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II CHld Carc and Chad Dcvelopmcnt

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3 The Effects of Child Care Chapters 3 through 5 review what has been learned about the lives of children in child care from research, clinical practice, and work with young children. In Chapter 3 we trace successive phases of child care research, which have moved to increasingly complex and fruitful questions about child care. In Chapter 4 we highlight the particular dimensions of child care quality (e.g., group size, ratio) that are most important to children's development. And in Chapter 5 we review what is known about how child care can support children's physical health and psychological development. PROCESSES OF CHILD DEVELOPMENT Before turning to these issues of child care and children's develop- ment, however, it is useful to outline briefly several basic principles about development that underlie the ensuing discussion. These principles emerge from and reflect important areas of agreement in different scientific dis- ciplines that shed light on children's development, notably developmental psychology, clinical work with children, and research in early education. First, children's development is multiply determined: by sources within the child, such as temperament, neurological integrity, and impairment; by factors in the child's immediate environment, such as quality of relationships and interactions with parents and quality of out-of-home care; and by factors in the child's larger social environment, including the immediate neighborhood and the broader culture. These factors do not operate separately but interact in a complex fashion to influence developmental outcomes. Child care must therefore be viewed as one of many sources of influence on children's development and one that interacts in complex ways with numerous others. 45

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46 WHO CARES FOR AMERICA)S CHILDREN? Second, children are not only influenced by their immediate and broader environments, but also shape these environments. Development reflects the transactional processes-or mutual influences of child and environment. In child care settings, for example, children are influenced by caregiver and peer behaviors, and they also selectively relate to certain teachers and peers. Third, children's development involves the biological, cognitive, and socioemotional domains. Although development in these domains is in- terrelated, progress across domains does not occur uniformly. Rather, children may advance or lag in one domain but not others. It is therefore important to consider the development of children in child care in specific domains, rather than to view patterns of influence as equally affecting all domains. Fourth, children's physiological, cognitive, and socioemotional needs differ markedly by developmental level. Consideration of the age of a child is fundamental to understanding the differing needs of children in child care settings.) Finally, the nature of environmental influences on children is best thought of as probabilistic. Recent research and practice with children posits risk factors, conditions or events that increase the probability of negative or less than optimal developmental outcomes, and protective factors, conditions or events that increase the probability of positive or optimal developmental outcomes. Risk and protective factors are thought to influence development most often by interacting with other sources of influence on a child's development. Child care could function as a protective factor, a risk factor, or a relatively neutral factor for particular developmental domains. In short, the relationship between child care and child development is complex. In light of this complexity, it is not surprising that there are no perfect studies and few that are conclusive about the relationship between child care and child development. Nonetheless, the cumulative weight of evidence from empirical studies, clinical work, and professional practice is sufficient to draw some conclusions that can serve as provisional guides to program and policy. The rest of this chapter and the next two review that evidence. ~ In this chapter, and indeed throughout this volume, infants refers to children in the first year of life, toddlers to those 13 to 36 months, preschool age to those 3 to 5 years old, and school age to those 6 years or older. We note, however, that there is some variation across researchers and legislators in the precise demarcations used for these developmental periods. Where a particular study, author, standard, or regulation uses age demarcations that differ from ours, we note the discrepancy and specify the intended age of the children.

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THE EFFECTS OF CHILD CARE EVOLUTION OF CHILD CARE RESEARCH 47 Marked social changes that impinge on the lives of families and chil- dren have often sparked an initial wave of psychological research that asks, "Is this harmful to children?" It has been the case repeatedly that this initial wave of research, which might be called the "alarm phase," does not address questions of sufficient subtlety or complexity to illuminate the impact of the social change. Typically, in the evolution of the research, the alarm phase gives way to a second research phase that examines the demographic shift in a more differentiated manner. The research on maternal employment (a "sister" literature to that on child care that is not restricted to young children receiving a particu- lar form of supplemental care) illustrates this evolution. Researchers and practitioners responded decades ago to the striking increases in rates of maternal employment by asking whether or not children were adversely affected by daily separations and nonmaternal care. But the great complex- ity in the research findings from those early studies indicated that it was not enough to ask about potential harm. Some children clearly benefited from their mothers' employment. Furthermore, it did not appear that ma- ternal employment was a unitary phenomenon with uniform implications (Bronfenbrenner and Crouter, 1982; Hoffman, 1979~. Rather, its impact on children was related to a number of child characteristics (e.g., age and sex), family characteristics (e.g., father involvement with children, mothers' role satisfaction, and extended family support), and factors beyond the family (e.g., culture) (Zaslow et al., in press). Research restricted to a status strategy mother is or is not employed- gave way to research focusing on mechanisms and processes, the factors associated with differing outcomes of maternal employment for children. The research on child care is following a similar pattern of evolution (Belsky, 1984; Phillips, 1988~. A first wave of studies asked whether the increasing rates of participation of young children in family day care and center care was cause for alarm. Did the development of children in supplemental child care differ from that of children cared for by parents? The accumulating evidence, however, has forced a shift in the research focus. Child care was not found to be inherently or inevitably harmful. Rather, it was found to vary greatly as an environment for children, and children's development was linked to the variation. A second wave of child care research, still in progress, examines children's development in light of variations in the environment of child care. According to Phillips (1988), the major focus of a third wave of child care research is beginning to emerge. This phase will view the home and child care environments as linked and mutually influential. Children's development is beginning to be understood in light of experiences across the two care settings.

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48 WHO CARES FOR AMERICA'S CHILDREN? Each successive wave of child care research reflects progressively greater conceptual complexity and methodological refinement. Yet the question central to each wave remains important, even as the new ques- tions emerge. That is, the waves of research overlap and complement one another, rather than supplanting each other. It is important to continue to ask how the development of children reared at home and in child care settings differs (the question focal to the first wave of research), even as questions are asked about the implications of poor-quality care in comparison to care that is adequate or of high quality (second wave) and about the joint impact of the child's home and the child care settings (third wave). Although there are methodological weaknesses as well as strengths in each research wave, we view each phase as using research approaches appropriate to the central question being addressed. We begin, however, not with the first wave, but one step further back, in the research on maternal deprivation. ROOTS OF CHILD CARE RESEARCH: MATERNAL DEPRIVATION The alarm phase of research in child care has its roots in the substantial body of clinical and empirical studies of children experiencing maternal de- privation and institutionalization (long or short stays in residential facilities for children). It was not only initially considered possible that child care might belong on a continuum with the institutionalization of children, but actually explicitly stated that this was the case. The influential 1951 World Health Organization Expert Committee on Mental Health concluded on the basis of the work of John Bowlby (1951), that "day nurseries" consti- tuted a form of maternal deprivation with permanent negative effects on children (Rutter, 1981a). Studies of short-term (hospitalization, short-stay residential nursery) and long-term ~ong-stay residential nursery, institutionalization) parent- child separations, many of them rooted in the psychoanalytic tradition, do indicate problems in children's development (e.g., Freud and Burlingham, 1944, 1973; Goldfarb, 1943; Provence and Lipton, 1962; Ribble, 1965; Robertson and Robertson, 1971; Spitz, 1945; Wolkind, 1974~. These prob- lems range from acute distress syndrome, associated with short periods in care, to conduct disorders, problems in forming relationships, and in- tellectual deficits, associated with longer term care (Rutter, 1981a). In particular, `'an institutional upbringing which involves multiple changing caretakers has been shown to lead to important social deficits and prob- lems in interpersonal relationships" (Rutter, 1981a:154~. But does the ac- cumulated evidence regarding weeks or years completely away from parents

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THE EFFECTS OF CHILD CARE 49 indicate that child care should be considered together with this grouping of studies, as a form of maternal deprivation? Rutter's (1979, 1981a) reassessments of the theory and research into maternal deprivation are extremely helpful in extracting those elements of early views of maternal deprivation (particularly those of Bowlby) that the research evidence has sustained and those elements that have required revision. According to Rutter, there have been two important and lasting contributions of the early work on maternal deprivation. First, that work identified deplorable conditions in short- and long-term residential settings for children. In response, there have been widespread changes in those conditions. Second, studies responding to that work have resulted in an understanding of experiences that are necessary for young children's normal development. Above all, that research showed that young children need to develop enduring relationships with a limited number of specific individuals, re- lationships that are characterized by affection, reciprocal interaction, and responsiveness to the particular and highly individualized cues of the infant and young child, and that the child's environment has to provide sufficient opportunity for stimulation (Rutter, 1981a, summarizes the evidence). It is in the context of familiar relationships that children make their major developmental advances in communication and understanding in the first years. The growth of language and social understanding depends on the child's social exchanges with familiar, responsive others (Bruner, 1983; Dunn, 1988; Lock 1978; I3revarthen, 1977~. In other respects, other early conclusions on maternal deprivation have required revision in light of subsequent research (Rutter, 1979, 1981a). Per- haps most central, the initial work emphasized the child's need to become attached to the mother in particular, and to be cared for in his or her own home, for healthy subsequent development. For example, Bowlby's early statements viewed the mother-child bond as different from all other rela- tionships (Bowlby, 1951~. Subsequent work has not confirmed this exclusive emphasis on the mother-child relationship. Rather, the evidence indicates a normal tendency for children to form multiple simultaneous attachments (Chibucos and Kail, 1981; Dunn, 1983~. These attachments tend to be hierarchical, with one attachment (often to the mother) most significant to the child (Rutter, 1981b). However, mothers are not the only caregivers who can provide the essential experiences for healthy early development. Children can benefit from '`multiple mothering" if it provides affection, warmth, responsiveness, and stimulation in the context of enduring rela- tionships with a reasonably small number of caregivers (according to Rutter [1981a], four or five caregivers), who have come to know and be able to respond to the child's individual needs and style.

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so WHO CARES FOR AMERICA'S CHILDREN? Accordingly, researchers no longer believe that the effects of institu- tionalization on children are solely the result of disruption of the mother- child relationship. In the more complex and differentiated view of insti- tutionalization that has evolved, it is now understood that some of the more serious developmental problems follow not from interruption of a mother-child relationship, but from an initial lack of any such relationship. Furthermore, the effects of residential care vary according to the setting's provision of enduring relationships and stimulation; according to the child's physical status (e.g., nutrition, pre- and postnatal complications); and to the family circumstances surrounding the institutionalization, particularly family discord. Thus, the nature and circumstances of the separation in combination with the characteristics of the child determine its implications rather than the single fact of mother-child separation (Rutter, 1979, 1981a; Wolkind, 1974). Of particular importance in the present context, Rutter's reassessment of the maternal deprivation research concludes that child care does not fall on a continuum with institutionalization (Rutter, 1981a:154~: [where is a world of difference between institutional care without any parental involvement and day care in which the mother remains a key figure who continues to actively participate in looking after the child. For these reasons, little weight can be attached to the results of residential group care as a basis for assessing the probable sequelae of group day care. In sum, infants and young children tend to form several attachments to a small number of selected individuals. A healthy environment for child development does include at least one secure attachment, but does not necessarily require care exclusively by a mother. Rather, environments that provide stable, warm, responsive, and stimulating relationships with several caregivers, if these relationships are limited in number, can encour- age healthy psychological development. Child care differs fundamentally from institutionalization and should not be considered part of the same phenomenon simply on the grounds of mother-child separation. Yet when child care environments fail to provide those elements found to be essential to normal development-and instead involve a large number of caregivers, frequent changes in caregivers, lack of responsiveness to the child as an in- dividual, and lack of social and cognitive stimulation they can be expected to have negative implications for development.

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THE EFFECTS OF CHILD CARE FIRST WAVE OF CHILD CARE RESEARCH: DEVELOPMENT OF CHILDREN IN CHILD CARE AND THOSE REARED AT HOME 51 The impetus for the first wave of empirical, systematic child care re- search, then, was the concern that young children would be harmed by daily separations from their mothers. As it became clear that mother-child separations and daily participation in child care did not have the drastic negative implications that the maternal deprivation construct predicted, important questions nevertheless remained: Did the development of chil- dren in supplemental child care differ from that of home-reared children in meaningful if less marked ways? Were there subgroups of children whose development was enhanced by the child care experience? Were there sub- groups of children whose participation in child care was associated with any degree of risk for development? Several comprehensive reviews of the first wave of child care research by Belsky and colleagues (Belsky, 1984; Belsky and Steinberg, 1978), Clarke- Stewart and Fein (1983), and Rutter (1981b) have addressed these questions and provide extensive documentation, summarized below. Consistent with the assumptions about development presented in the preface to these chapters, we assume that the impact of child care differs by domain of development. As such, we present the major findings separately for the areas of intellectual and social development. However, we cannot present findings separately by developmental level because researchers have made surprisingly little effort to differentiate the outcomes for children exposed to child care according to child age. The evidence rests largely on a mosaic of cross-sectional studies, rather than on longitudinal studies aimed at documenting the changes and consistencies in children's needs in child care as they get older. The major exception to this pattern is that the infancy period has been singled out for particular focus. But the years from toddlerhood through school age are rarely discussed in the child care literature with an assumption of changing developmental needs. A further limitation in this wave of child care research in the United States that is important to note is its very heavy reliance on studies of center care, rather than the demographically more prevalent family day care. In this respect much can be learned from the European research, which has more consistently encompassed family day care as well as center care in its attempts to examine the impact of child care experience versus parental care (e.g., Cochran, 1977; Lamb, Hwang, Bookstein, et al., 1988; Lamb, Hwang, Broberg, and Bookstein, 1988~. Intellectual Development On measures of intellectual development, reviews of the evidence conclude that "children in day care centers do as well as those at home

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52 WHO CARES FOR AMERICA'S CHILDREN? . . . or that they do better, at least for a time or on some measures" (Clarke-Stewart and Fein, 1983:965~. Social class is an important factor in understanding the findings for cognitive development among children in child care (Belsky, 1984; Belsky and Steinberg, 1978~. Studies of more economically advantaged children in community-based child care find either no differences in cognitive devel- opment related to child care participation or more advanced development among these youngsters. Studies of economically disadvantaged children in high-quality child care intervention programs, however, consistently find more advanced cognitive development in day care children than in home- reared children. These children do not show the declines found for their home-reared counterparts from disadvantaged families on tests of intellec- tual development. Although Belsky's reviews (Belsky, 1984; Belsky and Steinberg, 1978) conclude that, overall, middle-class child care and home-reared children do not differ on indices of intellectual development, Clarke-Stewart and Fein (1983) diverge in their assessment of the research, pointing to indications of superior scores on cognitive indices in some studies of children attending community-based child care programs (e.g., Doyle, 1975; Rubenstein et al., 1981~. Thus, for more economically advantaged children in community- based programs, the most consistent conclusion appears to be that child care attendance does not have negative implications for cognitive development. In children from disadvantaged families, measures of IQ (that are lan- guage dependent) typically decline beginning in the second year of life (see Slaughter [1983] for discussion of this pattern and the types of measures on which it occurs). Reviews of the evidence on early intervention pro- grams for children at risk for this decline indicate that such programs are effective in preventing or slowing the decline. Bryant and Ramey (1987), for example, in an excellent recent review of this evidence, restricted their examination to methodologically adequate experimental studies of early intervention programs and considered the role of child's age at entry, dura- tion and intensity of intervention program, nature of educational activities, and whether the child or parents were primary targets of the intervention. They conclude that program effectiveness was most closely linked with the child's (or family's or both) extent of contact with the intervention pro- gram and that "the most improvement in intellectual development occurs when children attend day care and families receive parent training or other services" (Bryant and Ramey, 1987:71~. Interventions were found to be effective irrespective of whether they were initiated during infancy, early childhood, or the preschool years. And the type of educational emphasis and the curriculum were not closely linked with outcomes. Findings of the early intervention programs indicate that gains on

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THE EFFECTS OF CHILD CARE 53 measures of intellectual development are temporary rather than permanent (evidence summarized by Clarke-Stewart and Fein, 1983; Haskins, 1989~. However, longitudinal evaluations of early intervention that include out- come measures in addition to IQ show some persistent effects. For example, in one longitudinal analysis of 10- to 17-year-olds who had attended early intervention programs, although group differences on IQ did not persist, differences on measures of school-related behavior did: children who had participated in intervention programs were less likely to repeat a grade in school and less likely to be referred for special education than those who had not participated (Darlington et al., 1980; Lazar et al., 1982~. Recent research also indicates that when an intervention program is continued into the elementary school years, complementing the child's regular school participation, differences can be sustained. Horacek and colleagues (1987:762) found that "children who participated in both [a] preschool program and [a] school-age support program performed better in school than the group that had only preschool" intervention, even though the intervention at school age was of limited intensity. Thus, children at risk for school failure may benefit most from a combination of early and sustained intervention. Haskins (1989), in reviewing the findings on the impact of early inter- vention programs, urges a distinction between model intervention programs (e.g., those considered in the Bryant and Ramey [1987] review) and Head Start. Haskins points out that both types of programs yield "significant and meaningful gains" on measures of intellectual performance by the end of the first year of intervention, but it is only for the model programs that there is evidence of strong positive effects on the later school-related behavior variables. He suggests several possible explanations for this differ- ence in the findings for model early intervention programs and Head Start. Since data collection has been far more extensive and systematic for the model programs, the long-term effects of Head Start may be undetected by the fewer and less rigorous Head Start outcome studies. However, there are fundamental program differences that could underlie the difference in longer term implications of the two kinds of programs: Head Start en- compasses sites ranging substantially in quality; while model programs are consistently high quality. Furthermore, Head Start selects for participation the most disadvantaged children and families, but draws control groups from those remaining on the waiting list and who are thus relatively less disadvantaged. Work by Lee and colleagues (1988) suggests that particu- larly because of Head Start selection practices the impact of Head Start may be systematically underestimated in studies. Haskins (1989), while apologizing for the tendency of social scientists to call for more research, notes the particular need for methodologically

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THE EFFECTS OF CHILD CARE 73 found to be significantly correlated with center quality: the value the family placed on social skills (as measured by parental reports) was positively related to the quality of the child care arrangement; the value the family placed on conformity (again measured through parental reports) was neg- atively correlated with quality (McCartney, 1984; Phillips et al., 1987~. A partial replication within the United States for this result is reported by Kontos and Fiene (1987~: center quality in the state of Pennsylvania was positively associated with the value the family placed on prosocial behavior. Howes (in press, by, in an excellent discussion of the issues, notes that family variables and the quality of care may have mutual influences over a period of time. A stressed family, for example, may not be able to persevere in a search for higher quality care and may place a child in a lower quality setting. Experiences in such a setting then influence the child's development (perhaps, for example, with regard to compliance), which in turn may increase stress levels in the home. Such patterns of mutual influence between school and family have been identified in older children, especially boys (Patterson, 1986~. The Link Between Child Care Quality and Family Variables Given the interrelated nature of family and child care quality measures, recent research has asked whether the quality of care has an impact separate from family economic and psychological variables. Evidence that family variables and the quality of care, separately, contribute to development is of two kinds: correlational studies in which care quality continues to predict child development with family variables controlled, and research designs involving random assignment to different child care situations. Studies using correlational designs have consistently concluded that family and quality of care variables are important contributors. Howes and Stewart (1987), for example, examined the role of family character- istics (factor scores describing families as "nurturing and supported" or "restrictive and stressed") and quality of child care in predicting the level of children's play with objects, peers, and adults. Each set of variables significantly predicted level of play with the other set of variables con- trolled. McCartney (1984) concluded that the quality of center care was as predictive of children's language skills as family background variables. As research using the strategy of controlling for correlated family variables progresses, one can anticipate the assessment of a wider range of family variables and the use of direct observation of family processes, rather than reliance on self-report measures. An excellent recent example of progress in both respects can be seen in the work of Owen and Henderson (1989~. In this study, child care quality at age 4 was found to be related to several measures of mother-child and father-child interaction as observed

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74 WHO CARES FOR AMERICA'S CHILDREN? at 12 months: children in higher quality care at age 4 had shown less negative affect at 12 months and had parents who had been rated as more sensitive and positive. However, even with these early observational measures controlled, children in higher quality care at age 4 were observed to show more advanced social skills. A study by McCartney and colleagues (1985) goes beyond a correla- tional design to ask what happens to children of lower socioeconomic status, compared with more advantaged children, when they are in center care of higher overall quality. In this study, the social and cognitive development of children attending a government-run center for low-income children in Bermuda was compared with the development of children attending eight private child care centers on the island. The children at the government centers had mothers not only with lower occupational status, but also with lower verbal IQ scores than mothers in the comparison group. At the same time, the overall quality of the government center was the highest of the centers as measured by the Early Childhood Environment Rating Scale. Analysis of the developmental status of the children in the government center with children of the same age attending all other child care programs indicated higher scores for those in the government center on measures of language development, intelligence, and task orientation, as well as on indices of sociability and considerateness. The authors comment that the findings "are especially convincing because the comparison group consists of children of higher SES . . . " (McCartney et al., 1985:251~. Studies involving random assignment of children to groups varying as to quality of care provide the most rigorous examination of whether quality has an impact independent of family factors. Experimental designs, which randomly assign children to differing child care situations, are a widely used strategy in studies of early intervention for children from disadvantaged families. In a recent review of that evidence, Bryant and Ramey (1987) identified assessments of 17 early intervention programs that involved random assignment to intervention or no-intervention groups. They restricted their attention to studies involving such designs in light of concerns about the failure, in other studies, "to ensure adequately the initial equivalence of educationally treated and untreated (control) groups" (Bryant and Ramey, 1987:35~. The crucial finding from that review is that the program benefits, as measured by IQ scores, were most closely related to the intensity of contact (amount and breadth) a child had with the intervention program. This pattern, identified by looking across studies, has also been found within a study that systematically varied children's extent of contact with an intervention program (Horacek et al., 1987~. This dose-response relationship in experimentally oriented research permits us

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THE EFFECTS OF CHILD CARE 75 to conclude with confidence that programs involving high-quality care have positive implications for children, independent of family background factors. Although designs involving randomization are widely used in early intervention studies, they are as yet rarely used in studies of variation in quality in community-based child care programs. A notable exception illustrates the feasibility and usefulness of such a strategy in studying quality. One substudy within the National Day Care Study (NDCS) (Ruopp et al., 1979) was carried out in the Atlanta public school system and involved random assignment of children, within child care centers, to classrooms varying systematically on quality factors. This substudy confirmed the findings of the overall NDCS that children's growth on cognitive measures from fall to spring was linked most closely to the quality component of group size in child care centers. Studies of variation in child care quality in community-based care appear to be at an early and descriptive phase, documenting naturally occurring variation and its correlates. Such a descriptive phase appears both important and necessary (e.g., it revealed the family-quality associations), and it will be especially important in future work on dimensions of quality to follow the path of the intervention studies and the NDCS in using experimental designs. The conclusion best supported by the existing research is that children who are cared for in both child care and the family are influenced by both. As the research in this new wave progresses, an increasingly clear picture will emerge of how care in one environment can offset or complement care in the other. One example of this more complex conceptualization comes from recent research by Howes and colleagues (1988~. In that study, toddlers with insecure attachments to both mother and caregiver showed the least ability to engage in interactions with caregivers while in child care. Children with insecure attachments to their mothers but secure attachments to caregivers showed behaviors indicating that the relationship with the caregiver was compensatory: "These children appeared more socially competent than the children who failed to form compensatory secure relationships with alternative caregivers (1988:415~." The social behavior of toddlers in child care was thus a reflection of relationships both at home and in the child care setting. As research progresses, consideration of indirect as well as direct effects can also be expected. That is, not only are children directly influenced by both of their care settings, but child care can have implications for parents that in turn influence children. Thus, for example, Parker and colleagues (1987) found that mothers who participated in the supportive activities offered by Head Start reported fewer psychological symptoms, more feel- ings of mastery, and greater satisfaction with the current quality of life at the

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76 WHO CARES FOR AMERICA'S CHILDREN? end of a year. The researchers note that such changes in the mothers may well have implications for children: "In addition to the direct effects on children of Head Start, future research should also examine the potentially positive indirect effects on children stemming from the enhanced parental well-being that parents' involvement in Head Start programs produces" (Parker et al., 1987:232~. Similarly, Edwards and colleagues (1987) found participation in a high-quality infant day care program to be associated with changes over time in parent-infant interaction. Parents of center children diverged over time from other parents in such behaviors as playing with, holding, and touching their babies. The authors relate the increases in those behaviors among the parents to the child-centered orientation and behavior of the center caregivers. Indeed, the changes in parental behavior mirrored observed caregiver behaviors. It will be important, then, in future work to examine further the implications for parents of their children's participation in programs of varying quality and to complete the picture by determining the indirect effects of these influences on children. Summary Work reveals that a child's experiences at home and in a child care setting are not separate and unrelated experiences: they are very much linked. Although family and care quality factors are not independent, both sets of factors contribute to children's development: that is, children who experience care both in child care settings and in the home show the influence of both. Thus far, the major focus of the third wave of research has been to document that a child's placement in child care of higher or lower quality in part reflects family psychological and socioeconomic factors. In the absence of subsidies or interventions, families that are more stressed, both psychologically and economically, are more likely to use lower quality care. The United States thus has a group of children in double jeopardy: the children in greatest need of high-quality care to offset stress at home often receive low~ualibr care. Increasingly thorough and rigorous research on the joint contributions of home and child care factors to children's development can be expected. For example, a few studies now identify and control for a wide range of family factors in considering the impact of care quality, but future work on this issue will have to incorporate views of the family-day care linkage that go well beyond the finding that family factors influence choice of care quality. For example, how care quality influences family stress levels and parent-child interaction needs to be examined.

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THE EFFECTS OF CHILD CARE 77 CONCLUSIONS The research on child care is evolving, and our evaluation of the evidence points to the continuing need to address issues of methodology. Even as it stands, however, the existing evidence from each of the research stages we have identified provides the basis for broad conclusions: Child care participation is not a form of maternal deprivation. Children can and do form attachment relationships to multiple caregivers, if the number of caregivers is limited, the relationships enduring, and the caregivers are responsive to the individual child. Child care is not inevitably or pervasively harmful to children's de- velopment. Indeed, the evidence points to aspects of development for which child care is beneficial. The quality of child care in either family day care or center care- is important to children's development, whatever their socioeco- nomic levels and whether one looks at cognitive or socioemotional development. Children from families enduring greater psychological and eco- nomic stress are more likely to be found in lower quality care settings. Thus, there are children in the United States, especially those from low-income families, in double jeopardy from stress both at home and in their care environments. There is no strong basis in our review for urging parents toward or away from enrolling children in child care settings, although we do find unresolved questions concerning full-time care in the first year of life. Rather, our review strongly directs attention to the issue of child care quality and its impact on children's development. Accordingly, the next chapter addresses in greater detail two key questions: What are the components of care quality? What are the thresholds demarcating high- and low-qualib, care on these dimensions? REFERENCES Ainsworth, M.D.S., M. Blehar, E. Waters, and S. Wall 1978 Pattems of Attachment. Hillsdale, NJ.: Erlbaum. Anderson, C.W., RJ. Nagle, W.N Roberts, and J.W. Smith 1981 Attachment to substitute caregivers as a function of center quality and caregiver involvement. Child Development 52:53-61. Barglow, P., B.E. Vaughn, and N. Molitor 1987 Effects of maternal absence due to employment on the quality of infant-mother attachment in a low-risk sample. Child Development 58:945-954. Belsly, J. 1984 INTO waves of day care research: Developmental effects and conditions of

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