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Who Cares for America's Children? (1990)

Chapter: 5 Supporting Physical and Psychological Development in Child Care Settings

« Previous: 4 Quality of Child Care: Perspectives of Research and Professional Practice
Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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Suggested Citation:"5 Supporting Physical and Psychological Development in Child Care Settings." National Research Council. 1990. Who Cares for America's Children?. Washington, DC: The National Academies Press. doi: 10.17226/1339.
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5 Supporting Physical and Psychological Development in Child Care Settings In Chapters 3 and 4, our discussion of child care and child devel- opment traced the evolution of research on child care and identified the key structural dimensions of quality in child care. This chapter takes a more differentiated look at specific aspects of physical and psychological development In the context of child care. Our aim is to identify practices that support both physical and psychological health in child care settings. We turn first to research on physical health and safety. We ask whether and to what extent participation in child care is associated with risk for infectious diseases, injury, abuse, or neglect; and we point to practices that protect children's health and safety in child care settings. We turn next to the psychological outcomes and examine practices supportive of specific developmental processes in child care. The research on child care is not "developmental" in the sense of yielding a detailed theory or picture of children's changing needs in child care with increasing age (beyond the in- fancy/postinfancy demarcation). It is developmental, however, in the sense of focusing on particular developmental processes (e.g., peer relations, language development) and asking how these are affected by child care settings. Accordingly, our discussion in this section is organized around developmental processes rather than age groups. In the last part of the chapter we address the needs of two special groups of children: children with developmental disabilities and school-age children. These children's needs differ from those of normally developing infants and preschoolers, and we consider child care practices that are supportive of their develop- ment. 108

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT PHYSICAL HEALTH AND SAFEI Y IN CHILD CARE 109 There is a burgeoning literature on children's physical health and safety in child care. Jarman and Kohlenberg (1988) reviewed more than 200 studies for the panel; they concluded that, despite a bewildering array of methodological obstacles and gaps in the research, the findings on several issues converge and lead to conclusions that have significant implications for policy and practice. Infectious Diseases Respiratory Pact Infections Respiratory tract infections (colds, ear infections, sore throats, laryngi- tis, croup, epiglottitis, bronchiolitis, bronchitis, pneumonia, and flu) account for the majority of young children's illnesses and absences from school and child care (Denny et al., 1986; Doyle, 1976; Fleming et al., 1987; Strangert, 1976; Wald et al., 1988~. The evidence indicates that children in child care tend to experience more of these infections and at a younger age (Denny et al., 1986; Doyle, 1976) than children cared for at home, although some question the strength of the pattern (Haskins and Kotch, 1986~. Studies show that children under 3 years of age who are in child care have more episodes of respiratory tract infection than children cared for at home; yet after the age of 3, they appear to have fewer infections of these kinds. Health experts indicate it is likely that these children encounter the common childhood viral pathogens at a younger age, and acquire immunity earlier, than children who first encounter them when entering group settings such as nursery school or kindergarten. In general, the respiratory tract infections that child care children ex- perience appear to be minor, self-limited, and inevitable. However, findings suggest that frequent early respiratory infections predispose these young- sters to ear infections that are more frequent, persistent, and recurrent (Daly et al., 1988; Fleming et al., 1987; Haskins and Kotch, 1986; Hen- derson and Giebink, 1986~. Such a pattern of early ear infections may have implications for children's language development. Accordingly, there is an urgent need for prospective studies that encompass not only micro- bial surveillance and measures of illness, but also audiological assessment and measures of language development. Studies of the developmental and family effects of the increased frequency of minor illnesses in infants and young children in child care are also needed.

110 Diarrheal Disease WHO CARES FOR AMERICA'S CHILDREN? The evidence regarding diarrhea! disease among children in child care is less consistent than that regarding respiratory illnesses; some but not all studies show these children at increased risk relative to children cared for at home (Bartlett et al., 1985; Dingle et al., 1964; Reeves et al., 1988; Sullivan et al., 1984~. Wide variation in risk estimates for diarrhea may partly reflect seasonal and geographic variations in the prevalence of infecting organisms. However, the evidence is consistent in identifying particular child care features that are associated with higher rates of diarrhea. By far the best-established risk factor is the presence of children who are not yet toilet trained (Ekanem et al., 1983~. The risk of diarrhea! disease is also higher when caregivers both diaper children and prepare food (Lemp et al., 1984~. The risk of diarrhea! disease can be diminished by limiting group size; separating same age from different age children (Pickering et al., 1981~; strictly adhering to the hygienic practice of hand washing after diapering infants and before food preparation (Gehlbach et al., 1973~; and excluding from child care and treating those children suspected of having bacterial diarrhea on the basis of blood or mucus in the stool (Weissman et al., 1975~. Meningitis Meningitis is an example of a formidable disorder of low prevalence that has major consequences for those children who become infected. There is strong agreement across studies that bacterial meningitis (most often caused by H. in~uenzue type b tHib]) can be transmitted among children and, further, that children attending child care are at increased risk of contracting primary cases of this disease (Cochi et al., 1986; Haskins and Kotch, 1986; Istre et al., 1985; Redmond and Pichichero, 1984~. However, there is no agreement across studies as to the extent of the risk to children in child care, once a primary case has occurred: some studies indicate a substantial risk of secondary disease and some do not (Band et al., 1984; Fleming et al., 1985; Ginsburg et al., 1977; Osterholm et al., 1987~. The evidence on the household contacts of primary cases more consistently documents increased risk than the evidence for child care contacts of primary cases (Filice et al., 1978; Granoff and Basden, 1980; Ward et al., 1979). For treatment, Rifampin may reduce the risk of secondary acquisi- tion of Hib meningitis in susceptible youngsters, but recommendations for this therapy vary. The American Academy of Pediatrics recommends such therapy only for household contacts of an index case in households with at

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 111 least one person 4 years old or younger, whereas the Immunization Prac- tices Advisory Committee of the Centers for Disease Control recommends Rifampin for all contacts in households as well as child care groups with one or more children under 2 years who have been exposed (American Academy of Pediatrics, 1986; Granoff and Basden, 1980~. New vaccines currently under development may offer protection for even very young chil- dren, thereby further reducing the threat of disease in child care settings (American Academy of Pediatrics, 1986~. Human Immunodeficiency Virus (HIV) The risk of transmission of HIV infection in a group care setting appears to be extremely low, and to date there is no report of a child or a caregiver becoming seropositive for HIV because of exposure in a child care center or family day care home. Despite the very low risk of transmission of HIV infection in child care settings, however, extremely restrictive guidelines have been promulgated for the exclusion of infected children (American Academy of Pediatrics, 1987; Blackman and Appel, 1987; Centers for Disease Control, 1985~. Such guidelines suggest the exclusion of infected children if they are not yet toilet trained, if they place hands or objects in their mouths, if they bite, or if they have oozing skin lesions. The guidelines are reactions to the extreme consequences of infection for a child and family rather than to the extremely limited risk of transmission by body fluids to peers. Retrospective research is clearly needed to evaluate the contacts of children who have been diagnosed with HIV infection to address public fears regarding peer transmission. Additional areas of concern include compliance with existing infection control recommendations (which reduce the risk to caregivers and to chil- dren with AIDS who have not yet been diagnosed) and the development of child care centers to serve children with AIDS. Viral Hepatitis Viral hepatitis presents a potentially substantial occupational health problem to child care workers, but a limited problem for child care chil- dren (Balistreri, 1988~. The limited research concerning viral hepatitis indicates that child care settings that cater to non-toilet-trained children are frequently a source of disease in attendees, adult caregivers, and house- hold contacts. Furthermore, although approximately 75 percent of infected children show very mild symptoms, 75 percent of infected adults develop a disabling illness lasting from 2 weeks to 2 months (Balistreri, 1988~. By far the most significant risk factor associated with an outbreak of viral

112 WHO CARES FOR AMERICA'S CHILDREN? hepatitis in a child care center is the presence of children under 2 years of age (Hadler et al., 1982~. Fortunately, medical intervention can be highly effective in limiting the transmission of viral hepatitis. Specifically, public health experts rec- ommend that the identification of one or more cases in a child care center should be followed by immunoglobulin prophylaxis for all staff and children in the same room as the index case (Centers for Disease Control, 1981~. Although prophylaxis for household members has not been shown to be effective, it is recommended for parents of children who wear diapers in circumstances in which three or more families associated with a child care group show infection. Immunoglobulin prophylaxis can virtually eliminate the spread of viral hepatitis within a child care group. In addition to the use of immunoglobulin prophylaxis, other practices (hand washing, disinfection of diaper change surfaces and toys, segregation of children by age group) are recommended to curb the spread of any disease that is transmitted via the fecal-oral route, although their efficacy specifically for viral hepatitis has not been demonstrated. There has been some progress in the development of a hepatitis A vaccine for use in humans, but it is not ready for general use (McLean, 1986~. Cytomegalovirus Although cytomegalovirus (CMV) does not cause symptoms of acute infection in child care children (acute infection is generally asymptomatic), it can cause serious neurological damage to an embryo or fetus in utero if a pregnant woman experiences her first CMV infection during the first half of pregnancy (Conboy et al., 1987; Melish and Hanshaw, 1973; Pass et al., 1980; Stagno et al., 1986~. Therefore, there is potential risk to the fetus carried by the mother of an infected child in child care and to that of a pregnant child care worker (Adler, 1988b). Evidence indicates that CMV is excreted by approximately one-half of the children in centers with 50 or more children. Furthermore, children between 1 and 3 years of age do spread CMV to each other in child care settings. Children bring infections home to their parents and particularly to their mothers. And child care workers are at some risk of acquiring CMV, although less so than parents of child care children (Adler, 1986, 1988b; Pass and Hutto, 1986; Pass et al., 1987~. There are as yet no specific measures to control the risks of CMV infection, which remain low for any given pregnancy. CMV transmission in child care settings can be limited by standard hygienic practices because the virus is inactivated by soaps, detergents, and alcohols (Adler, 1988a).

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT Injury 113 Data on rates and severity of injuries to children in child care are limited. ~ date, there are no studies contrasting the incidence of injury among child care children and home-reared children. Nor has there been a prospective study with rigorous measurement procedures. Available in- formation concerning injury among children in child care thus rests on documentation of injury rates within centers and family day care homes. From the few studies that have examined injuries, it is clear that child care children show similar types of injuries to children reared at home, with the possible exception of bites from other children (Garrard et al., 1988~. A majority of injuries in child care settings occur on the playground and particularly on climbing equipment (Aronson, 1983; Elardo et al., 1987; Landman and Landman, 1987~. Minor injuries (e.g., abrasions) are common, but they are widespread among young children in general. The most important conclusion regarding injuries is the need for rigorous prospective studies that contrast children in family day care and center care with home-reared children and document the circumstances associated with injuries. Abuse and Neglect There is only one major study of sexual abuse in child care settings. A national survey of sexual abuse in child care (supported by the National Center on Child Abuse and Neglect and the National Institute of Mental Health) indicates that the risk of a child being sexually abused in child care (5.5/10,000 children) is significantly smaller than the risk of sexual abuse by a family member in a child's own home (8.9/10,000 children) (Finkelhor et al., 1988~. That study also found that the traditional indicators of quality of care (e.g., group size, ratio) did not predict low risk for sexual abuse. Abusers in child care settings rarely had previous histories of arrest for abuse (8 percent did), the majority had some college education, and most had at least 2 years of experience in child care. Sixty percent of the abusers were men; 40 percent were women. Only 35 percent of the abusers were employed in the centers as child care workers. Similarly, the evidence on physical abuse and neglect is scarce. A study in Kansas, a state with strict supervision and enforcement procedures, indicated reports of abuse and neglect in only 1.4 percent of all child care facilities (which were rapidly followed up by legal intervention) (Schloesser, 1986~. By contrast, in North Carolina during 1982-83 (at that time one of the least regulated and supervised states) 16.5 percent of complaints to the Office of Child Care Licensing involved abuse or neglect (Russell and Clifford, 1987~. Complaints were filed for 8.6 percent of centers and 2.3

114 WHO CARES FOR AMERICA'S CHILDREN? percent of licensed family day care homes. This study indicated problems in the timing, quality, and rate of prosecution following complaints. There are no overall national figures for rates of physical abuse and neglect in child care. However, state-level data raise the possibility that supervision and enforcement mechanisms, which vary substantially by state, may be a factor associated with actual or possibly only reported rates of abuse and neglect. Exclusion Policy and Child Care for Sick Children There are substantial differences of opinion among parents, child care staff, and pediatricians about when it is appropriate to exclude a symp- tomatic child from a child care setting (Landis et al., 1988~. Furthermore, decision rules with a goal of limiting or preventing the spread of infection are often not based on sound scientific knowledge concerning transmis- sion, perhaps partly because the period or patterns of contagion and the appearance of symptoms often do not correspond closely. Jarman and Kohlenberg (1988) report that available medical evidence suggests several conclusions: 1. There is no evidence that excluding children with respiratory infec- tion changes the risk of disease for other children in child care or for their caregivers. 2. At present, available evidence does not justify policies that restrict child care attendance for all children with diarrhea! disease. Instead, exclusion is potentially valuable only in a small minority of cases, notably those marked by the presence of blood and mucus in the stools. 3. With the exception of children under age 2 (Klein, 1987), there is no evidence to suggest that fever itself merits exclusion from child care as a means of controlling infection (Shapiro et al., 1986~. Exclusion in such cases should be based on concerns for the comfort of the child, rather than the spread of infection. 4. In the case of hepatitis A, there is usually considerable spread of virus before the disease is detected. Prompt initiation of immunoglobulin prophylaxis once disease is detected generally eliminates the need for exclusion (Centers for Disease Control, 1981~. 5. Exclusion of a child with meningitis occurs automatically as a result of the usual need to hospitalize the ill youngster for appropriate therapy (see discussions of guidelines following identification of an index case, above). 6. The restrictive guidelines for exclusion of children diagnosed with HIV infection reflect the consequences associated with infection rather than the theoretical risk of transmission in child care settings (American Academy of Pediatrics, 1987; Centers for Disease Control, 1985~.

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 115 When children are ill, employed parents often lack options for their care. Stringent exclusion policies in many child care facilities have provided an impetus for the development of alternative models for child care for sick children. Four models for such care have been identified (Rodgers et al., 1986), though none is widely available: a "get-well room" within a child care center for a mildly ill child; a satellite family day care home to which a sick child is transferred; care in the child's own home by a trained worker from an agency or a caregiver from the child's own center; and an infirmary or independent facility that cares for mildly ill children. Given children's needs for psychological nurturing as well as physical care when they are ill, many professionals prefer care in the child's own home (Chang et al., 1978~. However, the feasibility of implementing this model is limited because the financial expense of hiring a trained professional to provide one-on-one care is beyond the means of many families. Summary and Implications for Practice Home-reared children and those in child care do not differ significantly in the kinds of diseases or injuries they experience. Differences that do occur are quantitative rather than qualitative. For example, there is a mild to moderate increase in the risk of a number of common infectious diseases for children in child care, but these generally do not entail long-term health consequences. Viral respiratory illnesses appear to be more common among child care children in the first 3 years; there are indications that they have fewer such illnesses in later years. The single longer term consequence of the common infections identified in this review is the possibility that more frequent middle-ear infections in early life may have lasting effects on hearing and language development. Children in child care also contract diarrhea! illnesses more frequently than children cared for at home, but these illnesses rarely have any long-term health consequences. Regarding rare but more serious infectious diseases, group child care does increase the risk for hepatitis A, CMV, and meningitis. There is no evidence of increased risk among child care children of HIV. From the perspective of children's health, it is only Hib disease (meningitis) that is of substantial concern. Children with hepatitis A or CMV are usually minimally symptomatic. Although primary as well as secondary infections with Hib disease are more frequent in child care settings, these account for very small percentages of child-care-related illnesses. Chemoprophylaxis diminishes the risk of secondary infections, and new vaccines may further diminish overall risk. Finally, there is no evidence to suggest that child care attendance is associated with increased risk of physical injury, sexual abuse, physical abuse, or neglect, although further study of these issues is needed. Thus,

116 WHO CARES FOR AMERICA'S CHILDREN? despite significant increases in a host of minor infectious diseases, it is apparent from this review that child care attendance poses no major risks to the health status of young children in the United States. Existing scientific evidence and best professional practice from the fields of pediatrics and public health suggest a number of practices for safeguarding the health and safety of children in child care settings: · limiting group size; separating groups of children according to age; · strictly adhering to hand-washing practices particularly after dia- pering and before food preparation; regularly cleaning and disinfecting diaper changing surfaces and communal objects and toys; excluding children presenting with bloody stool and children youn- ger than age 2 with fever, as well as other selected infectious diseases; Rifampin therapy following the identification of an index case of Hib meningitis; and immunoglobulin prophylaxis following identification of an index case of viral hepatitis. There is little documentation of specific measures that can reduce injury, abuse, and neglect among children in child care. Some evidence in the research suggests, however, that instances of abuse and neglect can be diminished by strict supervision, enforcement, and prosecution of reported cases. PSYCHOLOGICAL DEVELOPMENT IN CHILD CARE The years when children may be participating in child care are years of rapid transition in several domains of development. At very young ages, children form their first attachment relationships with adults as well as their first friendships with peers. They extract the rules of language from the speech they hear, and they use increasingly complex speech. Children identify themselves as part of a cultural group and, surprisingly early, assess for themselves the way in which their group is seen. From their interactions with the physical and social world, young children are constantly developing their perceptual, reasoning, and problem-solving abilities. What specific child care practices support these developmental pro- cesses? In this section, we examine the existing knowledge of child care features and practices that are related to social development (relationships with adults, relationships with peers, and positive group identity in a mul- ticultural context) and cognitive development (language development and more broadly defined intellectual development).

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT Relationships With Adults 117 Research on children's relationships with adults has focused on two processes: the quality of attachment relationships and children's coopera- tiveness with adults. Although studies examining child care and attachment have traditionally emphasized implications for children's attachment to their mothers, recent evidence suggests the need for a broader perspective. The evidence is as yet limited, but there are indications that children's attach- ments to their caregivers are also important and, further, that development among children in child care can be best understood through simultaneous consideration of attachments to parents and to caregivers. Attachment to Mother As discussed in Chapter 3, the quality of children's attachments to their mothers has been considered a useful index of their overall emotional well-being (Ainsworth, 1985; Bretherton and Waters, 1985; Campos et al., 1983; Sroufe, 1985~. Factors influencing that attachment are also assumed to have importance for later development. Individual differences in chil- dren's attachments to their mothers have been found to be influenced by the mothers' sensitivity and responsiveness to a child's needs and commu- nicative behavior in its first year and related to the mothers' own emotional well-being and network of support, to the child's personality, and to the socioeconomic stresses experienced by the family (Bretherton and Waters, 1985; Campos et al., 1983; Crockenberg, 1981; Sroufe, 1985~. An issue that remains clouded with some uncertainty concerns the nature of the effects of full-time child care during the first year of life on infant-mother attach- ment. Although research has consistently shown that children of working mothers are attached to their mothers (Clarke-Stewart and Fein, 1983; see also Chapter 3), the question has been raised as to whether the quality of such attachments differs for children in full-time care during their first 12 months. As we discussed in Chapter 3, current assessments of infants' attach- ments to their mothers rest on a single laboratory assessment, the "strange situation" that places infants under the stress of separation from their moth- ers and observes their responses to both the separation and the reunion (Ainsworth et al., 1978~. Using this assessment, studies have shown that in- fants whose mothers work full time in the infants' first year are more likely to show a pattern of "anxious-avoidant" attachment than infants whose mothers do not (Barglow et al., 1987; Belsky, 1988; Belsky and Rovine, 1988; Schwarz, 1983~. Children who spent their first year in full-time child care were also found in some studies to be more aggressive and uncoop- erative, although this finding is not consistent (Barton and Schwarz, 1981;

118 WHO CARES FOR AMERICA'S CHILDREN? Haskins, 1985; McCartney et al., 1982; Rubenstein and Howes, 1983; also see below). Although there is agreement about these research findings, their in- terpretation remains open. Some researchers argue that these findings indicate that babies whose mothers are absent for most of the day have missed experiences that are essential for the development of social rela- tionships outside the home, but this view has been criticized on several grounds: First, the validity of the laboratory situation as an assessment of the mother-child relationship for children accustomed to full-time child care has not been established. Second, it is not clear whether the observed associations are due to poor quality of care in infancy rather than to care per se, to continuity of poor care beyond infancy, or to differences in the families whose children are in full-time care in infancy from those whose children are not (Clarke-Stewart, 1989~. Further stringent monitoring of the implications of early full-time care and a broader based assessment of children's relationships with their mothers are clearly needed before the conflicting interpretations can be assessed. Attachment to Caregiver Recent research suggests that there may be important developmental implications of security of attachment not just to mothers but also to careg~vers. In addition, secure attachment to a caregiver may function to offset insecure infant-mother attachment (Howes et al., 1988~. Positive involvement with a particular caregiver in child care is associated with more exploratory behavior in children (Anderson et al., 1981~. Children with secure attachments to a caregiver also appear to spend more time engaged in activities with peers in child care (Howes et al., 1988~. Thus, a secure attachment to a caregiver may provide children with a "safe base" from which to explore both the physical and the social worlds. I-here are only a few indications from research of the child care cir- cumstances that foster the development of secure attachments to caregivers. Findings indicate that those attachments are more likely to occur in child care settings with fewer children per caregiver, in contexts in which children are less often ignored by caregivers (Howes et al., 1988), and when there is continuity for children in terms of the time they spend with a particular caregiver (Anderson et al., 1981~. These findings suggest that the precur- sors of secure attachment to mother and to a caregiver are similar: interest in, and availability for, interactions with the child.

SUPPORT NO PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT Cooperation With Adults 119 As we discussed in Chapter 3, an important finding of the first wave of child care research is a shift in the social orientation of children in child care toward peers and away from adults. In some cases, this shift appears to be accompanied by less cooperation with adults. An important question is whether this pattern occurs for all child care children or whether it is associated with specific features and practices in the child care setting. There is some evidence to suggest that the overall quality of the child care setting is related to the development of cooperative behaviors. Higher overall center quality among community-based centers is associated, for example, with more positive behavior with adults (Vandell and Powers, 1983) with more child compliance (Howes and Olenick, 1986), and with behavior that is more considerate (McCartney et al., 1985~. Children who have attended higher rather than lower quality child care centers at an early age also show differences in their later behavior toward adults. Children with a history of poorer quality early child care have been found to be on average more difficult in preschool settings and more hostile in kindergarten (Howes, 1988a). Clarke-Stewart (1989) notes, however, that a pattern of uncooperative behaviors has also been observed for children from very high quality model intervention programs, like those described by Haskins (1985~. As Haskins and others have noted, the focus of such programs to date has been largely on cognitive development, with a lack of emphasis on social skills. Thus, the global assessment of such programs as high quality may need qualifying for particular domains of development. The implication of these findings is that poor-quality overall care or high-quality care with a lack of emphasis on social skills, may underlie pre- viously observed patterns of uncooperative behavior in child care children. Clarke-Stewart (1989:271) concludes that in child care settings "children do not learn to follow social rules or to resolve social conflicts without resorting to aggression unless special efforts are made by their caregivers." Thus, the feature of child care most important to cooperative behavior in children appears to be "direct training in social skills" by caregivers (Clarke-Stewart, 1989:271~. Findings from the National Day Care Study (Ruopp et al., 1979) point also to group size and caregiver training as cor- relates of child cooperativeness. These features of group care may underlie the frequency with which a caregiver is free to, or motivated to, engage in social skills training. Relationships With Peers At one time researchers believed that interest in peer interactions and the formation of dyadic relationships with peers did not occur until children

120 WHO CARES FOR AMERICA'S CHILDREN? reached age 3. More recent studies indicate, however, that interactions with peers and stable peer friendships begin in the first years of life (Hay, 1985~. Early peer interactions follow a developmental sequence, from simple social interest and mutual responsiveness in infancy, through complementary and reciprocal interaction and the sharing of meaning in toddlerhood, to the social organization of peer groups in the preschool years (Howes, 1987~. Relationships with peers appear to be important for both contempora- neous and longer term development. Thus, for example, Clarke-Stewart and Fein (1983), in their comprehensive review of early childhood programs, suggest that greater social competence (e.g., self-confidence, sociability, independence, cooperativeness, perceptiveness regarding social roles) in children who have attended early childhood programs is in part related to their greater experience with peers. Hartup (1983:167), summarizing the evidence on the longer term implications of relations with age-mates, concluded: Poor peer relations are embedded in the life histories of individuals who are "at risk" for emotional and behavioral disturbance.... There is every reason to conclude that poor peer relations are centrally involved in the etiology of a variety of emotional and social maladjustments. Some of the factors that foster positive relations with peers among day care children and, conversely, those that foster antisocial behaviors have been identified. According to Howes (1987:157), "a large body of litera- ture reported that children with secure attachment relationships with their mothers are more socially competent in their relationships with peers...." New evidence complements these consistent findings in pointing to secure attachment to child care providers as a further, and perhaps ever more important, factor in fostering positive engagement with peers among child care children (Howes et al., 1988~. Researchers widely hypothesize that secure attachments provide the basis for young children to have positive expectations for responsiveness and positive interactions with peers (e.g., Howes, 1987), although another perspective suggests that positive and complex relations with adults and peers emerge as parallel developmental accomplishments, rather than as one set of relations growing out of the other (Hay, 1985~. The complexity of peer interactions also appears to be strongly influ- enced by the stability of the peer group (Howes, 1987, 1988b). Very young children transferred to a new school or preschool class often show signs of disruption, such as sleeplessness and increased aggression (Field et al., 1984~. Young children moved to a new child care group without friends are less socially skilled than those whose contacts are with a high proportion of established friends (Howes, 1988b). Thus "parents and teachers may

SUPPORTING PHYSICAL AND PSYCHOLO&ICAL DEVELOPMENT 121 need to be more sensitive to the issue of maintaining friendships" (Howes, 1988b:67). It is reasonable to infer from the existing evidence that caregiver guidance can also enhance children's peer relations. Research indicates that children's social competence, as manifested in such behaviors as sharing and taking the perspective of another, can be improved through demonstration, guided activity, deliberate encouragement of interpersonal problem solving, and desirable behaviors by adults (Clarke-Stewart and Fein, 1983~. Finally, Howes (1987) notes that moderate-sized groups simultaneously permit a choice of partners and protect children from overstimulation, which in turn promotes positive peer relations. In summary, the child care practices that foster the development of positive peer relations appear to be circumstances permitting secure attachment to caregivers, peer group stability, guidance by adults in interactions with peers, and moderate group size. This picture can be completed by asking if antisocial peer behaviors, identified as a concern in the first wave of child care research, are also re- lated to particular child care features? Uncooperative behavior with adults, like problematic peer behavior, has been found to be related to overall center qualitr (Vandell et al., 1988), though with the same qualifications noted above regarding cognitively oriented model intervention programs. Within the context of community-based care, larger group size (Holloway and Reichhart-Erickson, 1988; Ruopp et al., 1979), fewer opportunities for children to interact with caregivers, less adequate space, and less adequate educational materials (Holloway and Reichhart-Erickson, 1988) appear to be associated with less positive peer relations. Uncooperativeness with peers, just as with adults, may signal child care circumstances that are disruptive to, rather than supportive of, interpersonal relationships. Positive Group Identity in a Multicultural Context Child care experiences can affirm children's cultural identity in the context of a multicultural society. Such affirmation may have significant implications for children's eventual experience in school, which for minority students can represent a "frequently devastating encounter with the values of the broader society" (Holliday, 1985:120~. There are numerous indications that processes of cultural group iden- tification begin quite early and that many young children from minority groups form negative views of their cultural group (Aboud, 1988; Comer, 1989~. In one recent study, for example, 80 percent of black middle-class preschoolers showed preferences that valued whites and devalued blacks, despite positive self-concepts (Spencer, 1985~. Such dissonance between personal and group evaluations is common among black American children irrespective of age, stage of cognitive development, or geographic region

122 WHO CARES FOR AMERICA'S CHILDREN? (Spencer, 1985, 1986, 1988). The role that child care can play in such a pattern is underscored by findings indicating that when parents engage in "proactive" teaching about African-American history and contemporary racial history, in anticipation of children encountering discrimination, the children's academic performance is better. Furthermore, children with pos- itive group identity show greater resilience to psychological stress (Spencer, 1988~. Research points to several ways in which child care can play a role in fostering positive group identity in minority group students. First, child care programs can incorporate information about the cultural groups of children represented in the care group, and positive portrayals of group members, in educational programs and materials. Cummins (1986:25) notes that "considerable research data suggest that, for dominated minorities, the extent to which students' language and culture are incorporated in the school program constitutes a significant predictor of academic success." Well-articulated and detailed curricula have been developed that indicate how such an educational orientation can be carried out: for example, Williams and DeGaetano (1985) on the Alerta program; Arenas (1980) on the Bilingual/Multicultural Curriculum Development Effort; National Head Start Multicultural Task Force (1987~; and Phillips (1989~. Second, it is important to build on rather than negate the diverse learn- ing and interaction styles of children (and parents) from minority cultures (Fillmore and Britsch, 1988) and thus to foster an early sense of efficacy rather than helplessness in school. As one example, research has been carried out on understanding and incorporating differing learning styles in the framework of the Kamehameha Early Education Program in Hawaii (Au and Jordan, 1981~. As described by Cummins (1986:25~: "When read- ing instruction was changed to permit students to collaborate in discussing and interpreting texts," consistent with discourse patterns among siblings and peers encouraged by Hawaiian culture, "dramatic improvements were found in both reading and verbal intellectual abilities." Research on early intervention programs extends this concept to the culturally rooted interaction styles of parents as well as of children. Slaugh- ter (1983:68), for example, found that a discussion-group intervention pro- gram for lower income black mothers and their young children had "broad, extensive effects on dyads" on personality, attitude, and behavior measures, whereas an intervention focusing on toy demonstration, and modeling of in- teractive play behaviors, had more "situation-specific effects." In discussing these findings, Slaughter notes that the discussion-group intervention ap- peared more compatible with cultural values of reliance on extended family. The discussion group was consonant with, and may have substituted for, the functioning of this type of support.

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 123 Finally, child care can facilitate the development of minority group children through establishing a pattern of parent-teacher collaboration rather than excluding parents from their children's care and early education settings. Membership in a minority group often carries with it parental expectation of limited access to educational resources and environments. Parent participation develops a "sense of efficacy that communicates itself to children, with positive academic consequences" (Cummins, 1986:26~. Much of the evidence on the effectiveness of parent-teacher collabo- ration comes from studies with older children (Cummins, 1986~. Yet such a collaborative approach is important to children's well-being and devel- opment in child care settings from the earliest ages. Examples provided by child care workers concerning infants and toddlers include strong cul- tural preferences for sleeping positions and whether or not children of one gender should be permitted to enact roles of the other gender, or dress in clothing of the other gender, in fantasy play (Sale, 1986~. Respecting the cultural patterns and childrearing values of families with children in child care can be vital to children's positive adaptation. Language Development The language development among children in child care reflects both the amount and the kind of speech that is directed to them. Verbal in- teractions with caregivers rather than with peers appear to be important. Fine-grained examination of language development of children in child care centers suggests that the amount of speech that caregivers direct toward children is an important developmental predictor. McCartney (1984), for example, found that the total number of "functional utterances" by center caregivers predicted several measures of children's language development. And although child-initiated conversations with caregivers positively pre- dicted language development, children's initiations of conversations with peers was a negative predictor. Several studies go beyond quantity to identify particular types of verbal interactions in child care that foster language development. A key feature appears to be the combination of joint caregiver-child focus on an activity or object and the exchange of information. Carew (1980), for example, notes the importance in both caregiver-child and mother-child interaction of such activities as labeling objects, describing activities, and providing definitions. Similarly, McCartney (1984:252) found that children in child care "seem to profit from experiences in which they are given information and requested to give information . . . Conversely, children seem to be hampered by experiences in which their behavior is controlled." From these and other findings from the educational research literature (e.g., Brown et al., 1984; Wood, 1988; Wood et al., 1980), it might be

124 WHO CARES FOR AMERICA'S CHILDREN? expected that child care features that permit caregivers to engage more often in informational exchanges with children, and less often in the sheer management of behavior, would foster children's language development in these settings. In reviewing the relevant evidence, Goelman (1986) identified group size and the age mix of children as conditions that support these interchanges. Smaller groups appear to make it easier for caregivers to engage in joint focus and information exchanges with children. Similarly, in family day care settings, a mixed-age (rather than same-age) group is associated with more frequent (though shorter) verbal exchanges between caregivers and children. Goelman and Pence (1987) suggest yet another significant factor for children's understanding of, and use of language · . - careg~ver trammg. These findings have implications for practice. In child care, care- givers' speech involving information exchange promotes language develop- ment. Particular child care features that may make opportunities for such caregiver-child interaction more feasible include smaller group size, more extensive caregiver training, and possibly a broader age range of children in family day care groups. Cognitive Development Beyond language development, what does research indicate about child care features that more broadly foster cognitive development? As discussed in Chapter 3, existing research shows no indication that child care participation has detrimental effects on intellectual development, provided that the care is of good quality. Further, a range of early childhood cognitive enrichment programs for high-risk groups have been shown to prevent or slow declines on measures of intellectual development characteristic of such groups. These findings are based not only on the widely used IQ assessments, but also on a range of other measures of cognitive growth, including assessments of problem solving; reasoning; perceptual, spatial, and conceptual development; perspective taking; exploratory behavior; and creativity (Clarke-Stewart and Fein, 1983~. As we discussed in Chapter 4, children's cognitive achievement re- flects the amount of direct stimulation and teaching provided by caregivers (Clarke-Stewart and Fein, 1983~. Stimulating caregiver behavior, in turn, is enhanced by smaller group size and by caregiver training. In addition, child care programs that incorporate some organized educational activities, rather than serving a solely custodial function, have children who show greater cognitive development. The evidence suggests that child-initiated and -paced learning at early ages is more important than teacher-directed learning.

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 125 As we noted in Chapter 3, findings from intervention programs, in- cluding Head Start and a range of cognitive enrichment programs, indicate significant but temporary gains on IQ measures for high-risk groups when interventions terminate with the end of preschool. Although findings in- dicate that IQ differences are not sustained into early school years, other variables reflecting overall school adjustment (e.g., retention in grade, re- ferral for special instruction) do show lasting effects (Lazar et al., 1982~. Furthermore, there are indications that when interventions continue into the early school years rather than end prior to school entry, there are implications for academic performance in the school years (Horacek et al., 1987~. The extent of exposure to early intervention, and enrollment in a program that focuses on both child and family are factors in terms of cognitive development (Bryant and Ramey, 1986), but variation in educa- tional methods and practices in such projects do not relate systematically to intellectual development. Thus, `'there may be multiple paths to intel- lectual competence" (Bryant and Ramey, 1987:74~. Although particular curricular emphases may not have differential effects on global measures such as IQ, future research will need to study whether there are differential effects in terms of specific cognitive skills. A detailed analysis of cognitive development in relation to curricular emphases is especially needed. In summary, studies of the variation in quality in community-based child care point to stimulating caregiver behaviors as particularly important for children's cognitive development. Such behaviors are more likely in the context of smaller groups, in settings with some educational content, and with better trained caregivers. Studies of cognitive enrichment programs underscore the importance of the amount of time children spend in the program and the need to serve children as well as parents. The Balance of Emphasis in Children's Psychological Development There has been a tendency in the United States to conceive of high- quality child care, and particularly intervention programs for high-risk children, solely in terms of cognitive stimulation. But researchers in the area of early intervention are now sounding a cautionary note. They are suggesting that cognitive stimulation in children's programs be combined with attention to social development. Haskins (1985:702), for example, voiced concern that the intellectual advantages associated with cognitive stimulation programs were sometimes "purchased at the price of deficits in social behavior," when children in a cognitive enrichment program showed elevated rates of aggression in elementary school. Similarly, as discussed in Chapter 4, researchers tracking

126 WHO CARES FOR AMERICA'S CHILDREN? participants in the High/Scope preschool curriculum study concluded that the manner in which a cognitive stimulation program was carried out had implications for children's social adaptation: Programs that provided children with options for initiating their learning, rather than more passively following teacher-directed instruction, were associated with better social adjustment over a period of years (Schweinhart et al., 1986~. In contrast with the American experience with cognitive enrichment through child care, which suggests that there are social implications of cog- nitive programs, the Japanese preschool experience suggests that emphasis on social behaviors in preschool settings may have positive implications for cognitive development. In Japanese preschools, small groups are formed and assigned group projects, and the groups are composed so that chil- dren's individual qualities will complement one another. Group roles are rotated so that each child gains experience in being a group leader as well as a follower. Children learn to subordinate individual goals to those of the group, and they develop identification with their group and loyalty to it. As a result, children demonstrate relatively high levels of self-regulation by the time they enter grade school, so that they are able to settle down to classroom regimens and learn well even though they have had much less early training in letters and numbers (Lewis, 1984~. Our intent here is not to suggest that the educational approach of a culturally more homogeneous society such as Japan, in which there is a great deal of consensus (among educators and between parents and educators) regarding educational goals and processes, could or should be transplanted to the U.S. multicultural and highly individualistic society.) Rather, the contrast underlines the fact that classroom structure can be designed to place more or less emphasis on teaching children to be eDective members of groups. And whether this emphasis is present or not has consequences for children's subsequent social and cognitive development. As we noted at the beginning of Chapter 3, social and cognitive development do not always occur in unison. Yet development in one domain has implications for development in another. Both the U.S. and the Japanese experiences underscore the need to consider the implications of program emphases for both cognitive and socioemotional development, and indeed to include an explicit focus on both developmental processes. Professional standards emphasize the importance of maintaining a balance (see Appendix B). This view is echoed in the goals established jointly by parents and child care staff in one high-quality center (UCLA Child Care Services, 1989~. ~ It is interesting to note, however, that there are cross-cultural similarities in the academic per- formance of minority-group children in Japan and the United States (Ogbu, 1986; Spencer et al., 198~.

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT Summary and Implications for Practice 127 The development of children in child care is fostered by secure at- tachments to parents as well as caregivers. Research findings suggest that problems regarding cooperativeness with adults and with peers among children are frequently related to poor-quality care or care that focuses exclusively on cognitive development. Furthermore, cooperative relations with adults and peers can be fostered by caregiver behavior aimed directly at training in social skills. Child care also can provide an important oppor- tunity to affirm children's cultural group identity, by incorporating materials affirming children's cultural groups into program curricula, by promoting parent-caregiver collaboration, and by building on rather than negating culturally based patterns of learning and interaction. Children's language development in child care settings is fostered through frequent verbal interactions with caregiving adults that involve informational content and shared focus. Other aspects of cognitive devel- opment are supported by some (though not excessive focus on) organized learning that permits children to initiate and pace their own learning ac- tivities. For children from disadvantaged families, intensive exposure to a well-planned child care intervention project, particularly one that serves both child and family, can have important positive implications for intel- lectual development and later school and social adaptation. Child care programs need to balance their emphasis on socioemotional and cognitive development, and they need to recognize that efforts to foster development in one domain may well have implications for the other. CHILDREN WITH DISABILITIES AND SCHOOL-AGE CHILDREN Children With Disabilities During the past two decades, the nation's child care systems have faced the growing needs of a new group: children with developmental disabilities. In promulgating the Education for All Handicapped Children Act (P.L. 94-142), the U.S. Department of Education estimated that 12 percent of school-age children have handicapping conditions (Fine and Swift, 1986~. At younger ages, estimates of the incidence of disabilities- developmental, neurological, behavioral, or physical vulnerabilities vary substantially (Hauser-Cram et al., 1988~: for example, for children between birth and 3 years, estimates range from 3 percent to 26 percent (Hauser- Cram et al., 1988~. Despite this variation, it is clear that a nontrivial proportion of preschool children have potentially handicapping conditions. There are no national data available regarding the number of children with developmental disabilities presently enrolled in child care (Klein and

128 WHO CARES FOR AMERICA'S CHILDREN? Sheehan, 1987). However, state-level data suggest that, as in the general population, a substantial proportion of mothers of young children with disabilities are employed and use child care, often to complement early intervention programs that do not correspond to parents' hours of employ- ment (Rule et al., 1985~. For example, a statewide New Mexico survey of early intervention programs for infants and preschoolers with disabili- ties found that 46 percent of program parents were employed outside the home and that 40 percent used child care of varying types (Klein and Sheehan, 1987~. The average use of child care among families using early intervention programs was 26 hours per week (beyond the hours of early intervention). For parents of children with developmental disabilities, child care is essential to their continued employment, which may be particularly important given the additional financial burdens these families bear. It is also possible that child care is used by families when special programs do not exist to serve children with disabilities (Rule et al., 1985) and as a respite from the stress to parents caring full time for a child with special needs.2 Until the early 1970s, the majority of young children with developmen- tal disabilities faced institutionalization or placement in highly segregated child care programs. Subsequently, federal legislation has had a major impact on the integration of children with potentially handicapping condi- tions into regular child care and educational settings with their normally developing peers. As we discuss in Chapter 6, the Education for All Hand- icapped Children Act (P.L~ 94-142) and the Education of the Handicapped Amendments (P.L. 99-457) substantially altered the way children with hand- icapping conditions are served. The latter act may have a specific impact on the use of child care by families of young children with disabilities through its Individualized Family Service Plan component (see Chapter 7~. Development of Children With Developmental Disabilities Research on mainstreaming and integrating3 children with special needs into preschool settings with their normally developing peers indicates a number of potential benefits to both groups. Guralnick (1978), for example, notes that integration at the preschool level can prevent some of the deleterious effects documented to be associated with segregated 2 See Dyson and Fewell (1986) for a summary of the evidence regarding stress in parents of children with disabilities. sin mainstreaming, children with disabilities spend most of their time in a normal setting with support from special education staff. In an integrated setting, children spend the majority of time in a special education setting, with selected activities (e.g., free play, lunch, music) in a normal setting (Fredericks et al., 1978~.

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 129 programs for children with disabilities, most notably labeling and isolation. He further indicates that in integrated preschool groups, teachers can see the progress made by children with disabilities within a more complete developmental framework, and the social, play, and language environment available for observational learning is richer. In addition to the research on mainstreaming and integrating children with disabilities into model programs (e.g., Guralnick, 1976, 1978; Ispa, 1981), there is a small but growing body of research on the participation of these children in community-based child care programs (e.g., Fredericks et al., 1978; Jones and Meisels, 1987; Klein and Sheehan, 1987; Rule et al., 1985; Smith and Greenberg, 1981~. In both sets of studies there is a recurring finding that children with disabilities can indeed benefit from participation in settings with their normally developing peers, particularly fin social development, but such benefits occur only if there is appropriate staff training and careful programming. For example, Snyder and colleagues (1977:264) note: integrated settings do not necessarily result in increased cross group imitation and social interaction between handicapped and nonhandi- capped children. Apparently, teaching procedures designed to foster these effects are needed if retarded and other handicapped children are to benefit optimally from integrated preschool programming. There are some indications of negative eRects when children with special needs have been introduced with no special teacher training or programming. Smith and Greenberg (1981) found that without planning and teacher training in the child care setting, children with handicapping conditions showed fewer significant developmental gains over an academic year than their counterparts who remained in a special education setting. With teacher training or special curriculum, children with handicapping conditions in integrated preschool settings show positive changes in social behaviors, and, to some extent, in language behaviors that generalize to situations beyond the training or treatment context. For example, Gural- nick (1976, 1978) found that normally developing peers could be trained to model, prompt, and reinforce social and language behaviors in children with disabilities. Such peer instruction was found to be effective regarding social play, reduction of social withdrawal and self-directed behavior, and language usage. Fredericks and colleagues (1978) trained caregiving staff to facilitate the social and language skills of children with disabilities, reinforc- ing children with special needs as well as their normally developing peers, and found a substantial increase in the quality of play in the children with disabilities. Similarly, Devoney and colleagues (1974) found a noticeable increase in cooperative play when teachers intervened to structure group play between preschool children with and without handicapping conditions.

130 WHO CARES FOR AMERICA'S CHILDREN? Thus, while there are potential benefits of integrating children with special needs into child care settings, there are potential negative effects as well if children with disabilities are introduced with no special additional caregiver training or instructional program. Staff training and curriculum have been identified as the key components of integrated child care settings. Teacher Draining Model projects described by Rule and colleagues (1985) and Klein and Sheehan (1987) for~training child care providers to work with children with disabilities show a great deal of agreement in approach. Both reports note that few child care providers have been trained to serve children with special needs and that teacher attitude is an important ingredient in successful integration. In a program described by Rule and colleagues (1985), child care providers were prepared for the mainstream experience through a work- shop involving an introduction to "exceptionalities," the development of an individualized educational program, and use of positive discipline tech- niques. Caregivers visited special education settings serving children with disabilities. They then received training in educational techniques through informal discussion and demonstration and gradually assumed instruction while receiving supportive feedback in the classroom. A special education coordinator provided ongoing consultation to the child care teachers. This description is essentially in agreement with Klein and Sheehan's (1987) proposal of a special education and early childhood consultation model. It is important to note, however, that Klein and Sheehan also suggest that the other children in child care should be prepared for the introduction of a child with special needs. They should be acquainted with the special needs of the child and with any special equipment and procedures to be used with the child. In sum, both projects underscore the need to go beyond single workshops, to move training into the classroom, to tailor training to individual children's needs, and to provide ongoing support and consultation. Techniques to Foster Social Development Research emphasizes that child care, when used to complement special education programs, should have as its primary goal social rather than cognitive development. Programs should stress the social integration of children with disabilities, particularly the development of cooperative play skills and interactive language behavior. To basic strategies have been described for fostering positive interactions among preschool children with and without disabilities: the use of trained peers (Guralnick, 1976, 1978) and direct modeling and reinforcement by caregiving staff (Fredericks et al., 1978~. Both approaches involve modeling, prompting, and reinforcement of appropriate behaviors. Both the peer model and the caregiver reinforcement techniques have been documented

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 131 to be effective in increasing interactive social behaviors in children with special needs. Summary and Implications for Practice The social development of children with developmental disabilities can be fostered by exposure to the language and interactive environment of an integrated child care setting. Yet developmental benefits occur only when child care staff receive initial and ongoing training in the care of particular children with special needs, and techniques are used to encourage social interaction among children with and without disabilities. Research shows possible deleterious effects to children with disabilities of simply introducing them into child care settings without necessary staff training and appropriate programming. School-Age Children The need for child care does not end with children's entry into school. The amount of awake time that school-age children spend out of school exceeds the amount of time they spend in school each year, given hours before and after school and vacations. The limited evidence on after- school child care indicates that there is a problem with the amount of care currently available; that the needs of school-age children in child care differ from those of younger children; and that the quality of care is significant for developmental outcomes for school-age as well as preschool-age children. Estimates of the number of school-age children in self-care (for out- of-school-hours) vary markedly, though all estimates place the number in the millions. According to Fink (1986), the range in estimates of latchkey children from 2 million to 15 million is a reflection of self-report issues (parental reluctance to categorize their children as in self-care) and definition issues (How long must children be in self-care per day? Can a sibling be presents. Fink suggests that detailed studies in localities may yield more reliable estimates. In one such study, Vandell and Corasaniti (1988) found that 23 percent of the third graders attending seven elementary schools in a Dallas suburban school district returned home from school to a setting without adult supervision. Developmental Implications of Self-Care Just as estimates of latchkey children vary, so do reports of the im- plications of self-care. Studies by Rodman and colleagues (1985) and Steinberg (1986) found no differences between latchkey and adult-care

132 WHO CARES FOR AMERICA'S CHILDREN? children on measures of self-esteem, adjustment, and susceptibility to neg- ative peer pressure. Similarly, a study by Vandell and Corasaniti (1988) found no differences between mother-care and latchkey third graders on grades, standardized test scores, conduct in school, and self-reporting of competence. In contrast, a study of nearly 5,000 eighth graders in Los Angeles and San Diego (Richardson et al., 1989) found self-care to be a significant risk factor for substance use (alcohol, cigarettes, and marijuana). The relationship between self-care and substance use held for students "in dual-parent as well as single-parent households, those in high income as well as low income groups, those who get good grades as well as those who do not, and those who are active in sports, as well as those who are not . . ." (Richardson et al., 1989:563-564~. The researchers note that although substance use is consistently associated with self-care in this sample, there is nevertheless `'a large proportion of those in self-care not using these substances" (p. 564~. Accordingly, it is important to identify those factors that might be protective among children in self-care, as well as those factors most closely linked with substance use and other high-risk behaviors. Analyses carried out by Richardson and colleagues point to three possible mediating factors: risk-taking behaviors, having friends who smoke, and being offered cigarettes. The researchers speculate that "the self-care situation causes young adolescents to perceive themselves as more autonomous, more mature, and more able to make decisions that may not be approved by adults. This increasing autonomy may be manifested by increasing susceptibility to the influence of their peers" (p. 564~. Work by Long and Long (1983), focusing on a younger sample and on subjective feelings rather than substance use, also points to problems for children in self-care. Studying first- to third-grade latchkey children in a sample of black parochial schoolchildren, Long and Long found problems of loneliness, fear, and stress in these children. This work, however, involved limited documentation of sample characteristics and research procedures. As noted by Vandell and Corasaniti (1988) as well as Seligson (1988), the implications for children of self-care may vary by whether this arrange- ment was a necessity (i.e., no other care available or affordable) or chosen particularly for more competent or responsible children; how much time children are in self-care each day and over years; the restrictions placed on children's behavior while in self-care (i.e., to be at home alone or to be with peers); and the character of the surrounding neighborhood. Contradictory results concerning latchkey children may well be clarified by ongoing lon- gitudinal research that takes contextual factors into account (e.g., the work in progress by D. Belle, Boston University). The sheer number of school-age children in self-care strongly implies a need for child care beyond school hours that is not currently being met.

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 133 Little is known about what kind of care is needed for children in this age range; there are very few studies on which to base conclusions. I\vo recent studies, however, are helpful in portraying high-quality and poor-quality after-school care. Howes and colleagues (1987) describe a model after-school program for kindergarten children. Between 30 and 40 children were cared for after a morning kindergarten program by a highly trained staff with a good teacher/child ratio (a credentialed kindergarten teacher, two assistant teach- ers with B.N degrees, and an aide). The program showed the key features of continuity and complementarily with the morning program. Continuity was provided by keeping children in the same physical setting and having teachers in the morning and after-school programs meet regularly to dis- cuss children's progress and needs. Morning activities were continued and expanded on in the afternoon program: for example, the morning social studies curriculum was reinforced in afternoon walks in the community and other informal activities. Complementarily was manifested in pro- gram emphases: the morning program involved prescribed activities that stress preacademic skills development, and the afternoon program involved greater flexibility. In the afternoon program, the children decided whether or not to participate in planned activities, and opportunities were available for youngsters to initiate activities of their choosing, including sensory mo- tor and art activities. Teachers in the afternoon program were observed to be more nurturing and responsive toward children than teachers in the more structured morning program. In contrast, Vandell and Corasaniti (1988) describe after-school care for third graders in a suburban school district in Dallas, Texas, that did not provide continuity as to setting. Children were transported after school to child care centers. These centers organized children in large groups with limited numbers of caregivers who had minimal special training. Age- appropriate activities were limited and did not relate to curricular activities in their academic classrooms. Children in these two studies differed on at least one measure of social development. Howes and colleagues (1987) found that the children in the high-quality after-school program received more peer nominations as friends than did children from kindergartens not in the program. Vandell and Corasaniti reported that children who attended the child care centers after school received more negative peer nominations than mother-care children. They also had lower school grades and standard test scores than either mother-care or latchkey children. The two studies differed on many factors beyond quality of after-school care, including the age groups studied and possible differences in self-selection factors for participation in the high- and low-quality programs. Yet the possibility exists that "to the extent that an organized after-school program offers a high quality

134 WHO CARES FOR AMERICA'S CHILDREN? experience of age appropriate activities . . . one would expect very different outcomes to be associated with it" (Vandell~ and Corasaniti, 1988:18~. Summary and Implications for Practice At present, there are few studies of child outcomes related to variations in after-school care. The picture that emerges from the limited data base is that school-age children benefit from communication between teachers or caregivers in different settings and from an after-school program that com- plements structured school programs through activity options and flexibility, the possibility of more sensory motor activity, and caregiver behavior that is somewhat warmer and more personally responsive in style than that of the regular classroom teacher. Studies are needed to replicate initial findings and extend them to community-based rather than model programs and to varying age and socioeconomic groups. Research examining a variety of approaches to closeness of supervision in comparison with child autonomy, and the nature of activities in after-school programs, would also be helpful. CONCLUSIONS As in the previous chapters, our review of the evidence points to gaps and flaws, but existing research findings also suggest several firm conclusions. The evidence on physical health and safety points to quantitative but not qualitative differences in the health status of children reared at home by parents and those who spend time in child care settings. Our assessment of the magnitude of these differences leads us to conclude that child care attendance does not involve a major risk to the health status of young children. At the same time, we call for continued empirical research, particularly on the developmental implications of middle-ear infections among children in child care and on practices to diminish the risk of bacterial meningitis among these youngsters. The organization of the settings and the guidance provided by care- givers can foster positive social and cognitive development among children in child care. Thus, for example, positive relations among peers and coop- erative behavior with adults are more likely to occur when children receive guidance in social relations from caregivers. Similarly, language develop- ment in child care can be fostered by particular kinds of verbal interactions between children and caregivers, namely, those that involve shared focus and informational content. Child care settings also present unique oppor- tunities to enhance particular aspects of social and cognitive development. For example, they can serve as a context for the affirmation of children's cultural, racial, or ethnic group identity.

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 135 The social development of children with developmental disabilities can be enhanced by participation in an integrated child care environment. However, benefits occur only when staff receive both initial and ongoing training and there is appropriate programming. Many children of employed parents are in self-care, and there is some evidence of problems among children in self-care after school. Determining the need for after-school care and those features of after-school child care that are important to the development of school-age children should become a priority. The limited evidence available indicates that high-quality after-school programs involve communication between teachers and after- school caregivers and after-school activities that complement the regular school curriculum. Child care settings were traditionally viewed as environments that, by comparison with children's own homes, were deficient as contexts for development This and the previous two chapters present a different pic- ture. Family day care and center care can be environments that effectively support children's health and development. They can also provide some unique opportunities for enhancing development (e.g., for peer interac- tions, cognitive interventions, cultural affirmation). Yet existing evidence from research and professional practice forces us to face an important caveat: child care supports healthy physical and psychological development only when it is of high quality. REFERENCES Aboud, F. 1988 Adler, S.P. 1986 Children and Prejudice. New York: Basil Blackwell. Molecular epidemiology of cytomegalovirus: Evidence for viral transmission to parents from children infected at a day care center. Pediatric Infectious Disease Journal 5:315-318. 1988a Molecular epidemiology of pytomegalovirus: Viral transmission among children attending a day care center, their parents, and caretakers. Joumal of Pediatrics 112:366-372. 1988b Cytomegalovirus transmission among children in day care, their mothers, and caretakers. Pediatric Infectious Disease Joumal 7:279-85. Ainsworth, M.D.S. 1985 Patterns of infant-mother attachments: Antecedents and effects on development. Bulletin of the New York Academy of Medicine 61:771-791. Ainsworth, M.D.S., M. Blehar, E. Waters, and S. Wall 1978 Pattenzs of Attachment: Observations in the Strange Situation and at Home. Hillsdale, N.J.: Erlbaum. American Academy of Pediatrics 1986 Report of the Committee on Infectious Diseases. Georges Peter, ea., 20th ed. Elk Grove Village, Ill.: American Academy of Pediatrics. 1987 Health guidelines for the attendance in day-care and foster-care settings of children infected with human immunodeficiency virus. Pediatrics 79:466-471.

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SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 139 Goelman, H. 1986 The language environments of family day care. Pp. 153-179 in S. Kilmer, ea., Advances in Day Care and Early Education, loot IV. Greenwich, Conn.: JAI Press. Goelman, H., and JAR. Pence 1987 Some aspects of the relationship between family structure and child language in three types of day care. Pp. 129-146 in D. Peters and S. Kontos, eds., Annual Advances in Applied Developmental Psychology, Vot II. Norwood, N.J.: Ablex Publishing Corp. Granoff, D.M., and M. Basden 1980 Haemophi1~s ingenue infections in Fresno County, California: A prospective study of the effects of age, race, and contact with a case on incidence of disease. Journal of Infectious Diseases 141:40 46. Guralnick, MJ. 1976 The value of integrating handicapped and nonhandicapped preschool children. 19~78 ~ _ , . American Journal of Orthopsychiatry 46:236-245. Integrated preschools as educational and therapeutic environments: Concepts, design, and analysis. Pp. 115-145 in M.J. Guralnick, ea., Early Intervention and the Integration of Handicapped and Nonhandicapped Children. Baltimore, Md.: University Park Press. Hadler, S. C, JJ. Erben, D.P. Francis, H.M. Webster, and J.E. Maynard 1982 Risk factors for hepatitis in day care centers. Joumal of Infectious Diseases 145:255-261. Hartup, SEW. 1983 Peer relations. Pp. 103-196 in P.H. Mussen, ea., Handbook of Child Psychology, Volume Id, 4th ed. New York: Wiley. Haskins, R. 1985 Public school aggression among children with varying day-care experience. Child Development 56:689-703. Haskins, R., and J. Kotch 1986 Day care and illness: Evidence, costs, and public policy. Pediatrics 77(supp.~:951- 982. Hauser-Cram, P., ~C. Upshur, M.W. Krauss, and J.P. Shonkoff 1988 Implications of Public Law 99-457 for early intervention services for infants and toddlers with disabilities. Social Policy Report of the Society for Research in Child Development 3(~3~. Hay, D. 1985 Learning to form relationships in infancy: Parallel attainments with parents and peers. Developmental Review 5:122-161. Henderson, F.W., and G.S. Giebink 1986 Otitis media among children in day care: Epidemiology and pathogenesis. Reviews of Infectious Diseases ~4~:533-538. Holliday, B.G. 1985 Toward a model of teacher-child transactional processes affecting black children's academic achievement. Pp. 117-130 in M.B. Spencer, G.K Brookins, and W.R. Allen, eds., Begynnzr'gs: The Social and Affective Development of Black Children. Hillsdale, NJ.: Erlbaum. Holloway, S.D., and M. Reichhart-Erickson 1988 The relationship of day-care quality to children's free play behavior and social problem solving skills. Early Childhood Research Quarterly 3:39-54.

140 WHO CARES FOR AMERICA'S CHILDREN? Horaeek, HJ., C.T. Ramey, F.A. Campbell, KP. Hoffmann, and R.H. Fletcher 1987 Predicting school failure and assessing early intervention with high-risk children. Joumal of the American Academy of Child and Adolescent Psychiatry 26:758-763. Howes, C. 1987 Social competency with peers: Contributions from child care. Early Childhood Research Quarterly 2:155-167. 1988a Can Age of Entry and the Quality of Infant Child Care Predict Behaviors in Kindergarten? Paper presented at the International Conference of Infant Studies, Washington, D.C., April. 1988b Peer interaction of young children. Monographs of the Society for Research in Child Development 53~1~:Serial No. 217. Howes, C., and M. Olenick 1986 Family and child influences on toddlers' compliance. Child Development 57:202- 216. Howes, C., M. Olenick, and T. Der-Kiureghian 1987 After-school child care in an elementary school: Social development and continuity and complementarily of programs. The Elementary School Journal (September):93-103. Howes, C., C. Rodning, D.C. Galluzzo, and L. Myers 1988 Attachment and child care: Relationships with mother and earegiver. Early Childhood Research Quarterly 3:403-416. Ispa, J. 1981 Social interactions among teachem, handicapped children, and nonhandieapped children in a mainstreamed preschool. Joumal of Applied Developmental Psy cholo`~ 1:231-250. Istre, G.R., J.S. Conner, C.V. Broome, A. Hightower, and R.S. Hopkins 1985 Risk factors for primary invasive Haemophilus influence disease: Increased risk from day care attendance and school-aged household members. Journal of Pediames 106:190-195. Jarman, F.C., and T.M. Kohlenberg 1988 Health and Safety Implications of Day Care. Paper prepared for the Panel on Child Care Policy, Committee on Child Development Research and Public Policy, Commission on Behavioral and Social Sciences and Education, National Research Council, Washington, D.C Jones, S.N., and S.J. Meisels 1987 Training family day care providers to work with special needs children. Topics in Early Childhood Special Education 7:1-12. Klein, J.O. 1987 The febrile child and occult bacteremia. New England Joumal of Medicine 317:1219-1220. Klein, N., and R. Sheehan 1987 Stab development: A key issue in meeting the needs of young handicapped children in day care settings. Topics in Early Childhood Special Education 7:13-27. Landis, S.E., J.L. Earp, and M. Sharp 1988 Day-eare center exclusion of sick children: Comparison of opinions of day-eare staff, working mothers, and pediatricians. Pediatncs 81~5~:662-667. Landman, P.F., and G.B. Landman 1987 Accidental injuries in children in day-care centers. American Journal of Diseases of Children 141:292-293.

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 141 Lazar, I., R.B. Darlington, H. Murray, J. Royce, and A. Snipper 1982 Lasting effects of early education: A report of the Consortium for Longitudinal Studies. Monograms of the Society for Research in Child Development 47(~2- 3~:Serial No. 195. Lemp, G.F., WE. Woodward, and L^K. Pickenng, P.S. Sullivan, and H.L" DuPont 1984 The relationship of staff to the incidence of diarrhea in day care centers. American Journal of Epidemiology 120:750-758. Lewis, C.C. 1984 Cooperation and control in Japanese nursery schools. Comparative Education Review 28:69-84. Long, TO., and L" Long 1983 The Handbook for Latchkey Children and Their Parents. New York: Arbor House. McCartney, K. 1984 Eliect of quality of day care environment on children's language development. Developmental Psychology 20:244-260. McCartney, K., S. Scarr, D. Phillips, S. Grajek, and J.C. Schwarz 1982 Environmental differences among day care centers and their effects on children's development. Pp. 126-151 in E. Zigler and E. Gordon, eds., Day Care: Scientific and Social Policy Issues. Boston: Auburn House. McCartney, K., S. Scarr, D. Phillips, and S. Grajek 1985 Day care as intervention: Comparisons of varying quality programs. Journal of Applied Developmental Psychology 6:247-260. McLean, A.A. 1986 Development of vaccines against hepatitis A and hepatitis B. Reviews of Infectious Diseases 8~4~:591-598. Melish, M.E., and J.B. Hanshaw 1973 Congenital cytomegalovirus infections. American Joumal of Diseases of Children 126:190-194. National Head Start Multicultural Task Force 1987 Report for First Meeting. December 10-11. Administration for Children, Youth, and Families. Washington, D.C.: U.S. Department of Health and Human Services. Ogbu, J.U. 1986 Consequences of the American caste system. Pp. 19-56 in U. Neisser, ea., The School Achievement of Minority Children. Hillsdale, NJ.: Erlbaum. Osterholm, M.T, L.M. Pierson, HE. White, T.A. Libby, J.N. Kuritsky, and J.G. McCullough 1987 The risk of subsequent transmission of Haemophi~s influenzas type b disease among children in day care. New England Journal of Medicine 316:1-5. Pass, R.F., and C. Hutto 1986 Group day care and oytomegaloviral infections of mothers and children. Reviews of Infectious Diseases 8~4~:599-605. Pass, R.F., S. Stagno, ~J. Myers, and C.A. Alford 1980 Outcome of symptomatic congenital cytomegalovirus infection: Results of long- term longitudinal follow-up. Pediamcs 66:758-762. Pass, R.F., E.A. Little, S. Stagno, W.J. Britt, and C.A. Alford 1987 Young children as a probable source of maternal and congenital cytomegalovirus infection. New England Joumal of Medicine 316:136~1370. Phillips, C. 1989 Ann-Bi~s Curriculum. Washington, D.C.: National Association for the Education of Young Children.

142 WHO CARES FOR AMERICA'S CHILDREN? Pickering, L^K., D.G. Evans, H.L~ Dupont, J.J. Vottet III, and D.J. Evans, Jr. 1981 Diarrhea caused by Shigella, Rotavirus, and Giardia in day care centers: Prospective study. Joumal of Pediatrics 99:51-56. Redmond, S.R., and M.E. Pichichero 1984 Haernophi~s ingenue type b disease: Epidemiologic study with special refer- ence to day care centers. JAMS 252:2581-2583. Reeves, R.R., A.L Morrow, A.L Bartlett, and UK Pickering 1988 A Case Control Study of Acute Diarrhea in Children in a Health Maintenance Organization (HMO): Risk Estimates Associated with Non Breast Feeding and Day Care. Paper presented at Society for Pediatric Research annual scientific meeting, Washington D.C. Richardson, J.L, K. Dwyer, K McGuigan, W.B. Hansen, C. Dent, C.A. Johnson, S.Y. Sussman, B. Brannon, and B. Flay 1989 Substance use among eighth-grade students who take care of themselves after school. Pediatrics 84:556-566. Rodgers, F.S., G. Morgan, and B.C Fredericks 1986 Caring for the ill child in day care. Journal of School Health 56~4~:131-133. Rodman, H., D.J. Pratto, and R.S. Nelson 1985 Child care arrangement and children's functioning: A comparison of self-care and adult-care children. Developmental Psychology 21:413-418. Rubenstein, J.L^, and C. Howes 1983 Social-emotional development of toddlers in day care: The role of peers and individual differences. In S. Kilmer, ea., Early Education and Day Care' Vot 3. Greenwich, Conn.: JAI Press. Rule, S., J. Killoran, J. Stowitschek, M. Innocenti, and S. Striefel 1985 Staining and support for mainstreaming day care staff. Early Child Development and Care 20:99-113. Ruopp, R., J. leavers, F. Glantz, and C. Coelen 1979 Children at the Center: Final Results of the National Day Care Study. Boston: Abt Associates. Russell, S.D., and R.M. Clifford 1987 Child abuse and neglect in North Carolina day care programs. Child Welfare 67~2~:149-163. Sale, J.S.S. 1986 Promoting creativity and independence in young children: A challenge for teachers and parents. Speech delivered at the Centennial Celebration of Japanese Christian Kindergartens, Kanazawa, Japan. Available from UCLA Child Care Services, Los Angeles, Calif. Schloesser, P.T. 1986 Children in day care: 26(5):21-24. A public health challenge. Public Health Currents Schwatz, J.C. 1983 Infant Day Care: Effects at 2, 4, and 8 Years. Paper presented at the meeting of the Society for Research in Child Development, Detroit. Schweinhart, LJ., D.P. Weikart, and M.B. Lamer 1986 Consequences of three preschool curriculum models through age 15. Early Childhood Research Quarterly 1:15-45. Seligson, M. 1988 Paper prepared for Workshop on the Developmental Implications of Child Care, Panel on Child Care Policy, Committee on Child Development Research and

SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 143 Public Policy, Commission on Behavioral and Social Sciences and Education, National Research Council, Washington, D.C. Shapiro, E.D., J. Kuritsy, and J. Potter 1986 Policies for the exclusion of ill children from group day care: An unresolved dilemma. Review of Infectious Diseases ~4~:622-625. Slaughter, D.T. 1983 Early intervention and its effects on maternal and child development. Mono- t~aphs of the Society for Research in Child Development 48~43:Serial No. 202. Smith, C., and M. Greenberg 1981 Step by step integration of handicapped preschool children in a day care center for nonhandicapped children. Journal of the Division for Early Childhood 2:96-101. Snyder, L^, T. Apolloni, and UP. Cooke 1977 Integrated settings at the early childhood level: The role of nonretarded peers. Exceptional Children 43:262-266. Spencer, M.B. 1985 Black children's race awareness, racial attitudes, and self-concept: A reinterpre tation. Joumal of Child Psychology and Psychiatry 25:433-441. 1986 Black children's ethnic identity formation: Risk and resilience of castelike minorities. Pp. 103-116 in J.S. Phinney and M.J. Rotheram, eds., Children's Ethnic Socialization: Pluralism and Development. Beverly Hills, Calif.: Sage. 1988 Cognition, Identity, and Social Development as Correlates of African Ameri can Children's Academic Skills. Invited lecture sponsored by the Center for Afroamerican and African Studies, University of Michigan, Ann Arbor, March. Spencer, M.B., S.R. Kim, and S. Marshall 1987 Double stratification and psychological risk: Adaptational processes and school achievement of black children. Formal of Nemo Education 56:77-87. Sroute, LA. 1985 Attachment classification from the perspective of infant caregiver relationships. Child Development 56:1-14. Stagno, S., R.F. Pass, G. Cloud, W.J. Britt, R.E. Henderson, P.D. Walton, D.A Veren, F. Page, and CA. Alford 1986 Primary cytomegalovirus infection in pregnancy. Incidence, transmission to fetus, and clinical outcome. JAAL4 256:1904-1908. Steinberg, ~ 1986 Latchkey children and susceptibility to peer pressure: An ecological analysis. Developmental Psychology 22:433439. Strangert, K 1976 Respiratory illness in preschool children with different forms of day care. Pediatrics 57~2~:191-196. Sullivan, P., WE. Woodward, L.K Pickering, and H.L" Dupont 1984 Longitudinal study of diarrhea! disease in day care centers. American Joumal of Public Health 74:987-991. UCLA Child Care Services 1989 UCLA Child Care Seances Philosophy Statement. Los Angeles, Calif.: UCLA Child Care Services. Vandell, D.L^, and M.^ Corasaniti 1988 The relation between third graders' after-school care and social, academic, and emotional functioning. Child Development 59:868-875.

144 WHO CARES FOR AMERICA'S CHILDREN? Vandell, D.L~, and C.P. Powers 1983 Day care quality and children's free play activities. American Joumal of Orthopsychiatry 53:493-500. Vandell, D.L~, V.K Henderson, and K.S. Wilson 1988 A longitudinal study of children with day-care experiences of varying quality. Child Development 59:1286-1292. Wald, E.R., B. Dashefsly, C. Byers, N. Guerra, and F. Taylor 1988 Frequency and seventy of infections in day care. Journal of Pediatrics 112:540- 546 Ward, J.I., D.W Fraser, ID. Baraff, and B.D. Plikaytis 1979 Haemophi~s in~enzae meningitis: A national study of secondary spread in household contacts. New England Joumal of Medicine 301:122-126. Weissman, J.B., EJ. Gangorosa, A Schmerler, R.L" Marier, and J.N. Lewis 1975 Shigellosis in day care centers. Lancet i(7898~:88-90. Williams, L.R., and Y. DeGaetano 1985 Alerta: A Multicultural Bilingual Approach to Teaching Young Children. Menlo Park, Calif.: Addison-Wesley. Wood, D. 19~ How Children Think and Learn. Oxford: Basil Blackwell. Wood, D., L McMahon, and Y. Cranston 1980 Working With Under Fives. London: Grant McIntyre.

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Few issues have aroused more heated public debate than that of day care for children of working parents. Who should be responsible for providing child care—government, employers, schools, communities? What types of care are best?

This volume explores the critical need for a more coherent policy on child care and offers recommendations for the actions needed to develop such a policy.

Who Cares for America's Children? looks at the barriers to developing a national child care policy, evaluates the factors in child care that are most important to children's development, and examines ways of protecting children's physical well-being and fostering their development in child care settings. It also describes the "patchwork quilt" of child care services currently in use in America and the diversity of support programs available, such as referral services.

Child care providers (whether government, employers, commercial for-profit, or not-for-profit), child care specialists, policymakers, researchers, and concerned parents will find this comprehensive volume an invaluable resource on child care in America.

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