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Empowering Siblings through Creative Arts: Supporting the Whole Family in Autism Care

  • Muhamad Hafiz Hassan
  • Mohd Yusof Zulkefli
  • Adib Zakwan Al-Qayyum Shahbuddin
  • Ahmad Farid Abdul Fuad
  • Shahazwan Mat Yusoff
  • [acf field="fpage"]-[acf field="lpage"]
  • Apr 22, 2025
  • Education

Empowering Siblings through Creative Arts: Supporting the Whole Family in Autism Care

Muhamad Hafiz Hassan1*, Mohd Yusof Zulkefli2, Adib Zakwan Al-Qayyum Shahbuddin3, Ahmad Farid Abdul Fuad4, Shahazwan Mat Yusoff 5

5College of Creative Arts, Universiti Teknologi MARA, Cawangan Sarawak, Kampus Samarahan, Sarawak

2Fakulti Komunikasi dan Pengajian Media, Universiti Teknologi MARA, Shah Alam, Selangor

3Akademi Pengajian Bahasa, Universiti Teknologi MARA, Shah Alam, Selangor

4Pusat Asasi STEM, Universiti Malaysia Terengganu, Terengganu,

5Department of Curriculum & Instructional Technology, Faculty of Education, Universiti Malaya

*Corresponding Author: Adib Zakwan Al-Qayyum Shahbuddin2*

ABSTRACT

This phenomenological study investigates the role of creative arts in supporting siblings of children with Autism Spectrum Disorder (ASD) through a structured single-session intervention in Kuching, Sarawak. The research examines 25 sibling pairs participating in creative arts activities, employing pre and post assessments, observational data, and artwork analysis to understand the immediate impact of creative engagement on sibling relationships and family dynamics. Findings reveal significant improvements in sibling communication and emotional expression through artistic engagement. This research contributes to the growing body of knowledge on family support systems in autism care, particularly highlighting the potential of brief creative interventions in supporting sibling relationships.

Keywords—Autism Spectrum Disorder (ASD), sibling support, creative arts therapy, family dynamics, emotional expression, holistic support

INTRODUCTION

The impact of autism on family dynamics extends beyond the diagnosed child to significantly affect siblings, who often face unique challenges in understanding and adapting to their family situation. Recent studies indicate that siblings of children with ASD may experience increased stress, emotional challenges, and communication difficulties within the family unit (Hassan et al., 2024d). While much attention has been focused on parent support and interventions for children with autism, the needs of siblings often remain inadequately addressed.

The Ministry of Health Malaysia (2019) reports an increasing prevalence of ASD diagnoses, from 1 in 600 children to approximately 1.6% in recent years, highlighting the growing need for comprehensive family support approaches. This study builds upon previous research demonstrating the effectiveness of visual and creative approaches in autism support (Hassan et al., 2023), extending these principles to sibling support through structured creative arts interventions.

Recent research by Hassan et al. (2025) highlights that children with Autism Spectrum Disorder (ASD) often possess distinct visual-spatial abilities that can be effectively channeled into creative expression. This understanding provides a foundation for leveraging creative arts as a medium for supporting not only children with autism but also their siblings, who face unique challenges in navigating family dynamics.

Problem Statement

The challenge of supporting siblings in families affected by autism represents a significant gap in current support systems. Despite growing awareness of autism’s impact on family dynamics, siblings often face unique challenges that remain inadequately addressed by existing intervention programs. Recent research by Hassan et al. (2024d) indicates that siblings of children with autism experience heightened levels of stress and emotional complexity while navigating their family roles. This situation is particularly pronounced in Malaysia, where the increasing prevalence of ASD diagnoses (Ministry of Health Malaysia, 2019) has created an urgent need for accessible and effective sibling support programs. The lack of structured interventions specifically designed for siblings, combined with limited resources for implementing comprehensive support programs, creates a significant barrier to family well-being. Additionally, while creative approaches have shown promise in autism support (Hassan et al., 2023), there is limited evidence regarding their effectiveness in brief, intensive formats for sibling support. This research addresses these gaps by examining the potential of single- session creative arts interventions in fostering stronger sibling relationships and enhancing family dynamics.

Research Objectives

  • To examine the immediate impact of creative arts interventions on sibling relationships
  • To evaluate the effectiveness of single-session art activities in facilitating communication
  • To develop guidelines for implementing brief creative arts-based sibling support programs
  • To assess the potential of creative interventions in promoting family understanding
  • To establish a framework for sustainable creative support initiatives

LITERATURE REVIEW

Sibling Relationships in Autism Contexts

Recent research has highlighted the complex dynamics of sibling relationships in families affected by autism. Hassan et al. (2024d) emphasize the importance of understanding and supporting these relationships as part of comprehensive family care. Studies indicate that siblings of children with autism often experience unique challenges, including increased responsibility expectations, emotional processing difficulties, and communication challenges.

Recent research has highlighted the complexities of supporting family relationships in autism contexts. Zulkefli and Rabi (2021) emphasize that communication challenges often extend beyond the individual with autism to affect entire family dynamics. Their study of rural families demonstrated that siblings often develop unique coping mechanisms and communication strategies, though these may need structured support to be fully effective. Furthermore, Zulkefli et al. (2022) found that technology-assisted communication methods can significantly enhance interaction between family members, suggesting the potential value of incorporating creative and technological elements in sibling support interventions.

Creative Arts in Therapeutic Contexts

The therapeutic potential of creative arts has been well-documented in autism support contexts. Hassan et al. (2024b) demonstrate how visual-spatial abilities can be leveraged to enhance communication and expression. This finding is particularly relevant for brief interventions, where immediate engagement through artistic expression can facilitate rapid connection and understanding between siblings.

The effectiveness of creative approaches in autism support has been well-documented. Zulkefli and Rabi (2018) describe the challenges of communication and social behaviour as ‘drinking from a waterfall,’ emphasizing the overwhelming nature of traditional communication methods for individuals with ASD. Their research suggests that alternative communication channels, such as creative arts, can provide more manageable and effective means of expression. This is particularly relevant for sibling relationships, where shared creative activities can facilitate natural interaction and understanding.

Visual Communication and Support Systems

Previous research by Hassan et al. (2023) establishes the effectiveness of visual teaching tools in supporting children with ASD. The current study extends these findings by exploring how visual and creative approaches can strengthen sibling bonds and enhance family communication patterns, even in brief intervention formats.

Integrated Creative Arts Support Framework (ICASF)

This study proposes the following conceptual framework to show the gender disparities in artificial intelligence adoption.

Figure 1: Integrated Creative Arts Support Framework (ICASF)

Figure 1 shows that the integration of visual communication in autism support has shown particular promise in fostering family relationships. Zulkefli et al. (2021) demonstrate that computer-mediated communication can significantly enhance interaction patterns between individuals with ASD and their family members. Their research suggests that structured visual approaches not only facilitate immediate communication but also help build lasting communication patterns. This is especially relevant for sibling relationships, where shared visual experiences can create foundational bonds. Furthermore, Zulkefli and Rabi (2023) found that visual social stories can effectively modify behavior and enhance social understanding, suggesting that creative visual interventions may have broader implications for family dynamics.

The Integrated Creative Arts Support Framework (ICASF) presents a comprehensive approach to enhancing sibling relationships through creative arts interventions in autism support contexts. The framework synthesizes three key dimensions: input components, core processes, and targeted outcomes. Building on Zulkefli and Rabi’s (2021) findings on communication strategies and Hassan et al.’s (2024b) research on visual-spatial approaches, the framework demonstrates how creative arts activities can transform existing relationship dynamics into strengthened family bonds.

The framework begins with input components that consider existing sibling relationship dynamics, established communication patterns, and emotional connections. These elements feed into three interconnected core processes: Communication Development (progressing from primary communication to relationship enhancement), Creative Arts Activities (incorporating visual expression, collaborative creation, and shared storytelling), and Social Learning (moving from observation through to integration). Each process component builds upon and reinforces the others, creating a synergistic effect that aligns with Zulkefli et al.’s (2023) research on visual intervention effectiveness.

The framework culminates in three primary outcomes: enhanced understanding between siblings, improved communication patterns, and strengthened family bonds. This structured progression supports Hassan et al.’s (2024d) findings on the importance of comprehensive family support systems while incorporating Zulkefli et al.’s (2022) emphasis on technology- assisted communication strategies. The ICASF provides a practical model for implementing creative arts interventions in sibling support programs, particularly in brief, intensive formats as demonstrated in this study.

The proposed ICASF framework provides practical guidance for real-world implementation. Each component is linked to specific intervention steps: (1) Input Components require initial assessment of sibling relationships using structured questionnaires and observations; (2) Core Processes involve activities following established protocols, Communication Development activities begin with introductory games, followed by Creative Arts activities including collaborative drawing, and Social Learning is integrated through guided reflection; (3) Targeted Outcomes are evaluated using post-assessments and follow-up interviews. This framework can be implemented by art therapists, special educators, or social workers with minimal training, making it practical for resource-limited contexts.

METHODOLOGY

Research Design

This study employs a qualitative phenomenological approach examining the impact of a single-session creative arts intervention for siblings of children with autism. The research was conducted in Kuching, Sarawak, focusing on immediate effects of creative arts engagement on sibling relationships.

The phenomenological approach was selected based on research by Zulkefli et al. (2021), who demonstrated its effectiveness in capturing the lived experiences of families affected by autism. This methodology allows for deep understanding of both the challenges and opportunities in sibling relationships, particularly in the context of creative interventions.

Program Setting and Participants

Location: Kuching, Sarawak

Duration: One full-day session (6 hours)

Participants: 25 sibling pairs

Characteristic Number Percentage

Table 1: Participant Demographics

Neurotypical Siblings  
Age 7-10 10 40%
Age 11-14 8 32%
Age 15-16 7 28%

 

Gender    
Male   12                            48%  
Female 13 52%  
Siblings with ASD    
Age 5-8 12 48%  
Age 9-12 8 32%  
Age 13-15 5 20%  

The demographic data shows a balanced distribution of participants across age ranges and gender, which is crucial for understanding sibling dynamics in autism support. As noted by Zulkefli and Rabi (2021), family members, particularly siblings, play a vital role in supporting individuals with ASD, making the balanced representation in our study particularly significant. The age distribution of neurotypical siblings (40% aged 7-10, 32% aged 11-14, and 28% aged 15-16) aligns with research suggesting that early intervention in sibling relationships can positively impact family dynamics (Zulkefli et al., 2022).

Program Structure

Table 2: Detailed Program Structure and Activities

Phase Duration   Activities Materials Used Expected Outcomes
Introduction 1 hour •  Welcome briefing (15 min)

•              Ice-breaking games (20 min)

•  Pre-assessment (25 min)

•  Questionnaire forms

•  Name tags

•  Basic art supplies

•  Initial comfort level

•  Group cohesion

•  Baseline data

Creative Engagement 2 hour •           Basic art techniques (30 min)

•            Collaborative artwork (45 min) • Free expression (45 min)

•  Various paint types

•  Drawing materials

•  Canvas/paper

•  Skill development

•  Sibling interaction

•  Creative exploration

Sharing 2 hour •   Art gallery setup (30 min)

•  Story sharing (45 min)

•  Group interaction (45 min)

•  Display materials

•  Presentation space

•  Sharing circles

•  Pride in work

•  Communication skills

•  Peer connection

Reflection 1 hour •   Group discussion (20 min)

•      Post-assessment (20 min)

•  Closing ceremony (20 min)

•  Feedback forms

•  Certificates

•  Recognition items

•  Self-awareness

•  Progress measurement

•  Sense of achievement

The program structure reflects a carefully planned intervention incorporating elements of visual communication and social interaction, building on research by Zulkefli and Rabi (2018) regarding the importance of structured communication approaches for autism support. Each phase was designed to progressively build comfort and engagement, with the Creative Engagement phase particularly focusing on artistic expression as a communication medium. This aligns with findings from Zulkefli et al. (2021) about the effectiveness of visual and creative approaches in facilitating communication with individuals with ASD.

Data Collection Methods

Data collection incorporated multiple approaches:

Pre and Post Session Questionnaires

  • Standardized assessment tools
  • Rating scale: 1-5 Likert scale
  • Both closed and open-ended questions

Observational Data

  • Structured observation forms
  • Photo documentation
  • Interaction patterns
  • Engagement levels

Artwork Analysis

  • Visual documentation
  • Process documentation
  • Collaborative elements
  • Expression patterns

Table 3: Comprehensive Data Collection Methods

Method Tools Used Frequency Data Type Analysis Approach
Questionnaires •  Pre/Post forms

•  Likert scales

•Open questions

Twice Quantitative Statistical analysis, Mean comparison,

Thematic coding

Creative Engagement •   Structured forms

•                       Photo

documentation

•  Field notes

Continuous Qualitative Pattern recognition, Behavioral analysis, Interaction mapping
Artwork Analysis •                     Visual

documentation

•  Process records

•   Collboration notes

Throughout Mixed Creative assessment, Expression analysis, Style evaluation

The data collection framework was designed to capture both immediate and observable impacts of the creative arts intervention. The multi-method approach, as shown in Table 4, enabled comprehensive documentation of both quantitative changes in sibling relationships and qualitative observations of interaction patterns. This integrated approach, built on methodologies from Hassan et al. (2024b), allowed for triangulation of findings across different data sources, enhancing the reliability of our conclusions about the intervention’s effectiveness.

The comprehensive data collection framework integrates multiple methods to ensure robust analysis of the intervention’s impact. This approach is built on research by Zulkefli et al. (2023) demonstrating the importance of multi-modal assessment in autism interventions. The combination of questionnaires, creative engagement observation, and artwork analysis provides triangulated data supporting the validity of findings regarding sibling relationship changes.

Artwork analysis was conducted using the following systematic criteria: (1) Color usage and density (emotional value and intensity), (2) Composition and spatial organization (indicating relationship structures), (3) Collaboration in artwork (markers of interaction and problem-solving), (4) Subject selection and symbolism (revealing understanding and communication), and (5) Technical development (demonstrating patience and support). Each artwork was evaluated by two researchers independently using a structured rubric, with discrepancies resolved through discussion.

RESULTS

Questionnaire Analysis

Analysis of pre and post intervention questionnaires revealed improvements across measured dimensions:

Table 4: Pre and Post Session Questionnaire Results (n=25)

Dimension Pre-Session

Mean

Post-Session Mean Change p-value
Emotional Connection 2.9 3.8 +0.9 <0.01
Communication 2.7 3.7 +1.0 <0.01
Shared Activities 3.0 4.0 +1.0 <0.01
Understanding 3.2 4.1 +0.9 <0.01

The significant improvements in communication scores align with findings from Zulkefli and Rabi (2021), who identified that structured interventions can enhance family communication patterns. The post-session increase in shared activities scores (from 3.0 to 4.0) particularly reflects their observation that joint activities can serve as effective bridges for strengthening family bonds. Moreover, the improvement in understanding scores supports Zulkefli et al.’s (2022) findings regarding the importance of creating shared experiences for enhancing family relationships.

Qualitative Findings

Table 5: Thematic Analysis of Observational Data

Theme Key Observations   Frequency Representative Examples Impact Level
Enhanced Communication •Non-verbal cues

•  Verbal sharing

•Active listening

  High (85%) 1.       Joint artwork planning

2.       Spontaneous conversations

3.       Response to suggestions

Significant
Emotional Bonding •  Physical proximity

•  Emotional support

•  Empathetic responses

  Moderate (75%) 4.       Sharing materials

5.       Encouraging gestures

6.       Comfort during challenges

Moderate
Creative Collaboration •  Joint decision- making

•  Problem-solving

•  Shared creativity

  Very High (90%) 7.       Color choice discussions

8.       Design compromises

9.       Combined art style

Significant

The thematic analysis revealed strong patterns of improved interaction between siblings during the creative arts session. As illustrated in Table 5, the highest impact was observed in creative collaboration, where 90% of sibling pairs demonstrated significant improvements in their ability to work together. Enhanced communication emerged as the second most prominent theme, with 85% of pairs showing increased verbal and non-verbal interaction. These findings align with previous research by Hassan et al. (2023) on the effectiveness of visual communication tools in autism support.

DISCUSSION

The findings demonstrate the potential impact of even brief creative arts interventions in supporting sibling relationships within families affected by autism. The immediate improvements observed in communication and emotional connection suggest that structured creative activities can serve as effective catalysts for enhancing sibling bonds.

IMPLICATIONS FOR PRACTICE

The implications of this research extend significantly beyond the immediate context of the study, informing both practical implementation and theoretical understanding of sibling support in autism care. For program development, our findings suggest that even brief, intensive creative arts interventions can catalyze meaningful changes in sibling relationships. This has particular relevance for resource-limited settings, where full-length programs may not be feasible. The success of the single-session format indicates that well-structured, focused interventions can achieve significant immediate impacts, providing a practical model for implementation in various contexts.

The findings also inform professional practice in special education and family support services. The demonstrated effectiveness of creative arts as a medium for sibling connection suggests the need for incorporating artistic elements into existing support programs. Furthermore, the observed improvements in communication and emotional connection indicate that creative activities can serve as valuable tools for building family resilience and understanding.

The effectiveness of the creative arts intervention aligns with research by Zulkefli et al. (2023) on technology-assisted communication in autism support. Their findings suggest that alternative communication channels can significantly improve family dynamics when properly structured and implemented. The success of our single-session format particularly resonates with their observation that focused, well-designed interventions can catalyze meaningful changes in relationship patterns.

RECOMMENDATIONS AND SDG INTEGRATION

Our recommendations are deeply aligned with multiple Sustainable Development Goals, reflecting a commitment to inclusive, sustainable support systems for families affected by autism. In connection with SDG 3 (Good Health and Well-being), we advocate for the integration of creative arts interventions into existing healthcare and support services. This approach promotes mental health and emotional well-being not only for children with autism but for their entire family unit. The alignment with SDG 4 (Quality Education) is demonstrated through our emphasis on inclusive learning approaches that acknowledge and support the educational and emotional needs of all family members.

The research particularly resonates with SDG 10 (Reduced Inequalities) through its focus on enhancing family understanding and promoting social integration. The creative arts intervention model provides a framework for reducing communication barriers and fostering more equitable family dynamics. This approach, as demonstrated by Hassan et al. (2024d), contributes to building more inclusive communities by strengthening family bonds and promoting greater understanding of neurodiversity.

To translate the research findings into action aligned with SDGs, we propose the following concrete implementation strategies: (1) SDG 3 (Health and Well-being) – Integration of sibling support programs into existing healthcare services through the development of arts intervention resource kits for healthcare facilities; (2) SDG 4 (Quality Education) – Creation of training modules for educators based on the ICASF framework for implementation in inclusive school environments; (3) SDG 10 (Reduced Inequalities) – Development of community-based pilot programs in underserved areas using the creative arts intervention approach. Each strategy includes key performance indicators for monitoring progress and periodic reviews for program adaptation.

Our findings complement Zulkefli and Rabi’s (2021) work on family perceptions in rural areas, suggesting that creative interventions can be effectively adapted across different contexts. The observed improvements in sibling relationships support their assertion that structured support programs can enhance family understanding and acceptance. Furthermore, the integration of creative arts aligns with Zulkefli et al.’s (2022) recommendations for developing comprehensive support systems that address both communication and social-emotional needs.

This research builds upon and extends previous work by Zulkefli and colleagues (2018-2023) on communication support for families affected by autism. While their research established the importance of alternative communication channels, our study demonstrates the specific potential of creative arts in fostering sibling relationships. The success of our single-session format particularly supports Zulkefli et al.’s (2022) assertion that focused interventions can yield significant improvements in family dynamics.

The improvements observed in sibling communication align with findings from Hassan et al. (2025), who established a framework for collaborative co-creation between autistic children and professional designers. Their research demonstrated how creative engagement can serve as a bridge for meaningful connection, suggesting similar principles apply in sibling relationships. The Integrated Creative Arts Support Framework (ICASF) presented in this study extends these concepts to family support contexts, providing a structured approach to enhancing sibling bonds through creative engagement.

While this study demonstrates significant positive effects in a single-session intervention, we acknowledge the limitations in assessing long-term impact. Future follow-up studies involving assessments at 3, 6, and 12 months post-intervention are necessary to determine the durability of the observed changes in sibling relationships. We recommend longitudinal studies to evaluate whether the communication skills and emotional bonds developed through these creative arts interventions persist or require periodic reinforcement sessions.

CONCLUSION

This study makes several significant contributions to our understanding of sibling support in families affected by autism. First, it demonstrates the viability and effectiveness of single-session creative arts interventions in promoting positive sibling relationships. The immediate improvements observed in communication, emotional connection, and collaborative abilities suggest that even brief, structured creative engagements can catalyze meaningful changes in family dynamics.

Second, the research provides a practical framework for implementing creative arts interventions in resource-conscious settings. The success of the one-day program format offers an accessible model that can be readily adapted across various contexts and communities. This is particularly relevant in the Malaysian context, where the need for effective, scalable support programs continues to grow.

Third, the study contributes to the broader discourse on family-centered autism support, highlighting the often-overlooked needs of siblings while demonstrating practical approaches to addressing these needs. The integration of creative arts as a medium for connection and understanding offers a promising pathway for future program development and family support initiatives.

Looking forward, this research opens several avenues for future investigation, including the long-term impact of brief creative interventions, the potential for program scaling, and the development of culturally adapted versions for different communities. The findings support the continued exploration of creative approaches in building stronger, more resilient families affected by autism, while contributing to the broader goals of inclusive education and community support.

REFERENCES

  1. Hassan, M. H., Ahmad, M. F., Wardi, R. H., Abdullah, M. H., Isa, B., Safwan, N. S. Z., & Yusoff, S. M. (2024a). The influence of Picture Exchange Communication Systems (PECS) on the affective development of speech utterances in Autism Spectrum Disorder (ASD). Journal of Contemporary      Health       Research, 14(2), Article    4088. https://jchr.org/index.php/JCHR/article/view/4088
  2. Hassan, M. H., Wardi, R. H., Abdullah, M. H., & Isa, B. (2024b). Leveraging visual-spatial abilities to unlock speech: An arts-based interdisciplinary approach to promoting inclusion and equity for children with autism. Idealogy Journal, 9(1), 96-102. https://doi.org/10.24191/idealogy.v9i1.513
  3. Hassan, M. H., Wahed, W. J. E., Wardi, R. H., Abdullah, M. H., Isa, B., & Ahmad, M. F. (2023). Help me help you: Designing visual teaching tools for the Autism Spectrum Disorder (ASD) children. International Journal of Art and Design, 7(1), 106-117. https://journal.uitm.edu.my/ojs/index.php/IJAD/article/view/1152
  4. Hassan, M. H., Wardi, R. H., Silah, S. B., Abdullah, M. H., Michael, V. A., Isa, B., & Ahmad, M. F. (2024d). Building inclusive communities: Examining expert perspectives on support systems for families with autistic children in Malaysia. Malaysian Journal of Social Sciences and Humanities,      9(11),         e003097-e003097. http://www.msocialsciences.com/index.php/mjssh/article/view/3097
  5. Hassan, M. H., Wardi, R. H., Isa, B., Michael, V. A., Hassan, M. M., Abdullah, M., & Silah, S. (2024c). A study on The Preferred Sensory Modalities for Learning among Children with Autism      Spectrum Disorder      (ASD).      Telematique,                23(01),       181-193. https://scholar.google.com/citations?view_op=view_citation&hl=en&user=F3Z92GMAAAAJ&citation_for_view=F3Z92GMAAAAJ:tKAzc9rXhukC
  6. Hassan, M. H., Wardi, R. H., Michael, V. A., Ahmad, M. F., & Safwan, N. S. Z. (2025). Collaborative Co-Creation: Transforming Naive Art of Autistic Children into Fashion Design Through Graphic Design Intervention. International Journal of Research and Innovation in Social Science, 9(1), 1682-1690. https://dx.doi.org/10.47772/IJRISS.2025.9020137
  7. Ministry of Health Malaysia. (2019). Clinical practice guidelines: Management of autism spectrum disorder in children and adolescents. Ministry of Health Malaysia.
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  9. Zulkefli, M. Y., & Rabi, N. M. (2018). Drink from a waterfall: Challenges of having autistic children on communication and social behavior. Idealogy, 3(3), 60-70. https://ir.uitm.edu.my/id/eprint/30452
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  13. Zulkefli, M. Y., Ibnu, I. N., Mohamed, S., & Sahharon, H. (2023). Role play: The usage of dolls in improving the selfcare skills among autism spectrum disorder individuals with sexual behaviour problems. Journal of Contemporary Education Research, 59-63. https://ir.uitm.edu.my/id/eprint/83203/1/83203.pdf
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