Childcare Dilemma: Are Children at Risk?

What the study did

The researchers followed 1,300 children in 10 different cities in a variety of childcare situations ranging from organized free standing agencies to paid home care for multiple children. The children in the study came from families with varied socioeconomic levels and were evaluated on various measures of behavior and cognitive ability in kindergarten.

What the study found

The finding that is causing the most concern is that at age 4 ½ years of age and later, 17% of the children who spent at least 30 hours a week in non-parental care scored higher for specific behavioral problems such as "cruelty", "talking too much", and "demands a lot of attention". More time spent in day care was also associated with children being rated as more fearful, shy and sad, yet the difference between children with and without these symptoms did not exist by kindergarten. The benefits of childcare were also identified by the study. Higher quality childcare through age 4 ½ was associated with better cognitive skills and memory, and the particular types of caregiver-child interactions were associated with better language skills. Childcare for infants was not related to particular positive or negative results.

Characteristics of the childcare arrangement were linked to the positive findings. Children in care with better trained staff who were sensitive to children's needs and provided stimulation in a structured setting with a high adult-to-child ratio fared best.

Other issues to consider in understanding the results

Although 17% of the children exhibited behaviors of concern, such as being demanding, and aggressive, none were to a degree beyond the norm or worthy of referral for evaluation and intervention. In addition, these statistics mean that 83% of the children were doing well. Certainly we must consider what accounted for the difference, but extrapolating from research to policy is usually a premature and dangerous leap.

We must also look at the results in light of children's mental health issues. One-third to one-half of all referrals to mental health professionals are for aggressive behavior. In addition, we know that the incidence of attention-deficit/hyperactivity disorder is anywhere from 5-15%, conduct disorder is 3-10% and anxiety disorders is 5-20%. Therefore, statistically a certain percentage of children in kindergarten will have problems due to the genetic, biologic, and environmental nature of mental illnesses, not necessarily due to a previous childcare situation.

Family composition is an additional factor to be considered. Before reaching adulthood, 59% of all children will have lived in a single parent household at some time in their life and 2/3 of all families have two working parents. Thus, childcare is often a necessity, not a choice. These realities may make for additional family stress that is impacting on children rather than just inadequate childcare.

What are the implications of the study

The study points to an association between specific situations and behaviors, but is careful not to identify cause and effect. We cannot know for sure if a particular caregiver arrangement caused the problems or other variables not yet identified played a role. Further research should now focus on what factors in the childcare environment as well as within the home may account for positive and negative behaviors in children.

What parents and caregivers should do

Parents should not automatically pull their children out of existing caregiver situations nor should they worry about any immediate consequences for their child. By pointing out differences in certain areas, the study could be used as a guide to delineating the most beneficial environment for raising preschoolers—both at home and in childcare environments. The results support existing research regarding the optimal elements of infant and childcare. Infants and toddlers need caregivers—parents as well as non parents who:

• maximize the goodness of fit between the child's temperament and the parent's style
• spend time providing undivided individual attention
• provide a routine and structure
• maintain a well organized environment
• listen and attend to the child's physical and emotional needs
• teach cooperation and sensitivity to others
• provide cognitive stimulation in the form of talking, reading, and interactive play

Minimizing parent stress—economic and emotional—and effective parent and caregiver education is also crucial for children's healthy development. Improving the quality of both in-home and out-of-the-home environments should go hand in hand. The study points the way towards future research questions needing answers. Specifying optimal childcare will ensure quality care for children regardless of where they are cared for.

About the Authors

Robin F. Goodman, Ph.D., is a clinical psychologist specializing in bereavement issues.

About the NYU Child Study Center

The New York University Child Study Center is dedicated to increasing the awareness of child and adolescent psychiatric disorders and improving the research necessary to advance the prevention, identification, and treatment of these disorders on a national scale. The Center offers expert psychiatric services for children, adolescents, young adults, and families with emphasis on early diagnosis and intervention. The Center's mission is to bridge the gap between science and practice, integrating the finest research with patient care and state-of-the-art training utilizing the resources of the New York University School of Medicine. The Child Study Center was founded in 1997 and established as the Department of Child and Adolescent Psychiatry within the NYU School of Medicine in 2006. For more information, please call us at (212) 263-6622 or visit us at www.AboutOurKids.org.