Katherine Schwab
Using the NBO to Facilitate Sibling AMOR
by Katherine Schwab LMHC, ECMH-E®
I am a therapist in private practice, and I specialize in Early Childhood Mental Health with Neurodivergent (ND) children. As most of my clients are preschool and very early elementary aged, I struggled a bit to figure out how I was going to utilize the NBO in my work. Additionally, I was trained during the heart of COVID lockdown, so all my work was being done via telehealth. I finally got my first opportunity when one of the families I work with told me that they were expecting another baby.
Knowing that transitions can be much more challenging for the ND population, I started to think about how to conduct the NBO with families to help the older siblings get to know their infant sibling and become more comfortable with their role as an older sibling.
Over the course of COVID, I completed NBOs (via telehealth) with several families whose older children ranged in age from 3 to 11. I asked the parents to interact with the baby for certain tasks and invited the older sibling(s) to take part in activities such as hand grasp, habituation to light/sound, orientation to sound, visual tracking, and response to face and voice. For any items that I asked the older sibling(s) to help with, I first modeled the task (using a stuffed animal and my NBO tool kit and asking the family to find something similar at home) then reviewed their “job” before they started.
One of the most meaningful “A-ha!” moments I noticed during several of the NBOs was teaching families how to use pressure on the back side of the hand to help release the infant’s hand grasp reflex. When explaining that this could be useful if the baby grabs onto a sibling’s toy, clothes, or hair, families were excited to have a way to solve a potential problem in a simple, safe manner.
Additionally, I began to use some of the concepts from frameworks such as Social Thinking® and The Zones of Regulation™ during my NBOs, as my clients are often familiar with these through working with SLPs and OTs. In particular, I have had some success with using concepts such as “thinking with our eyes” and being a “Social Detective” to help older siblings begin to observe their infant sibling. Older siblings had a chance to watch their infant sibling’s reactions and responses to various interactions, and to consider what volume of voice, types of facial expressions, and types of movements might be enjoyable to the baby and beneficial for connection. Using the Zones, older siblings were able to observe the changes in state of their infant sibling, and realize when their infant sibling would be more open to interactions with them.
Lastly, I found that whenever an infant was fussy or crying during an NBO, this presented an opportunity to discuss coping skills for the older siblings. Some siblings wanted to try to help their parent(s) soothe the baby, while others who were more sensitive to noise preferred putting on headphones or going into another room. The NBO offered a chance to help families understand ways to validate and support an older sibling’s experience of a crying infant.
I have really enjoyed using the NBO as a tool to help build sibling connections in the families I am working with. I propose the following Sibling AMOR for everyone’s consideration.
A – Adjustment – The addition of a younger sibling is an adjustment for everyone in the family, especially the existing child(ren). It is important to honor this and offer support for this adjustment.
M – Mentalizing – How can we support the older sibling(s) with understanding that their infant sibling is an individual with their own skills, needs, and ways of communicating and interacting?
O – Observing – How can we support the older sibling(s) with the skills of observing and wondering about their infant sibling?
R – Role change – What is it like for the older sibling to transition to their new role? How can this best be supported?
I believe that including the older sibling(s) in a family NBO can assist with these skills, helping to ease the adjustment for older sibling(s) and begin to build strong connections within the family.
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