Play and emotional availability in young children with Down syndrome

Bodily-tactile early intervention: a pilot study of the role of maternal touch and emotional availability in interactions between three children with visual impairment and additional disabilities and their mothers

Background

Children with visual impairment and additional disabilities (VIAD) have difficulty accessing the visual information related to their parents' facial expressions and gestures. Similarly, it may be hard for parents to detect their children's subtle expressions. These challenges in accessibility may compromise emotional availability (EA) in parent-child interactions. The systematic use of the bodily-tactile modality for expressive and receptive communicative functions may function as a strategy to compensate for a child's lack of vision. This multiple-case study explored the effects of a bodily-tactile early intervention for three mothers and their one-year-old children with VIAD.

Methods

Video data from baseline, intervention, and follow-up sessions were analyzed using a bodily-tactile coding procedure and EA Scales.

Results

During the intervention, all mothers began to use a more bodily-tactile modality in early play routines and in different communicative functions. They increased their use of anticipatory cues, noticing responses, and tactile signs. Moreover, the children were more emotionally available to their mothers during the intervention and follow-up compared to the baseline.

Conclusion

The results indicated that, during a short intervention, mothers could adopt a systematic use of the bodily-tactile modality in interactions with their children with VIAD. The results also suggest that, when mothers increased flexibility in communication channels, it was positively linked to their children's EA.

Association between caregiver-child interaction and autistic-like behaviors at around three years of age

BACKGROUND

The prevalence of autistic-like behaviors is increasing worldwide, both in developed and developing countries. With a high disease burden and complex developmental causes, there has been much interest in the etiology of the disease, and there is a lack of evidence on the relationship between caregiver-child interaction and autistic-like behaviors.

AIM/OBJECTIVE

This study investigated the association between caregiver-child interaction and children's autistic-like behaviors during early childhood.

METHOD

The subjects of this study were 171 kindergartens selected from the Longhua Child Cohort Study (LCCS), and a total of 40,237 children around the age of three were included. Sociodemographic characteristics, family income, and frequency of interaction between caregivers and children were all filled in by the child's primary caregiver, and the adapted Chinese Autism Behavior Checklist was used to assess children's autism-like behaviors. Tobit Regression and ancovariance analysis (ANCOVA) were used to measure the relationship between caregiver-child interactions (family and social activities) and autism-like behaviors, with a two-tailed p value of <0.05 being significant.

RESULTS

Tobit regression analyses found that in the 0-1 year age group, different frequencies of singing activities by caregivers with children (<3 times per week, 3-6 times per week, 6 times or more per week) were significantly negatively associated with autistic-like behaviors in a dose-response manner (B values of -0.323, -0.381, -0.544, all p < 0.0001); in the 1-3 year age group, different frequencies of reading interactions by caregivers with children (<3 times per week, 3-6 times per week, 6 times or more per week) were also significantly negatively associated with autistic-like behaviors in a dose-response manner (B values of -0.388, -0.632, -0.956, all p < 0.0001), and similar associations were found in singing and chatting interactions.

CONCLUSIONS

Our findings suggest that higher frequencies of early caregiver-child interactions are associated with lower levers of autistic-like behaviors in children around the age of three years.

Story stems in early mother-infant interaction promote pretend play at 30 months

During early childhood, play develops through levels of sensory exploration and manipulation, to functional activities and during the second year of life to the level of pretend and symbolic play. However, little is known about the factors contributing to individual variations in the development of play. The present study investigated associations between maternal sensitivity and play conditions with different ways of engaging and participating and children's development of pretend play. Participants were 64 primiparous mothers and their 30-months-old children. Sensitivity was assessed using the Coding Interactive Behavior (CIB) coding system, and children's play was coded using the 12 Step Play Scale. Analyses showed no significant associations between sensitivity and children's play development but a play condition introducing a story stem was associated with a higher developmental play level and longer duration of pretend play compared to free interactive play. The findings suggest that the use of a story stem may promote pretend play in interactive settings with the mother.

Four-year-old children's pretend play complexity during free play and story stem play and associations with maternal sensitivity

Theory and research have linked pretend play in early childhood with the development of language and theory of mind. In 102 mother-child dyads at 4.5 years, we examined whether (1) introducing a story stem (a play narrative with socioemotional dilemmas) in a mother-child play context increases pretend play complexity compared with mother-child free play; and (2) maternal sensitivity is associated with pretend play complexity. Further, we explored whether the story stem increased child pretend play complexity more in dyads with mothers with low sensitivity compared with highly sensitive mothers. Sensitivity was coded using Coding Interactive Behavior and pretend play complexity with a global, integrated measure of the developmental level and quantity of play. Using generalized estimating equations, we found that pretend play complexity was positively associated with introducing a story stem and maternal sensitivity. Mixed methods ancova showed no significant interaction between play situation and maternal sensitivity. The findings stress the importance of maternal sensitivity and participation for play and how introducing a story stem may help promote child pretend play complexity.

Embedding Play to Enrich Physical Therapy

Play is an active process by which an individual is intrinsically motivated to explore the self, the environment, and/or interactions with another person. For infants and toddlers, engaging in play is essential to support development across multiple domains. Infants and toddlers with or at risk of motor delays may demonstrate differences in play or challenges with engaging in play activities compared to typically developing peers. Pediatric physical therapists often use play as a modality to engage children in therapeutic assessment and interventions. Careful consideration of the design and use of physical therapy that embeds play is needed. Following a 3-day consensus conference and review of the literature, we propose physical therapy that embeds play should consider three components; the child, the environment, and the family. First, engage the child by respecting the child's behavioral state and following the child's lead during play, respect the child's autonomous play initiatives and engagements, use activities across developmental domains, and adapt to the individual child's needs. Second, structure the environment including the toy selection to support using independent movements as a means to engage in play. Allow the child to initiate and sustain play activities. Third, engage families in play by respecting individual family cultures related to play, while also providing information on the value of play as a tool for learning. Partner with families to design an individualized physical therapy routine that scaffolds or advances play using newly emerging motor skills.

Symbolic Play among Children with Autism Spectrum Disorder: A Scoping Review

Symbolic play is considered an early indicator in the diagnosis of autism spectrum disorder (ASD) and its assessment. The objective of this study was to analyze the difficulties in symbolic play experienced by children with ASD and to determine the existence of differences in symbolic play among children with ASD, children with other neurodevelopmental disorders and children with typical development. A scoping review was carried out in the Web of Science (WoS), Scopus, ERIC, and PsycInfo databases, following the extension for scoping reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The number of papers included in the review was 22. The results confirm that children with ASD have greater difficulties with symbolic play than children with other neurodevelopmental disorders and children with typical development, even when controlling for their verbal age. Difficulties are greater in situations of free or spontaneous play. Results evidenced that the absence or deficiency in the symbolic play can serve as an early indicator of ASD between the first and second year of life, the developmental moment in which this type of play begins.

Family Variables and Quality of Life in Children with Down Syndrome: A Scoping Review

The purpose of this scoping review was to identify the family and child quality of life variables that have been studied in relation to one another in children with Down syndrome, the frequency with which different relationships have been studied, and the extent to which family variables were the focus of the research aims. A literature search was conducted to find studies published between January 2007 and June 2018. The initial search yielded 2314 studies; of these, 43 were selected for a final review. Researchers most often addressed family resources and family problem-solving and coping concerning child personal development and physical well-being. Little attention to child emotional well-being was observed, with none considering family appraisal of child emotional well-being. The relationship between family variables and child QoL rarely was the primary focus of the study. Methodologically, most reviewed studies used cross-sectional designs, were conducted in North America and based on maternal report. From future research considering the issues found in this review, healthcare providers can obtain an in-depth understanding of relationships between children and family variables.

The Focal Play Therapy: An Empirical Study on the Parent-Therapist Alliance, Parent-Child Interactions and Parenting Stress in a Clinical Sample of Children and Their Parents

The present study aims to investigate the outcomes of the Focal Play Therapy with Children and Parents (FPT-CP) in terms of parent-therapist alliance, parent-child interactions, and parenting stress. Thirty parental couples (N = 60; 30 mothers and 30 fathers) and their children presenting behavioral, evacuation and eating disorders took part to the study. Through a multi-method longitudinal approach, data were collected at two time points (first and seventh sessions) marking the first phase of the intervention specifically aimed to build the alliance with parents, a crucial variable for the remission of the child's symptoms (and to the assessment of the child's symptoms within family dynamics.) Therapeutic alliance was assessed by the Working Alliance Inventory by therapists and parents. Parent-child interactions and parenting stress were evaluated using the Emotional Availability Scales and the Parenting Stress Index, respectively. Results showed that a positive parent-therapist alliance was developed and maintained during the first seven sessions. Furthermore, parent-child interactions significantly improved on both parents' and child's dimensions. However, parenting stress levels remained unchanged between the two time points. The findings should enrich scientific knowledge about the role of parental engagement in preschool child-focused treatments as to better inform practice and improve the quality of care for children and their families.

Parents' Past Bonding Experience with Their Parents Interacts with Current Parenting Stress to Influence the Quality of Interaction with Their Child

Healthy dyadic interactions serve as a foundation for child development and are typically characterised by mutual emotional availability of both the parent and child. However, several parental factors might undermine optimal parent-child interactions, including the parent's current parenting stress levels and the parent's past bonding experiences with his/her own parents. To date, no study has investigated the possible interaction of parenting stress and parental bonding history with their own parents on the quality of emotional availability during play interactions. In this study, 29 father-child dyads (18 boys, 11 girls; father's age = 38.07 years, child's age = 42.21 months) and 36 mother-child dyads (21 boys, 15 girls; mother's age = 34.75 years, child's age = 41.72 months) from different families were recruited to participate in a 10-min play session after reporting on their current parenting stress and past care and overprotection experience with their parents. We measured the emotional availability of mother-child and father-child play across four adult subscales (i.e., sensitivity, structuring, non-intrusiveness, non-hostility) and two child subscales (i.e., involvement and responsiveness). Regression slope analyses showed that parenting stress stemming from having a difficult child predicts adult non-hostility, and is moderated by the parents' previously experienced maternal overprotection. When parenting stress is low, higher maternal overprotection experienced by the parent in the past would predict greater non-hostility during play. This finding suggests that parents' present stress levels and past bonding experiences with their parents interact to influence the quality of dyadic interaction with their child.

Physiological arousal and observed behaviour in parent-child interactions involving young children with Down syndrome

BACKGROUND

Parents of children with Down syndrome (DS) play an important role in their child's development. Physiological measures, such as electrodermal activity (EDA), can shed light on parent-child relations beyond the behavioural level. The goals of the current study were to assess the feasibility of collecting EDA data in preschool age children with DS, examine the association between parent and child EDA during play-based interactions, and investigate the relation between parent and child EDA and observed parent behaviours.

METHOD

Two parents in 15 families participated in dyadic free play interactions with their child with DS (i.e., 15 mother-child and 15 father-child interactions). The children with DS (aged 24-61 months) and both of their parents wore multisensory wristbands measuring EDA. Parent behaviours were coded as requests for behavioural complies, requests for verbal complies, or comments.

RESULTS

Usable EDA data were collected for 13/15 children and 11/15 mothers during the mother-child interactions and 14/15 children and 12/15 fathers during the father-child interactions. Parent and child EDA variability was significantly positively related for father-child but not mother-child dyads. Maternal use of requests for behavioural complies was positively related to child EDA variability.

CONCLUSIONS

The collection of EDA data through wristbands worn by young children with DS during early parent-child interactions was feasible. Preliminary findings indicated that some aspects of parent and child physiology in DS may be related in different ways for mother-child and father-child dyads.

Parenting children with intellectual disability: linking maternal insightfulness to sensitivity

BACKGROUND

This study examined mothers' representation of their children's inner world - maternal insightfulness - and its link to sensitive maternal behaviour. We aimed to understand some of the parental processes that underlie parenting children with intellectual disability (ID).

METHODS

The sample included 38 mothers and their children with non-specific ID aged 2.5 to 5.5 years. Children had developmental quotient scores of M = 56.29, SD = 9.65 and adaptive behaviour scores of M = 60.72, SD = 10.43. We hypothesised that mothers who were insightful show more sensitive behaviour when interacting with their children than non-insightful mothers do. Maternal insightfulness was assessed using the insightfulness interview, and maternal sensitive behaviour during mother-child interaction was assessed using the emotional availability observation scales.

RESULTS

Forty-one per cent of the mothers showed positive insightfulness regarding their children's inner world. These mothers showed higher levels of sensitive behaviour than did the non-insightful mothers. The insightfulness-sensitivity link was not associated with any of the mothers' or the children's characteristics, including the level of developmental quotient, suggesting that these parental constructs are not simply a reflection of the level of the children's developmental delay.

CONCLUSIONS

Better understanding of the mechanism of parenthood, including the insightfulness-sensitivity link, may help personalise the support provided to parents of children with ID. The associations between maternal insightfulness and sensitivity imply that promoting maternal insightfulness may enhance mothers' sensitivity towards their children.

Communicative Mediation by Adults in the Construction of Symbolic Uses by Infants

Adult semiotic mediation in the origin and evolution of the first symbolic uses of objects by infants in contexts of triadic interactions was investigated. Six infant-parent dyads interacting together with ten objects were observed longitudinally from 9 to 15 months of age, with an interval of three months between each observation. The communicative mediators used by adults, in the form of demonstrations and ostensive gestures, decrease as infants grow up. The orchestration of these semiotic mediators also decreases and the functions of the demonstrations change. At the beginning, the adults use them merely to demonstrate the symbolic uses of object, but later they use them to evaluate, complete or correct the symbolic uses by the infants. The semiotic mediators are first used to guide the child at the level of attention and later at the level of cultural practices of symbolic uses of objects. These changes in communicative mediators and their functions reveal the educational role of adults through adjustment in communication, always in tune with the infant's knowledge and performance.

Mother-Child Play: A Comparison of Autism Spectrum Disorder, Down Syndrome, and Typical Development

The purpose of the present study was to analyze mother-child collaborative play in children with Autism Spectrum Disorders (ASD) compared to children with Down Syndrome (DS) and typical developing children (TD). Children with ASD are often described as having deficient play skills, particularly in the symbolic domain. Caregivers’ involvement in child play activities increases the structural complexity of playing in both typically developing children and children with disabilities. Participants included 75 mothers and their children with ASD (n = 25), with down syndrome (n = 25) and with typical development (n = 25). Mother–child play sessions were analyzed using a coding system for exploratory and symbolic play. Results indicated that children with ASD showed more exploratory play compared to children in the other groups. No significant differences emerged between the three groups for child symbolic play or for mother play. These findings are discussed in relation to the debate about functional and symbolic play in children with ASD and in relation to the importance of setting and age for play assessment.

Syndrome specificity and mother-child interactions: examining positive and negative parenting across contexts and time

This study examined the extent to which child syndromes and observation context related to mothers' parenting behaviors. Longitudinal observations were conducted of parenting behavior across ages 3, 4, and 5 years during structured and unstructured activities. The 183 participants included mothers of children with autism spectrum disorders, cerebral palsy, Down syndrome, undifferentiated developmental delay, or typical cognitive development. Negative parenting behaviors were higher in structured activities and higher in mothers of children in all developmentally delayed groups. Positive parenting was higher in unstructured activities and especially high for mothers of children with Down syndrome. Despite differences found through direct observation of parenting children in different diagnostic groups, they are not as strong as syndrome-group differences found through more commonly used self-report questionnaires assessing domains like parenting stress.

Maternal functional speech to children: a comparison of autism spectrum disorder, Down syndrome, and typical development

Children with developmental disabilities benefit from their language environment as much as, or even more than, typically developing (TD) children, but maternal language directed to developmentally delayed children is an underinvestigated topic. The purposes of the present study were to compare maternal functional language directed to children with two developmental disabilities--autism spectrum disorder (ASD) and Down syndrome (DS)--with TD children and to investigate relations of maternal functional language with child language skills. Participants were 60 mothers and their children with TD (n = 20), DS (n = 20), or ASD (n = 20). Children's mean developmental age was 24.77 months (SD = 8.47) and did not differ across the groups. Mother and child speech were studied during naturalistic play. We found (a) similarities in maternal functional language directed to the two groups of children with developmental disabilities compared to that directed to TD children and (b) a positive association between subcategories of information-salient speech and child mean length of utterance in TD dyads only. The clinical and developmental implications of these findings are discussed.

Emotional Relationships in Mothers and Infants: Culture-Common and Community-Specific Characteristics of Dyads from Rural and Metropolitan Settings in Argentina, Italy, and the United States

This study uses country and regional contrasts to examine culture-common and community-specific variation in mother-infant emotional relationships. Altogether, 220 Argentine, Italian, and U.S. American mothers and their daughters and sons, living in rural and metropolitan settings, were observed at home at infant age 5 months. Both variable- and person-centered perspectives of dyadic emotional relationships were analyzed. Supporting the notion that adequate emotional relationships are a critical and culture-common characteristic of human infant development, across all samples most dyads scored in the adaptive range in terms of emotional relationships. Giving evidence of community-specific characteristics, Italian mothers were more sensitive, and Italian infants more responsive, than Argentine and U.S. mothers and infants; in addition, rural mothers were more intrusive than metropolitan mothers, and rural dyads more likely than expected to be classified as mid-range in emotional relationships and less likely to be classified as high in emotional relationships. Adaptive emotional relationships appear to be a culture-common characteristic of mother-infant dyads near the beginning of life, but this relational construct is moderated by community-specific (country and regional) context.

Emotional relationships between mothers and infants: knowns, unknowns, and unknown unknowns

An overview of the literature pertaining to the construct of emotional availability is presented, illustrated by a sampling of relevant studies. Methodological, statistical, and conceptual problems in the existing corpus of research are discussed, and suggestions for improving future investigations of this important construct are offered.

Maternal and paternal pragmatic speech directed to young children with Down syndrome and typical development

The aim of this study was to compare functional features of maternal and paternal speech directed to children with Down syndrome and developmental age-matched typically developing children. Altogether 88 parents (44 mothers and 44 fathers) and their 44 young children (22 children with Down syndrome and 22 typically developing children) participated. Parents' speech directed to children was obtained through observation of naturalistic parent-child dyadic interactions. Verbatim transcripts of maternal and paternal language were categorized in terms of the primary function of each speech unit. Parents (both mothers and fathers) of children with Down syndrome used more affect-salient speech compared to parents of typically developing children. Although parents used the same amounts of information-salient speech, parents of children with Down syndrome used more direct statements and asked fewer questions than did parents of typically developing children. Concerning parent gender, in both groups mothers used more language than fathers and specifically more descriptions. These findings held controlling for child age and MLU and family SES. This study highlights strengths and weaknesses of parental communication to children with Down syndrome and helps to identify areas of potential improvement through intervention.

Maternal and infant behavior and context associations with mutual emotion availability

Emotional availability (EA) is a prominent index of mutual socioemotional adaptation in the parent-infant dyad. This study examines zero-order and unique associations of multiple maternal and infant behavior and context indicators to variation in aspects of EA in mothers and their young infants. The associations to each were explored in separate analyses for maternal sensitivity and infant responsiveness in 369 European American mothers and their firstborn 5½-month-olds. Beyond zero-order relations, robust regression analyses revealed differentiated patterns of unique relations of mother and infant behavior and context indicators to the EA dimensions of maternal sensitivity and infant responsiveness. Although potential behavior and context relations to EA are many, prominent relations to maternal sensitivity and infant responsiveness are few, and patterns of association vary for the two dimensions of EA. Adequate EA is fundamental to a healthy parent-infant relationship, and understanding the behavior and context indicators associated with EA is fundamental to its enhancement.

Mother-child interaction and child developmental capacities in toddlers with major birth defects requiring newborn surgery

BACKGROUND

Evidence exists of the important role of the mother-child relationship in child development, yet with the exception of prematurity, little is known of the impact of biologic risk on this relationship.

AIMS

We investigated the quality of the mother-child interaction in association with early development in toddlers who had newborn surgery for major birth defects.

METHODS

Ninety-three toddlers (Mean age=24.7 months, SD=4.6) requiring newborn surgery for major birth defects, underwent developmental testing and participated in a videotaped free play interaction with their mothers. Interactions were rated using the National Institute of Child Health and Human Development schema. Interaction ratings were compared with normative data and within group differences were also examined in relation to child developmental status.

RESULTS

Overall mean interaction ratings were suboptimal and significantly different from normative data; with the exception of child negative mood. Forty-one children (44%) had developmental delay. Mother and child interactive behaviour ratings were consolidated into three factors (Maternal Responsivity, Maternal Intrusiveness, and Child Positive Interactivity) for multivariate analyses. Compared to children developing normally, those with developmental delay showed significantly less positive interactivity and had mothers who were less responsive and more intrusive. Child behaviour with the tester was related to child behaviour with the mother.

CONCLUSION

Quality of mother-child interaction is nonoptimal in children with major birth defects requiring newborn surgery. Mothers of infants with developmental delay are most at risk of interaction difficulties and may benefit from early identification and timely intervention.

Social cognition in children with Down's syndrome: challenges to research and theory building

Characterising how socio-cognitive abilities develop has been crucial to understanding the wider development of typically developing children. It is equally central to understanding developmental pathways in children with intellectual disabilities such as Down's syndrome. While the process of acquisition of socio-cognitive abilities in typical development and in autism has received considerable attention, socio-cognitive development in Down's syndrome has received far less scrutiny. Initial work in the 1970s and 1980s provided important insights into the emergence of socio-cognitive abilities in the children's early years, and recently there has been a marked revival of interest in this area, with research focusing both on a broader range of abilities and on a wider age range. This annotation reviews some of these more recent findings, identifies outstanding gaps in current understanding, and stresses the importance of the development of theory in advancing research and knowledge in this field. Barriers to theory building are discussed and the potential utility of adopting a transactional approach to theory building illustrated with reference to a model of early socio-cognitive development in Down's syndrome. The need for a more extensive model of social cognition is emphasised, as is the need for larger-scale, finer-grained, longitudinal work which recognises the within-individual and within-group variability which characterises this population. The value of drawing on new technologies and of adapting innovative research paradigms from other areas of typical and atypical child psychology is also highlighted.

Mother-child play: children with Down syndrome and typical development

Child solitary and collaborative mother-child play with 21 children with Down syndrome and 33 mental-age-matched typically developing children were compared. In solitary play, children with Down syndrome showed less exploratory but similar symbolic play compared to typically developing children. From solitary to collaborative play, children with Down syndrome increased their exploratory play, attaining the same level as typically developing children. Pretense significantly increased from solitary to collaborative play only in typically developing children. Differences between mothers' play in the two groups mirrored those between their children. Both groups showed similar attunement and synchrony. Mothers contribute to the play development of children with Down syndrome through their own adaptation to their children's limitations and potentialities.

Fathers' play with their Down Syndrome children

BACKGROUND

In children with Down Syndrome (DS), as in other groups of special needs children, development depends crucially on the degree to which parents provide appropriate stimulation and effective support. The majority of recent studies investigating interactions between parents and children with DS have been conducted on mothers.

METHOD

Through observation of child solitary play, child collaborative play with their father, and father play with their child, the current study focused on paternal contributions to child play in association with the effective quality of father-child interactions. A total of 19 children (M chronological age = 35.32 months, SD = 10.35; M mental age = 19.58, SD = 5.43) with DS and their fathers participated in the study. Two 10-min sessions, of child solitary play and collaborative play with their father, were videorecorded. A coding system for exploratory and symbolic play was applied to both sessions, and the Emotional Availability (EA) Scales were independently applied to the collaborative play session as a measure of the effective quality of the father-child interaction.

RESULTS

Children showed more symbolic play during collaborative sessions compared with solitary sessions. Bivariate correlations showed positive associations between father play and child exploratory and symbolic play. Cluster analysis identified dyads in low, medium and high EA groups, which differed in terms of each partner's play. Specifically, both fathers and children of high EA dyads were more likely to show more symbolic play and less exploratory play than those with low EA dyads.

CONCLUSIONS

Our findings enrich the theoretical perspective that dyadic interactions based on emotional involvement may lead to enhanced cognitive functioning in children with DS.

Mother-child emotional availability in ecological perspective: three countries, two regions, two genders

This study used a cross-national framework to examine country, region, and gender differences in emotional availability (EA), a prominent index of mutual socioemotional adaptation in the parent-child dyad. Altogether 220 Argentine, Italian, and U.S. mothers and their daughters and sons from both rural and metropolitan areas took part in home observations when the children were 20 months old. In terms of country, Italian mothers were more sensitive and optimally structuring, and Italian children were more responsive and involving, than Argentine and U.S. dyads. In terms of region, rural mothers were more intrusive than metropolitan mothers, and boys from metropolitan areas were more responsive than boys from rural areas. In terms of gender, mothers of girls were more sensitive and optimally structuring than mothers of boys, and daughters were more responsive and involving than sons. Understanding how country, region, and gender influence EA exposes forces that shape child development, parent-infant interaction, and family systems.