PARENTING: SCIENCE AND PRACTICE, 9: 198215, 2009Copyright Taylor & Francis Group, LLCISSN: 1529-5192 print / 1532-7922 onlineDOI: 10.1080/15295190902844381

HPAR1529-51921532-7922Parenting: Science and Practice, Vol. 9, No. 3-4, April 2009: pp. 136Parenting: Science and PracticeMotherChild and FatherChild Emotional Availability in Families of Children

with Down SyndromeEA in Families of Children with Downs Syndromede Falco et al. Simona de Falco, Paola Venuti, Gianluca Esposito,

and Marc H. Bornstein

SYNOPSIS

Objective. Emotional availability (EA) is a relationship construct that can be considered aglobal index of the emotional quality of parentchild interaction. The present study aimed toaddress several specific questions about motherchild and fatherchild emotional availabilityin families with a child with Downs syndrome (DS). Design. Free-play interactions of 22 childrenwith DS (M chronological age = 35.32 mo) We coded separately with each parent using theEmotional Availability (EA) Scales (Biringen, Robinson, & Emde, 1998). Results. Overall, mothersand fathers and their children with DS were equally emotionally available to one another.Bivariate correlations between maternal and paternal EA ratings of Sensitivity, Structuring, andNonhostility showed significant positive associations. Moreover, bivariate correlations alsohighlighted the stability of child Responsiveness and Involvement across interactions with thetwo parents. There were no differences between mothers and fathers in mean levels of Sensitivity,Structuring, Nonintrusiveness, or Nonhostility, nor were there differences in mean levels ofchild Responsiveness and Involvement between motherchild and fatherchild interactions.Conclusions. We discuss the clinical utility of the EA Scales for assessing relationships betweenparents and their children with DS.

INTRODUCTION

ParentChild Mutual Emotional Availability

Healthy parent-child interaction is as essential to the early development of childrenwith special needs as it is for children undergoing typical development (Fogel, 1993;Greenspan, 1997; Harris, Kasari, & Sigman, 1996; Marfo, Cynthia, Dedrick, & Barbour,1998; Marcheschi, Millepiedi, & Bargagna, 1990; Pino, 2000; Sander, 2000; Sroufe, 2000;Venuti, de Falco, Giusti, & Bornstein, 2008). Through their caregiving, parents supplytheir children with the experiences they need for both physical and psychologicalgrowth (Bornstein, 2002, 2003; Brinker, Seifer, & Sameroff, 1994). However, the parentchild relationship is not unidirectional, with only parents affecting their children. It is,rather, a fluid two-way exchange where signals and behaviors from both partners con-stantly affect each other in bidirectional transaction (Bornstein, 2003, 2008; Sander,2000; Stern, 1985; Trevarthen & Aitken, 2001; Van Egeren, Barratt, & Roach, 2001;Venuti et al., 2008).

In early childhood, this transaction is largely regulated by reciprocal emotionalexchanges between partners (Emde & Easterbrooks, 1985; Greenspan, 1997; Trevarthen,

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2003; Tronick, 2005). Expressing emotions through their voices, faces, and gestures,parents engage their children, direct and maintain child attention, and build therhythm of expectable dyadic interaction (Bornstein, Gini, Putnik, et al., 2006; Martin,Clements, & Crnic, 2002; Weinberg & Tronick, 1996). Reciprocally, even young childrenuse multiple signals that convey their emotional states and needs to their parents(Barnard et al., 1989; Bornstein, Gini, Suwalsky, Leach, & Haynes, 2006; Trevarthen,1993, 2003).

In the present study, we aimed to investigate how reciprocal emotional interactionsplay out when parents engage with children who have a developmental disability.Contemporary opinion is that positive emotional sharing is an indispensable frame toeffective caregiving of children with a developmental disability. At the same time, it isrecognized that specific cognitive and/or motor impairments may short-circuit thechilds ability to understand and exchange emotions (Greenspan, 1997; Trevarthen &Aitken, 2001; Venuti et al., 2008).

Emotional Availability

Emotional availability (EA; Biringen, 2000; Biringen & Robinson, 1991) is a relation-ship construct that refers specifically to emotional transactions between children andtheir parents (Aviezer, Sagi, Joels, & Ziv, 1999; Biringen & Robinson, 1991; Bretherton,2000; Emde, 1980). More specifically, it signifies the quality of emotional exchanges,focusing on partners accessibility to each other and their ability to read and respondappropriately to each others communications (Biringen & Robinson, 1991). This frame-work integrates Emdes (1980) emotions perspective with attachment theory(Ainsworth, Blehar, Waters, & Wall, 1978). Mutual understanding and expression ofemotions are barometers of dyadic functioning (Biringen, 2000). EA operationalizes fouraspects of parental behaviors (Sensitivity, Structuring, Nonintrusiveness, Nonhostility)as well as two aspects of child behavior (Responsiveness and Involvement with theParent) in the Emotional Availability (EA) Scales (Biringen, Robinson, & Emde, 1990,1993, 1998) that rate EA on the basis of observations of parent-child interaction.

A growing body of literature using these scales shows that both parent and childcomponents of EA relate to key aspects of the parentchild relationship (for reviews,see Biringen, 2000; Pipp-Siegel & Biringen, 1998) as well as to maternal characteristics(Biringen, Matheny, Bretherton, Renouf, & Sherman, 2000; Easterbrooks, Chaudhuri, &Gestsdottir, 2005; Ziv, Sagi, Gini, Karie-Koren, & Joels, 1996) and child behaviors(Pressman, Pipp-Siegel, Yoshinaga-Itano, & Deas, 1999; Sagi, Tirosh, Ziv, Guttman, &Lavie, 1998; Wiefel et al., 2005). Several findings support a specific link between the level ofdyadic EA during motherchild interaction and patterns of attachment (Easterbrooks &Biringen, 2000, 2005). Furthermore, recent studies have provided strong evidence for thepsychometric properties of the EA Scales. Notably, short- and mid-term longitudinalstudies (Bornstein, Gini, Putnik, et al., 2006; Bornstein, Gini, Suwalsky, et al., 2006; Ziv,Gini, Guttman, & Sagi, 1997) have reinforced the appeal of the construct in terms ofindividual-level stability and group-level continuity across time and context.

To date, the majority of studies of EA have involved typically developing (TD)children mainly interacting with their mothers. Very few studies using the EA Scaleshave involved children with special needs (Venuti, de Falco, Giusti, & Bornstein, 2008;de Falco, Esposito, Venuti, & Bornstein, 2008; Wiefel et al., 2005) or fathers. The presentstudy aimed to investigate EA in children with Downs syndrome (DS) interacting

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separately with their mothers as well as their fathers. Several reasons motivated thisdesign. First, both researchers and clinicians have suggested that the development ofchildren with a developmental disability, such as DS, depends crucially on the degreeto which parents provide appropriate stimulation and social enrichment (Cielinski,Vaughn, Seifer, & Contreras, 1995; Greenspan, 1997; Harris et al., 1996; Pino, 2000; Siller &Sigman, 2002). Second, it has been hypothesized that children with DS have difficultyunderstanding emotional expressions in their parents and they produce atypical andambiguous emotional signals themselves, leading to impaired reciprocal regulation ofthe interaction (Carvajal & Iglesias, 1997; Hyche, Bakeman, & Adamson, 1992; Slonims& McConachie, 2006; Sorce & Emde, 1982; Walden, 1996). Third, parental interactionstyle may be affected by childrens diminished responsiveness as well as by legitimateworries (for example, about medical illness), the expectation delusion (i.e., bearing andrearing an imperfect child), and personal challenge (of accepting the childs diagnosisand condition; Carvajal & Iglesias, 2000; Drotar, Baskiewitz, Irvin, Kennel, & Klaus, 1975;Hodapp, 2002; Marfo et al., 1998; Slonims & McConachie, 2006; Venuti et al., 2008).Fourth, the two EA studies that have included fathers (Lovas, 2005; Volling, McElwain,Notaro, & Herrera, 2002) reported that fathers were less emotionally available whencompared to mothers.

Recently, guidelines were provided for the application of the EA Scales to childrenwith disabilities and have considered DS in particular (Biringen, Fidler, Barrett, &Kubicek, 2005). These guidelines stress the importance of taking into account thatparent EA and child EA are separable qualities in these dyads, and the ability of theparent to use therapeutic parenting techniques to help the child with emotionalcommunication (p. 372).

Enhancing our knowledge about emotional availability in parents and children withDS promises to expand the literature in three ways. First, such a study deepens thenature of EA and utility of the EA Scales in a clinical context that represents the maincause of intellectual disabilities today. Second, our sample includes both mothers andfathers of the same children, thereby allowing for direct comparison of EA dimensionsbetween the two parents of children with DS and for assessing continuity and stabilityof EA in children with DS interacting with their two parents. Third, studying childrenin their different caregiving relationships presents a unique opportunity to investigatethe childs contribution to relationship functioning.

MotherChild and FatherChild Interaction with Children with Downs Syndrome

Several studies have investigated motherchild interaction in children with develop-mental disabilities, and many have involved children with DS (Carvajal & Iglesias, 2000;Cielinski et al., 1995; Roach, Barratt, Miller, & Leavitt, 1998; Slonims & McConachie,2006). However, only one study has considered the EA construct. That study examinedthe relation between EA and child play in children with DS (Venuti et al., 2008). Theresults highlighted a positive association between maternal EA and child symbolicplay. Although all children increased in exploratory play when interacting with theirmothers, only children of more emotionally available mothers increased in their levelof symbolic play. These results are consistent with the hypothesis that dyadic interac-tions based on a healthy level of emotional involvement lead to enhanced cognitivefunctioning in children with special needs (Greenspan, 1997; Trevarthen & Aitken,2001).

EA IN FAMILIES OF CHILDREN WITH DOWNS SYNDROME 201

One relevant debate that emerges consistently in the general literature on parentalinteraction with children with DS concerns directive versus intrusive style (Cielinskiet al., 1995; Marfo, 1990; Marfo et al., 1998; McCathren, Yoder, & Warren, 1995). In thepast, some investigators considered excesses of directiveness as intrusive and stressedits possible negative impact on child development (Berger & Cunningam, 1983). Otherinvestigators claim that enhanced directiveness is observed in these mothers and that itmay be adaptive and lead to more effective parenting (Roach et al., 1998). This debatebegs an investigation of interactions of parents and their children with DS thataccurately discerns the delicate balance of contributions of each partner and how theircontributions shape, and are shaped by, each other. The EA Scales encompass thismutual complexity and can help to address this debate.

Investigations of other aspects of the affective quality of motherchild with DS inter-action provide a complex picture of both strengths and weaknesses. Some authorsassume that, given the transactional nature of this relationship, mothers sensitivity isnegatively influenced by features of their children with special needs (Slonims &McConachie, 2006), whereas others have found few differences in terms of affectivequality of interaction between mothers of children with DS and mothers of TD children(Beeghly, Weiss-Perry, & Cicchetti, 1989; Crawley & Spiker, 1983).

In the area of developmental disabilities, compared to motherchild interaction,fatherchild interaction has been much less investigated (Girolametto, 1994; McConachie,1989), and no recent studies have been conducted that involved children with DS. Itcould be that fathers of children with DS are less emotionally available compared tomothers, as in typical development, or it could be that fathers feel the need to usegreater sensitivity when interacting with a child with a disability, to compensate for thechilds developmental difficulties. Differences in feelings and emotional reactionsbetween the parents of children with developmental disabilities may influence patternsof parentchild affective interaction leading fathers to the same, if not higher, levels ofEA as compared to mothers.

This Study

This study aimed to address some specific questions about motherchild and fatherchild emotional availability in families with children with DS. We wanted to investigatethe affective quality of the parentchild relationship using a construct that encom-passes different dimensions of parents and childrens exchanges focusing onemotional communication. Specifically, our goals were to: (1) ascertain EA in familiesof children with DS, (2) determine similarities and differences in mothers and fathers ofchildren with DS in any or all EA dimensions; (3) assess associations between EA Scalesbetween motherchild and fatherchild pairs; (4) evaluate correlations between EAdimensions in mothers and fathers in the same families; and (5) compare EA dimen-sions displayed by children with DS in interactions with their two parents. To achievethese goals, we coded free-play interactions of children with DS separately with eachparent using the EA Scales. Investigating these dimensions of the affective relationshipof mothers and fathers and their children with DS through the EA Scales promisesclinical implications, and the results may be useful for the development and evaluationof early intervention programs for families of children with DS or other developmentaldisabilities. Intervention programs that attempt to enhance EA in both parents mayresult in greater opportunities for children to develop secure attachment and healthy

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levels of socioemotional adaptation, leading in turn to childrens coping more success-fully with their developmental challenges.

METHODS

Participants

Altogether this study involved 44 parentchild dyads, 22 children with DS (M chro-nological age = 35.32 months, SD = 10.35, range = 18-48; M developmental age = 18.59months, SD = 5.91, range = 1026) with their mothers (M age = 35.45 years, SD = 5.87)and fathers (M age = 38.32 years, SD = 6.24). All children had the trisomy 21 type,confirmed by chromosomal analysis. Children were recruited from an early interven-tion center in the metropolitan area of Naples, Italy. We individually contacted themothers of 18- to 50-month-old children with DS regularly attending the center andwho were living with their married biological parents. As is common in studies ofclinical populations, our sample was not homogeneous or balanced demographically.It included 15 boys and 7 girls, and child chronological and developmental age variedwidely. However, the childrens age range does not differ from other studies in theliterature focusing on young children with DS (Cielinski et al., 1995; Fewell, Ogura,Notai-Syverson, & Wheeden, 1997; Libby, Powell, Messer, & Jordan, 1997), and allprocedures were appropriate to the age span. The socioeconomic status of the parents,calculated with the Four-Factor Index of Social Status (SES; Hollingshead, 1975), indi-cated a low to middle status in the Italian population (M = 27.89, SD = 13.53).

Procedure

To assess parentchild EA, data were collected during two consecutive 10-min ses-sions video recorded continuously by a female filmer. Observations took place at theintervention center in a quiet room that was familiar to the participants. To determinechildrens developmental age, the Bayley Scales of Infant and Toddler Development(2nd ed.; Bayley, 1993) were administered after the observation sessions.

Although the authors recommend at least 20 to 30 min of observation time (Biringenet al., 1998), the findings of previous studies using 5- to 10-min observations of motherchild interaction indicate the validity of this temporal parameter with the EA Scales(Easterbrooks, Biesecker, & Lyons-Ruth, 2000; Swanson, Beckwith, & Howard, 2000;Ziv, Aviezer, Gini, Sagi, & Koren-Karie, 2000) and show that motherchild EA is robustto context differences between home and laboratory (Bornstein, Gini, Putnik, et al.,2006).

A set of standard, age-appropriate toys was used that represented feminine, mascu-line, and gender-neutral categories (Caldera, Huston, & OBrien, 1989). During eachsession, the mother or the father was asked to play individually with her or his child inthe ways she or he typically would and to disregard the filmers presence as much aspossible. Mothers or fathers and children could use any or all of the toys provided. Theorder of motherchild and fatherchild play sessions was counterbalanced.

Emotional availability in motherchild and fatherchild dyads was evaluated fromthe video recorded observations using the Emotional Availability Scales: Infancy toEarly Childhood Version (3rd ed.; Biringen et al., 1998). These scales consist of six

EA IN FAMILIES OF CHILDREN WITH DOWNS SYNDROME 203

dimensions concerned with emotional regulation in the parent-child dyad. Fourdimensions address the emotional availability of the parent in relation to the child(Sensitivity, Structuring, Nonintrusiveness, and Nonhostility), and two address theemotional availability of the child in relation to the parent (Responsiveness and Involve-ment). The EA sensitivity scale (9 points: 1 = highly insensitive, 9 = highly sensitive) wasinspired by Ainsworth (Ainsworth et al., 1978) but adds emphasis to emotional fea-tures; it is designed to assess the parents contingent responsiveness to child communi-cations, appropriate affectivity, acceptance, flexibility, clarity of perceptions, affectregulation, conflict resolution, and variety and creativity in play displayed toward thechild. Structuring (5 points: 1 = nonoptimal, 5 = optimal) assesses the degree to which theparent appropriately facilitates, scaffolds, or organizes the childs activities, explora-tion, or routine by providing rules, regulations, and a supportive framework forinteraction without compromising the childs autonomy. Nonintrusiveness (5 points:1 = intrusive, 5 = nonintrusive) measures the degree to which the parent is able tosupport the childs play, exploration, or routine by waiting for optimal breaks beforeinitiating interactions, without interrupting the child by being overdirective, overstim-ulating, overprotecting, and/or interfering. Nonhostility (5 points: 1 = markedly andovertly hostile, 5 = nonhostile) measures the degree to which the parent is able to talk toor behave with the child in a way that is generally patient, pleasant, and harmoniousand not rejecting, abrasive, impatient, or antagonistic. Child Responsiveness (7 points:1 = nonoptimal, 7 = optimal) focuses on the childs age- and context-appropriate abilityand interest in exploring on his or her own and in responding to the parents bids (i.e.,the balance between connection and autonomy) as well as the extent of the childsenjoyment of the interaction. Involvement (9 points: 1 = nonoptimal, 9 = optimal) assessesthe childs ability and willingness to engage the parent in interaction (see Biringen,2000; Easterbrooks & Biringen, 2000). The flexible nature of the scales, which can beused with children from infancy to early childhood, and the choice of an ecological con-text of free play with a standard toy set for preschool children, allowed us to use thesame observational situation for all participants. Coding was carried out by two inde-pendent coders who were first trained on the EA Scales to obtain satisfactory interraterreliability with Biringen and then between themselves. Motherchild and fatherchilddyads for every family were separately coded by independent coders who were blindto one anothers EA ratings. The coders followed the guidelines for the use of the EAScales with children with disabilities (Biringen, Fidler, et al., 2005). Interrater reliability(Biringen, 2005) was assessed using average absolute agreement intraclass correlationcoefficients (ICC; McGraw & Wong, 1996) on 25% of the interactions coded, and ICCsranged from .84 to .95.

RESULTS

Preliminary Analysis

Distributions of the six individual EA Scales from the two visits were examined fornormalcy and outliers. The EA Nonhostility scale was distributed as a noncontinuousvariable and showed significantly skewed distributions and was therefore treated asordinal. Preliminary correlations were conducted to investigate associations betweenchild chronological age, child developmental age, mother age, father age, and family

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SES with EA scores. Neither paternal age nor family SES correlated significantly withEA scores in our sample, and therefore were not considered further. Maternal ageshowed significant negative correlations with all motherchild EA scores (p < .05)except Nonintrusiveness. Child chronological age was not associated with EA Scales inmotherchild interactions but was positively associated with Responsiveness andInvolvement in fatherchild interactions. Child developmental age was not associatedwith EA in motherchild interactions but was positively associated with Involvementin fatherchild interactions; thus, child chronological age, child developmental age,and mother age standardized residuals were used in the analyses. In addition, no childgender differences were found in motherchild and fatherchild interactions; therefore,the data are reported for girls and boys combined.

Person-level analyses were computed using a K-means cluster analysis (Hartigan &Wong, 1979) of the five continuous EA Scales. We pooled all dyads into a single analy-sis so that the clusters would be comparable. The distribution of Nonhostility wasexamined in relation to the clusters derived from the other five EA Scales. Finally, thedistributions of motherchild and fatherchild dyads across clusters were exploredwith first-order configural frequency analyses (von Eye, 2002) using Lehmachers testwith Kchenhoffs continuity correction.

Analytic Plan

The first section of Results provides descriptive statistics. The second section pre-sents group comparisons between the two parents in terms of parent EA mean scores.The third section presents correlations among EA ratings separately for motherchildand fatherchild interactions and compares these correlations. The fourth sectionpresents associations of parental EA ratings between husbands and wives. The fifthsection explores child EA with the two parents in two ways: (1) using bivariate correla-tion analyses between child EA ratings from motherchild and fatherchild interac-tions and (2) employing paired comparisons of child EA means. The sixth sectiondescribes cluster analyses. Because child chronological and developmental age andmother age were associated with the EA scores, analyses were carried out on the stan-dardized residuals of a regression with these three variables as predictors.

Descriptive Statistics

Table 1 presents descriptive statistics for each EA Scale separately for motherchildand fatherchild dyads. Considering our sample size, all scales showed a reasonablerepresentation of most of their potential range.

Maternal versus Paternal EA Ratings

Mean comparison tests showed no differences between the two parents in Sensitivity,Structuring, Nonintrusiveness, and Nonhostility (Table 1).

Correlations among EA Scales in MotherChild versus FatherChild Dyads

Table 2 presents correlations among EA dimensions separately for motherchild andfatherchild dyads. We found significant positive associations between all pairs of

EA IN FAMILIES OF CHILDREN WITH DOWNS SYNDROME 205

scales except StructuringNonintrusiveness, which did not show significant associa-tions in either motherchild or fatherchild dyads, and paternal NonintrusivenessNonhostility. The mean of significant intercorrelations between all other pairs of scalesfor motherchild dyads was .63 and for fatherchild dyads was .57 (ranges = .48.90 and.40.80, respectively, p < .05), with lowest coefficients for Nonintrusiveness. The corre-sponding shared variances ranged from 23 to 81% for motherchild dyads and from 16to 64% for fatherchild dyads. Intercorrelation patterns in this sample resemble thosereported in previous studies (e.g., Biringen, 2000; Biringen, Damon, et al., 2005;Bornstein, Gini, Putnik, et al., 2006). We compared correlation coefficients among theEA Scales in mothers versus fathers using Fishers z (1921; see Howell, 2001, p. 278) andfound no significant differences (z range from .05 to 1.49).

TABLE 1Descriptive Statistics for Emotional Availability Scales in MotherChild and FatherChild Dyads

MotherChild FatherChild t(21)a rb

ParentSensitivity (19)

M 5.75 5.73 .09 .54**Range 38 3.58.5SD 1.28 1.15

Structuring (15)M 3.64 3.77 1.06 .63**Range 24.5 2.55SD .74 .63

Nonintrusiveness (15)M 4.09 4.11 .12 .25Range 2.54.5 2.55SD .80 .65

Nonhostility (15)M 4.59 4.64 234 .60**Range 3.55 45SD .48 .41

ChildResponsiveness (17)

M 4.95 5.21 1.12 .39Range 2.56.5 3.56.5SD 1.06 .78

Involvement (17)M 4.72 5.11 1.43 .46*Range 2.56.5 3.56.5SD 1.08 .72

Note. Because mother age, child chronological and child developmental age were associatedwith the EA Scales, we used as scores the standardized residuals of a regression with these threevariables as predictors.

aDependent t-test values are reported; for Nonhostility, paired Wilcoxon signed-ranks testvalue is reported.

bPearson productmoment r coefficients values are reported; for Nonhostility, Spearmansrank order coefficient value is reported.

*p < .05; **p < .01.

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Agreement between Maternal and Paternal Emotional Availability

Bivariate correlations between maternal and paternal EA ratings showed significantpositive associations for the following EA dimensions: Sensitivity, Structuring, andNonhostility, but not for Nonintrusiveness (Table 1).

Child EA with Mothers and Fathers

Bivariate correlations highlighted the stability of Responsiveness and Involvementacross interactions with the two parents. As for continuity of these scales, paired-sample t-tests indicated no differences in mean levels of child Responsiveness andInvolvement between motherchild and fatherchild interactions (Table 1).

Cluster Analysis

In addition to variable approaches to our analyses, we applied cluster analyses to EAscores of the dyads to ascertain the nature of the distributions of clusters betweenmotherchild and fatherchild dyads. The five continuous Emotional AvailabilityScales were subjected to a K-means cluster analysis. We empirically identified dyads asbelonging to one of three clusters: (1) Lower EA, (2) Medium EA, and (3) Higher EA,and means and standard deviations for each group are presented in Table 3. Overall,for all five scales the three cluster means differed significantly from one another.Furthermore, no significant differences emerged between the clusters for child chrono-logical and developmental age, mother and father age, SES, and child sex, as verifiedthrough ANOVAs and square (Table 3). As an additional check on the validity of ourclusters, we used chi squares and configural frequency analyses (von Eye, 2002) toexamine the cluster distributions of mothers who exhibited higher (above the mean) orlower (below the mean) levels of Intrusiveness or Hostility. Mothers who exhibited higheror lower levels of Hostility were not equally distributed across clusters, 2 (2, n = 22) =24.09, p .001. Also, fathers who exhibited higher or lower levels of hostility were notequally distributed across clusters, 2 (2, n = 22) = 14.30, p .001. Configural frequency

TABLE 2Correlations among EA Scales Scores in MotherChild and FatherChild Dyads Separately

Sensitivity Structuring Nonintrusiveness Nonhostility Responsiveness Involvement

Sensitivity .82** .55** .63** .64** .75**Structuring .80** .24 .56** .48** .62**Nonintrusiveness .49* .15 .65** .54** .56**Nonhostility .65** .57** .32 .55** .56**Responsiveness .59** .61** .26 .31 .90**Involvement .52** .54** .10 .48* .40**

Note. Correlations above the diagonal are for mothers EA Scales, and correlations below the diagonal arefor fathers EA Scales. Because mother age, child chronological age, and child developmental age wereassociated with the EA Scales, we used as scores the standardized residuals of a regression with these threevariables as predictors. For Nonhostility, Spearmans rank order coefficients are reported; for the remainingscales, Pearson productmoment r coefficients values are reported.

*p < .05; **p < .01.

EA IN FAMILIES OF CHILDREN WITH DOWNS SYNDROME 207

analyses (von Eye, 2002) showed no differences in the distributions of motherchildand fatherchild dyads across clusters.

DISCUSSION

Our goal in this study was to examine emotional availability among parents and theirchildren with DS in ways that might contribute to understanding patterns of maternalchild and paternalchild interaction in families with children with special needs. Spe-cifically, we wanted to explore EA levels in families of children with DS and comparedimensions of EA between the parents of children with DS to evaluate if fathers showsimilar or different levels of EA than mothers, as suggested by the literature in typicallydeveloping children (Lovas, 2005; Volling et al., 2002). Moreover, we wanted to assessif motherchild and fatherchild dyads differed in associations among EA dimensions.

TABLE 3Cluster Means in MotherChild and FatherChild Dyads Separately

Lower EA Medium EA Higher EA

F/2

MC dyads = 7 FC dyads = 5

MC dyads = 7 FC dyads = 10

MC dyads = 8 FC dyads = 7

M SD M SD M SD

Demographic variablesChild chronological age 34.91 11.05 35.63 10.27 39.33 4.16 nsChild developmental age 19.88 5.90 18.27 5.30 23.67 1.53 nsMother age 38.91 4.78 30.00 3.89 37.33 2.31 nsFather age 40.45 5.56 34.13 6.24 41.67 2.52 nsSES 30.88 16.28 26.85 11.48 33.67 2.89 ns

MotherChild EA ScalesSensitivity 4.42a .71 5.50b .41 7.12c .58 40.06***Structuring 2.92a .45 3.50b .58 4.37c .23 21.78***Nonintrusiveness 4.42a .53 4.71b .49 5.00b .00 3.69*Nonhostilitya 28% 43% 75% 24.09***Responsiveness 4.00a .81 5.42b .53 6.00c .53 19.16***Involvement 3.57a .53 5.14b .38 6.12c .35 67.681***

FatherChild EA ScalesSensitivity 4.40a .65 5.60b .66 6.85c .85 17.84***Structuring 3.30a .45 3.60b .57 4.35c .38 7.93**Nonintrusiveness 4.20a .45 4.90b .32 5.00b .00 12.91***Nonhostilitya 20% 50% 43% 14.30*Responsiveness 4.40a .55 5.40b .51 6.28c .49 19.70***Involvement 4.40a .54 5.20b .42 6.14c .38 23.67***

Child gender ratio (M:F)Motherchild dyads 3:2 5:5 7:0 nsFatherchild dyads 5:2 4:3 6:2 ns

Note. Means with different subscripts (a, b, and c) are significantly different in Tukey HSD post-hoc tests.aPercentage of parents in the cluster who engaged in lower level of hostility. Test statistic reported is

a chi-square.*p < .01; **p < .001; ***p < .0001.

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We also wanted to know if EA in mothers and fathers were associated. Finally, startingfrom the systems view of parentchild interaction in general (Bornstein, 2003; Sander,2000; Stern, 1985; Trevarthen & Aitken, 2001; Venuti et al., 2008) and the dyadic natureof the EA construct in particular (Biringen, 2000; Birigen, & Robinson, 1991; Emde,1980), we aimed to investigate the extent to which children with DS show different lev-els of responsiveness and involvement with the two parents, and if these levels areassociated.

Concerning the first aim, our findings allow us to draw some general conclusionsabout the application of the EA Scales to families of children with DS. First, based onthe EA Manual (Biringen et al., 1998), the mean level reached by the dyads in our studywas slightly above the midpoint for Sensitivity and Structuring, close to the optimallevel for Nonintrusiveness, even closer for Nonhostility, and good enough forResponsiveness and Involvement. As for Sensitivity, the scores of our sample didnot differ from those reported in the other studies of special needs or at-risk children(Easterbrooks et al., 2005; Wiefel et al., 2005). Nor do these scores appear to differ fromreports of TD children in Italy and other countries (Bornstein et al. 2008; Lovas, 2005),and they accord with the results of some investigators who found, using a differentassessment of maternal sensitivity, no differences between mothers of children with DSand mothers of TD children (Beeghly et al., 1989; Crawlay & Spiker, 1983).

However, it is worth noting that our findings concern a sample of families living inthe metropolitan area of the biggest city of southern Italy. In Italy, parents reportedlygive special importance to social style and to interactive and affective dyadic exchanges(Senese, Poderico, & Venuti, 2003; Venuti & Senese, 2007). Moreover, in a cross-culturalstudy on motherchild EA in 20-month-old TD children, Italian mothers weregenerally more sensitive and optimally structuring than Argentine and U.S. mothers(Bornstein et al., 2008). Consistent with these observations, Hsu and Lavelli (2005)found that Italian mothers displayed greater social/affective behaviors and spent moretime in synchronous dyadic social exchanges with their infants compared to U.S. moth-ers. It would be interesting, therefore, to extend this study to families of children withDS living in different countries, or even in different regions (urban/rural) of the samecountry.

Relative to the directive style often described in the literature about mothers ofchildren with DS, both parents in our study showed high levels of nonintrusive behav-ior. In their guidelines for applying the EA Scales to children with disabilities, Biringen,Fidler et al. (2005) suggested that investigators might profitably focus on both Structur-ing and Nonintrusiveness to disentangle the debate about maternal directiveness(whether positive, i.e. scaffolding, or negative, i.e. intrusive) with children with DS. Wefound that this pair of scales was not associated, indicating that higher intrusiveness isnot always associated with lower structuring. This finding accords with the idea that,when interacting with children with DS, parents may need to use a more directive styleto successfully promote sophisticated play, without necessarily being intrusive. Theoptimal level of Nonhostility observed in our sample offers two observations. One is arguedby Biringen, Damon et al. (2005); the free-play context, compared to more emotionallydemanding situations, renders parental hostility infrequent. The other is that, althoughinteracting with children who have objective impairments, parents of children with DSdo not display a rejecting, abrasive, or impatient attitude. On average, children with DSin our study reached a good enough level in Responsiveness, which indicates thatthey were generally positive and emotionally available, even if they showed less clear

EA IN FAMILIES OF CHILDREN WITH DOWNS SYNDROME 209

joy or appropriateness in their affective responsiveness than expected optimally(Biringen et al., 1998). Similarly, for Involvement, children with DS showed unambiguous,although not optimal, tendencies to engage a parent in play. Although we do not havecomparative data to offer, these findings are consistent with the idea that children withDS generally display more cheerful, sociable personalities compared to children withother types of disability (Hodapp, 2002).

We obtained a wide range of scores for all the scales (except Nonhostility), indicating thatthe EA Scales discriminated among different levels of dyadic emotional availability in thispopulation of children with developmental disabilities. This diversity was found both in par-ents and in children. As expected from Biringen, Fidler et al. (2005), we found that althoughchildren with DS may have objective impairments that undermine their ability to interactand the readability of their emotional signals, their parents still show high levels of EA:

Yet, some parents are able to read their childs emotional signals, regardless of the disability orin spite of the disability, and such parents are more likely to respond to their children appropri-ately. Thus, a child might seem highly unresponsive (to the observer) but the parent may bedoing an exquisite job in drawing him or her out, and thereby begin the makings of emotionalconnection. (p. 373)

However, the wide range of child scores observed also indicates that, despite thedeficits imposed by the syndromes phenotype, children with DS may look different interms of their affective responses to parental cues and their willingness to engageparents in interaction.

With respect to the second aim, our results indicate that mothers and fathers in oursample were similar in their EA. In the literature on TD children, fathers (compared tomothers) are often depicted as less sensitive (Lamb, Frodi, Frodi, & Hwang, 1982;Nakamura, Stewart, & Tatarka, 2000), if more active and fun playmates (Caneva &Venuti, 1998; Hewlett, 1992; Lamb, 1977, 2004; Notaro & Volling, 1999; Parke, 1996; Venuti &Giusti, 1996). Only two existing studies that specifically aimed to compare parents withregard to EA have also confirmed this idea (Lovas, 2005; Volling et al., 2002). Specifically,Lovas (2005) applied the EA Scales to fatherchild as well as motherchild dyads; shereported that fathers had lower scores compared to mothers. Similarly, in a study basedon a different measure of EA, Volling et al. (2002) found that mothers were more sensitiveand expressed more positive affect than fathers during parentinfant interactions. How-ever, Wiefel et al. (2005), in their application of the EA Scales to a child psychiatric popu-lation, reported no differences between parents EA ratings. Thus, it could be that, infamilies with children with special needs, fathers compensate and reach the same levelsof emotional availability as mothers. In other words, it could be that, perceiving thespecial parenting needs of their children, fathers tailor their interaction style, payingmore attention to their own and their childrens emotional exchanges. However, lowstatistical power (small n, unbalanced gender) could also account for why no significantdifferences emerged between parents. Our results should be interpreted with caution.

Some other cues to help interpret this finding may come from results of research thatconcerns parental stress and emotional reactions in fathers of children with disabilities,DS in particular. Although there is ample evidence that both parents of children withdisabilities suffer from more psychological problems, parental stress, and lower levelsof well-being (Hodapp, 2002; Lamb & Billings, 1997), some authors argue that fathers,compared to mothers, feel themselves more in control of the situation and experience

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less stress (Bristol, Gallagher, & Shopler, 1988; Damrosch & Perry, 1989; Goldberg,Marcovitch, MacGregor, & Lojkasek, 1986; Hodapp, 2002).

Relative to our third aim, motherchild and fatherchild with DS dyads in our sampledid not differ with regard to the patterns of associations among individual EA dimen-sions, which were strong for almost all pairs of scales. This pattern of findings indicatesthat the EA construct is relatively coherent when applied to parents and children withdisabilities. We found a positive associations between maternal/paternal and child rat-ings, which underscores the bidirectional nature of parentchild EA. Child EA dimen-sions shared up to 56% of their variance with parental EA Sensitivity, but shared muchless with Nonintrusiveness.

With respect to our fourth aim, we found that corresponding EA dimensions of oneparent tended to be positively associated with those of the other parent for Sensitivity,Structuring, and Nonhostility. A possible interpretation could be that although EA isnot a personality trait, but rather a systemic measure of the emotional quality of dyadicinteraction (Biringen, 2000), it encompasses general features of empathy and socioemo-tional competence, which tend to be similar in married couples and is consistent withthe process of assortive mating. Or it could be that childrens own ways of interact-ing exert similar influences on their two parents EA (see below). Yet Nonintrusivenesslevels of the two parents were not significantly associated with each other; this dimen-sion shows the weakest link to child EA, and may be one reason the EA Scale waschanged in the fourth edition (Biringen, 2008). Of course, a larger sample is needed toconfirm this pattern of results.

Considering child EA dimensions, we found both continuity and (moderate) stabilityacross childrens interactions with their two parents. Continuity means that the meanlevels of motherchild and fatherchild EA were comparable, and this finding extendsour observations concerning a general similarity with regard to EA between motherchild and fatherchild dyads; it also reveals that there were no general quantitative orqualitative differences in the ways children were responsive to or involving of theirmothers compared to their fathers. Stability tells us about the consistency of individualdifferences in the group. On the one hand, our findings accord with the bidirectionalnature of parentchild interaction and specifically with the idea of the childs contribu-tion to dyadic exchanges, telling us that each child brings to the interaction with bothparents the childs own ways of being responsive and involving. On the other hand, themoderate degree of stability confirms that child EA is also related to individual parentalinteractive style and probably to the history of the parentchild relationship.

Finally, to complement the usual fragmentation of the global quality of EA intoits several dimensions (which we differentiated to give completeness to the construct),in this study we applied person-level cluster analysis. The results of this analysiswere consistent with the EA theoretical framework, distinguishing three clusters ofdyads that were lower, medium, and higher for all parent and child dimensions. Inthis way, the EA Scales discriminate, within this special population, lower-, medium-,and higher-functioning dyads. Consistent with the results of mean level compari-sons, motherchild and fatherchild dyads were equally distributed across theclusters.

Future research is needed to examine more broadly the nature of parentchild EA inDS. In this connection, several limitations in this study should be noted. First, as iscommon in studies of clinical populations, the sample was small and unbalanced interms of child gender; a larger and gender balanced sample would allow investigation

EA IN FAMILIES OF CHILDREN WITH DOWNS SYNDROME 211

of relations between dyadic EA and child gender (Lovas, 2005). Second, our samplewas relatively homogeneous middle-to-low socioeconomic status (Ziv et al., 1996); awider and more heterogeneous sample for SES may have brought to light any associationwith the EA Scales. Third, the inclusion of other variables, such as maternal and pater-nal levels of stress and anxiety, and parents reactions (stress/coping) to the diagnosisthat their child has DS, would enrich our understanding. Fourth, the inclusion of controlgroups of typically developing children and of children with intellectual disabilitieswith mixed etiology would enable future research to draw conclusions more specific tothe population of children with DS.

Our results take a first step in showing that the Emotional Availability Scales can bea useful tool for assessing relationships between parents and their children with DS,discriminating, in general, the functioning of dyads and, in particular, the contributionof each member to specific EA dimensions. The use of the EA Scales could be particu-larly valuable in the Italian context, where most interventions provided by the publichealth care system focus on the child and little attention is given to motherchildinteraction (and even less to fatherchild interaction). Being able to assess higher levelsof EA in clinical practice would mean uncovering an important strength to supportinterventions focused on other weak areas of child development. Indeed, there isempirical evidence that both motherchild and fatherchild EA can influence cognitiveperformance in children with DS during joint play (Venuti et al., 2008; de Falco,Esposito, Venuti, & Bornstein, 2008). Revealing a specific profile of low parentchildEA would enable us to implement (and evaluate afterward) intervention programsfocused on the parentchild relationship aimed to prevent secondary deficits that origi-nate from or are comorbid with dysfunctional dyadic interactions.

AFFILIATIONS AND ADDRESSES

Simona de Falco, Department of Cognitive Science and Education, Via Matteo Del Ben5, 38068 Rovereto (TN), Italy. E-mail: defalco@form.unitn.it. Paola Venuti and GianlucaEsposito are also at the University of Trento. Marc H. Bornstein is at the Eunice KennedyShriver National Institute of Child Health and Human Development.

ACKNOWLEDGMENTS

We thank Z. Giusti and D. Putnick for assistance. This research was partially supportedby Intramural Research Program of the NIH, NICHD.

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