was examined and themes were determined through content analysis. Results indicate these participants can take usable snapshots, which frequently focus on family; other themes of the photographs included friends, objects, and buildings. This preliminary study suggests that photography may be one way to allow students with developmental disabilities to contribute information regarding what they value in their lives.

A large body of literature exists related to parent-implemented interventions for children with disabilities, so it is helpful to synthesize the results of outcome-based interventions for children with developmental disabilities. Specifically, what are the effects of parent-implemented interventions intended to improve children's (1) social behaviors, (2) life skills/adaptive behavior, and (3) communication skills? Using meta-analytic aggregation of effect sizes across 30 studies with a total of 1,356 participants, this review examined the association between parent-implemented interventions and intended outcomes for young children with developmental disabilities. Across all 30 studies comparing children's outcomes to control groups, the random-effects-weighted average effect size was d = 0.495 (95% confidence interval = 0.31 to 0.68). Effect sizes ranged from d = -0.28 to 3.23, with the index of heterogeneity reaching statistical significance (Q (29) = 72.0, p < .001; I2 = 59.7%). The overall results were not moderated by the four participant characteristics evaluated'age, gender, socioeconomic status (SES), and disability. All parent-implemented interventions resulted in child outcomes that were statistically significantly better than the control group. Interventions targeting communication skills resulted in the greatest relative gains, and interventions targeting life skills/adaptive behavior resulted in the smallest relative gains (yet statistically better than the control group). Findings indicate clinical benefits when professionals include parents in interventions intended to influence the social'behavioral, communication, and adaptive development of young children with developmental disabilities.

Although a large body of literature exists supporting the relationship between positive parenting and child outcomes for typically developing children, there are reasons to analyze separately the relevant literature specific to children with developmental disabilities. However, that literature has not been synthesized in any systematic review. This study examined the association between positive parenting attributes and outcomes of young children with developmental disabilities through meta-analytic aggregation of effect sizes across 14 studies including 576 participants. The random effects weighted average effect size was r = .22 (SE = .06, p < .001), indicative of a moderate association between positive parenting attributes and child outcomes. Publication bias did not appear to be a substantial threat to the results. There was a trend for studies with more mature parents to have effect sizes of higher magnitude than studies with young parents. The results provide support for efforts to evaluate and promote effective parenting skills when providing services for young children with disabilities.

Although considerable research exists concerning families raising children with disabilities, relatively little work has examined the linkages between parent and sibling functioning. The purpose of this study, therefore, was to investigate the relationship between parental perceptions of family functioning and school-aged siblings' social skills and problem behaviors. A purposive sample of 78 sets of parents and their school-aged children participated. Half of the families were raising a child with a disability, and half of the families were not raising a child with a disability. Mothers and fathers completed the Porter-O'Leary Scale and Bloom's Family Functioning Measure. Teachers of the school-aged children completed a modification of the Gresham and Elliot Social Skills Rating System. Results indicated siblings of both groups demonstrate more social skills than problem behaviors, and siblings of children with disabilities were higher in cooperation and self-control than siblings of children without disabilities. Hierarchical regression analyses revealed fathers' perceptions of family conflict and external locus of control orientation, and mothers' perceptions of marital conflict predicted externalizing behaviors for female siblings of children with a disability.

Adults who have lived much of their life with type 1 diabetes have learned lessons that can benefit health care providers (HCPs), families, and young people who live with the condition. This study was undertaken to gain a better understanding of the challenges of growing up and living with type 1 diabetes from adults who have experienced those challenges and to recommend strategies for parents, caregivers, and HCPs who work with children or adolescents with type 1 diabetes. Thirty-five adults with type 1 diabetes participated in this qualitative study consisting of two in-depth interviews with each participant. Six themes emerged: 1) It's not who you are, 2) Don't let it limit you, 3) Get involved in diabetes support groups, 4) It's going to be OK, 5) Teach them; don't scare them, and 6) Don't single kids out. Through hindsight and the more mature perspective of adulthood, study participants were able to share valuable insights that could inform the efforts of those who work with or care for younger people with type 1 diabetes.

The presence of a child with disabilities elicits a variety of stress demands on the family. Religion is recognized as a powerful personal, family, and cultural variable. However, little is known about the influence of religion in dealing with disability among families within particular religious groups. This descriptive study explored themes of spiritual belief and religious support among families of the Church of Jesus Christ of Latter-Day Saints (LDS, or Mormon) with a child with developmental disabilities. Parents shared perspectives of meaning that emerged from experiences with religion and family beliefs perceived to be unique. The core theme, 'This is a Spiritual Experience,' provides the foundation for a descriptive model that depicts aspects of finding meaning and perceived transcendence.

Chapter 1: Developing Caring Relationships in Schools Chapter 2: Skills for Communicating with Families Chapter 3: Communicating with Families throughout the School Year Chapter 4: Communicating with Families in Meetings Chapter 5: Addressing Difficult Topics with Families

This case study focused on skill generalization following instruction of an adolescent girl with multiple disabilities using two augmentative and alternative communication (AAC) devices: a simple pictographic display and a voice output communication aid (VOCA) with an identical display used as an overlay. An alternating treatments design was used to assess community members' response latency, focus of attention, and comprehension of requests made via the two AAC devices. Skill generalization occurred for both devices, with similar rates of efficiency. These findings underscore the importance of the use of multiple modalities and of incorporating individual preferences to enhance the communicative competence of individuals who use AAC in natural environments.

Bullying, a serious issue in today's schools, negatively impacts children. This article summarizes research and emphasizes the need for effective tools, such as bibliotherapy, to deter bullying. To assist professionals in selecting books for bibliotherapy, 38 bully-themed children's K-3 picture books ranked 1- 4 by The Horn Book Guide (HBG) during January 1, 2004 through January 1, 2010 were analyzed. Comparisons were made between the selected books' portrayals of bullying and aspects of bullying, and bully prevention described in research literature. Information was summarized, including the following details: (a) gender of bully and victim, (b) type of bullying, (c) location of bullying, (d) responses of bystanders and adults, and (e) resolution of bullying problems. Considering this descriptive information, professionals are advised to more selectively recommend books to fit the unique needs of students and encourage desired bullying resolution strategies.

Results of three focus groups identifying issues facing educators who advocate for special education students are presented. Findings indicate that special educators regularly advocate for students with special needs but believe that there are risks, both personal and professional, associated with advocacy. Additionally, participants suggested that training was needed in the areas of special education law, communication skills, collaboration and conflict resolution, and teacher advocacy. Participants felt a need for support in their advocacy efforts from school administrators and professional organizations.

Bullying, a serious issue in today's schools, negatively impacts children. This article summarizes research and emphasizes the need for effective tools, such as bibliotherapy, to deter bullying. To assist professionals in selecting books for bibliotherapy, 38 bully-themed children's K-3 picture books ranked 1- 4 by The Horn Book Guide (HBG) from January 1, 2004 through January 1, 2010 were analyzed. Comparisons were made between the selected books' portrayals of bullying and aspects of bullying, and bully prevention described in research literature. Information was summarized, including the following details: (a) gender of bully and victim, (b) type of bullying, (c) location of bullying, (d) responses of bystanders and adults, and (e) resolution of bullying problems. Considering this descriptive information, professionals are advised to more selectively recommend books to fit the unique needs of students and encourage desired bullying resolution strategies.

In order to discover if differences or relationships exist between religiosity, spirituality, and marital relationships, 111 parents raising a child with a disability (CWD) and 34 parents raising typically developing children independently completed self-report questionnaires assessing religiosity, spirituality, and marital relationships. Parents raising typically developing children scored higher on private and public religiosity and marital satisfaction than parents raising a CWD; mothers scored higher on religiosity variables than fathers. Mothers' ratings of spirituality and family type (disability or typically developing child) predicted their ratings of marital conflict. Higher spirituality and raising typically developing children were associated with higher ratings of marital satisfaction for both mothers and fathers. However, spirituality also moderated the relationship between private/public religiosity and marital satisfaction only for fathers. This information helps improve interventions for families raising CWD and adds to the literature on the interplay of religiosity/spirituality/marital relationship.

Although many authors have identified guidelines in the evaluation and subsequent selection of contemporary children's literature, few have studied how individuals with mental retardation and autism (MR/A) are depicted in children's literature. Dyches and Prater (2000) took a unique approach in creating evaluation guidelines based not only upon general literary standards, but also with regard for the portrayal of individuals with disabilities (Turnbull, Turnbull, Shank, & Leal, 1999). Based on the Dyches and Prater guidelines, characterizations and plots in eligible children's books published during 1997 and 1998 were evaluated. Twelve books are discussed in detail, in terms of each guideline. The results showed that there was inconsistency in the books, in terms of the themes that emerged: (a) characterization and positive portrayal, (b) relationships, (c) changes in characters without MR/A, and (d) changes in characters with MR/A. Special topics that were present in the books are also discussed: schooling, recreation, and residence. The characters in the books were portrayed as making more choices in their lives, and were educated in more inclusive settings, than characters in books in an earlier study by Prater (1998). The conclusion highlights the use of this study as the basis of an international award for children's literature that includes characters with mental retardation and/or autism.

Like other young people, those with autism spectrum disorder (ASD) have an impact on siblings in both positive and negative ways. Research indicates positive attributes include maturity and responsibility; positive self-concept; less quarrelling and competition; admiration for the person with ASD; and satisfactory sibling relationships. Negative attributes include fear of frightening or violent behavior, decreased sibling intimacy, and social and emotional difficulties. However, most research relies on information from parents/teachers, rather than from siblings. Therefore, this qualitative descriptive study explored experiences of 11 brothers and 11 sisters living with a young person with ASD through audiorecorded semi-structured interviews. Analysis revealed the overall theme was contradiction. Participants recognized difficulties (decreased parental attention, extra responsibility, bothersome behaviors, communication difficulties) and positive aspects (became empathetic, loved and appreciated the child, realized the experience was life-changing) of living with a young person with ASD. Younger siblings frequently reflected on childhood experiences, wished they could play together, and mentioned what the young person could do. Adolescent siblings learned life lessons from the experience, talked about life changes when ASD was diagnosed, and seemed introspective and protective toward the young person with ASD. Male siblings often wished they played more often while growing up with the young person, and frequently mentioned the child/adolescent's aggressive behaviors; female siblings focused on relationship and communication difficulties of the young person ASD. Interventions to help siblings provide positive behavioral support, engage in developmentally appropriate play, and communicate reciprocally are warranted. Nurses can help parents understand siblings' perceptions and can encourage parents to support siblings.

Parents of children with disabilities are at risk for high stress and low marital quality; therefore, this study surveyed couples (n'='112) of children with Down syndrome (n'='120), assessing whether respite hours, stress, and uplifts were related to marital quality. Structural equation modeling indicated that respite hours were negatively related to wife/husband stress, which was in turn negatively related to wife/husband marital quality. Also, wife uplifts were positively related to both wife and husband marital quality. Husband uplifts were positively related to husband marital quality. Therefore, it is important that respite care is provided and accessible to parents of children with Down syndrome.

The consequences of bullying are both widespread and severe. It disrupts learning, threatens school safety, and poses long-term emotional repercussions for bullies, victims, and bystanders. Although multiple strategies have targeted bullying, bullying must be understood within a social contextual framework beyond the bully-victim dyad. Davis and Davis (2007) emphasize the importance of focusing on the broad base of bystanders, strengthening this vast majority of students to speak up and take an active stand against bullying. To this end, bibliotherapy is recommended as a potential tool to address these factors and to create positive, supportive, and inclusive classroom environments. Although frequently used by mental health professionals as an activity aligned with cognitive-behavioral therapy (CBT) and play therapy, bibliotherapy is also recommended for teachers and parents as a teaching aid to address social skills and normal developmental challenges. Grounded in principles of CBT, bibliotherapy supports classrooms in promoting and modeling desired social interactions. In turn, the majority of children--bystanders--will be empowered to actively take a stand against bullying. Reading carefully selected bully-themed literature and participating in related discussions and activities strengthens core prosocial messages and builds classroom unity against bullying. Additionally, stories help school psychologists and teachers initiate important classroom discussions about friendship, kindness, and conflict resolution. (Contains 12 resources and 5 online resources.)

Aim. The aim of this study was to describe what children and adolescents know and want to know about type 1 diabetes, from their perspectives. Background. Research indicates that young people?s knowledge of diabetes may minimize their health complications, because with greater knowledge they may engage in more effective management practices and adherence. Methods. In this qualitative study, a purposive sample of 58 children and adolescents with type 1 diabetes were interviewed regarding their perceptions of what they knew and wanted to know about their disease (data collection completed in 2005). Through a process of induction, major themes emerged from the analysis of the interviews. Findings. The six major themes included: (a) Care, including both physical and emotional care, (b) Physiology, (c) Consequences, including both short- and long-term, as well as positive and negative consequences, (d) Cure, (e) Effects on the Family, and (f) Experience at Diagnosis. Themes related to the unique challenges associated with type 1 diabetes also emerged. Conclusions. Nurses, diabetes educators, and parents should provide developmentally appropriate information for diabetes care and management, scaffolding on existing knowledge. They should provide child-centered contexts in which children and adolescents can freely ask questions about their condition and problem-solve. Programs that allow youth to develop coping skills and share experiences could also prove beneficial.

We investigated the daily stressors and coping responses of 19 children and 33 adolescents with type 1 diabetes (65% female). In this qualitative descriptive study participants were given a diary and for 2-3 weeks responded daily to open-ended statements regarding stressors and coping responses. Five broad themes of daily stressors emerged from the 736 coded diary entries: no stressor, ambiguous, people, self, and context. Coping responses emerged into three general themes: ambiguous, submission, and personal responsibility. Younger children reported more stressors related to friends/peers and siblings, and adolescents described more stressors related to self, parents, and school. Younger children used more coping that involved choosing an alternate activity, helping others, and an emotional response, whereas adolescents used more coping that involved persistence, alternate thinking, and talking things over. Youth with diabetes did not consider diabetes-related stressors to be the most salient in their daily lives.

The purpose of this study was to examine how support and communication are related to hardiness in families who have young children with disabilities. A sample of 108 parents (54 couples) of preschool-age children with disabilities completed the measures. Among demographic variables, family income was positively correlated with family hardiness. Hierarchical regression analyses revealed perceived family support as a predictor of family hardiness for both parents. Incendiary communication was negatively related to family hardiness for mothers, whereas income was positively associated with fathers' assessments of hardiness. Results provide family nurses with a foundation for exploring constructs important to help families with children with disabilities.

Authors of this qualitative descriptive study interviewed 30 parents concerning their experiences raising a child or adolescent with type 1 diabetes (T1D) and celiac disease (CD). Analysis revealed six themes: (a) health complications of T1D, (b) challenges of daily disease management, (c) financial concerns, (d) the young person's emotional/mental health, (e) experiences with healthcare providers, and (f) experiences with people outside the family and at school. Results suggest nurses need to be sensitive to challenges young people living with T1D and CD and their parents face, conduct ongoing assessments, and provide time during interactions to adequately address concerns.

Special education faculty members at Brigham Young University voluntarily participated in a four-year professional development program centered on increasing their cultural responsiveness. The program was particularly needed at the time given the recent increased cultural and linguistic diversity (CLD) in the local schools and the university's acquisition of a grant to support CLD teacher candidates completing the special education and English as a Second Language (ESL)/bilingual licensure programs. Overall professional development goals included preparing all special education faculty to (a) become educated in the Center for Research on Education, Diversity, and Excellence (CREDE) standards, (b) be knowledgeable about current issues in multicultural special education, (c) identify and infuse cultural competencies into courses and fieldwork, (d) be trained is ESL observation techniques, and (e) become familiar with and respond appropriately to the unique needs of CLD teacher candidates. Faculty committed to 16 hours of professional development each year. Activities included guest presentations by faculty internal and external to the university, faculty discussion groups, interviewing the CLD teacher candidates, and observing in ESL classrooms, among other activities. During the fourth year, faculty designed individual professional development plans with self-selected goals and activities. At the end of the fourth year the faculty members were interviewed regarding their perceptions of these experiences. Generally they found them to be very valuable with the teacher candidate interviews having the most impact. Additional future steps include reviewing course syllabi and observing university classrooms to ensure the knowledge gained is being implemented, followed by observing the cultural competence of teacher candidate graduates in K-12 classrooms.

Because characters with developmental disabilities (DD) in children?s books are often the first images many children encounter, their accurate and multidimensional portrayal is critical. Therefore, the depictions of characters with DD in 41 children?s books were analyzed. These books were eligible for the biennial Dolly Gray Children?s Literature Award, and were published between 2004 and 2007. Data were analyzed for four main themes, namely characterization, relationships, changes in characters, and special topics. Trends across this and two previous studies (Dyches, Prater, & Cramer, 2001; Dyches & Prater, 2005) include an increasing number of books published annually, increasing numbers of characters with DD who are culturally diverse, more positive portrayals, characters who are being more self-determined, engaging in more caregiving and teaching roles, and enjoying more inclusionary recreational activities. Recommendations for future authors and educational services providers are provided.

A study investigated perceptions of five junior high general-education teachers and three special education teachers participating on a collaborative inclusion team. Both general and special-education teachers were positive about the inclusion and the teaming and believed the arrangement provided a rich learning environment for students with disabilities.

Here's practical help for mastering the process of developing and writing quality individualized education programs (IEPs). This best-selling, essential resource includes step-by-step instructions backed by examples, practice, and feedback to help users gain the critical skills and knowledge they need to write effective IEPs, meet the standards of IDEA, and ultimately plan for students with disabilities. Guide to Writing Quality Individualized Education Programs includes an easy-to-understand summary of IDEA 2004; a workable organization of the IEP process into seven manageable steps; explanations, modeling, practice, and feedback for mastering each step of the process; and a brief procedural summary at the end of each step. The new edition features the latest information and references to help readers as they work through the process in such areas as: Recognizing and referencing IEPs for a variety of disabilities, genders, and grade levels. Basing IEPs on required state or core curricula. Phrasing goals that address standards, while also meeting the needs of students performing below-grade level. Understanding the role of Response to Intervention in addressing needs in the general classroom. Learning how the No Child Left Behind Act affects high-stakes testing for students with disabilities. Ideal for teacher candidates, in-service educators, parents and other IEP team members, the guide can be used for whole group instruction, out-of-class assignments, or as independent study.

Stress and burnout contribute significantly to the shortages of school-based speech-language pathologists (SLPs). At the request of the Utah State Office of Education, the researchers measured the stress levels of 97 school-based SLPs using the Speech-Language Pathologist Stress Inventory. Results indicated that participants? emotional-fatigue manifestations, instructional limitations, biobehavioral manifestations, lack of professional supports, and total stress were significantly below that of the original national sample. However, of the 48 survey items, participants? responses indicated more stress in three specific areas, namely, case load size, salary, and the use of prescription drugs. Caseload and salary have been identified in other studies as major sources of stress for SLPs. No significant differences in stress were identified with the type of school district (rural and urban), number of years? experience, or number of students served. Efforts to reduce stress levels of SLPs should be aimed at increasing supports, reducing caseloads, and increasing salaries.

The use of simple augmentative and alternative communication systems for physically able individuals with autism and severe disabilities has not been sufficiently explored. Individuals with severe physical disabilities have used switches primarily to gain control over their environment, yet these switches have the potential to also serve as communication strategies. Thus, investigation of switch training for communicative purposes is warranted. This action-oriented study examined the effects of switch training on the communication of four functionally nonverbal students with severe disabilities and autism. Several elements of communication were investigated: (a) number of communicative interactions, (b) number of spontaneous communicative interactions, (c) percentage of independent communicative interactions, and (d) number of verbalizations. Results indicated that switch training was an effective strategy for helping the students communicate a simple message. The benefits of switch use and implications for future research are discussed.

This study used photography to capture important symbols in the lives of 14 siblings of 13 youth with autism (ASD) and 16 siblings of 15 youth with Down syndrome (DS), and then determine if there were differences in photographs taken according to type of developmental disability, age, and gender of the sibling. Photographs were divided into two categories: photographs of people, including family and non-family members, and non-people, including personal items/objects, animals, and buildings/scenery. Siblings of youth with DS took a higher percentage of photographs of people and family members than siblings of youth with ASD. There were also differences according to age and gender in the people/non people and within family photographs. The 7-9-year-olds took a higher percentage of snapshots of typically developing siblings and him/herself whereas the 10-12-year-olds and the 13-16-year-olds took a higher percentage of photographs of the youth with the disability than the younger age group. Sisters took a higher proportion of people photographs than brothers, while brothers took a higher proportion of family photographs than sisters. Results validate the importance of gathering data in an open-ended manner directly from young people, confirm the use of photography as a method of facilitating communication with young people about important symbols in their lives, and indicate there are differences in the percentage of photographs taken of people/non people and family/non family according to disability, age, and gender of siblings.

Parent perceptions and attitudes regarding the inclusion of students with mild to moderate disabilities into general classrooms have been mixed. In this qualitative study, the parents of 17 students with learning disabilities and 1 student with behavior disorders were interviewed following the first year of a junior high inclusion pilot program based on teacher and student collaborative teams. Twelve response categories are identified. Parents recognized personal attention for students and positive attributes of teachers as strengths of the program and increased student self-esteem as a positive outcome. The results indicate that the majority of the parents were supportive of the program and wanted it to continue.

A study of 17 middle school students with learning disabilities examined their perceptions of their experiences with an inclusive delivery system organized around a team of teachers and students. Results found that most students preferred this delivery system to the pull-out program in which they had been involved the previous year.

Purpose The purpose of this pilot study was to explore relationships among metabolic control, self-care behaviors, and parenting in adolescents with type 1 diabetes. Methods Twenty-nine adolescents (mean age, 14.1 years) and their parents participated. Metabolic control was determined by an average of 4 A1C values taken prior to study enrollment; self-care behaviors were measured with a 12-item self-report questionnaire; parenting style was evaluated using the Parenting Practices Report. Results The mean for A1C values was 8.5%; the mean for overall self-care behaviors was 4.93 (5 = usually). Participants rated themselves highest on the self-care behaviors of giving insulin shots when indicated and adjusting insulin when eating a lot. They ranked themselves lowest on eating a low-fat diet and testing urine for ketones. Parents tended to be more authoritative in their approaches to parenting than either authoritarian or permissive. A significant relationship was found between authoritative mothering and adolescent self-care behaviors and metabolic control. Regression analyses controlling for age and length of time with diabetes confirmed the significance of these relationships. Authoritative fathering positively correlated with the self-care behaviors of monitoring blood glucose, taking insulin, and not skipping meals. A relationship was also noted between permissive parenting by mothers/fathers and poorer metabolic outcomes. However, the permissive parenting correlations did not remain significant when controlling for age and length of time with diabetes. Conclusions Clinicians may help prevent declining participation in self-care behaviors and metabolic control in adolescents with type 1 diabetes by working with parents, particularly mothers, and encouraging authoritative parenting.

The purpose of this article is to briefly describe each of the books on our top 25 list so that readers can make informed decisions when selecting books which include characters with disabilities. Included are 14 chapter and 11 picture books. Interestingly these books span a wide range of publication dates ? the oldest was first published in 1955 and the most recent in 2006. Almost all of the 13 disabilities recognized by the Individuals with Disabilities Education Act are portrayed. Five of the books received the prestigious Newbery Medal or Honor award and one the Caldecott Honor. Five additional books earned either the Dolly Gray or Schneider Family Awards. These two awards specifically honor juvenile books that portray disabilities. Fourteen of our selected books did not win noteworthy awards, but deserve attention for their literary and artistic qualities, as well as their appropriate and realistic portrayals of disabilities.

Newbery books represent quality literature that has a profound social-emotional impact on its readers, yet these books have not been systematically evaluated for their portrayal of characters with disabilities. Thirty-one Newbery Award and Honor books from 1975'2009 were identified and portrayed 41 main or supporting characters with disabilities. These books were evaluated using the Rating Scale for Quality Characterizations of Individuals with Disabilities in Children's Literature. Results indicate the representation of Newbery characters with disabilities is not proportionate to the current U.S. population of students with disabilities. Further, racial representation portrayed in these books is not representative of the students receiving special education services. Trend analyses indicate that overall the portrayal of characters with disabilities is increasingly positive. School personnel are encouraged to select appropriate books for their instructional or bibliotherapeutic purposes. Authors are encouraged to include dynamic, exemplary, and memorable characters who are representative of today's school population of students with disabilities.

Educational professionals agree that traditional preservice preparation has been inadequate in preparing educators to teach culturally and/or linguistically diverse students. Reasons for this lack of preparation are generally identified as an insufficient number of diverse teacher candidates and poor infusion of culturally competent practices across programs. Most universities and colleges have responded to these needs, but neglect the need to improve faculty members' own cultural competence. We present the journey taken by one traditional special education teacher preparation program to increase the number of diverse candidates enrolled, infuse cultural diversity competence across the program, and improve faculty members' sensitivity and appropriate responses toward cultural differences.

Using family systems theory as a theoretical framework, we investigated direct and indirect associations between type of disability, caregiver burden, and sibling relationships with structural equation modeling. We recruited 172 families raising typically developing children or a child with a disability. Participants volunteered at meetings and workshops for families of children with disabilities and were also recruited through snowball sampling. Mothers and fathers independently completed self-report questionnaires on caregiver burden and perceptions of the sibling relationship. Mothers experienced higher levels of caregiver burden than fathers. Parents of children with autism reported higher levels of caregiver burden than parents of typically developing children. Mothers of children with Down syndrome and multiple disabilities reported more positive sibling relationships than mothers of typically developing children. Mothers' and fathers' perceptions of caregiver burden were negatively related to their perceptions of the sibling relationship. Caregiver burden mediated the relationship between having a child with autism and positive sibling relationships. Results indicate the benefits of using a systems framework in examining families raising children with disabilities. Future research should focus on interventions for families of children with disabilities that help alleviate parental burden and foster positive sibling relationships. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

This article provides current information relevant to school social workers who serve students with obsessive-compulsive disorder (OCD), including how OCD is defined in children and adolescents, the impact of OCD on schooling, issues in identifying students with OCD, and effective interventions. The authors offer suggestions for collaboration among school personnel and families and for linking school with home. Finally, they present recommendations for educating peers of students with OCD. (Contains 2 tables.)

Background: Raising a child with a disability (CWD) in the home is increasing across the globe. Due to caregiver burden and the complexity of care, there is growing concern for typically developing sibling (TDS) outcomes. Objective: To examine whether caregiver burden, parenting style, and sibling relationships in families raising a CWD predict cooperative and externalizing behaviors in TDS. Methods: This correlational study included 189 families raising both a CWD and a TDS. Multilevel modeling was used to identify which variables were most predictive of TDS outcomes and if there were parent gender effects. Results: Authoritative parenting was positively associated with cooperative behaviors. Authoritarian parenting was positively associated with externalizing behaviors. Multilevel modeling revealed caregiver burden was a significant predictor of sibling behaviors in the first model. When parenting style was added as a predictor, it was also significant. When sibling relationships were added as predictors, they were significant predictors for both cooperative and externalizing TDS behaviors; however, caregiver burden was no longer significant. Authoritarian parenting significantly predicted externalizing behaviors, and authoritative parenting was significantly related to cooperative behaviors. Discussion: In families raising a CWD, positive sibling relationships may help negate the effects of caregiver burden and are more predictive of TDS outcomes than some parenting practices.

The purpose of this qualitative, descriptive study was to use photography to capture important symbols in the lives of 17 siblings living in families raising a child with Down syndrome (DS). The siblings used disposable cameras to take photographs over a two-week time period of what was important to them. Content analysis discovered the photographs could be categorized into two major categories: people/non-people. Photographs in the people category included snapshots of family members and friends. Photographs in the non-people category were of important objects (toys, books, electronics), animals (domestic and non-domestic) and buildings (house, school, church). Stories about the photographs reflected experiences siblings had with people/non-people in the snapshots, as well as everyday activities. Results validate the importance of gathering data from children using qualitative methods and confirm the use of photography as one of these methods.

BACKGROUND: Past research focused on the effects of raising a child with autism spectrum disorder on families. However, most research examined parents' perspectives rather than siblings' perspectives. Therefore, the purpose of this qualitative descriptive design was to use photo elicitation to capture perspectives of siblings living with a child with autism spectrum disorder. METHODS: Fourteen siblings (nine male) of 13 children with autism spectrum disorder received disposable cameras with 24-27 colour exposures, and were asked to photograph what was important to them within 2 weeks. After developing snapshots, investigators interviewed siblings about their photographs, and used open, axial and selective coding to determine photograph categories and subcategories. RESULTS: Two major categories were found: people (family members, non-family members) and non-people (personal items/objects, animals, buildings, scenery). Interviews about photographs reflected experiences siblings had with people/non-people in the snapshots and their normal everyday activities. Most photographs revealed family life and activities any sibling would experience whether or not they lived in a family raising a child with autism spectrum disorder. CONCLUSIONS: Photo elicitation facilitates communication between children and health-care professionals, and provides information about living with a child with autism spectrum disorder from the sibling's perspective. This information contributes to our knowledge base and allows development of specific intervention plans for siblings of these children.

Introduction: Using family systems theory as a theoretical framework, we examined differences in sibling relationships and caregiver burden by parent gender and type of disability. We also investigated direct and indirect associations between type of disability, caregiver burden, and sibling relationships with structural equation modeling. Methods: We recruited 172 families raising typically developing children or a child with a disability (CWD). Participants volunteered at meetings and workshops for families of CWD and were also recruited through snowball sampling. Mothers and fathers independently completed self-report questionnaires on caregiver burden and perceptions of the sibling relationship. Results: Mothers experienced higher levels of caregiver burden than fathers. Parents of children with autism reported higher levels of caregiver burden than parents of typically developing children. Mothers of children with Down syndrome and multiple disabilities reported more positive sibling relationships than mothers of typically developing children. Mothers' and fathers' perceptions of caregiver burden were negatively related to their perceptions of the sibling relationship. Caregiver burden mediated the relationship between having a child with autism and positive sibling relationships. Discussion: Results indicate the benefits of using a systems framework in examining families raising a CWD. Future research should focus on interventions for families of CWD that help alleviate parental burden and foster positive sibling relationships.

[...] concentrating on schoolwork and completing homework are the two most common problems in school-aged children with OCD (Piacentini, Bergman, Keller, & McCracken, 2003). Because obsessions interfere with concentration, students with OCD often perform below their potential on such academic tasks as reading and computation (Adams, 2004; APA, 2000). [...] more people will read a book to help themselves than will visit a mental health professional (Norcross, 2006); therefore, school professionals should have knowledge about books to recommend to families who are living with a child with OCD.

Children with type 1 diabetes need to monitor their blood glucose and food intake, administer insulin, and participate in physical activity during school hours. School concerns for this group include school personnel, the medical directive plan, classmates, school lunches, and physical education classes. Nurse practitioners should take an active role in advocating for improved T1DM management in schools by talking with patients and their parents about experiences in school, identifying challenges and discussing possible solutions for improving diabetes management during school hours, and accessing online resources to assist patients, parents, and school personnel.

Obsessive-compulsive disorder (OCD) i s a neurobiological condition affecting 1 of every 200 school-age children. OCD greatly affects students' academic, behavioral, and social functioning, and it can lead to additional problems such as depression. To effectively collaborate with other individuals providing appropriate support to students with OCD, teachers need to understand this disorder, particularly its manifestations in school settings. This article addresses typical manifestations of OCD in school settings and provides general and specific accommodations for teachers to implement in their classrooms.

AIMS AND OBJECTIVES: To identify challenges children and youth with type 1 diabetes encounter from their own perspectives. BACKGROUND: Type 1 diabetes requires lifestyle changes involving diet modification, monitoring blood glucose, counting carbohydrates and administering insulin. Learning self-care and developing positive attitudes can improve glucose management and promote long-term benefits. Therefore, understanding challenges of youth living with type 1 diabetes from their own perspective is an important first step in improving diabetes outcomes for this age group. DESIGN: Qualitative descriptive design using focus groups to identify the experiences and challenges of children and youth living with type 1 diabetes. METHODS: Six focus groups were held over a four-month period in 2010; each participant attended one focus group. A total of 16 children and youth with type 1 diabetes participated. The focus group discussions were audio recorded, transcribed verbatim and analysed for common themes according to qualitative methodology. To assure trustworthiness, investigators independently coded interviews and themes were refined and adjusted until consensus was reached. RESULTS: Three themes emerged after analysing transcripts from the focus groups that embody challenges children and youth with type 1 diabetes faced: (1) low blood glucose; (2) self-care activities; and (3) feeling different and/or alone. CONCLUSIONS: Data indicated type 1 diabetes is challenging for this age group. These challenges must be addressed to assist youth in learning to manage their disease and promote healthy outcomes. RELEVANCE TO CLINICAL PRACTICE: It is important for nurses to discuss challenges, understand perspectives of this age group, listen to their concerns, work with them to develop strategies promoting health, minimise complications, reduce or eliminate feeling different or alone and assist parents' efforts to be supportive.

This article provides current information relevant to school social workers who serve students with obsessive-compulsive disorder (OCD), including how OCD is defined in children and adolescents, the impact of OCD on schooling, issues in identifying students with OCD, and effective interventions. The authors offer suggestions for collaboration among school personnel and families and for linking school with home. Finally, they present recommendations for educating peers of students with OCD.

Researchers suggest that video-based interventions can provide increased opportunity for students with disabilities to acquire important academic and functional skills; however, little research exists regarding video-based interventions on the academic skills of students with autism and intellectual disability. We used a multiple-baseline-across-participants design to investigate the effects of video self-modeling (VSM) on the mathematics skill acquisition of adolescents with autism. Four adolescent male students viewed videos of themselves on an iPad solving mathematical problems to estimate the amount of money used to pay for a given item and the amount to receive in change. Findings support a functional relationship between VSM and performance on math skills for each participant. Subsequently, the VSM was systematically faded during maintenance sessions, with little deterioration of skill. Follow-up data probes were interpreted to conclude that student characteristics may affect retention of skill. Implications for practice and research are discussed.

Children's literature often portrays characters with disabilities. These books may be used to promote awareness, understanding, and acceptance of those with diabilities. We provide guidelines for selecting high quality literature and present ideas for using characterizations of learning disabilities to teach students about themselves and others. Two sample lesson plans and a list of 30 recommended books are included.

Researchers suggest that video-based interventions can provide increased opportunity for students with disabilities to acquire important academic and functional skills; however, little research exists regarding video-based interventions on the academic skills of students with autism and intellectual disability. We used a multiple-baseline-across-participants design to investigate the effects of video self-modeling (VSM) on the mathematics skill acquisition of adolescents with autism. Four adolescent male students viewed videos of themselves on an iPad solving mathematical problems to estimate the amount of money used to pay for a given item and the amount to receive in change. Findings support a functional relationship between VSM and performance on math skills for each participant. Subsequently, the VSM was systematically faded during maintenance sessions, with little deterioration of skill. Follow-up data probes were interpreted to conclude that student characteristics may affect retention of skill. Implications for practice and research are discussed.

Increasing numbers of students in U.S. schools are at greater risk of school failure because of social, economic, and family stress factors. Teachers can use literature as bibliotherapy for both children and adolescents to create a safe distance, allowing them to deal with sensitive issues related to these problems, as well as to teach social skills that can then help prevent school failure. In this article, the authors present a 10-step process for implementing bibliotherapy in the classroom and provide a sample of juvenile books that could be used in bibliotherapy.

Aim To explore if young people with higher and lower levels of metabolic control of type 1 diabetes have different perceptions about their lives and illness. Background Adolescence through emerging adulthood is a developmental stage made more challenging when the person has type 1 diabetes. Little research has investigated if individuals with high and low levels of metabolic control in this age group perceive their disease differently. Design Qualitative descriptive. Methods In this study, 14 participants, ages 11'22 years were interviewed in 2008 about their perceptions of living with type 1 diabetes. Through a process of induction, major themes were identified. Results/findings Participants with high and low metabolic control levels reported similar themes related to reactions of others, knowledge about type 1 diabetes, and believed healthcare providers used authoritarian interactions. However, high metabolic control level participants believed type 1 diabetes would be cured; had negative initial responses to being diagnosed; rarely received parental support in managing their diabetes; and were negligent in self-care activities. Participants with low metabolic control levels did not believe a cure was imminent or have negative responses to being diagnosed; received parental support in managing diabetes; and were diligent in self-care activities. Conclusion Nurses should give information to young people with type 1 diabetes beyond initial diagnosis and help and support this age group learn appropriate ways to manage their disease, develop positive relationships with healthcare professionals, and participate in interactions with others their age successfully managing type 1 diabetes.

The authors read all of the books that received Caldecott Medal and Honor status awarded between 1938 and 2005 and found that 11 included a character with a disability. For each book, they analyzed characterizations of those with disabilities and generated tips for using the book to teach about disabilities. They argue that accurate portrayals of characters with disabilities, particularly the types of disabilities encountered most frequently by young children, are needed in award-winning picture books.

Chapter 1: Bullying and the Opposing Power of Bystanders Chapter 2: Sharing Books with Your Classroom: The Basics of Bibliotherapy Chapter 3: Lesson Plans: Strengthening Classroom Bystander Support Chapter 4: Lesson Plans: Vulnerable Classmates

The purpose of this descriptive exploratory study was to explore the meaning of being a sibling using Parse's human becoming perspective. Twelve children between 5 and 15 years of age with a younger sibling with a cleft lip and palate or Down Syndrome participated. Through semi-structured interviews and the use of art, children talked about their experiences. Major themes portrayed the complex and paradoxical nature of being a sibling. The themes also revealed that having a sibling with special circumstances includes some unique opportunities and challenges. The finding of this study is the descriptive statement, being a sibling is an arduous charge to champion close others amid restricting-enhancing commitments while new endeavors give rise to new possibilities. Implications for nursing are discussed in the context of understanding being a sibling.