PARENTING: SCIENCE AND PRACTICE, 9: 198215, 2009

Copyright Taylor & Francis Group, LLC

ISSN: 1529-5192 print / 1532-7922 online
DOI: 10.1080/15295190902844381

MotherChild and FatherChild Emotional

Availability in Families of Children
with Down Syndrome

1532-7922 Science and Practice

1529-5192
HPAR
Parenting:
Practice, Vol. 9, No. 3-4, April 2009: pp. 136

EAFalco
de
in Families
et al. of Children with Downs Syndrome

Simona de Falco, Paola Venuti, Gianluca Esposito,

and Marc H. Bornstein
SYNOPSIS

Objective. Emotional availability (EA) is a relationship construct that can be considered a

global index of the emotional quality of parentchild interaction. The present study aimed to
address several specific questions about motherchild and fatherchild emotional availability
in families with a child with Downs syndrome (DS). Design. Free-play interactions of 22 children
with DS (M chronological age = 35.32 mo) We coded separately with each parent using the
Emotional Availability (EA) Scales (Biringen, Robinson, & Emde, 1998). Results. Overall, mothers
and fathers and their children with DS were equally emotionally available to one another.
Bivariate correlations between maternal and paternal EA ratings of Sensitivity, Structuring, and
Nonhostility showed significant positive associations. Moreover, bivariate correlations also
highlighted the stability of child Responsiveness and Involvement across interactions with the
two 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 of
child Responsiveness and Involvement between motherchild and fatherchild interactions.
Conclusions. We discuss the clinical utility of the EA Scales for assessing relationships between
parents and their children with DS.

INTRODUCTION
ParentChild Mutual Emotional Availability
Healthy parent-child interaction is as essential to the early development of children
with 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 supply
their children with the experiences they need for both physical and psychological
growth (Bornstein, 2002, 2003; Brinker, Seifer, & Sameroff, 1994). However, the parent
child 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 constantly 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 emotional
exchanges between partners (Emde & Easterbrooks, 1985; Greenspan, 1997; Trevarthen,

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199

2003; Tronick, 2005). Expressing emotions through their voices, faces, and gestures,
parents engage their children, direct and maintain child attention, and build the
rhythm of expectable dyadic interaction (Bornstein, Gini, Putnik, et al., 2006; Martin,
Clements, & Crnic, 2002; Weinberg & Tronick, 1996). Reciprocally, even young children
use 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 interactions
play out when parents engage with children who have a developmental disability.
Contemporary opinion is that positive emotional sharing is an indispensable frame to
effective caregiving of children with a developmental disability. At the same time, it is
recognized that specific cognitive and/or motor impairments may short-circuit the
childs 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 relationship construct that refers specifically to emotional transactions between children and
their 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 respond
appropriately to each others communications (Biringen & Robinson, 1991). This framework integrates Emdes (1980) emotions perspective with attachment theory
(Ainsworth, Blehar, Waters, & Wall, 1978). Mutual understanding and expression of
emotions are barometers of dyadic functioning (Biringen, 2000). EA operationalizes four
aspects of parental behaviors (Sensitivity, Structuring, Nonintrusiveness, Nonhostility)
as well as two aspects of child behavior (Responsiveness and Involvement with the
Parent) 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 child
components 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 of
dyadic EA during motherchild interaction and patterns of attachment (Easterbrooks &
Biringen, 2000, 2005). Furthermore, recent studies have provided strong evidence for the
psychometric properties of the EA Scales. Notably, short- and mid-term longitudinal
studies (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 of
individual-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 Scales
have involved children with special needs (Venuti, de Falco, Giusti, & Bornstein, 2008;
de Falco, Esposito, Venuti, & Bornstein, 2008; Wiefel et al., 2005) or fathers. The present
study 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 this
design. First, both researchers and clinicians have suggested that the development of
children with a developmental disability, such as DS, depends crucially on the degree
to 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 difficulty
understanding emotional expressions in their parents and they produce atypical and
ambiguous emotional signals themselves, leading to impaired reciprocal regulation of
the interaction (Carvajal & Iglesias, 1997; Hyche, Bakeman, & Adamson, 1992; Slonims
& McConachie, 2006; Sorce & Emde, 1982; Walden, 1996). Third, parental interaction
style may be affected by childrens diminished responsiveness as well as by legitimate
worries (for example, about medical illness), the expectation delusion (i.e., bearing and
rearing an imperfect child), and personal challenge (of accepting the childs diagnosis
and 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 when
compared to mothers.
Recently, guidelines were provided for the application of the EA Scales to children
with disabilities and have considered DS in particular (Biringen, Fidler, Barrett, &
Kubicek, 2005). These guidelines stress the importance of taking into account that
parent EA and child EA are separable qualities in these dyads, and the ability of the
parent to use therapeutic parenting techniques to help the child with emotional
communication (p. 372).
Enhancing our knowledge about emotional availability in parents and children with
DS promises to expand the literature in three ways. First, such a study deepens the
nature of EA and utility of the EA Scales in a clinical context that represents the main
cause of intellectual disabilities today. Second, our sample includes both mothers and
fathers of the same children, thereby allowing for direct comparison of EA dimensions
between the two parents of children with DS and for assessing continuity and stability
of EA in children with DS interacting with their two parents. Third, studying children
in their different caregiving relationships presents a unique opportunity to investigate
the childs contribution to relationship functioning.
MotherChild and FatherChild Interaction with Children with Downs Syndrome
Several studies have investigated motherchild interaction in children with developmental 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 examined
the relation between EA and child play in children with DS (Venuti et al., 2008). The
results highlighted a positive association between maternal EA and child symbolic
play. Although all children increased in exploratory play when interacting with their
mothers, only children of more emotionally available mothers increased in their level
of symbolic play. These results are consistent with the hypothesis that dyadic interactions based on a healthy level of emotional involvement lead to enhanced cognitive
functioning in children with special needs (Greenspan, 1997; Trevarthen & Aitken,
2001).

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201

One relevant debate that emerges consistently in the general literature on parental
interaction with children with DS concerns directive versus intrusive style (Cielinski
et al., 1995; Marfo, 1990; Marfo et al., 1998; McCathren, Yoder, & Warren, 1995). In the
past, some investigators considered excesses of directiveness as intrusive and stressed
its possible negative impact on child development (Berger & Cunningam, 1983). Other
investigators claim that enhanced directiveness is observed in these mothers and that it
may be adaptive and lead to more effective parenting (Roach et al., 1998). This debate
begs an investigation of interactions of parents and their children with DS that
accurately discerns the delicate balance of contributions of each partner and how their
contributions shape, and are shaped by, each other. The EA Scales encompass this
mutual complexity and can help to address this debate.
Investigations of other aspects of the affective quality of motherchild with DS interaction provide a complex picture of both strengths and weaknesses. Some authors
assume that, given the transactional nature of this relationship, mothers sensitivity is
negatively influenced by features of their children with special needs (Slonims &
McConachie, 2006), whereas others have found few differences in terms of affective
quality 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. It
could be that fathers of children with DS are less emotionally available compared to
mothers, as in typical development, or it could be that fathers feel the need to use
greater sensitivity when interacting with a child with a disability, to compensate for the
childs developmental difficulties. Differences in feelings and emotional reactions
between the parents of children with developmental disabilities may influence patterns
of parentchild affective interaction leading fathers to the same, if not higher, levels of
EA as compared to mothers.
This Study
This study aimed to address some specific questions about motherchild and father
child emotional availability in families with children with DS. We wanted to investigate
the affective quality of the parentchild relationship using a construct that encompasses different dimensions of parents and childrens exchanges focusing on
emotional communication. Specifically, our goals were to: (1) ascertain EA in families
of children with DS, (2) determine similarities and differences in mothers and fathers of
children with DS in any or all EA dimensions; (3) assess associations between EA Scales
between motherchild and fatherchild pairs; (4) evaluate correlations between EA
dimensions in mothers and fathers in the same families; and (5) compare EA dimensions displayed by children with DS in interactions with their two parents. To achieve
these goals, we coded free-play interactions of children with DS separately with each
parent using the EA Scales. Investigating these dimensions of the affective relationship
of mothers and fathers and their children with DS through the EA Scales promises
clinical implications, and the results may be useful for the development and evaluation
of early intervention programs for families of children with DS or other developmental
disabilities. Intervention programs that attempt to enhance EA in both parents may
result 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 successfully with their developmental challenges.

METHODS
Participants
Altogether this study involved 44 parentchild dyads, 22 children with DS (M chronological age = 35.32 months, SD = 10.35, range = 18-48; M developmental age = 18.59
months, 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 intervention center in the metropolitan area of Naples, Italy. We individually contacted the
mothers of 18- to 50-month-old children with DS regularly attending the center and
who were living with their married biological parents. As is common in studies of
clinical populations, our sample was not homogeneous or balanced demographically.
It included 15 boys and 7 girls, and child chronological and developmental age varied
widely. However, the childrens age range does not differ from other studies in the
literature focusing on young children with DS (Cielinski et al., 1995; Fewell, Ogura,
Notai-Syverson, & Wheeden, 1997; Libby, Powell, Messer, & Jordan, 1997), and all
procedures were appropriate to the age span. The socioeconomic status of the parents,
calculated with the Four-Factor Index of Social Status (SES; Hollingshead, 1975), indicated 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 sessions video recorded continuously by a female filmer. Observations took place at the
intervention center in a quiet room that was familiar to the participants. To determine
childrens 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 (Biringen
et al., 1998), the findings of previous studies using 5- to 10-min observations of mother
child 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 robust
to context differences between home and laboratory (Bornstein, Gini, Putnik, et al.,
2006).
A set of standard, age-appropriate toys was used that represented feminine, masculine, and gender-neutral categories (Caldera, Huston, & OBrien, 1989). During each
session, the mother or the father was asked to play individually with her or his child in
the ways she or he typically would and to disregard the filmers presence as much as
possible. Mothers or fathers and children could use any or all of the toys provided. The
order of motherchild and fatherchild play sessions was counterbalanced.
Emotional availability in motherchild and fatherchild dyads was evaluated from
the video recorded observations using the Emotional Availability Scales: Infancy to
Early 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. Four

dimensions address the emotional availability of the parent in relation to the child
(Sensitivity, Structuring, Nonintrusiveness, and Nonhostility), and two address the
emotional availability of the child in relation to the parent (Responsiveness and Involvement). The EA sensitivity scale (9 points: 1 = highly insensitive, 9 = highly sensitive) was
inspired by Ainsworth (Ainsworth et al., 1978) but adds emphasis to emotional features; it is designed to assess the parents contingent responsiveness to child communications, appropriate affectivity, acceptance, flexibility, clarity of perceptions, affect
regulation, conflict resolution, and variety and creativity in play displayed toward the
child. Structuring (5 points: 1 = nonoptimal, 5 = optimal) assesses the degree to which the
parent appropriately facilitates, scaffolds, or organizes the childs activities, exploration, or routine by providing rules, regulations, and a supportive framework for
interaction without compromising the childs autonomy. Nonintrusiveness (5 points:
1 = intrusive, 5 = nonintrusive) measures the degree to which the parent is able to
support the childs play, exploration, or routine by waiting for optimal breaks before
initiating interactions, without interrupting the child by being overdirective, overstimulating, overprotecting, and/or interfering. Nonhostility (5 points: 1 = markedly and
overtly hostile, 5 = nonhostile) measures the degree to which the parent is able to talk to
or behave with the child in a way that is generally patient, pleasant, and harmonious
and not rejecting, abrasive, impatient, or antagonistic. Child Responsiveness (7 points:
1 = nonoptimal, 7 = optimal) focuses on the childs age- and context-appropriate ability
and 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 childs
enjoyment of the interaction. Involvement (9 points: 1 = nonoptimal, 9 = optimal) assesses
the childs ability and willingness to engage the parent in interaction (see Biringen,
2000; Easterbrooks & Biringen, 2000). The flexible nature of the scales, which can be
used with children from infancy to early childhood, and the choice of an ecological context of free play with a standard toy set for preschool children, allowed us to use the
same observational situation for all participants. Coding was carried out by two independent coders who were first trained on the EA Scales to obtain satisfactory interrater
reliability with Biringen and then between themselves. Motherchild and fatherchild
dyads for every family were separately coded by independent coders who were blind
to one anothers EA ratings. The coders followed the guidelines for the use of the EA
Scales with children with disabilities (Biringen, Fidler, et al., 2005). Interrater reliability
(Biringen, 2005) was assessed using average absolute agreement intraclass correlation
coefficients (ICC; McGraw & Wong, 1996) on 25% of the interactions coded, and ICCs
ranged from .84 to .95.

RESULTS
Preliminary Analysis
Distributions of the six individual EA Scales from the two visits were examined for
normalcy and outliers. The EA Nonhostility scale was distributed as a noncontinuous
variable and showed significantly skewed distributions and was therefore treated as
ordinal. Preliminary correlations were conducted to investigate associations between
child chronological age, child developmental age, mother age, father age, and family

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DE FALCO ET AL.

SES with EA scores. Neither paternal age nor family SES correlated significantly with
EA scores in our sample, and therefore were not considered further. Maternal age
showed significant negative correlations with all motherchild EA scores (p < .05)
except Nonintrusiveness. Child chronological age was not associated with EA Scales in
motherchild interactions but was positively associated with Responsiveness and
Involvement in fatherchild interactions. Child developmental age was not associated
with EA in motherchild interactions but was positively associated with Involvement
in fatherchild interactions; thus, child chronological age, child developmental age,
and mother age standardized residuals were used in the analyses. In addition, no child
gender 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 analysis so that the clusters would be comparable. The distribution of Nonhostility was
examined in relation to the clusters derived from the other five EA Scales. Finally, the
distributions of motherchild and fatherchild dyads across clusters were explored
with first-order configural frequency analyses (von Eye, 2002) using Lehmachers test
with Kchenhoffs continuity correction.
Analytic Plan
The first section of Results provides descriptive statistics. The second section presents group comparisons between the two parents in terms of parent EA mean scores.
The third section presents correlations among EA ratings separately for motherchild
and fatherchild interactions and compares these correlations. The fourth section
presents associations of parental EA ratings between husbands and wives. The fifth
section explores child EA with the two parents in two ways: (1) using bivariate correlation analyses between child EA ratings from motherchild and fatherchild interactions and (2) employing paired comparisons of child EA means. The sixth section
describes cluster analyses. Because child chronological and developmental age and
mother age were associated with the EA scores, analyses were carried out on the standardized residuals of a regression with these three variables as predictors.
Descriptive Statistics
Table 1 presents descriptive statistics for each EA Scale separately for motherchild
and fatherchild dyads. Considering our sample size, all scales showed a reasonable
representation 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 and
fatherchild dyads. We found significant positive associations between all pairs of

EA IN FAMILIES OF CHILDREN WITH DOWNS SYNDROME

205

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

FatherChild

Sensitivity (19)
M
Range
SD

5.75
38
1.28

5.73
3.58.5
1.15

Structuring (15)
M
Range
SD

3.64
24.5
.74

t(21)a

rb

Parent
.09

.54**

3.77
2.55
.63

1.06

.63**

4.09
2.54.5
.80

4.11
2.55
.65

.12

4.59
3.55
.48

4.64
45
.41

234

Responsiveness (17)
M
Range
SD

4.95
2.56.5
1.06

5.21
3.56.5
.78

1.12

.39

Involvement (17)
M
Range
SD

4.72
2.56.5
1.08

5.11
3.56.5
.72

1.43

.46*

Nonintrusiveness (15)
M
Range
SD
Nonhostility (15)
M
Range
SD

.25

.60**

Child

Note. Because mother age, child chronological and child developmental age were associated
with the EA Scales, we used as scores the standardized residuals of a regression with these three
variables as predictors.
a
Dependent t-test values are reported; for Nonhostility, paired Wilcoxon signed-ranks test
value is reported.
b
Pearson productmoment r coefficients values are reported; for Nonhostility, Spearmans
rank order coefficient value is reported.
*p < .05; **p < .01.

scales except StructuringNonintrusiveness, which did not show significant associations in either motherchild or fatherchild dyads, and paternal Nonintrusiveness
Nonhostility. The mean of significant intercorrelations between all other pairs of scales
for 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 corresponding shared variances ranged from 23 to 81% for motherchild dyads and from 16
to 64% for fatherchild dyads. Intercorrelation patterns in this sample resemble those
reported in previous studies (e.g., Biringen, 2000; Biringen, Damon, et al., 2005;
Bornstein, Gini, Putnik, et al., 2006). We compared correlation coefficients among the
EA Scales in mothers versus fathers using Fishers z (1921; see Howell, 2001, p. 278) and
found no significant differences (z range from .05 to 1.49).

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DE FALCO ET AL.

TABLE 2
Correlations among EA Scales Scores in MotherChild and FatherChild Dyads Separately
Sensitivity Structuring Nonintrusiveness Nonhostility Responsiveness Involvement
Sensitivity
Structuring
Nonintrusiveness
Nonhostility
Responsiveness
Involvement

.80**
.49*
.65**
.59**
.52**

.82**

.15
.57**
.61**
.54**

.55**
.24

.32
.26
.10

.63**
.56**
.65**

.31
.48*

.64**
.48**
.54**
.55**

.40**

.75**
.62**
.56**
.56**
.90**

Note. Correlations above the diagonal are for mothers EA Scales, and correlations below the diagonal are
for fathers EA Scales. Because mother age, child chronological age, and child developmental age were
associated with the EA Scales, we used as scores the standardized residuals of a regression with these three
variables as predictors. For Nonhostility, Spearmans rank order coefficients are reported; for the remaining
scales, Pearson productmoment r coefficients values are reported.
*p < .05; **p < .01.

Agreement between Maternal and Paternal Emotional Availability

Bivariate correlations between maternal and paternal EA ratings showed significant
positive associations for the following EA dimensions: Sensitivity, Structuring, and
Nonhostility, but not for Nonintrusiveness (Table 1).
Child EA with Mothers and Fathers
Bivariate correlations highlighted the stability of Responsiveness and Involvement
across interactions with the two parents. As for continuity of these scales, pairedsample t-tests indicated no differences in mean levels of child Responsiveness and
Involvement between motherchild and fatherchild interactions (Table 1).
Cluster Analysis
In addition to variable approaches to our analyses, we applied cluster analyses to EA
scores of the dyads to ascertain the nature of the distributions of clusters between
motherchild and fatherchild dyads. The five continuous Emotional Availability
Scales were subjected to a K-means cluster analysis. We empirically identified dyads as
belonging 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 chronological and developmental age, mother and father age, SES, and child sex, as verified
through ANOVAs and square (Table 3). As an additional check on the validity of our
clusters, we used chi squares and configural frequency analyses (von Eye, 2002) to
examine the cluster distributions of mothers who exhibited higher (above the mean) or
lower (below the mean) levels of Intrusiveness or Hostility. Mothers who exhibited higher
or 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 not
equally distributed across clusters, 2 (2, n = 22) = 14.30, p .001. Configural frequency

EA IN FAMILIES OF CHILDREN WITH DOWNS SYNDROME

207

TABLE 3
Cluster Means in MotherChild and FatherChild Dyads Separately

Demographic variables
Child chronological age
Child developmental age
Mother age
Father age
SES

Lower EA

Medium EA

Higher EA

MC dyads = 7
FC dyads = 5

MC dyads = 7
FC dyads = 10

MC dyads = 8
FC dyads = 7

SD

SD

SD

F/2

34.91
19.88
38.91
40.45
30.88

11.05
5.90
4.78
5.56
16.28

35.63
18.27
30.00
34.13
26.85

10.27
5.30
3.89
6.24
11.48

39.33
23.67
37.33
41.67
33.67

4.16
1.53
2.31
2.52
2.89

ns
ns
ns
ns
ns

7.12c
4.37c
5.00b
75%
6.00c
6.12c

.58
.23
.00

40.06***
21.78***
3.69*
24.09***
19.16***
67.681***

6.85c
4.35c
5.00b
43%
6.28c
6.14c

.85
.38
.00

MotherChild EA Scales
Sensitivity
Structuring
Nonintrusiveness
Nonhostilitya
Responsiveness
Involvement

4.42a
2.92a
4.42a
28%
4.00a
3.57a

.71
.45
.53

FatherChild EA Scales
Sensitivity
Structuring
Nonintrusiveness
Nonhostilitya
Responsiveness
Involvement

4.40a
3.30a
4.20a
20%
4.40a
4.40a

.65
.45
.45

Child gender ratio (M:F)

Motherchild dyads
Fatherchild dyads

.81
.53

.55
.54
3:2
5:2

5.50b
3.50b
4.71b
43%
5.42b
5.14b

.41
.58
.49

5.60b
3.60b
4.90b
50%
5.40b
5.20b

.66
.57
.32

.53
.38

.51
.42
5:5
4:3

.53
.35

.49
.38
7:0
6:2

17.84***
7.93**
12.91***
14.30*
19.70***
23.67***
ns
ns

Note. Means with different subscripts (a, b, and c) are significantly different in Tukey HSD post-hoc tests.
Percentage 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.
a

analyses (von Eye, 2002) showed no differences in the distributions of motherchild

and fatherchild dyads across clusters.
DISCUSSION
Our goal in this study was to examine emotional availability among parents and their
children with DS in ways that might contribute to understanding patterns of maternal
child and paternalchild interaction in families with children with special needs. Specifically, we wanted to explore EA levels in families of children with DS and compare
dimensions of EA between the parents of children with DS to evaluate if fathers show
similar or different levels of EA than mothers, as suggested by the literature in typically
developing children (Lovas, 2005; Volling et al., 2002). Moreover, we wanted to assess
if motherchild and fatherchild dyads differed in associations among EA dimensions.

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We also wanted to know if EA in mothers and fathers were associated. Finally, starting
from the systems view of parentchild interaction in general (Bornstein, 2003; Sander,
2000; Stern, 1985; Trevarthen & Aitken, 2001; Venuti et al., 2008) and the dyadic nature
of 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 levels of responsiveness and involvement with the two parents, and if these levels are
associated.
Concerning the first aim, our findings allow us to draw some general conclusions
about the application of the EA Scales to families of children with DS. First, based on
the EA Manual (Biringen et al., 1998), the mean level reached by the dyads in our study
was slightly above the midpoint for Sensitivity and Structuring, close to the optimal
level for Nonintrusiveness, even closer for Nonhostility, and good enough for
Responsiveness and Involvement. As for Sensitivity, the scores of our sample did
not 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 from
reports 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 different
assessment of maternal sensitivity, no differences between mothers of children with DS
and 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 in
the metropolitan area of the biggest city of southern Italy. In Italy, parents reportedly
give special importance to social style and to interactive and affective dyadic exchanges
(Senese, Poderico, & Venuti, 2003; Venuti & Senese, 2007). Moreover, in a cross-cultural
study on motherchild EA in 20-month-old TD children, Italian mothers were
generally 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 more
time in synchronous dyadic social exchanges with their infants compared to U.S. mothers. It would be interesting, therefore, to extend this study to families of children with
DS living in different countries, or even in different regions (urban/rural) of the same
country.
Relative to the directive style often described in the literature about mothers of
children with DS, both parents in our study showed high levels of nonintrusive behavior. 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 Structuring and Nonintrusiveness to disentangle the debate about maternal directiveness
(whether positive, i.e. scaffolding, or negative, i.e. intrusive) with children with DS. We
found that this pair of scales was not associated, indicating that higher intrusiveness is
not 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 style
to successfully promote sophisticated play, without necessarily being intrusive. The
optimal level of Nonhostility observed in our sample offers two observations. One is argued
by Biringen, Damon et al. (2005); the free-play context, compared to more emotionally
demanding situations, renders parental hostility infrequent. The other is that, although
interacting with children who have objective impairments, parents of children with DS
do not display a rejecting, abrasive, or impatient attitude. On average, children with DS
in our study reached a good enough level in Responsiveness, which indicates that
they were generally positive and emotionally available, even if they showed less clear

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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 have
comparative data to offer, these findings are consistent with the idea that children with
DS generally display more cheerful, sociable personalities compared to children with
other types of disability (Hodapp, 2002).
We obtained a wide range of scores for all the scales (except Nonhostility), indicating that
the EA Scales discriminated among different levels of dyadic emotional availability in this
population of children with developmental disabilities. This diversity was found both in parents and in children. As expected from Biringen, Fidler et al. (2005), we found that although
children with DS may have objective impairments that undermine their ability to interact
and 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 or
in spite of the disability, and such parents are more likely to respond to their children appropriately. Thus, a child might seem highly unresponsive (to the observer) but the parent may be
doing an exquisite job in drawing him or her out, and thereby begin the makings of emotional
connection. (p. 373)

However, the wide range of child scores observed also indicates that, despite the
deficits imposed by the syndromes phenotype, children with DS may look different in
terms of their affective responses to parental cues and their willingness to engage
parents in interaction.
With respect to the second aim, our results indicate that mothers and fathers in our
sample were similar in their EA. In the literature on TD children, fathers (compared to
mothers) 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 with
regard 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; she
reported that fathers had lower scores compared to mothers. Similarly, in a study based
on a different measure of EA, Volling et al. (2002) found that mothers were more sensitive
and expressed more positive affect than fathers during parentinfant interactions. However, Wiefel et al. (2005), in their application of the EA Scales to a child psychiatric population, reported no differences between parents EA ratings. Thus, it could be that, in
families with children with special needs, fathers compensate and reach the same levels
of emotional availability as mothers. In other words, it could be that, perceiving the
special parenting needs of their children, fathers tailor their interaction style, paying
more attention to their own and their childrens emotional exchanges. However, low
statistical power (small n, unbalanced gender) could also account for why no significant
differences emerged between parents. Our results should be interpreted with caution.
Some other cues to help interpret this finding may come from results of research that
concerns parental stress and emotional reactions in fathers of children with disabilities,
DS in particular. Although there is ample evidence that both parents of children with
disabilities suffer from more psychological problems, parental stress, and lower levels
of 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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DE FALCO ET AL.

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 sample
did not differ with regard to the patterns of associations among individual EA dimensions, which were strong for almost all pairs of scales. This pattern of findings indicates
that the EA construct is relatively coherent when applied to parents and children with
disabilities. We found a positive associations between maternal/paternal and child ratings, which underscores the bidirectional nature of parentchild EA. Child EA dimensions shared up to 56% of their variance with parental EA Sensitivity, but shared much
less with Nonintrusiveness.
With respect to our fourth aim, we found that corresponding EA dimensions of one
parent tended to be positively associated with those of the other parent for Sensitivity,
Structuring, and Nonhostility. A possible interpretation could be that although EA is
not a personality trait, but rather a systemic measure of the emotional quality of dyadic
interaction (Biringen, 2000), it encompasses general features of empathy and socioemotional competence, which tend to be similar in married couples and is consistent with
the process of assortive mating. Or it could be that childrens own ways of interacting exert similar influences on their two parents EA (see below). Yet Nonintrusiveness
levels of the two parents were not significantly associated with each other; this dimension shows the weakest link to child EA, and may be one reason the EA Scale was
changed in the fourth edition (Biringen, 2008). Of course, a larger sample is needed to
confirm this pattern of results.
Considering child EA dimensions, we found both continuity and (moderate) stability
across childrens interactions with their two parents. Continuity means that the mean
levels of motherchild and fatherchild EA were comparable, and this finding extends
our observations concerning a general similarity with regard to EA between mother
child and fatherchild dyads; it also reveals that there were no general quantitative or
qualitative differences in the ways children were responsive to or involving of their
mothers compared to their fathers. Stability tells us about the consistency of individual
differences in the group. On the one hand, our findings accord with the bidirectional
nature of parentchild interaction and specifically with the idea of the childs contribution to dyadic exchanges, telling us that each child brings to the interaction with both
parents the childs own ways of being responsive and involving. On the other hand, the
moderate degree of stability confirms that child EA is also related to individual parental
interactive style and probably to the history of the parentchild relationship.
Finally, to complement the usual fragmentation of the global quality of EA into
its several dimensions (which we differentiated to give completeness to the construct),
in this study we applied person-level cluster analysis. The results of this analysis
were consistent with the EA theoretical framework, distinguishing three clusters of
dyads that were lower, medium, and higher for all parent and child dimensions. In
this way, the EA Scales discriminate, within this special population, lower-, medium-,
and higher-functioning dyads. Consistent with the results of mean level comparisons, motherchild and fatherchild dyads were equally distributed across the
clusters.
Future research is needed to examine more broadly the nature of parentchild EA in
DS. In this connection, several limitations in this study should be noted. First, as is
common in studies of clinical populations, the sample was small and unbalanced in
terms of child gender; a larger and gender balanced sample would allow investigation

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211

of relations between dyadic EA and child gender (Lovas, 2005). Second, our sample
was relatively homogeneous middle-to-low socioeconomic status (Ziv et al., 1996); a
wider and more heterogeneous sample for SES may have brought to light any association
with the EA Scales. Third, the inclusion of other variables, such as maternal and paternal levels of stress and anxiety, and parents reactions (stress/coping) to the diagnosis
that their child has DS, would enrich our understanding. Fourth, the inclusion of control
groups of typically developing children and of children with intellectual disabilities
with mixed etiology would enable future research to draw conclusions more specific to
the population of children with DS.
Our results take a first step in showing that the Emotional Availability Scales can be
a useful tool for assessing relationships between parents and their children with DS,
discriminating, in general, the functioning of dyads and, in particular, the contribution
of each member to specific EA dimensions. The use of the EA Scales could be particularly valuable in the Italian context, where most interventions provided by the public
health care system focus on the child and little attention is given to motherchild
interaction (and even less to fatherchild interaction). Being able to assess higher levels
of EA in clinical practice would mean uncovering an important strength to support
interventions focused on other weak areas of child development. Indeed, there is
empirical evidence that both motherchild and fatherchild EA can influence cognitive
performance in children with DS during joint play (Venuti et al., 2008; de Falco,
Esposito, Venuti, & Bornstein, 2008). Revealing a specific profile of low parentchild
EA would enable us to implement (and evaluate afterward) intervention programs
focused on the parentchild relationship aimed to prevent secondary deficits that originate from or are comorbid with dysfunctional dyadic interactions.
AFFILIATIONS AND ADDRESSES
Simona de Falco, Department of Cognitive Science and Education, Via Matteo Del Ben
5, 38068 Rovereto (TN), Italy. E-mail: defalco@form.unitn.it. Paola Venuti and Gianluca
Esposito are also at the University of Trento. Marc H. Bornstein is at the Eunice Kennedy
Shriver National Institute of Child Health and Human Development.
ACKNOWLEDGMENTS
We thank Z. Giusti and D. Putnick for assistance. This research was partially supported
by Intramural Research Program of the NIH, NICHD.
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