Attachment classification and dissociation in siblings of pediatric cancer patients

The purpose of this study was to examine attachment style and dissociation as correlates of sibling adjustment following a brother or sister's diagnosis of childhood cancer. Twenty families who had a child diagnosed with cancer participated in the study and parents completed a demographic questionnaire, the Child Behavior Checklist (CBCL), and the Parent Impact Questionnaire. Siblings completed the Child Attachment Interview (CAI), the Trauma Symptom Checklist for Children Alternate Version (TSCC-A), the Sibling Knowledge of Illness Test (SKIT), and the Sibling Impact Questionnaire. As in prior studies, dissociation and posttraumatic stress were highly related. This study found higher rates of insecure attachment in siblings of pediatric cancer patients as compared with normative samples. Specifically, siblings were found to demonstrate more preoccupied attachment than established norms. Siblings who were more preoccupied had more knowledge of their brother or sister's illness, more somatic complaints, and significantly higher levels of anxiety, depression, posttraumatic stress, and dissociation than siblings who demonstrated more dismissal. As a group siblings showed more internalizing problems and dissociation, while siblings who were insecurely attached to their maternal attachment figure demonstrated more externalizing problems and behavioral problems including aggression, opposition, and defiance. The present study also aids in identifying subsets of siblings that could be at higher risk for developing adjustment problems. Females showed higher levels of anxiety, depression, and somatic complaints. Siblings who had a brother or sister in an active stage of cancer showed significant levels of dissociation. Strengths and limitations of the study are discussed as well as directions for future research and clinical intervention with siblings of pediatric cancer patients.