The Day-Care Scare

Four years ago, research seemed to indicate that day care was turning out a generation of bullies. Now, new data suggest those fears were way overblown, and the national day-care debate is about to be rekindled.

In the spring of 2001, a press conference held by federally funded researchers generated a flurry of headlines that struck a blow at the core of modern women's lives. "Day care linked to child aggression" was how The New York Times put it. The potential danger of day care was not a new subject; it had been fiercely debated ever since the women's movement sent legions of moms into the workforce and launched a revolution in how young children spent their days. But this press conference carried unprecedented weight. The researchers, most of them developmental psychologists, represented the biggest study that had ever been done on the effects of day care. Coordinated by the National Institute for Child Health and Human Development (NICHD), the study enlisted researchers at 10 sites throughout the United States, including Seattle, to track more than 1,300 children from birth until an age yet to be determined. Still ongoing—the children will be 15 in January 2006—its aim has been to finally to answer the question, Does day care harm kids?

The suggestion in 2001 was that it does. Or at least, that's what the press picked up on as the scientists announced their findings at that stage. What got the most play was a correlation between the number of hours children spent in day care—or "child care," as it is termed in the field—and a small increase in various difficult behaviors, including bullying, disobedience, and demanding attention. The pundits and editorial cartoonists went wild. The antifeminist camp reveled in the news. "The advocates of 'it takes a village to raise a child' are having a rough month," crowed Phyllis Schlafly in a column.

UW researcher Cathryn Booth-LaForce.

(Pete Kuhns)

Feminists weren't pleased. Salon writer Jennifer Foote Sweeney, referring to "screaming headlines" and "deeply traumatic announcements," bashed the NICHD as a "cruel and bullying institution," which, she seemed to imply, had no right to even ask the questions it was asking. "What makes the NICHD think that we have a choice in the first place?" she demanded. Four years later, a recently released book called Child Care and Child Development (Guilford Press, $48) offers many of the study's most important papers collected in one place. At the same time, the NICHD is, at last, getting ready to explain its findings to parents in plain language through a pamphlet due out this November. Most importantly, new study results are in. And what's now clear is that the impression left by the 2001 brouhaha—that the study gave a thumbs-down to day care—is vastly misleading.

A new paper not yet in print shows that the correlation between day care and increased troublesome behavior is no longer evident by third grade. "The effect everyone was so alarmed about seems to have disappeared," says Cathryn Booth-LaForce, a University of Washington psychologist who is the study's principal investigator in Seattle.

The paper, scheduled to come out in the next couple weeks in the American Educational Research Journal, isn't entirely good news. It also shows that while some of the old negative behaviors fade away, some new ones appear by third grade for day-care kids, namely problems with social skills and work habits. Yet the day-care kids, in aggregate, scored only slightly worse than their peers on these behaviors. In other words, the differences between day-care kids and other kids are pretty small.

Indeed, it is just how small these findings are—all the study's findings, including some hailed as good news—that is the most significant, most surprising finding of the entire 15-year effort. To scientists eager for results, it has been a bit of a letdown. "It's so frustrating to have done such a large study and to have found such small differences," says Alison Clarke-Stewart, a University of California– Irvine psychologist who works on the study.

But that's precisely what's so significant. Day care, despite all the controversy, despite the huge shift it has brought in the lives of children, despite even its generally mediocre quality in this country, turns out to be a relatively insignificant factor in how kids turn out. "What we have shown is that there doesn't seem to be any long-lasting effects of good-enough child care," says Susan Spieker, the other University of Washington psychologist involved with the study, referring to day care's generally so-so quality.

While the effects may be small and fleeting, however, they do seem to exist. "The question is, are they important? Is it something to worry about?" says Sarah Friedman, who works in Maryland at the NICHD as the scientific coordinator of the study. It's a hot debate, not least among the study's researchers, several of them big names in the field who have long expressed conflicting views on day care.

Sarah Friedman of NICHD.

"I must say that to me it's a reassuring story," says Friedman. "We're finding again and again that child care is not the source of worry that existed when we started the study."

Offering the loudest dissenting voice is a sharp-tongued psychologist who serves as the study's bad boy and works on it from the University of London: Jay Belsky. "What is more important for society, for schools, for the community," he asks, "a large effect that applies to very few or a small effect that applies to many?" The possibility that many kids who have been through day care may bring their mildly disruptive behavior to school could mean that teachers spend less time teaching and more time managing, he suggests. "What happens when small effects pile up?" he asks. "L.A. has very lousy air. But no one car contributes very much."

Before assessing the implication of day care's effects, he continues, "it might be wise to put it in the context of how many kids are we talking about. Is it a relatively rare number? No."

In 1975, according to the study's literature, citing U.S. Census figures, 37 percent of married women with children under 6 worked. In 1998, 64 percent did. The overwhelming majority of working moms entrust their children to someone else's care while they work. This may, as many have noted, hark back to earlier times when mothers worked in the fields and raising children was more of a community endeavor, but in recent history, it represents a dramatic change. We've gone from a situation in which most young children stayed at home with their moms to one in which most young children attend day care. "We are conducting a huge experiment on an entire generation of kids," says Bob Marvin, director of the Mary D. Ainsworth Child-Parent Attachment Clinic at the University of Virginia Medical Center.

The NICHD's attempt to measure the results is proving illuminating not just about the role of day care in shaping children's lives but about the role of family in an era when day care is the norm.

"I don't think any of us really knew what we were getting ourselves in for," says Booth-LaForce in her UW office overlooking the Montlake Cut. She's discussing the study's origins.

University of London's Jay Belsky.

The time was the late 1980s, and the controversy over day care was heating up. Much of the psychological research had initially given the green light to day care, but that started to change. In 1986, Belsky published a paper titled "Infant Day Care: A Cause for Concern," which reported "a slow steady trickle of disconcerting evidence." Were day-care moms putting their kids at risk? The major media were all over the story, which became a cultural flash point as feminism went mainstream. Academics busied themselves arguing about whether Belsky was right or wrong.

The NICHD responded by proposing a new kind of study, one that would not just occur in one lab under the direction of one scientist but would be a vast nationwide project undertaken jointly by scientists crisscrossing the country. It's the kind of study made famous by the Human Genome Project, the federally funded endeavor to map our DNA. "Big science" is what Sharon Landesman Ramey, an outside observer who is a Georgetown University professor of child and family studies, calls it in a commentary for the NICHD's new book Child Care and Child Development.

Big science is a big challenge in terms of coordination. It took two years for the project's more than two dozen researchers to collectively design the study with measures to ensure uniformity. "We've all been more careful than any other study I've ever heard of," says Booth-LaForce. The scientists wrote meticulously detailed training manuals for research assistants, down to the size of the heel of the women's pump that would be put in a dress-up box used in one videotaped exercise of children playing with their mothers. Research assistants, who do the hands-on data collection with families and child-care providers, flew to centralized locations to train. Like Alfred Kinsey's students who went out in the field to ask people about their sex lives, the NICHD research assistants had to be aware of the sensitivities of research subjects, albeit of a different nature. "First, as soon as you see the baby, notice and comment on something positive about this child to the mother," instructs one training manual, warning about inadvertent slights. "Even an innocent comment can stay in the mother's mind for a long time."

The payoff of this logistical feat is a much bigger and more varied set of data than ever before. Previous day-care studies followed maybe 120 families at most. This one offers information about more than 10 times that number from a variety of disparate regions. One-tenth of those families, about 130, are from the Seattle area. What's more, the study asked more sophisticated questions. Researchers realized that they couldn't determine the influence of day care without first determining and controlling for the varying influences of family. To that end, they set about finding out not just about socioeconomic status, the marker usually used, but about parenting quality. Research assistants watched videotapes of children playing with their mothers and went into families' homes to observe, and came up with scores to measure what the study calls "maternal sensitivity."

The way one raises one's child has always been a topic of ceaseless judgment. Being assigned an actual test score is enough to get any mother's back up. But the training manuals that explain how to calculate those scores reveal criteria that may be somewhat subjective but do not seem unreasonable, although they are artifacts of modern, touchy-feely attitudes toward parenting. Research assistants were to give high marks to mothers who praised their children (at least twice during a home visit) and caressed them (at least once). An optimal score required that a mother not "raise her voice to a level above that required by the distance between her and the child" (and if there's a mother alive who can meet this standard at all times, she should win a Nobel Prize) and refrain from restricting the child (more than three times), even if the child entered forbidden territory like a purse.

While mothers were supposed to encourage children's development by showing them how to work new, complicated toys, they would be downgraded if they elbowed their kids out of the way and took over, failing to respect their children's autonomy and read their cues. Research assistants were also to give points to mothers for weekly trips to the grocery store, considered stimulating places for toddlers. And the assistants were to note the presence of adult books in the home, not as a sign of literacy, but as evidence of the mother's willingness to accept the fact that they might get damaged as her child explored.

Of course, if the study was going to control for variances in parenting quality, it also had to control for variances in the quality of day care. Equally detailed manuals told research assistants how to score day-care providers. Much of the criteria was the same for providers as for parents: enthusiasm, praise, developmental instruction, and responding to cues were all valued. Research assistants were to especially watch what happened when children lost interest in what they were doing. It is then, one manual suggested, that insensitive day-care providers would reveal themselves by their listless or inappropriate responses. Research assistants also collected information about the ratio of adult to child and any training caretakers had received.

There was one more crucial design decision the researchers made. Rather than locating day-care centers and observing families that were enrolled, they started by contacting parents in hospitals immediately after their babies were born. Over the next months and years, the researchers followed their choices about child care. In the Seattle area, they contacted parents at Swedish Medical Center, Group Health Cooperative, and the University of Washington Medical Center. "It's really the only study that started from scratch," says Moncrieff Cochran, a professor of human development at Cornell University. "They went out to families where they were and allowed what they found to be their definition of what child care is."

That meant looking not just at day-care centers but at child care provided in homes, by nannies, by grandparents, even—controversially—by fathers. "We still get dinged for that," says Booth-LaForce. She explains that the decision to look at all kinds of nonmaternal care was driven by one overriding concern when the study began: the idea that the daily separations engendered by day care might interfere with the formative mother-child bonding process known as attachment.

The spotlight on mother-child attachment came about as the result of two pioneering figures in child development: John Bowlby and Mary Ainsworth. Bowlby was a British psychiatrist whose work with juvenile delinquents and children separated from their parents during World War II convinced him that children's troubled behavior often resulted from disrupted or poor relationships with their mothers. He cemented the idea among psycholo-gists that whether or not children "securely attach" to their mothers can have fateful consequences. Ainsworth, an American psychologist, fleshed out Bowlby's ideas by demonstrating that even babies and very young children relate to their mothers in different ways, indicating secure or insecure attachments. She developed an experiment called the "Strange Situation Test," in which mothers would briefly separate and reunite with their babies. Securely attached babies would get upset when their moms left but would eagerly go to their moms when they returned and be soothed by them. Those insecurely attached might turn away or fail to find comfort from their mothers.

Day-care opponents frequently refer to ideas gleaned from attachment theory and its architects. There is a whole movement known as "attachment parenting." Popular not among traditionalists but hip, granola types, it encourages women to literally stay attached to their children, through slings and "family beds," 24/7. "Trust me—as a working mother, you may be well bonded to your baby, but it is not the same thing [as staying home]," read an essay I came across a few years ago on a Web site on attachment parenting.

In a 1998 article for the conservative publication The American Enterprise, titled "The Problem With Day Care," Editor in Chief Karl Zinsmeister quotes Ainsworth: "It's very hard to become a sensitively responsive mother if you're away from your child ten hours a day. It really is."

Bob Marvin of the Mary D. Ainsworth Clinic.

Yet according to Bob Marvin, neither Ainsworth nor Bowlby ever took a firm position on day care. Marvin, the director of the Virginia attachment clinic named after Ainsworth and a former student of hers, says he's not familiar with the American Enterprise quote. But, he says, "I knew her very intimately. She and I were like mother and son. And I think I can speak for her. What she meant if she said that was that if you are away from your baby 10 hours a day, then you have an additional challenge in learning to read your baby's signals accurately. That doesn't mean it can't happen."

Marvin helped Ainsworth conduct her first, famous experiments with the Strange Situation in the 1960s. And he says she learned a lot from one of the 26 mothers they observed. She was a working mom, a teacher. "Her kid was one of the most securely attached kids, if not the most securely attached kid, in the entire sample," Marvin says. "She thought this woman walked on water." Yet the mother was not complacent, according to Marvin. "When she came home at night, she made sure she had enough time with the baby and she made sure that she had a very understanding husband. And this woman struggled." She confided to Ainsworth about the challenges of her life.

So in the end, Marvin believes, Ainsworth kept an open mind about day care. "Boy, I don't know what impact it's going to have," he says was her attitude. "Maybe it's OK, maybe it's not, but we need to keep a close watch on it."

The UW team took oversight over this critical part of the NICHD study. Spieker supervised the design and Booth-LaForce chaired the committee that wrote the paper.

The result, as reported in the paper: "Even in extensive, early, unstable, or poor-quality [child] care, the likelihood of infants' insecure attachment to mother did not increase." In other words, day care didn't make kids turn away from their mothers, nor render mothers any less effective in comforting their children. The finding authoritatively contradicts previous, smaller studies. It's also quite remarkable when you think about it. Children can be away from their mothers most of the day, for most of the week, and yet there remains an undeniable primacy of the mother-child relationship. The magnetic force that pulls us toward our mothers is apparently even more powerful than we knew. It is not, however, all there is to the story. In her office, Booth-LaForce takes a copy of the paper off her shelves and looks at a chart that breaks the study's population down into subgroups according to attributes pertaining to day care and family. When those attributes are looked at in combination, differences start to appear. Most notably, the rate of secure attachment was quite a bit lower—by 22 percentage points—among children who got both bad day care and bad parenting. Forty-four percent of those kids were securely attached. "That's an important finding," Booth-LaForce says.

The findings led the NICHD researchers to conclude that day care, in some circumstances, serves as a risk factor. It could mean nothing on its own, or it could mean a lot if there are other things going on in a child's life, similar to the way smoking is a particular risk for people who have a family history of heart disease. For populations of kids already at risk, those who come from poor, troubled families, the day-care findings are particularly worrying.

Even so, Booth-LaForce reflects, they are not as alarming as might be expected. "Look at it this way," she says. "Forty-four percent of kids are in pretty poor quality care at home and in pretty poor quality child care and yet are still securely attached to their mothers."

As central as questions about attachment have been in the day-care debate, these mostly nonalarmist findings generated little news, overshadowed by what seemed to be scarier findings about aggression. Those findings emerged when researchers had teachers, day-care providers, and parents fill out a 113-item checklist that asked them to say whether a child was exhibiting various kinds of behavior, from not getting along with other kids to crying a lot to overeating. When the results came back, they showed that children who had experienced extensive day care were rating higher on a set of aggressive, assertive, and disobedient behaviors thought by psychologists to be related and which are termed "externalizing."

In 2001, Belsky told The New York Times that those kids "scored higher on things like gets in lots of fights, cruelty, bullying, meanness, as well as talking too much, demands must be met immediately." The Times ran a photo of a child in a room full of blocks and put this caption beneath it: "a day-care center, the sort of place in which bullies are bred, according to a new study." A generation seemed to be in trouble.

Many of the study's researchers, however, were appalled that their work was being interpreted that way. "It has been blown out of proportion," says Sarah Friedman, the NICHD coordinator.

You have to look at the numbers to understand why. Margaret Burchinal, the study's statistical guru and a psychologist at the University of North Carolina, points to the crucial figures, which rate kids according to the difficulty of their behavior, with a higher score indicating more problems. If you look at the scores from day-care providers for 4-and-a-half-year-olds, you see that children who received between 30 and 45 hours weekly of day care scored an average of 51.3—a meager 1.3 points above the mean of 50. Those who had more day care still rated only 53.1. For behavior to be bad enough to be considered for clinical treatment, a child would have to score over 65.

"We're not talking about creating monsters," stresses Booth-LaForce. Susan Campbell, a University of Pittsburgh psychologist who specializes in psychopathology and works on the study, says she looks at scores a couple points above the mean and says, "Oh, that's nothing."

"The other thing that's always struck me is that the kids in very little day care had scores that were very low," Campbell continues. Indeed they averaged a little under 48, below the mean. That led one outside analyst, writing in a special 2003 issue of the journal Child Development devoted to day care, to wonder whether children who don't experience day care are "overly passive." Campbell doesn't quite say that, but she does raise the possibility that what we're seeing is not necessarily "bad" behavior but "adaptive" behavior, skills that allow children to get attention they need or toys they want in a hustle-bustle environment.

In a similar vein, others have suggested that a precocious socialization might be at work. Children in day care, exposed sooner to peers, have more occasion to get into tussles. When other children later get the same exposure by starting school, they catch up, a theory bolstered by the upcoming paper that offers data through third grade. That paper shows that these kinds of behavioral differences disappear because the stay-at-home kids toughen up.

That's the kind of talk that drives Belsky crazy. Speaking by phone from London, where he paints himself as being in exile because of his politically incorrect observations about day care, Belsky castigates his colleagues for their "readiness to cavalierly explain things away."

"When kids take drugs at 15 rather than 22, we don't call them precocious," he says. "When kids get pregnant at 15, we don't call them precocious." He sees children's aggression in the same way, and he isn't reassured by the fact that the non-day-care kids eventually exhibit the same behaviors. He says we need to entertain the possibility that there is some kind of "social contagion process" going on, an idea that neatly blames day care for everybody's behavior, even those who have never stepped foot in one.

There's obviously some oppositional hyperbole going on. Let's keep in mind the kind of behaviors we're talking about. Pushing a child out of the way to take a turn at jump rope or failing to clean up one's room is not exactly on par with teen pregnancy.

But what Belsky won't let anybody forget is that the study has turned up negative effects, no matter how small, and psychologists are now puzzling over why that might be. The "developmental mystery," as Belsky calls it, deepens with the emergence of poorer social skills and work habits by third grade.

Child psychologist Penelope Leach.

The mystery is furthered by preliminary findings of negative effects not yet announced in the United Kingdom, where one of several studies modeled on the NICHD's is taking place. Penelope Leach, the celebrated English child psychologist and author who works alongside Belsky at the University of London, is co-directing that study. "It is looking as though the more time a child spends in center care by the time he is 3, the less emotionally balanced he is, the less confident, the less talkative, and the more stressed," she says. Those behaviors are known as "internalizing." The study has not yet analyzed results for externalizing behaviors.

Those findings are worth paying attention to, but again, you have to look at their size, which are comparable to those found by the NICHD on aggression. "All these statistical effects are minute," says Leach. In the past, Leach has expressed reservations about day care but she acknowledges that her views have evolved. "These are significant findings if you're looking at society or the state or, at the minimum, a large school but"—and this is bottom line for parents—"not for the individual child."

The so-called "good news" on day care, sadly, is just as microscopic as the bad and has been exaggerated almost as much. The NICHD found that children in high-quality day care have consistently scored better on cognitive tests than their counterparts in shoddy day care. Those impassioned by the laudable aim of improving day-care quality have seized upon the news. Yet consider this: The NICHD determined that a big increase in day-care quality—by a statistical marker known as one standard deviation—would result in tiny cognitive test score gains of between one-half and one and a half points. Clearly, there are humanistic reasons for improving day care, but let's face it, we can't turn to big academic gains as justification.

Here's a sizable effect the NICHD did find, however. As researchers looked at various influences on a child, one stood out as far more significant than day care. That was parenting, specifically the scores that mothers received on sensitivity. (The NICHD did not study the father's influence as extensively and so less can be said about that.) Typically, the correlation between parenting and children's attributes was two to three times bigger than any correlation with day care. What's more, notes the study's Allison Clarke-Stuart, "the apparent influence of parents doesn't go away even if the child is in full-time care."

For mothers, this brings the welcome suggestion that supporting them, regardless of whether they work or not, may be the most important thing we could do for children. It also implies a new way of looking at the day-care issue. "If women want to work and are more satisfied, the quality of their parenting is going to be better," says the University of Pittsburgh's Susan Campbell. And that, in the end, is going to be way more important than whether children attend day care or not.

The UW's Susan Spieker.

(Pete Kuhns)

So should parents relax and stop agonizing about day care? This is where science meets your gut. Anyone who has held their own vulnerable infant in their arms and contemplated handing that child over to somebody else knows that the day-care question will never be easy.

"It may be hard to convince yourself that putting children in all these hours of child care is a good thing," says the UW's Spieker. "Not because it's ultimately going to harm them but because it's no fun. They miss you. You miss them."

Making the dilemma even more excruciating is the quality of day care that's out there, which was documented by the NICHD. Most that it observed fell into the squishy middle, neither particularly good nor bad. Just 17 percent of the day care through age 3 was considered "excellent." That's actually a better picture than has been portrayed in the past, but Sharon Landesman Ramey, in her impassioned and compelling commentary, still labels it "shocking and intolerable."

Interviewed by phone, the Georgetown psychologist compares the findings on day care to those on divorce. "People say divorce doesn't affect kids. Their IQ isn't wiped out. They're healthy and they grow up and go to college. And thank goodness. But to say divorce doesn't affect kids is ridiculous." Ramey's point is well taken. It's obvious that having good or bad experiences in day care matters, even if it doesn't seal a child's fate.

Talk to people who have worked in day care, Ramey urges. Many of them have felt unable to meet children's needs. One such person is Donna Thornell, who was employed as Ramey's nanny and went on to work at day-care centers and eventually leave the business. "I found it to be very frustrating," says Thornell, from Birmingham, Ala., where she lives.

Thornell does feel good about her work as a nanny. "There was a special bond between Sam and me," she says of Ramey's son. "I felt like he was part mine." At the day-care centers where she went next, though, she faced the challenge of looking after multiple kids. She remembers working in the infant room of one high-end facility. "The ratio was one teacher to three babies, which is really good, but it's not enough," she says. Sometimes they would all cry at once. "I remember sitting in the room, more than once, having one on each leg and one between them, and just trying to comfort each. It was very, very tiring. I thought, maybe I could do one, maybe two. . . . "

She's also watched children be dropped off for day care at 6:30 in the morning, still wearing their pajamas, only to be picked up at 6 that night. "I didn't want my children to live that way," she says. She stays home with her two kids.

It's a similar picture to the one painted by Kim Buehlman, a former NICHD research assistant who assessed the Seattle-area child care used by the local families in the study. While she remembers some stellar facilities that engaged children with creative activities like skin paints and a Day of the Dead table for remembering deceased loved ones, most did not leave her with a good impression. "I was seeing a lot of care I did not enjoy being at," she says. These were not horror stories. The providers were not neglectful. "It was the ratios more than anything else. . . . They were just trying to get kids' basic needs met," she says. Their emotional needs were often too much.

On the positive side, Buehlman now works with a UW professor on a project to help day-care providers improve. She watches videotapes with providers of their interactions with children and discusses how to handle problems. "The changes are amazing," Buehlman says. All the day-care workers want, she says, "is someone to talk to." Still, in her own life, Buehlman is opting out of day care, at least temporarily. Weeks away from giving birth to her first child when we talk, she says she and her husband are going to alternate days at home so that they don't need any child care for their child's first year. "I don't think day care is bad," she says. But she adds, "The first year of life is so important, and it only happens once. I don't want to miss it."

The research is one thing, and it has told us a lot. Day care does not appear to be truly damaging children, a conclusion that is changing the tone of the day-care debate. Many early-childhood professionals are now talking about improving day care rather than questioning whether it should exist. But ultimately, parents who have the luxury to choose vote on day care largely with their hearts. How do they feel about the day-care providers they've observed? Do they think their children will be happy with those caretakers? How much does work mean to parents? These are questions that scientists can't answer for us. Despite the exhaustive research, there's a lot we have to figure out ourselves.

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