9

Nurturing Relationships

In this report, we have emphasized the remarkable achievements of young children and the strong developmental thrust that characterizes these accomplishments. Each achievement—language and learning, social development, the emergence of self-regulation—occurs in the context of close relationships with others. These close relationships are typically with parents or those who serve the parenting role in the child's life. We turn our attention to these relationships in this chapter and explore their influence on early development. Although we address young children's relationships with their child care providers given their pervasive and significant role in the earliest years of life, we reserve the fuller discussion of child care for Chapter 11. We start the discussion of parenting with a focused synthesis of the extensive literature on parent-infant attachment, followed by a discussion of other aspects of parenting that extend beyond the provision of emotional security. Next, we examine disruptions in parenting. We include an examination of the orphanage-to-adoption research as a demonstration of the extent to which young children can recover from early adverse experiences when the contexts of their lives change dramatically. We use this as a backdrop for an initial discussion of parenting interventions, which is placed in a broader context in Chapter 13.



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From Neurons to Neighborhoods: The Science of Early Childhood Development 9 Nurturing Relationships In this report, we have emphasized the remarkable achievements of young children and the strong developmental thrust that characterizes these accomplishments. Each achievement—language and learning, social development, the emergence of self-regulation—occurs in the context of close relationships with others. These close relationships are typically with parents or those who serve the parenting role in the child's life. We turn our attention to these relationships in this chapter and explore their influence on early development. Although we address young children's relationships with their child care providers given their pervasive and significant role in the earliest years of life, we reserve the fuller discussion of child care for Chapter 11. We start the discussion of parenting with a focused synthesis of the extensive literature on parent-infant attachment, followed by a discussion of other aspects of parenting that extend beyond the provision of emotional security. Next, we examine disruptions in parenting. We include an examination of the orphanage-to-adoption research as a demonstration of the extent to which young children can recover from early adverse experiences when the contexts of their lives change dramatically. We use this as a backdrop for an initial discussion of parenting interventions, which is placed in a broader context in Chapter 13.

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From Neurons to Neighborhoods: The Science of Early Childhood Development INTRODUCTION Starting with the mother's reproductive health and behavior, the child's primary caregivers—be they parents or grandparents or foster parents—structure the experiences and shape the environments within which early development unfolds. A vast store of research, summarized in this chapter, has confirmed that what young children learn, how they react to the events and people around them, and what they expect from themselves and others are deeply affected by their relationships with parents, the behavior of parents, and the environment of the homes in which they live (Bradley et al., 1988; Collins and Laursen, 1999; Dunn, J., 1993; Hartup and Rubin, 1986; Maccoby and Martin, 1983). Even when young children spend most of their waking hours in child care, parents remain the most influential adults in their lives. We shall also see, however, that efforts to change the course of development by strengthening parenting have met with mixed success. Shifting parental behavior in ways that shift the odds of favorable outcomes for children is often remarkably difficult. This perplexing mismatch between the power of parenting and the difficulty of altering it in ways that are sufficient to affect development is one of the major dilemmas confronting developmental scientists and interventionists alike. It is important to clarify that we use the term “parenting” to capture the focused and differentiated relationship that the young child has with the adult (or adults) who is (are) most emotionally invested in and consistently available to him or her. Usually this is a birth or adoptive parent (thus the use of the term “parenting ”), but sometimes it is a grandparent, a foster parent, or another primary caregiver. Who fills this role is far less important than the quality of the relationship she or he establishes with the child. The hallmark of this important relationship is the readily observable fact that this special adult is not interchangeable with others. A child may not care who cuts his hair or takes his money at the toy store, but he cares a great deal about who is holding her when she is unsure, comforts her when she is hurt, and shares special moments in her life. Understanding Parenting Parenting has been a centerpiece of developmental inquiry from the beginning of the field, reflecting the firm belief that childrearing makes the child. Only in the 1990s has this belief come under intense scrutiny, in debates over the influence of parenting relative to that of genetics and peers (Borkowski et al., in press; Harris, 1995, 1998; Rowe, 1994). While these debates have focused on children of school age and older (few dispute the significant role of parents during the earliest years of life), they have implications for the understanding of the more enduring influences of parenting

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From Neurons to Neighborhoods: The Science of Early Childhood Development in adolescence and adulthood. The controversy, moreover, highlights important shifts in studying and understanding the role of parents in early development. The classic, early studies of childrearing sought to identify styles of parenting that promoted competent behavior in preschoolers (i.e., a child who is happy, self-reliant, self-controlled, friendly, and cooperative as distinct from withdrawn or immature) (see Baldwin et al., 1945; Baumrind, 1967, 1971, 1973; Emmerich, 1977). The answers yielded by this research highlighted the combined influence of clear standards of conduct, firm control, and ample warmth. The heritage of this research is an abiding interest in both the management or control function and the emotional quality of parent-child relationships. In the ensuing 25 years, however, static characteristics of parents as restrictive or warm have been challenged by substantial evidence that parenting changes over time, varies from one child to another, and is not just received, but is also shaped, by the child's own behavior (Grusec and Goodnow, 1994; Holden and Miller, 1999). The result is a concept of parenting and parental influence that is more complex and conditional than that which emerged from prior eras of research (Collins et al., 2000; Maccoby, 2000). Succinct formulas for good parenting have been replaced by an appreciation for the many ways in which parents adjust what they do in response to the needs and characteristics of their children, the conditions in which they live, and the circumstances of their own lives (Cowan and Cowan, 1992; Elder, 1991; Holden and O'Dell, 1995). Whereas scientists used to study parenting in isolation, contemporary researchers take into account the network of contexts in which parenting is embedded. These contexts include the child care programs that children attend, the peers they associate with, the stability and socioeconomic strata of their families, their parents' marital relationship, the neighborhoods they live in, and the times they live in. Challenges to the notion that children are relatively passive players in the socialization process (Bell, 1968; Bell and Chapman, 1986; Engfer et al., 1994) have led to a substantial body of evidence showing the many ways in children contribute to their rearing environments, including influences on the parenting they receive. Researchers now realize that they need to consider the ways in which parents affect children and children affect parents. The growing reliance on research designs that address the interplay of genetics and socialization has both confirmed the substantial influence of parenting on child development and increased awareness of the complex ways in which parenting intersects with the child's inherited strengths and vulnerabilities to affect the pathways that are followed en route to adulthood (see Collins et al., 2000; Rutter et al., in press). The methodological challenges involved are considerable, as discussed in more

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From Neurons to Neighborhoods: The Science of Early Childhood Development detail in connection with the effects of impaired parenting. Accordingly, research on parenting has become a very complex endeavor. Bringing Fathers into the Picture The research discussed in this chapter on the multifaceted dimensions of parenting is primarily focused on mothering. Fathering, in contrast, has received less attention, and this literature has tended to focus on men's economic contributions to their families, the developmental consequences of father absence, and distinctions between the roles of fathers and mothers (Lamb, 1999; Parke, 1996; Pleck and Pleck, 1997). This began to change in the 1970s with a growing emphasis on family dynamics, including the marital relationship, as they affect child development (see Belsky, 1984; Cummings and O'Reilly, 1997; Dunst, 1985) and is continuing to change as an increasingly interdisciplinary group of scholars is exploring how fathers affect developmental trajectories (see Cabrera et al., 2000). Contemporary research on fatherhood has highlighted several themes. First, fathers seem to be both more and less involved in their children 's lives today than was true even a decade ago, revealing a growing dichotomy in children's experiences of fathering. On one hand, there is evidence that paternal involvement has increased over the past three decades, as seen in higher rates of single fathers raising children, greater involvement of fathers in child care while their wives are in the labor force, and more self-reported time spent by fathers with their children (Pleck, 1997; Yeung et al., 1998). At the same time, unprecedented numbers of children are now spending part or all of their childhoods in families headed by single mothers (see Chapter 10). While there is a growing appreciation of the extensive father involvement that can characterize children in single-mother families and extensive policy interest in the issues involved, scientists are only beginning to explore the factors that predict this involvement (Coley and Chase-Lansdale, 1999; W. Johnson, 1998) and its effects on children (see Garfinkel et al., 1994). It certainly appears to be the case that fathers' economic situation is closely involved. The consequences of these markedly different experiences of fathering for children's development, for their conceptions of parenting, and for their assumption of parenting roles remain largely unexamined. Second, fathering is increasingly viewed as involving multiple functions that go well beyond the role of breadwinner (Amato and Rivera, 1999; Lamb et al., 1985a; Parke, 1996; Parke and Buriel, 1998). Indeed, there is growing acceptance that father involvement per se is not necessarily linked to positive outcomes for children (see, for example, Hoffman et al., 1999). Rather, it is the variety of ways in which fathers take responsibility for their children that many now believe to be the most important component of

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From Neurons to Neighborhoods: The Science of Early Childhood Development fathering (Lamb, in press). This entails not only financial responsibility, but also functions that have typically been thought of as the purview of mothers—tasks such as taking children to the doctor or to lessons, arranging for and transporting the child to and from child care, monitoring the child's safety and whereabouts, and scheduling play dates. As with mothers, the emotional quality of the father-child relationship also appears to be extremely important to children' s adjustment and well-being and may, in fact, influence the benefits of increased involvement and responsibility. Finally, despite the rapid changes affecting the ethnic and racial composition of the nation's families, there is almost no research on how the roles of fathers and other men in young children's lives are evolving in the context of diverse values and family structures (Cabrera et al., 2000). Both theoretical models and empirical work need to incorporate culturally diverse conceptions of fatherhood related to race and ethnicity, as well as other dimensions of culture such as immigrant status and religion. In the following discussion of parenting, we note the research that specifically addresses fathers. The examples are far from plentiful, but we are hopeful that the renewed attention to fathering that is now characterizing developmental science will foster expanded efforts to study parenting in all of its varieties and certainly as it involves both mothers and fathers. ATTACHMENT RELATIONSHIPS What gives the parent a special place in the young child's life? What does the close emotional relationship with the parent provide that other adults cannot replicate? To answer such questions, researchers have focused on the development of security, confidence, and trust between infants and toddlers and their parents. This central feature of early relationships is captured by the concept of “attachment security.” In the rare situations in which infants do not have the opportunity to form an attachment with even one trusted adult, their development can deteriorate rapidly and dramatically. The remarkable recovery that these infants display once they receive stable care and loving attention further reveals the importance of the child 's earliest intimate relationships. Indeed, long ago the field was riveted by evidence that toddlers who were languishing in institutional settings could be made to thrive cognitively, emotionally, and physically simply by providing them with loving care—even if this meant that they were moved onto wards for young women with mental retardation who held them, played with them, hugged them, and lavished attention on them. As dramatic, the remarkable recovery observed today in children adopted from orphanages in Romania and other areas of the world speaks to the power of consistent care, attention, and affection in the lives of young children. Virtually all infants develop close emotional bonds, or attachments, to

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From Neurons to Neighborhoods: The Science of Early Childhood Development those who regularly care for them in the early years of life. These early attachments constitute a deeply rooted motivational system that ensures close contact between babies and adult caregivers who can protect, nurture, and guide their development. Indeed, the infant appears to be so strongly motivated and prepared to develop attachments to one or more caregivers that, given the opportunity to interact regularly with even a modestly responsive caregiver, he or she will develop an emotional tie to that person. Those who study attachment believe that children's first relationships, especially with their parents or other primary caregivers, address two fundamental needs (Ainsworth, 1973; Ainsworth et al., 1978; Belsky and Cassidy, 1994; Bowlby, 1969; Cassidy, 1999; Sroufe, 1996). First, the caregiver's company reduces a young child 's fear in novel or challenging situations and enables the child to explore with confidence (so-called secure base behavior) and to manage stress (Ainsworth, 1967; Emde, 1980; Emde and Easterbrooks, 1985; Gunnar, in press; Gunnar et al., 1996). “Stay here so I can do it myself!” captures this emotional regulation function of early attachments in the words of a toddler. Second, attachment relationships strengthen a young child's sense of competence and efficacy. The adult's contingent responding strengthens a young child's awareness of being able to influence others and affect the world (Carson and Parke, 1996; Cassidy et al., 1992; Denham et al., 1997; Hooven et al., 1994). This might be called, therefore, the self-efficacy function of early attachment relationships. Well before the first birthday, infants clearly exhibit preferences for and special responsiveness to certain adults. About the time children become more mobile (i.e., 6-12 months), they organize their behavior to maintain proximity to one or a few people. They advance into the world to explore, but return periodically to touch base with these people. If frightened, they seek proximity and physical contact, and when forced to be separated from them, they often protest, sometimes frantically. In short, they appear to use these people as secure bases. Secure base behavior describes the presence of an attachment bond, and toddlers show in these behaviors that they are gradually acquiring an awareness of the psychological qualities of other people (Stern, 1985; Tomasello et al., 1993) and constructing expectations for their behavior (Gekoski et al., 1983; Lamb and Malkin, 1986). Security of Attachment Although virtually all infants become attached to their caregivers, attachment relationships differ in how much security they provide. Assessments of attachment security, whether conducted in a laboratory or at home, focus on the child's exploratory behavior in the presence of the

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From Neurons to Neighborhoods: The Science of Early Childhood Development caregiver, responses to separation, and reactions upon reunion. A secure attachment is assumed to exist when the infant or toddler explores comfortably in the presence of his or her caregiver, keeps track of and seeks proximity with the caregiver, happily and eagerly seeks contact after having been separated, and, in general, shows signs of trust and delight in the caregiver's presence. In contrast, children whose exploratory play is disrupted because they are preoccupied with the caregiver, who avoid or resist contact after separation, display distress and anger upon reunion, and are not easily comforted are considered insecurely attached. An insecure attachment is not, however, equivalent to no attachment at all. Even a young child who is insecure about the caregiver's nurturance derives important emotional support from her presence that is not derived from the company of someone to whom the child has no attachment at all. After all, even a resistant infant turns to the caregiver for help. Recent research on children who have experienced highly disruptive, sometimes abusive care has led to important refinements in views of insecure attachment. Studies of physically abused infants and toddlers have noted significantly elevated proportions of insecure attachments (Crittenden, 1988; Lyons-Ruth et al., 1987), as have studies of children of clinically depressed mothers (DeMulder and Radke-Yarrow, 1991; Lyons-Ruth et al., 1990, 1991). Studies of neglected children, such as those reared in orphanages or removed from their homes because of severe neglect, have shown that some, but certainly not all, of these children do not seem to organize their behavior in meaningful ways around one or a few adults. They do not fit typical patterns of insecurity, but rather display inconsistent and disorganized responses to their caregivers. The field is just beginning to document these unusual patterns of attachment behavior and to explore their clinical roots and implications for children's development. We are far from being able to say anything definitive about these disordered patterns of attachment behavior, but they form one of the cores of the nascent field of infant mental health (Osofsky and Fitzgerald, 2000; Zeanah, 2000). This field of clinical research, albeit new, highlights what has become increasingly evident: infants and young children have rich emotional/psychological lives and can suffer in ways that heretofore had never been realized. The interest in documenting unusual patterns of attachment behavior in search of a better understanding of infant mental health and disorder increases the need to broaden cultural understanding of attachment and the assessment of its security. It is important to realize that the laboratory assessments that have formed the basis for much of the research on attachment security have been designed to produce only mild challenges for the infant. The meaning of the laboratory assessment depends on whether the challenges are both mild and meaningful within the child's culture and life history.

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From Neurons to Neighborhoods: The Science of Early Childhood Development For example, the standard laboratory assessment (termed the “strange situation”) relies on brief (e.g., 3 minute) separations from the parent. In cultures in which infants are frequently separated from parents for brief periods, the child's reactions are presumably influenced by expectations, based on previous history, that the parent will return and be helpful. In cultures in which separations rarely occur, it is presumed that these experimentally imposed separations may take on a very different meaning for the infant. Indeed, research on Japanese infants who are rarely separated from parents during their first year initially demonstrated high rates of presumably insecure attachment (Takahashi, 1986, 1990). Later reinterpretations of the results, however, emphasized the vast difference in the strange situation between the Japanese and European-American cultures (van IJzendoorn and Sagi, 1999). A study of desirable and undesirable attachment behavior among white and Hispanic (Puerto Rican) mothers provides a compelling illustration of these differences (Harwood et al., 1995). The white mothers preferred that toddlers balance autonomy and relatedness (playing at a distance and involving the mother prior to separation and greeting the mother happily during the reunion), and they disliked clinginess (clinging to the mother prior to separation, crying continuously during separation, and being unhappy during the reunion). In contrast, Puerto Rican mothers preferred that toddlers display respectfulness (sitting near the mother and waiting for a signal before playing with the toys prior to separation, waiting quietly for the mother to return during separation), and they disliked highly active or avoidant (ignoring the mother before, during, and after separation) behavior. This and other cross-cultural evidence on attachment raises significant issues regarding the ways in which parents and young children form expectations about each other and, in turn, behave and react in each other's presence (and in the strange situation). We strongly suspect that, across all cultures, children form attachments and use parents as sources of security and comfort. Even when the relationship is somewhat insecure, children seek comfort and maintain proximity to parents, deriving important emotional support from the caregiver 's presence that other adults cannot provide; however, they do not derive the same developmental benefits that accrue from a secure attachment. Specific attachment patterns result from an intricate interplay among characteristics of the child, the capacities of the parent, and the broader context of their relationship (see Isabella, 1995; Lamb et al., 1985b; Thompson, 1999a, for reviews). Secure attachments are seen more often in the context of parenting that is dependable and sensitive to the child's intentions and needs, enabling the child to count on the caregiver's future availability and assistance (Ainsworth et al., 1978; Belsky, 1999; De Wolff

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From Neurons to Neighborhoods: The Science of Early Childhood Development and van IJzendoorn, 1997; Isabella, 1995; Thompson, 1997, 1998a). Infants and toddlers are less likely to establish secure attachments with caregivers who are generally detached, intrusive, erratic, or rejecting. The important role of sensitive caregiving in the establishment of secure attachments is compellingly illustrated by a recent intervention that randomly assigned low-income mothers of infants who were observed in the first two weeks of life to be irritable to a program designed to enhance maternal sensitivity and responsiveness or to a control group. After 9 months, the mothers who had received the programs were significantly more responsive and stimulating than the control group mothers and their infants engaged in more sophisticated exploratory behavior and were significantly more likely to be securely attached (van den Boom, 1994, 1995). A follow-up when the children were 3 ½ years old documented sustained effects in maternal sensitivity, attachment security, and the children's observed cooperation with the mother. Interestingly, the husbands of mothers who participated in the intervention were also more responsive to their preschoolers. Adoption studies add to the evidence regarding the importance of sensitive, responsive care. Toddlers fostered or adopted from conditions of extreme neglect have been found to reorganize their attachment behavior over time, exhibiting behavior reflective of secure expectations of support and comfort as they adapt to foster or adoptive parents who provide sensitive, responsive, and consistent care (Chisholm, 1998; Dozier, in press a, in press b; O'Connor et al., 1999). Providing sensitive, responsive, and consistent parenting of infants and toddlers is challenging work. Both characteristics of the child and of the parent can make this type of parenting difficult to achieve. For example, newborns who continue to react to repeated stimuli after other newborns have tuned out or habituated to the repeated stimulation are somewhat more likely to form insecure attachment relationships to caregivers (Warren et al., 1997). Babies who become disorganized when stressed and those who get very upset when limits are placed on their actions are also somewhat more likely to develop insecure attachments (Fox, 1985; Gunnar et al., 1996; Izard et al., 1991). These infant characteristics don't predestine children to insecure attachment; rather they shift the odds. This may be because it is harder for people to provide the sensitive parenting such children need. It may be because it is not clear what the baby needs or because the needs of such infants exceed the time, attention, and sensitivity that the parents can provide given all of the demands on them. Indeed, when parents can manage to maintain high degrees of sensitivity and responsiveness, even temperamentally difficult infants develop secure and trusting relationships (Goldberg, 1990; Mangelsdorf et al., 1990; van IJzendoorn et al., 1995). Challenging parental life circumstances can also result in an imbalance between the infant's needs and what the parent can

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From Neurons to Neighborhoods: The Science of Early Childhood Development provide. Emotional problems such as depression, economic stress, and marital conflict can interfere with sensitive and responsive parenting, be disruptive of secure attachments (see Belsky and Isabella, 1988; Thompson, 1999b; Waters, 1978), and constitute a significant source of instability over time in attachment security. It also appears to be the case that atypical attachments are more common among atypical samples, including premature infants, children with Down syndrome, and children with autism (Atkinson et al., 1999; Capps et al., 1994). In particular, a significantly larger share of children at the extremes of reproductive risk or who have an identifiable developmental disability display disorganized or unclassifiable patterns of attachment to their mothers. Much remains to be understood about the meaning and consequences of atypical attachments. They may arise from problems parents experience in being sensitive to their child (i.e., difficulty of reading the infant's cues), from these children 's cognitive limitations, from the added stress that can accompany raising a child with special needs, or from limitations of the typical model for studying attachment when applied to these special populations. There is a tremendous need for research in this area, given its role in elucidating child factors and surrounding conditions that impinge on early attachments, as well as the developmental significance of behavioral differences in patterns of relating to important others among both atypically and typically developing children (see Vondra and Barnett, 1999). Mothers and Others The large majority of research on early attachments has focused on the parent-child relationship and, specifically, on the mother-infant relationship, despite the fact that young children establish close relationships with a surprising variety of people, including relatives, child care providers, and friends. Children certainly develop secure attachments to their fathers that do not depend on the security they derive from their attachments to mothers (Thompson et al., 1985). Grandmothers are also important attachment figures, and their support of the mother can facilitate secure attachment in infants (Crockenberg, 1987; Myers et al., 1987). Grandmothers are an especially important source of child care during the earliest months and years of life, as we discuss in Chapter 11. Howes (1999) proposed the following three criteria for identification of attachment figures other than the mother: provision of physical and emotional care, continuity or consistency in the child's life, and emotional investment in the child. We do not know whether there is a specific limit to the number of people with whom very close emotional connections can be established at different ages. Regardless of their number and variety, from

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From Neurons to Neighborhoods: The Science of Early Childhood Development the child's perspective, close personal relationships are not interchangeable. The child may turn to a substitute attachment figure or even a relatively unfamiliar but friendly person when the preferred one is not available, but the distress about the loss of one beloved person is not easily alleviated by the ongoing availability of the others, as many parents faced with their children's reactions when a beloved babysitter or child care teacher goes out of their lives can attest. Young children clearly benefit from opportunities to develop close relationships with different caregivers. As with the mother, the security of these relationships is based primarily on the trust and confidence that each adult has inspired in the child. It is also clear that the child's primary caregiver (usually the mother) remains central in this constellation of attachment relationships (Berlin and Cassidy, 1999; Howes, 1999; NICHD Early Child Care Research Network, 1997a). The security of attachment between a mother and her child is more influential on early psychosocial growth than are the relationships a child has with other caregivers at home or outside the home, and even children in extensive child care continue to show an overwhelming preference for their mothers (Easterbrooks and Goldberg, 1990; NICHD Early Child Care Research Network, 1997a, 1998a, 1998b, 1999a, in press(a)). Although there once was concern that spending many hours in nonparental care might undermine the child's primary relationships, recent studies now reassure parents that this is not the case (Berlin and Cassidy, 1999; Easterbrooks and Goldberg, 1990; Howes, 1999; NICHD Early Child Care Research Network, 1997a). Moreover, attachment relationships are specific to each adult, so that an insecure attachment to one caregiver may develop at the same time that a secure relationship grows with another (Howes et al., 1988; Suess et al., 1992). For example, children often exhibit secure attachment behavior with one parent but not the other (Belsky et al., 1996a). Infants and toddlers who develop secure attachments either to their mothers or their child care providers are observed to be more mature and positive in their interactions with adults and peers than are children who lack a secure attachment. However, the most socially skilled children are those who have established secure attachments with both their mothers and care providers (Howes et al., 1995a). In this context, it is important to recognize that child care can be used effectively to provide respite for highly stressed parents who may be prone to child abuse or at risk of having their children placed in foster care (Crittenden, 1983; Kempe, 1987; Roditti, 1995; Subramanian, 1985). Unfortunately, as a result of pervasively high turnover in child care providers and frequent changes in arrangements, children are more often insecurely than securely attached to their child care providers (Galinsky et al., 1994; Howes, 1999; Seltenheim et al., 1997; Whitebook et al., 1990).

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From Neurons to Neighborhoods: The Science of Early Childhood Development ence on children who might otherwise be expected to succumb to the deleterious circumstances of their early lives. Recent work has explored the presence of posttraumatic stress symptoms in maltreated children, with a special concern for potential alterations in fear-stress physiology that have been found to accompany reactions to trauma among adults and older children. Work is currently ongoing with children 3 years and under to discover how trauma manifests itself in preverbal children (Scheeringa and Zeanah, 1995). By 4 and 5 years of age, however, trauma symptoms typically assessed in older children and adults can be observed (Pynoos and Eth, 1985; Scheeringa et al., 1995). Many children who show these symptoms following traumatic experiences appear to recover when their circumstances improve. In others, however, there is evidence of fairly long-term alterations in the physiology of the fear-stress system, seen in higher levels and atypical daily patterns of cortisol and adrenaline production, that correspond to the duration of maltreatment (De Bellis et al., 1999b; Hart et al., 1996; Kaufman, 1996; Kaufman and Charney, 1999; Pynoos et al., 1996a, 1996b). More severe physiological changes are noted when children suffered for longer periods before rescue (De Bellis and Putnam, 1994; De Bellis et al., 1999b). Do these changes in the physiology of fear-stress in children have developmental consequences? Certainly chronic abuse in childhood is associated with problems in emotion and behavioral regulation (Pynoos et al., 1995). In addition, maltreatment in childhood is a risk factor for multiple forms of psychopathology that are often seen to co-occur with post trauma symptoms (Cicchetti and Lynch, 1995; Kaufman, 1996; National Research Council, 1993). Many suspect that chronic activation of the physiology of stress during periods of rapid brain development may be producing pathology because of the effects of stress physiology on brain development (e.g., Cicchetti, 1994). However, there has been only one peer-reviewed scientific study that imaged the brains of maltreated children. The 44 children in this study had all been sexually abused, typically beginning between ages 2 and 6, and most had also been physically abused beginning between ages 1 and 3 and had witnessed violence in the home. The duration of abuse varied but averaged around 3 or more years. These children, who were all of school age at the time of testing and had been living in stable, presumably nonabusive circumstances for several years, were all selected to meet clinical criteria for posttraumatic stress disorder, and many also met criteria for depression and other clinical syndromes (De Bellis et al., 1999a). The imaging data showed that, compared with physically and mentally healthy children matched for age and sex, these children had smaller brain volumes, larger lateral ventricles (i.e., the fluid-filled cavities of the brain), and smaller areas of connection (i.e., the corpus callosum) between the left and right sides of the brain. Most importantly,

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From Neurons to Neighborhoods: The Science of Early Childhood Development these findings were correlated with the duration of trauma (although not with age of onset), with children who had been abused longer showing greater differences from their matched controls than children who were rescued after shorter periods of abuse. These results are preliminary and require replication, but they suggest that a history of chronic and severe trauma in early childhood can be associated with alterations in fear-stress physiology and in brain development. At the same time, there is no reason to interpret these results as indicating permanent impairment. Indeed, there is no evidence on whether or how therapeutic interventions may affect the fear-stress system or the neurological development of children who suffer maltreatment early in life. There is, however, compelling evidence from research on children reared in orphanages and then later adopted into loving families of the remarkable capacity of the young child to recover from aberrant early care. Orphanage Rearing and Later Adoption Children growing up in institutions have been the focus of a long-standing literature on early privation (Rutter, 1981a; Skeels, 1966). Studies of orphanage-reared children are now focusing on the wave of Romanian children adopted into families during the early 1990s (Benoit et al., 1996; Groze and Ileana, 1996; Morison et al., 1995; Rutter and the English and Romanian Adoptees [ERA] Study Team, 1998). This literature tells a compelling story about the severe developmental consequences of institutional care that affords neither stimulation nor consistent relationships with caregivers, which often confronts children with other physical adversities, including malnutrition, exposure to pathogens, and untreated chronic illness. It also reveals the remarkable recovery that characterizes many children exposed to these environments once they are adopted into loving homes, as well as the long-term impairments that continue to plague some of them many years after their life circumstances have improved. On both accounts, the fundamental message concerns the vital importance of consistent and committed adults in young children's lives. Orphanage-reared infants and toddlers who have received adequate medical care and nutrition, but virtually no social or cognitive stimulation and few opportunities to establish a relationship with a consistent caregiver, show striking delays in motor and cognitive growth over the period of institutionalization (Provence and Lipton, 1962). They become extremely unresponsive, showing minimal crying, cooing, babbling, or motor activity. When tested in the orphanage, the deficits increase over time (Ames, 1997; Dennis, 1973; Provence and Lipton, 1962; Rutter and the English and Romanian Adoptees [ERA] Study Team, 1998). When adequate physical care and developmentally appropriate stimu-

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From Neurons to Neighborhoods: The Science of Early Childhood Development lation are provided and only the availability of stable caregivers is lacking, development is substantially less delayed (Hodges and Tizard, 1989a, 1989b; Tizard and Hodges, 1978; Tizard and Joseph, 1970; Tizard and Rees, 1974). This suggests that stable relationships, as distinct from social-cognitive stimulation, are not required to ensure adequate physical, sensorimotor, cognitive, and language development. Children who have lacked stable and consistent caregiving, however, are not free of problems. Using parent and teacher reports, these children have been found in several studies to show impairments in regulatory aspects of thinking that involve concentration, attention regulation, and inhibitory control, generalizing problem solutions, and excessive concreteness of thought (Hodges and Tizard, 1989b; Tizard and Hodges, 1978, as reviewed in Gunnar, in press). Importantly, removing children from institutions and placing them in stable families with adequate resources can produce remarkable catch-up growth on developmental milestones and in general cognitive (i.e., measures of IQ) and language development (Ames, 1997; Rutter, 1972, 1981b; Rutter and the English and Romanian Adoptees [ERA] Study Team, 1998). Even children delayed a year or more in behavioral and physical development can achieve normal levels of functioning once they are given the opportunity to live with a loving family. Nonetheless, a persistent minority of institutionalized children across all studies and samples fails to show this dramatic recovery. They continue to exhibit multiple, debilitating problems in cognition and behavior years after entering their new families. Multiple, often unknown factors are likely to constrain developmental outcomes for this persistent minority. Case by case, these factors may include varying mixtures of genetic, prenatal, and postnatal conditions. If institutional rearing is involved, the continuing deficits found in some children should show a consistent dose-response relationship with the duration of privation experienced. Duration of orphanage exposure is highly confounded with illness, maltreatment, repeated changes in caregiving, and so on, making it exceedingly difficult to isolate duration as the causal factor. However, recent findings based on the Romanian children offer a reasonable test of this hypothesis (O'Connor et al., 2000; Rutter and the English and Romanian Adoptees [ERA] Study Team, 1998). In fact, a strong dose-response relationship was found (with a 24-point IQ difference between the extremes), in which children who spent more time in the institutions showed more persistently poor outcomes. The study controlled for a series of alternative explanations, including the possibilities that later-adopted children might have had greater impairments at birth and that the differing outcomes may have been due to the children's degree of malnutrition, which adds to the credibility of the conclusion. The outcomes of institutionalized children may also be constrained by

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From Neurons to Neighborhoods: The Science of Early Childhood Development the capacity of the adoptive family to provide for the special needs of the child and the availability of appropriate remedial treatment. Surprisingly little is known about post-adoption effects on the recovery of children from such neglectful early environments. As with any family of a child with special needs, however, the challenge for such families may tax their emotional and financial resources. This may be one reason why the recent work on Romanian adoptees has shown that persistent problems were more common for children when two or more were adopted simultaneously from the orphanage by the same family (Ames, 1997). In contrast to the rapid recovery from gross cognitive and language deficits that is often seen in formerly institutionalized children, social and emotional development appears to be more compromised or more susceptible to long-term impacts (Ames, 1997; Hoksbergen, 1981; Rutter and the English and Romanian Adoptees [ERA] Study Team, 1998; Tizard and Rees, 1974; Verhulst et al., 1990, 1992). Specifically, children from the most depriving conditions, which often included illness, malnutrition, frequent relocations, and thus disruptions in care, appear to be at increased risk for enduring behavioral problems and difficulties in peer relationships that have been seen well into adolescence (Ames, 1997; Fisher et al., 1997; Hodges and Tizard, 1989b; Tizard and Hodges, 1978; Verhulst et al., 1992). Once again, however, many of the children, including some with the most depriving and adverse early backgrounds, do remarkably well when taken out of those circumstances and given the opportunity to develop in stable, loving, and economically resourceful families. The natural experiment provided by orphanage-reared children also affords the opportunity to ask if children deprived of stable, consistent attachment relationships early in life remain capable of forming such relationships when opportunities arise later in childhood (see Thompson, in press(a)). In contrast to expectations from early attachment theory, the window for forming attachments appears to remain open for a rather long period, at least through the early childhood years, and possibly later. Children seem to be capable of forming their first attachments to parents even when adopted or fostered later in development, although it is unknown how long this adaptive capability endures. Nevertheless, the quality of these children's attachment relationships varies considerably. A substantial minority have difficulties establishing secure attachments with adoptive or foster parents (Chisholm, 1998; Hodges and Tizard, 1989b; O'Connor et al., 1999). Some also display quite shallow relations with others and reduced likelihood of forming intimate relationships with peers later in development (Hodges and Tizard, 1989b). This implicates the importance of stable relationships during infancy for organizing competencies that support the development of attachments that entail strong emotional commitments to specific partners (Gunnar, in press).

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From Neurons to Neighborhoods: The Science of Early Childhood Development A final look at whether the problems seen in institutionalized children derive from their institutionalized rearing or from other factors is provided by another study of Romanian children (Roy et al., 2000). These investigators compared children reared from infancy in residential group homes and those brought up in individual foster homes. Almost all of the children had biological parents with overt psychopathology. The rearing provided by the foster parents differed significantly and in positive ways from the rearing received by the institutionalized children. The findings showed that the institutional children had a much higher level of overactivity and inattention than the foster family children, suggesting that the institutional rearing was the more probable culprit. It is important to note that this finding applies to the children who were studied, namely, those who also came from very high-risk backgrounds. In sum, the literature on orphanage rearing and later adoption illustrates the dual nature of early experiences. On one hand, highly disrupted or aberrant experiences of early care can have devastating effects on development. On the other hand, the impacts of even these extreme environments are modified by subsequent experiences. Indeed, the rebound shown by orphanage-reared children when they are adopted into loving homes highlights the vital role that caregiving in all of its facets plays in the lives of young children. The literature attests that early deprivation does not doom children to lives of compromised development. It also reveals, however, that not all children escape unharmed. Some children institutionalized as infants continue to show lingering, persistent, and even severe problems, and a substantial minority show traces of their conditions of early care in what appear to be problems in their capacity or willingness to form intimate, secure, and deep relationships with others. Improving care can certainly improve child outcomes, but given the massiveness of the change entailed in adoption (most families involved in international adoptions are middle to upper income, given the expense involved) and the lingering problems of some children, questions are raised about what can realistically be expected from far more modest attempts to alter the consequences for children of adverse early life experiences. EFFORTS TO IMPROVE PARENTING Some of the strongest evidence available on the efficacy of parenting behavior in fostering positive developmental outcomes comes from evaluations of interventions focused on parenting. For example, a long-standing parent management training program focused on elementary-age and older children has been instrumental in demonstrating that coercive parenting plays a role in the causal mechanisms leading to antisocial behavior (Dishion et al., 1992; Forgatch, 1991; Forgatch and DeGarmo, 1999; Patterson and

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From Neurons to Neighborhoods: The Science of Early Childhood Development Forgatch, 1995). There have been a number of recent reviews of the literature on parenting interventions (Barnard, 1997; Barnes et al., 1995; Benasich et al., 1992; Brooks-Gunn et al., 2000; Cowan et al., 1998; Farran, 2000; Gomby et al., 1999; Heinicke, 1993; McCollum and Hemmeter, 1997; Olds and Kitzman, 1993). They converge on two fundamental conclusions. First, parenting is open to change. A number of carefully evaluated interventions have successfully improved various dimensions of parenting and, for some, have linked these changes to improved child outcomes. Second, it is not easy to change parenting. There are at least as many failures as there are success stories. Learning from the unsuccessful efforts is vitally important to the intervention enterprise, as well as to understanding the many influences that impinge on parenting. This brief discussion emphasizes the implications of this literature for understanding parenting generally. Chapter 13 discusses this literature in the broader context of interventions aimed at improving young children's well-being and life chances. Parenting interventions do not constitute a coherent field or delimited set of strategies. They range from relatively brief (several months), intensive interventions focused on highly specific objectives to multiyear initiatives that provide a range of services to families aimed at the broad goal of supporting family functioning. The focal points of intervention range from parent literacy to the sensitivity of parent-child interactions to maternal health behaviors. The interventions often, but not always, take place in the home; they rely on a multiplicity of service providers ranging from nurses and highly trained parent educators to paraprofessionals recruited from the same neighborhoods as the clients, who are sometimes (but not always) given substantial training. Increasingly, intervention approaches that were developed on largely middle-class white populations are being extended to families from different ethnic and culturally defined groups and to families at many levels of risk (Cowan et al., 1998). There are surprisingly few studies of efforts to improve parenting that have simultaneously examined the causal influence of changes in parental behavior on child outcomes. The exceptions have, however, provided compelling evidence that successfully applying what is known about beneficial parenting to intervention efforts can improve outcomes for children. Carefully designed intervention programs have proven successful in improving the sensitivity and reciprocity of care that parents give their infants and toddlers, with some programs also succeeding in strengthening the security of attachment in young children as a consequence (van IJzendoorn et al., 1995). The most effective of such interventions (e.g., Heinicke et al., 1998, 1999; Lieberman et al., 1991; Quint and Egeland, 1995; van den Boom, 1994, 1995) strive to improve a caregiver's sensitivity through sustained, individualized sessions that take into account the mother's broader life

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From Neurons to Neighborhoods: The Science of Early Childhood Development circumstances and needs. The Family Development Service Program in Los Angeles, for example, places a strong emphasis on helping mothers work with the child's father and with institutions outside the nuclear family (Heinicke and Ponce, 1999) and has documented that a relationship-based intervention can have a significant impact on parent-child interaction and on the infant's security of attachment. The Infant-Parent Psychotherapy Program in San Francisco emphasizes intergenerational patterns of attachment and devotes substantial resources to helping mothers cope with life issues in the world outside the family (Lieberman et al., 1991). It remains difficult, however, to delineate the key mediators involved in the positive findings that these studies are producing. These successful approaches confirm correlational evidence of the extent to which parenting sensitivity is tied to the extent of marital support, socioeconomic stress, demands in the neighborhood, and other life circumstances that can compete for the adult's energy and attention to a young child's needs (Belsky, 1984, 1999). It is therefore not surprising that such intensive strategies also improve child functioning indirectly by improving the sensitivity of the care they receive. It is also important to note that these interventions typically rely on professional staff who are clinically trained to deal with parent-child issues and place a strong emphasis on staff continuity as essential to the central task of supporting relationships. Other similarly intensive, localized programs have been successful in teaching low-income parents to facilitate their young children 's early literacy skills (Whitehurst et al., 1994) and improve parents ' behavior management strategies (Webster-Stratton, 1992), with significant program effects on young children's reading and vocabulary and reduced aggressive and oppositional behavior, respectively. Cowan and Cowan (2000), in a randomized design, showed that largely middle-class parents' participation in 16-week therapist-led discussion groups on effective parenting just prior to their children's entry into kindergarten resulted in better school adjustment and higher academic achievement for kindergartners and first graders, compared with children whose parents attended discussion groups without an emphasis on effective parenting. While these model programs with explicitly defined goals and painstaking attention to implementation and service quality can be effective in changing parenting practices and affecting targeted child outcomes, the literature on larger-scale parenting interventions is substantially less consistent. This is not to say that promising results are never found; rather, they are more sporadic and of smaller magnitude. Nevertheless, there are important exceptions among the larger-scale efforts. Randomized trials of the Nurse Home Visitation Program (Olds et al., 1999), for example, have reported reduced maternal smoking, positive changes in maternal attitudes and behaviors related to abuse and neglect, and improved safety of home

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From Neurons to Neighborhoods: The Science of Early Childhood Development environments, as well as fewer reported cases of child abuse and neglect and reduced hospital visits due to injuries and ingestions in the first four years of life. One evaluation of the national Even Start Family Literacy Program that randomized treatment at five sites found positive program effects on school readiness and language scores for 3- and 4-year-olds (St. Pierre et al., 1995a), despite weak effects on the aspects of parenting that were measured. There is, however, little empirical documentation that nonspecific, general family support interventions for high-risk families are able to produce significant or enduring changes in parenting behavior. For example, a review of 15 randomized trials of home visiting programs aimed at promoting the cognitive and linguistic development of young children in low-income families found that only 6 produced significant benefits for children and 5 of the 6 programs employed professional staff (Olds and Kitzman, 1993). A more recent review of six high-quality evaluations (i.e., primarily randomized experiments) of home visitation programs that are being, or have been, implemented nationally called for “a dedicated effort, led by the field, to improve the quality and implementation of existing home visiting services, and a more modest view of the potential of the broad array of home visiting programs” (Gomby et al., 1999:24). Widely implemented programs that have extended their services beyond home visiting to provide a mix of adult education, job training, parenting education, and child care have also yielded, at best, modest results (Berrey and Lennon, 1998; St. Pierre and Layzer, 1998; St. Pierre et al., 1995a), particularly when they do little to address the multiple risk factors that often characterize the families they are trying to reach and do not focus extensive resources on addressing the parent-child relationship (Cowan et al., 1998). In sum, the question today is not whether interventions focused on parents can be effective, but rather what does it take to change parenting behavior in ways that will be sufficient to produce improved child outcomes (and for whom is this unlikely to be the right approach). The complex evidence on parenting interventions suggests that this is not an easy task for which success can be readily assumed. The challenges become even more daunting in light of the multiple problems that face many at-risk families today. The committee agrees with others (see Cowan et al., 1998; Teti, 1999) who have suggested that these families are likely to require more intensive services than the typical parenting intervention program provides, interventions that go beyond the enhancement of parenting skills to address the serious life issues (e.g., poverty, hopelessness and depression, substance abuse, troubled relationships) they face and involve adults other than just the mother and utilize program staff who are specifically qualified to work with multiproblem families. The growing diversity of families with young children also raises profoundly important questions about how best

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From Neurons to Neighborhoods: The Science of Early Childhood Development to match programs to the needs, values, and goals of various ethnic and cultural groups. A final challenge to parenting interventions is posed by the demographics and circumstances of working parents, for whom finding the time to participate in these programs is exceedingly difficult. Evaluations of the next generation of parenting interventions also face a new set of challenges: (1) the importance of subjecting to direct assessment the underlying assumption that improving parenting will produce meaningful changes in children's functioning, (2) the need to thoroughly document program implementation and, in particular, to study the interactions that transpire between program staff and participating families, and (3) the need to distinguish children and families for whom parenting interventions are effective from those for whom an alternative intervention strategy holds more promise. Figuring out the conditions and mechanisms that underlie successful efforts to change parenting will contribute not only to more successful interventions but also to efforts to understand parenting more generally. SUMMARY AND CONCLUSIONS Relationships are among the most significant influences on healthy growth and psychological well-being. The mother-child relationship is the primary one for most children, but relationships with others inside and outside the home have become increasingly important as young children receive care from many different individuals. These are not new conclusions, but research during the past quarter-century has highlighted how early relationships are influential, how diverse are their consequences, and how significant are the harms resulting from relational abuse or neglect on young children. Early in life, a young child enjoys relationships that are unique to different partners. Relationships with mothers are different from relationships with fathers, grandparents, and a caregiver in child care, but each relationship can be supportive and secure in its own way. Moreover, relationships are established and sustained in a cultural context in which how children and adults regard each other is influenced by the beliefs, values, and expectations of the wider social community. Indeed, a central function of early caregiving relationships addresses the child's socialization into a specific cultural niche within society. In these ways, early relationships are diverse and multifaceted and have different effects on young children. Despite their diversity, however, all young children seem to require certain things from early abiding relationships. These include: (a) reliable support that establishes confident security in the adult, (b) responsiveness that strengthens a young child's sense of agency and self-efficacy, (c) pro-

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From Neurons to Neighborhoods: The Science of Early Childhood Development tection from the harms that children fear and the threats of which they may be unaware, (d) affection by which young children develop self-esteem, (e) opportunities to experience and resolve human conflict cooperatively, (f) support for the growth of new skills and capabilities that are within the child's reach, (g) reciprocal interaction by which children learn the mutual give-and-take of positive sociability, and (h) the experience of being respected by others and respecting them as human beings. In these ways, relationships shape the development of self-awareness, social competence, conscience, emotional growth and emotion regulation, learning and cognitive growth, and a variety of other foundational developmental accomplishments. Relationships are also important because these attachments buffer young children against the development of serious behavior problems, in part by strengthening the human connections and providing the structure and monitoring that curb violent or aggressive tendencies. But strong, supportive early attachments do not inoculate young children against later difficulty. Relationships may begin well but decline over time, and many other influences affect early psychosocial growth. Stability and consistency in these relationships is important, as are the adult's sensitivity, love, availability, and unflagging commitment to the child's well-being. Fulfilling these responsibilities does not always come naturally, nor is it easy. The circumstances that surround parents and other caregivers, as well as their own mental health, exert a powerful influence on their capacity to fulfill the responsibilities that are entailed in raising children. Characteristics of the child can also make good parenting difficult to achieve. It should come as no surprise that early child-caregiver relationships can go awry in many ways. When they do, children suffer and the harms they experience can be life-threatening. Short of this, they include alterations in fear-stress physiology, blunted capabilities for emotion and attention regulation, delays in cognition and learning, and social dysfunction. Remarkably, when young children are removed from these deleterious conditions, many recover amazingly well. The capacity to rebound in supportive relationships speaks to the growth-fostering importance of close relationships for young children. Nonetheless, not all children who experience harmful care early in life rebound so well. Why one child recovers while another struggles is difficult to know without being privy to all the harmful influences the child experienced prior to being rescued. But there is evidence that the longer children remain in care that is threatening or fails to meet their basic needs, the greater the challenge in getting them on a healthy trajectory. Early relationships can improve if they begin badly. It is thus vitally important for society to do everything possible to enable parents to establish good relationships with their children from the beginning and, when

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From Neurons to Neighborhoods: The Science of Early Childhood Development this fails, to help parents become better caregivers. The quality of an adult's caregiving can be strengthened, but it is not easy to do. Because the quality of caregiving has diverse roots in the family ecology, marital relationship, and the adult's individual past, improving the quality of care requires carefully designed interventions that take these contextual features of families into consideration. It also involves reducing the stresses that impinge on parents from circumstances beyond the family unit, ranging from work-related pressures to community violence. The central and irreplaceable nature of young children's close relationships also point to the importance of evaluating the impact of programs affecting families (such as welfare reform, child care policies, and economic/child support policies) through the prism of young children's relational needs.