Siblings of children with disabilities are more likely than those with typically developing brothers or sisters to struggle with relationships, schoolwork, behavior and leisure time, a new study suggests.

In what’s believed to be the largest study of its kind, researchers looked at responses from parents of 245 children whose siblings had disabilities compared to feedback from parents of 6,564 children with only typically developing siblings. Kids were considered to have a disability if they were limited or unable to do things that other children their age could.

Overall, researchers found that parents of children with disabilities reported that their typically developing sons and daughters were more likely to feel sad, nervous or afraid. They also cited more problems with behavior, relating to adults or kids, completing schoolwork and participating in recreational activities, according to the study published online Monday in the journal Pediatrics.

What’s more, siblings of those with disabilities had higher levels of significant functional impairment than those with only typically developing brothers or sisters, the study found. Functional impairment is considered a key indicator that mental health services are needed, the researchers said.

“Environmental factors including stress, parenting styles, poverty status and living arrangement during childhood, together with biological factors, can have a direct and indirect impact on functional impairment in a child,” wrote Anthony Goudie of the University of Arkansas for Medical Sciences and his colleagues in the study. “We contend that one such environmental factor of note is growing up with a sibling who has a disability.”

The researchers said that their findings suggest that professionals working with children with disabilities should also be mindful of the impact on siblings and parents.

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