This article highlights some of the issues and challenges facing the siblings of autistic children. Sibling relationships are critical to interpersonal development. The birth of an autistic child brings issues of mourning and loss to the fore, forcing family members to readjust their fantasies, wishes, and expectations associated with “primary (maternal) preoccupation” (Winnicott, 1956) prior to the birth of the autistic child. Siblings (and families) may respond with denial, masochistic submission, guilt, and reaction formation, among other reactions. Implications for intervention, notably in the areas of psycho-education and clear communication, are discussed.