Typically developing siblings of a child with autism spectrum disorder may be at increased risk of mental health difficulties. A support group is one approach to improve mental health outcomes for typically developing siblings. During support groups, typically developing siblings discuss their feelings, learn coping strategies and problem-solving skills, and develop a peer network. We conducted a randomized controlled trial comparing a support group to an attention-only social control group. Some areas of mental health improved. Autism spectrum disorder symptom severity in the sibling with autism spectrum disorder moderated effects. Findings suggest continuing to examine what areas of mental health and adjustment are improved with support groups and subgroups of typically developing siblings for whom support groups might be particularly effective. Lay abstract Typically developing siblings of a child with autism spectrum disorder may show mental health difficulties. A support group is one approach to help typically developing siblings. During support groups, typically developing siblings discuss their feelings, learn coping strategies and problem-solving skills, and develop a peer network. We compared a support group to participation in a similar group without a focus on the sibling with autism spectrum disorder. Some areas of mental health improved. Improvements were also impacted by autism spectrum disorder symptom severity in the sibling with autism spectrum disorder. Findings suggest continuing to examine how support groups can help typically developing siblings and for which siblings support groups might be particularly effective.

Many persons with autism spectrum disorder (ASD) have clinically significant anxiety, with 17.4% presenting with symptoms characteristic of obsessive-compulsive disorder (OCD; Van Steensel, Bögels, & Perrin, 2011). OCD is characterized by intrusive thoughts, urges or images (obsessions), and engagement in repetitive behaviors or mental acts (compulsions) assumed to reduce anxiety or distress (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; DSM-5; American Psychiatric Association [APA], 2013). A diagnostic requirement of ASD is restricted and/or repetitive behavior (RRB) that includes stereotyped movements, self-injury, need for sameness, compulsions, ritualized verbal and nonverbal behavior, and circumscribed or perseverative interests (APA, 2013). Increasingly, researchers differentiate RRBs as "higher level"-for example, washing, rigid routines, ordering, and arranging-that resemble OCD symptoms, and "lower level"-for example, restricted stereotypy and selfinjury (

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