While this exploratory study did identify many themes involved in the experience of living with individuals with FASD, there are still many limitations to consider. The first limitation to this study was the sample size. Although using a minimum of six participants is often recommended when conducting qualitative interviews using a phenomenological approach (Denzin & Lincoln, 1994; Kuzel, 1999; Morse, 2000), because this study is mixed methods, it was the quantitative portion that posed limitations. First, the sample size was too small to detect statistically significant differences or relationships (Cohen 1992; Schmidt, 1996; Schmidt & Hunter, 1997), and second, the use of a non-random sample limits the generalization of results to the larger sibling population (Onwuegbuzie, Jiao, & Bostick, 2004). The latter is especially true as this sample sought to include all siblings, both adoptive and biological, however, aside from one half-sibling, only adoptive siblings asked to participate in the current study, limiting generalizations to biological siblings of individuals with FASD. The small sample size also limited the ability to expand on population sub-groups such as age differences in the sample. With three participants in their early teens, three in their mid-late teens and four above 20 years, qualitatively the sample size was not big enough to make specific generalizations to each sub-
group. However, it is important to convey that age differences did exist within this sample. This was especially evident when asking the participants about future caretaking, where the older population did report more stress associated with future caregiving than did the younger
individuals. As individuals got older they were better able to highlight some of the more complex emotions such as resentment, they highlighted issues with mental health, better explain the strain their parents faced. Interestingly, older participants were able to raise the issue of role
reversal/confusion which focused on having to play a parent role to their sibling or act as an older sibling although they were younger. Nevertheless, it would be beneficial to examine the specific experience of both young and older siblings of individuals with FASD to gain
knowledge on their stressors and outlook over time.
Despite the downfalls, the greatest benefit to this study is the integration of both the quantitative and qualitative data across the conceptualization, experiential and inferential stages, as suggested by Teddlie and Tashakkori (2009). The combination of both methods, in turn increased the depth, strengthened the themes and provided a greater degree of trustworthiness, more so than what either method could have provided alone (Creswell, 2014; Guest, MacQueen, & Namey, 2012; Teddlie & Tashakkori, 2009).
Transparency was also a key factor in improving the degree of trustworthiness in the qualitative analysis (Guest et al., 2012). As mentioned, the incongruities between the qualitative and quantitative data were included and presented by the researcher. For example, some
questions pertaining to the public’s reactions on the DHUS indicated that the public stared
sometimes or less so, causing siblings to be only a little bit upset, according to the majority of the participants. But, in the interviews, many siblings commented on the public giving strange looks, suggesting that this type of experience was more impactful among siblings than previously
indicated in the quantitative measures. It was discrepancies like these that were included, increasing the reciprocity of information between the researcher and the audience. These inconsistencies across methods of data collection also highlighted the importance of including more than one method of gathering information as one may be able to identify information that the other may not. Additionally, the member checks which were conducted, ensured that
participants perspectives were honoured and accurately conveyed, increasing the trustworthiness of the study.
Given that all of the siblings diagnosed with FASD were adopted, this study is representative of the adoptive population, which makes up approximately 80% of infants in foster care (Dicker & Gordon, 2004). Although these results are generalizable, knowing if the themes are reflective of either the disability or the adoptive status is difficult to identify as it is challenging to separate genetic and environmental factors. In order to gain more knowledge on the matter, future research should consider studying and comparing the presence of a family member with FASD in biological families. Though this type of study would be ideal it may be challenging to gather biological siblings without FASD due to the many siblings that are likely to be affected by FASD.
Last, the questionnaires that were used during this study were normed for individuals between the ages of 6-16 years. However, in the current study, participants from the ages of 11- 37 used these measures. To be specific, almost half of our sample used questionnaires that were not normed for their age. The problem this posed was that participants who were older and out of their childhood setting had to think back to how they thought and felt during this time, which decreased the validity of the questionnaires. Self-report measures also present a number of biases such as social desirability bias whereby the participants will answer questions in a way that
makes them look favorable to the researchers. For example in the present study, the Sibling Inventory of Behaviour asked participants to rate their sibling’s behaviour towards them on a number of items and vice versa. In many of the items, the siblings recorded themselves as helping and caring much more than their siblings with FASD. Thus, there is a possibility that they made themselves look much more favourable to the researcher or maybe, due to the feelings of resentment discussed, they made their sibling look worse.
Another type of bias in a questionnaire is end aversion, where participants will avoid the ends of the scales and respond in the middle section to be conservative (Choi & Pak, 2005). Though social desirability may also play a role in this bias, there were numerous items in the questionnaires where siblings responded in the middle, selecting “sometimes”, and avoided using the ends of the scales. Additionally, some siblings also felt guilty about saying anything bad about their sibling with FASD evidenced by the participant’s hesitation, worrisome tone, or them following up with a positive statement about their love for their sibling. Thus, avoiding the ends may have made them look favourable as well. Despite the potential biases, the results presented in this study are likely a valid representation of the population as they were congruent with the themes and supported by the qualitative data.