Should parents of an autistic child have a second child?

Lisa Jo Rudy

Question: Should Parents of An Autistic Child Have a Second Child?

Our only child is four years old and has autism. My pregnancy and the first year and a half of our baby’s life went smoothly. When she stopped talking and regressed at 18 months, it was really hard at first, but she is making good progress. We love her dearly, but we realize that she will always need a lot of extra help in life. We have been able to get back to some semblance of a normal life, and now we are thinking about having another child, as we had planned before we knew our toddler was autistic, but we have our doubts. I seem to have more doubts than my husband. Can you give us some insight?

Answer: This question is, of course, only relevant to families who feel comfortable with birth control. But for those families, the question is very complex. Families with one autistic child do have an increased risk of having a second child with the disorder - and even a typical child may have a tough time coping with the reality of a sibling on the autism spectrum. Drs. Robert Naseef and Cindy Ariel are both psychologists with a specialty in families coping with special needs. Each has a slightly different take on the topic.

Dr. Robert Naseef's Response:

You are not alone, as an individual or as a couple, in facing the risks of what seems like a genetic lottery. Recent research now confirms that the risk of having a child who will be eventually diagnosed on the autistic spectrum is one in 150. In some parts of the country, it is close to one in 100. Even more sobering is that the chances of having a second child with autism are over 5%. While this is nothing to take lightly, still the chances of having a typical child are over 90%. This makes this a personal decision that will shape the rest of your life and your family’s life.

In our psychology practice, we have several families with more than one child on the spectrum. One thing is sure: These children are different as individuals in terms of their functional levels and their personalities. They are also quite connected to each other as siblings.

Some parents cope well, and others are overwhelmed beyond my ability to describe in words. Some have no regrets and love and cherish each child as unique and special in the universe. Others wish they had never tried to have another child and wonder what might have been. There are also couples who cannot make up their minds as well as couples deeply divided on the issue. There are also many people who had a typical child and feel “brand new.”

With all this in mind, we try to help people talk openly and honestly about their reasons for wanting another child and about how they would feel if they had another child with special needs. Also it is essential to consider what kind of life that hoped-for typical child might have. The most important thing is to not push your partner one way or the other while being really honest about how you imagine you would deal with a second child with autism as well as how you could deal with each other without trying to having a second child. Some people resent each other and even if they stay married they begin to live separate emotional lives.

Another way to look at life in your situation is to put all of your parenting energy in the child you have. The joy and satisfaction can make you happy for a lifetime, if you are secure with this decision for yourself and your marriage. Some people go the adoption route which is also not without risks. So you have a lot to think about. Definitely there is no right or wrong decision.

What’s important is how you get there. If you still can’t arrive at a decision you are both comfortable with, you might want to consider consulting with a mental health professional who has experience helping people sort out these kinds of dilemmas. Having a child with a disability such as autism certainly teaches how little we are in control of. What we do have control over is the decisions that we can make when we do so with an open and clear mind.

Dr. Cindy Ariel's Perspective:

This is one of the most difficult questions that comes up in our practice. It is much easier to help people to deal with the children and family that they already have than to discuss throwing in a wild card. This is a wild card because we know absolutely nothing of the child that is yet to be born. We do know that there is a significant risk that the second child will have an autism spectrum disorder, though, as Dr. Naseef points out, there is still an even greater chance that s/he will not.

During pregnancy, we are filled with hopes and dreams and the occasional worry that something could go wrong. When the baby does not live up to the original parental dreams and is born with or develops any kind of illness or disability, there is even more to worry about the second time around.

Now that you and your husband know firsthand about the risks in the genetic lottery, you realize the possibilities for nature to shift and surprise us. On the other hand, you also know that you can handle it. Your daughter’s progress attests to her own abilities as well as your abilities as loving and nurturing parents.

Doubts are normal during any couple’s decision to make dramatic changes in the constellation of their family. Adding a new life to the family will affect the current family and the new member in deep and countless ways. Having concerns about the health of the new baby may make it even harder when doubts surface before and during the pregnancy. The more you discuss and work out ahead of time, the less the worry will consume you as you move ahead with whatever plan you and your husband agree on.

If you do decide to have another baby, keep in mind that there may be some initial regression in your little girl; and a neurotypical sibling will eventually live with the struggles inherent in living with a sibling who does not develop in the same way as other children. Then again, many children with siblings with special needs develop a maturity and tolerance not seen as often in the general population; they can be the best kind of teacher, model and advocate the child with special needs can have.

You and your husband must also be prepared to love and nurture whatever child comes your way, including another child on the autism spectrum. These are not reasons to not go forward, but are things to be sensitive about as you and your husband do the necessary soul-searching and consider the future of your current family and any possible additions.

Robert Naseef, Ph.D., and Cindy Ariel, Ph.D., are the co-editors of "Voices from the Spectrum: Parents, Grandparents, Siblings, People With Autism, and Professionals Share Their Wisdom" (2006). On the web at

Courtesy of Lisa Jo Rudy,, a NYTimes Company

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