Child Care, Early Learning, and Child Care, Early Learning, and Children’s Development Children’s Development

Cathryn Booth-LaForce, PhD, FAPSCathryn Booth-LaForce, PhD, FAPSCharles & Gerda Spence Professor of NursingCharles & Gerda Spence Professor of Nursing

Conference on Early LearningConference on Early LearningSeptember 24, 2007September 24, 2007

Media ReportsMedia Reports

Some Recent HeadlinesSome Recent Headlines

““Poor Behavior is Linked to Time in Day Poor Behavior is Linked to Time in Day Care”Care”

------New York TimesNew York Times

““Study Links Child Care to Acting Out”Study Links Child Care to Acting Out”

------Associated PressAssociated Press

““How nurseries ‘still breed aggression’”How nurseries ‘still breed aggression’”

------London TimesLondon Times

““Day Care is Linked to Behavior Lasting Day Care is Linked to Behavior Lasting Through 6Through 6thth Grade” Grade”

------The Wall Street The Wall Street JournalJournal

““Few Effects of Poor Daycare Last Past Age Few Effects of Poor Daycare Last Past Age 11”11”

------ReutersReuters

““Quality of Early Child Care Makes a Quality of Early Child Care Makes a Difference But Good Parenting Matters Difference But Good Parenting Matters More, US Study Finds”More, US Study Finds”

------Medical News TodayMedical News Today

““Day Care News: Parents, You Count Most”Day Care News: Parents, You Count Most”

------NewsdayNewsday

““A day care center, the sort of place in A day care center, the sort of place in which bullies are bred, according to a new which bullies are bred, according to a new

study”study”------New York Times, 2001New York Times, 2001

Some statistics….Some statistics….

National Maternal National Maternal Employment Statistics Employment Statistics

(2005)(2005)

60% of married mothers of 60% of married mothers of preschool childrenpreschool children are in the are in the work forcework force

53.5% of married mothers of 53.5% of married mothers of infantsinfants are in the work force are in the work force

---Monthly Labor Review, Feb, ---Monthly Labor Review, Feb, 20072007

Child-Care StatisticsChild-Care Statistics

Each year, parents + Each year, parents + government spend roughly $50 government spend roughly $50 billion on child carebillion on child care

---Univ. MD, 2006---Univ. MD, 2006

About 12 million children are in About 12 million children are in child care in the U.S. (9.8 million child care in the U.S. (9.8 million under 5 years in 40+ hours)under 5 years in 40+ hours)

---U.S. Census Bureau, ---U.S. Census Bureau, 19991999

Why are young children Why are young children spending so much time in child spending so much time in child

care?care?

National trends—maternal National trends—maternal employmentemployment

Families need two incomesFamilies need two incomes Work preferenceWork preference

Costs to Women of the “Off Costs to Women of the “Off Ramp”Ramp”

Short (1-2 year) time out—lose Short (1-2 year) time out—lose 18% of earning power (28% in 18% of earning power (28% in business and banking/finance)business and banking/finance)

3 or more years—lose 37% of 3 or more years—lose 37% of earning powerearning power

------Center for Work-Life Policy, Center for Work-Life Policy, 20052005

What are the effects of What are the effects of childcare on children and childcare on children and

families?families?

ScienceScience

NICHD Study of Early Child NICHD Study of Early Child Care and Youth Care and Youth DevelopmentDevelopment

NICHD Early Child Care Research Network

Virginia Allhusen

Mark Appelbaum

Jay Belsky

Cathryn Booth-LaForceRobert Bradley

Celia BrownellPeg Burchinal

Bettye Caldwell

Susan CampbellAlison Clarke-Stewart

Martha Cox

Sarah L. FriedmanWillard HartupTy HartwellKathryn Hirsh-PasekAletha Huston

University of California: IrvineUniversity of California: San DiegoBirkbeck College, University of LondonUniversity of WashingtonUniversity of Arkansas at Little RockUniversity of PittsburghUniversity of North Carolina at Chapel HillUniversity of Arkansas at Little RockUniversity of PittsburghUniversity of California: IrvineUniversity of North Carolina at Chapel HillNICHDUniversity of MinnesotaResearch Triangle InstituteTemple UniversityUniversity of Texas-Austin

Lyz JaegerDeborah JohnsonJean KellyBonnie KnokeNancy MarshallKathleen McCartneyFred MorrisonPhil Nader

Marion O’BrienMargaret OwenRoss Parke

Chris Payne

Deborah PhillipsRobert PiantaSuzanne Randolph

Wendy RobesonSusan SpiekerDeborah Vandell

Marsha Weinraub

St. Joseph’s UniversityMichigan State UniversityUniversity of Washington Research Triangle InstituteWellesley CollegeHarvard University Loyola University Chicago University of California: San DiegoUniversity of KansasUniversity of Texas-DallasUniversity of California: RiversideUniversity of North Carolina at GreensboroGeorgetown UniversityUniversity of VirginiaUniversity of Maryland, College ParkWellesley CollegeUniversity of WashingtonUniversity of Wisconsin- MadisonTemple University

AcknowledgementsAcknowledgements

NICHD Grant #HD25447 NICHD Grant #HD25447 Susan J. Spieker, Co-PISusan J. Spieker, Co-PI Jean F. Kelly, Co-PIJean F. Kelly, Co-PI Sumi Hayashi, Site Sumi Hayashi, Site

CoordinatorCoordinator Participating familiesParticipating families

……and a small army of data and a small army of data collectorscollectors

Purpose of the Purpose of the NICHD StudyNICHD Study

To examine how variations in child-rearing contexts (childcare, home, school, etc.) are related to children’s social, emotional, cognitive, and language development and health.

Ecological Model: Concurrent Ecological Model: Concurrent and Longitudinal Relationsand Longitudinal Relations

Family and maternalcharacteristics

Demographiccharacteristics

Homeenvironment

Childcare and school environments

Childcharacteristics

ChildOutcomes:

Social, emotional,cognitive, language, health

Families in the StudyFamilies in the Study

1,364 eligible 1,364 eligible births occurring births occurring during 1991during 1991

Sampling designed Sampling designed to assure adequate to assure adequate representation of representation of major socio-major socio-demographic demographic nichesniches

Ten data collection Ten data collection sites sites

24 hospitals 24 hospitals

Recruited in these locations

Exclusion CriteriaExclusion Criteria

Mother younger than 18 yearsMother younger than 18 years Family planned to moveFamily planned to move Multiple birthMultiple birth Infant had disabilityInfant had disability Infant stayed in hospital > 7 daysInfant stayed in hospital > 7 days Substance abuse—motherSubstance abuse—mother Mother did not speak EnglishMother did not speak English > 1 hour from lab site> 1 hour from lab site Extremely unsafe neighborhoodExtremely unsafe neighborhood

Current Locations of the Current Locations of the 1009 Study Families1009 Study Families

Who are the Families in the Who are the Families in the Study?Study?

Maternal EducationMaternal Education

10% no HS degree10% no HS degree21% HS degree or GED21% HS degree or GED33% some college33% some college21% college degree21% college degree15% postgrad education15% postgrad education

Income-to-Needs (1 Income-to-Needs (1 m)m)

13% poverty13% poverty18% near-poverty18% near-poverty69% non-poor69% non-poor

Marital Status (1 m)Marital Status (1 m)

14% single14% single

Race/Ethnicity (%)Race/Ethnicity (%)

StudyStudy USAUSA

White, non-HispanicWhite, non-Hispanic 75 75 6565

Black, non-HispanicBlack, non-Hispanic 13 13 16 16

HispanicHispanic 6 6 15 15

AsianAsian 1 1 3 3

Native AmericanNative American 1 1 1 1

OtherOther 4 4 NA NA

Work/School Plans at Work/School Plans at BirthBirth

Employment/School Plans--child’s first Employment/School Plans--child’s first year:year:

YesYes 79%79%

NoNo 18%18%

Don’t knowDon’t know 3% 3%

Planned Hours of Planned Hours of Work/SchoolWork/School

< 10< 10 4% 4%

10-2910-29 29%29%

30+30+ 67%67%

Early Entry into Many Hours Early Entry into Many Hours of Childcareof Childcare

Median age at entry—3 monthsMedian age at entry—3 months Mean hrs per week (1-54 months)—31 Mean hrs per week (1-54 months)—31

hrshrs ““Informal” care arrangements most Informal” care arrangements most

common during first yearcommon during first year

Study Assessment AgesStudy Assessment Ages

1, 6, 15, 24, 36, 54 months1, 6, 15, 24, 36, 54 months K, Grades 1, 2, 3, 4, 5, 6K, Grades 1, 2, 3, 4, 5, 6 Age 15Age 15

Types of AssessmentsTypes of Assessments

InterviewsInterviews QuestionnairesQuestionnaires ObservationsObservations Direct Direct

AssessmentsAssessments RecordsRecords

InformantsInformants MothersMothers Fathers/PartnersFathers/Partners Child-care ProvidersChild-care Providers After-school Care ProvidersAfter-school Care Providers TeachersTeachers PrincipalsPrincipals ChildrenChildren Best FriendsBest Friends Mothers and Teachers of Mothers and Teachers of

Best FriendsBest Friends Nurse PractitionersNurse Practitioners

ContextsContexts

HomeHome Child-care arrangementsChild-care arrangements SchoolSchool After-school settingsAfter-school settings NeighborhoodNeighborhood

Number of Variables Number of Variables (birth to Grade 6)(birth to Grade 6)

Raw data—70,000 variablesRaw data—70,000 variables Analysis data sets—8,700 variablesAnalysis data sets—8,700 variables Data are available to other investigatorsData are available to other investigators

What did we measure What did we measure in the child-care in the child-care

setting?setting?

Child-Care MeasuresChild-Care Measures Quantity Quantity : :

Hours/weekHours/week Observed QualityObserved Quality

(ORCE)(ORCE)

Type Type : : Relative/ In Home Relative/ In Home

CareCare Child-care HomeChild-care Home Child-care CenterChild-care Center

Quality of CareQuality of CareORCE ORCE

(Observational Record of the Caregiving Environment)(Observational Record of the Caregiving Environment)

6, 15, 24, 36, 54 months of age6, 15, 24, 36, 54 months of age

ORCE BehaviorsORCE Behaviors• Shared positive Shared positive

affectaffect• Positive physical Positive physical

contactcontact• Responds to Responds to

vocalization/child’s vocalization/child’s talktalk

• Speaks positively Speaks positively to childto child

• Asks questions of Asks questions of childchild

• Other talk to childOther talk to child

• Stimulates Stimulates cognitive cognitive development/teachdevelopment/teaches academic skilles academic skill

• Facilitates behaviorFacilitates behavior• Mutual exchange Mutual exchange • Negative/Negative/

restricting actions restricting actions (reversed)(reversed)

• Speaks negatively Speaks negatively to child (reversed)to child (reversed)

ORCE RatingsORCE Ratings

• StimulationStimulation

• Sensitivity/responsiveness Sensitivity/responsiveness

• Positive regardPositive regard

• Detachment/disengagementDetachment/disengagement

• Flat affectFlat affect

• Intrusiveness (at 36, 54 months)Intrusiveness (at 36, 54 months)

• Fosters exploration (at 36, 54 Fosters exploration (at 36, 54 months)months)

ORCE is related to…ORCE is related to…

Quality of the physical Quality of the physical environmentenvironment

““Regulable” features of child careRegulable” features of child care

Type of Care:Type of Care:Child Care CentersChild Care Centers

Larger groups ofLarger groups of childrenchildren

More toysMore toys More structured More structured

activitiesactivities More children More children

per adultper adult Children grouped Children grouped

by ageby age

Child-Care HomesChild-Care Homes

More informal More informal carecare

More time in free More time in free playplay

Varying ages of Varying ages of children; often children; often siblingssiblings

Activities are Activities are more “home-like”more “home-like”

Relative/In-Home CareRelative/In-Home Care Most informal Most informal Care provider Care provider

follows usual follows usual routine and routine and incorporates childincorporates child

Little structureLittle structure May be just May be just

caregiver and child caregiver and child or other related or other related childrenchildren

……including Fathersincluding Fathers

Quality of Care by TypeQuality of Care by Type

Full range of quality in every type of Full range of quality in every type of care.care.

Especially during the first two years, Especially during the first two years, the average quality of care was higher the average quality of care was higher in less formal care with fewer children.in less formal care with fewer children.

---NICHD ECCRN, 1996---NICHD ECCRN, 1996

What did we measure What did we measure in the home setting?in the home setting?

Parenting QualityParenting Quality

Quality of Mother-child Quality of Mother-child InteractionInteraction

Ratings from 15 minute Ratings from 15 minute videotaped structured play videotaped structured play interactions:interactions:

Sensitivity to distressSensitivity to distress Sensitivity to nondistressSensitivity to nondistress DetachmentDetachment IntrusivenessIntrusiveness Cognitive stimulationCognitive stimulation Positive regardPositive regard Negative regardNegative regard Flat affectFlat affect

HHome ome OObservation for bservation for MMeasurement of the easurement of the EEnvironment nvironment

((HOMEHOME))

Checklist of quantity Checklist of quantity and quality of support and quality of support and stimulation and stimulation available to the child in available to the child in the home environmentthe home environment (e.g., books, age-(e.g., books, age-appropriate play materials, appropriate play materials, appropriate responses to appropriate responses to child, affection)child, affection)

Based on interview of Based on interview of mother with child mother with child presentpresent

Is early, extensive Is early, extensive participation in childcare a participation in childcare a

risk factor for insecure risk factor for insecure attachment?attachment?

A 30-sec introduction to A 30-sec introduction to

attachment…attachment… Secure attachment—”comfortable sense of Secure attachment—”comfortable sense of

trust in the primary caregiver”trust in the primary caregiver” Security is predicted by warm, sensitive, Security is predicted by warm, sensitive,

responsive parenting from primary caregiverresponsive parenting from primary caregiver Insecurity is predicted by detached, Insecurity is predicted by detached,

uninvolved, unresponsive, intrusive uninvolved, unresponsive, intrusive parentingparenting

Insecurity is a risk factor for subsequent Insecurity is a risk factor for subsequent behavior problems, problems with peers, behavior problems, problems with peers, relationships, poor social competencerelationships, poor social competence

Attachment ResultsAttachment Results

Security/insecurity was related to the Security/insecurity was related to the quality of parenting.quality of parenting.

Security/insecurity was not related to Security/insecurity was not related to the quality, quantity, or age of entry the quality, quantity, or age of entry into childcare.into childcare.

Dual-risk effect: Very insensitive Dual-risk effect: Very insensitive parenting parenting plusplus poor quality childcare, poor quality childcare, or many hours in childcare—greater or many hours in childcare—greater proportion of insecure infants.proportion of insecure infants.

------NICHD ECCRN, 1997NICHD ECCRN, 1997

Child Care and Child Child Care and Child Outcomes: More Outcomes: More

QuestionsQuestions Is child care related to child Is child care related to child cognitive, cognitive,

language and social outcomes at language and social outcomes at

4.5 years?4.5 years? If so, how? What are the specific If so, how? What are the specific effects effects

of quality, quantity of care, and type of quality, quantity of care, and type of of

care on child outcomes?care on child outcomes? How How bigbig are these effects? are these effects?

Statistical ControlsStatistical Controls

Site, gender, ethnicity, maternal Site, gender, ethnicity, maternal education,education,

proportion time mother had partner in proportion time mother had partner in

household, maternal depression, income, household, maternal depression, income,

maternal sensitivitymaternal sensitivity

I. QualityI. Quality of Early Child of Early Child Care Care

For preschoolers, higher For preschoolers, higher qualityquality care over the first 4.5 care over the first 4.5 years is associated withyears is associated with

better pre-academic skills better pre-academic skills

better language skillsbetter language skills

Differences in Child Care Quality vs. Differences in Child Care Quality vs. Differences in Parenting Quality: Differences in Parenting Quality:

Language CompetenceLanguage Competence

LanguageCompetence

Parenting Qualityd = .87

Child Care Qualityd = .29

LanguageCompetence

0

85

90

95

100

105

Low High

m=95.3

m=97.6

0

85

90

95

100

105

Low High

m=88.8

m=102.5

II. TypeII. Type of Child Care of Child Care

More experience in child care More experience in child care centerscenters is associated with is associated with

better language skills better language skills more problem behaviorsmore problem behaviors

III. QuantityIII. Quantity of Child Care of Child Care (all types of care)(all types of care)

More More hourshours of child care over the of child care over the

first 4.5 years is associated withfirst 4.5 years is associated with

more problem behaviorsmore problem behaviors

(aggression, disobedience)(aggression, disobedience)

All types of careAll types of care Not a function of qualityNot a function of quality No thresholdNo threshold Not just assertive behavior Not just assertive behavior Not clinical levels of Not clinical levels of

aggressionaggression

Differences in Amount of Child Differences in Amount of Child Care vs Differences in Parenting Care vs Differences in Parenting Quality: Behavior Problems at Quality: Behavior Problems at

54 Months54 Months

CaregiverReportedBehaviorProblems

CaregiverReportedBehaviorProblems

Parenting Qualityd = .23

Quantity of Cared = .38

<10 hrs/wk 30>hrs/wk

0

45

50

55

m=48.1

m=51.7

0

45

50

55

Low High

m=51.0

m=48.8

Grade 5/6 ResultsGrade 5/6 Results

Statistical ControlsStatistical Controls

Site, gender, ethnicity, maternal Site, gender, ethnicity, maternal education,education,

proportion time mother had partner in proportion time mother had partner in household, maternal depression, income, household, maternal depression, income, maternal sensitivity, classroom quality,maternal sensitivity, classroom quality,after-school hours.after-school hours.

I. QualityI. Quality of Early Child of Early Child Care Care

Higher Higher qualityquality care over the care over the first 4.5 years is associated first 4.5 years is associated with:with:

higher vocabulary scores in higher vocabulary scores in Grade 5Grade 5

II. TypeII. Type of Child Care of Child Care

More experience in child care More experience in child care centerscenters is associated with is associated with

more behavior problems in more behavior problems in Grade 6Grade 6

Comparison of Effect Comparison of Effect SizesSizes

Vocabulary:Vocabulary: Child-care quality--.06Child-care quality--.06 Parenting quality--.25-.33Parenting quality--.25-.33

Behavior ProblemsBehavior Problems Prop. center care--.08-.12Prop. center care--.08-.12 Parenting quality--.11-.19Parenting quality--.11-.19

Behavior-Problem Mean Behavior-Problem Mean ScoresScores

Average score Average score 50.050.0 ““At-risk” score At-risk” score 60.060.0 No time in child care: No time in child care: 49.649.6 1-2 years in center care: 1-2 years in center care: 50.050.0 3 years in center care: 3 years in center care: 51.4 51.4

(10% of sample)(10% of sample) 4 years in center care: 4 years in center care: 52.0 52.0

(5% of sample)(5% of sample)

Effect Size Effect Size Considerations…Considerations…

Length of time between Length of time between measurementsmeasurements

Parenting—genetic and Parenting—genetic and environmental influences?environmental influences?

Childcare—cumulative Childcare—cumulative societal effects?societal effects?

Classroom effects?Classroom effects?

Are the effects of child care Are the effects of child care contagious?contagious?

Dmitrieva, Steinberg, & Belsky (in press)Dmitrieva, Steinberg, & Belsky (in press) 3440 children in 282 Kindergarten 3440 children in 282 Kindergarten

classrooms—ECLS-K studyclassrooms—ECLS-K study Beginning and end of Kindergarten yearBeginning and end of Kindergarten year Externalizing problems (teacher report)Externalizing problems (teacher report) Achievement (teacher report + testing)Achievement (teacher report + testing)

Question:Question:

What are classroom composition What are classroom composition effects, beyond demographic effects, beyond demographic variables and effects of the variables and effects of the child’s individual child-care child’s individual child-care history on her/his development?history on her/his development?

For children with limited For children with limited child-care experience…..child-care experience…..

Those in classrooms with Those in classrooms with manymany children with extensive center-children with extensive center-based child-care experience had based child-care experience had better academic growth than did better academic growth than did children in classrooms with children in classrooms with fewfew children with extensive center-children with extensive center-based experience.based experience.

For children with limited For children with limited child-care experience…..child-care experience…..

Those in classrooms with Those in classrooms with manymany children with extensive child-care children with extensive child-care experience were more aggressive experience were more aggressive and disobedient than were and disobedient than were children in classrooms with children in classrooms with fewfew children with extensive child-care children with extensive child-care experience.experience.

Back to the NICHD Back to the NICHD Study…Study…

What are the limitations of What are the limitations of the study?the study?

It is not nationally representativeIt is not nationally representative We did not include the most high-We did not include the most high-

risk disadvantaged familiesrisk disadvantaged families It is not an “experiment” It is not an “experiment” Therefore, we cannot claim that Therefore, we cannot claim that

child care child care causescauses child outcomes. child outcomes.

What are the strengths of What are the strengths of the study?the study?

Largest, longest-term study of child Largest, longest-term study of child care in relation to child developmentcare in relation to child development

Prospective studyProspective study Began at birthBegan at birth ““Ecological” model – included data Ecological” model – included data

about about the family, home, school, neighborhoodthe family, home, school, neighborhood Multiple aspects of child development & Multiple aspects of child development &

healthhealth Exceptionally high-quality dataExceptionally high-quality data Diversity of investigators’ viewsDiversity of investigators’ views

Summing up: What do these Summing up: What do these results mean?results mean?

Parent(s) Matter!Parent(s) Matter!

Parents are spending more Parents are spending more time with their childrentime with their children

1965--mothers spent 10.2 hrs per week 1965--mothers spent 10.2 hrs per week tending to their childrentending to their children

2003--mothers spent 14.1 hrs per week2003--mothers spent 14.1 hrs per week 1965—fathers spent 2.5 hrs per week1965—fathers spent 2.5 hrs per week 2003—fathers spent 7 hrs per week2003—fathers spent 7 hrs per week 2003 paid work + time spent with child = 2003 paid work + time spent with child =

65 hrs/wk for mothers, 64 for fathers.65 hrs/wk for mothers, 64 for fathers.---Bianchi et al., 2006---Bianchi et al., 2006

In our study at 7 months of In our study at 7 months of age…age…

Compared families in which the infant Compared families in which the infant waswas

in 30 or more hours of childcare vs. atin 30 or more hours of childcare vs. at

home with mom since birth.home with mom since birth. Time interacting with mother—only 12 Time interacting with mother—only 12

hours difference per week.hours difference per week. Time not related to quality of mother-Time not related to quality of mother-

infant interaction or child outcomes.infant interaction or child outcomes.

---Booth et al., 2002---Booth et al., 2002

A conservative A conservative politician…politician…

Our study “…proves what has long been Our study “…proves what has long been

obvious, that kids do better if nurtured obvious, that kids do better if nurtured by by

their own parents.”their own parents.”

Is there a developmental Is there a developmental advantage to staying home advantage to staying home

with mom?with mom?

““Thank goodness I’m a Thank goodness I’m a stay-at-home mom!”stay-at-home mom!”

No evidence that exclusive No evidence that exclusive maternal care is bestmaternal care is best

Only 52 children with exclusive Only 52 children with exclusive maternal care, birth to 60 monthsmaternal care, birth to 60 months

Not different from child-care children in Not different from child-care children in cognitive, language, social developmentcognitive, language, social development

High-quality child care > exclusive High-quality child care > exclusive maternal care > low-quality child care—maternal care > low-quality child care—cognitive and language development.cognitive and language development.

Are childcare quality Are childcare quality and quantity and quantity important?important?

Results of other Results of other studies…studies…

Importance of child-care quality Importance of child-care quality for lower-income and at-risk for lower-income and at-risk children (correlational and children (correlational and experimental studies)experimental studies)

Quantity findings consistent with Quantity findings consistent with those from ECLS and from a those from ECLS and from a study in Englandstudy in England

Consider child-care Consider child-care quantity and quality quantity and quality from the perspective from the perspective of the child’s everyday of the child’s everyday experiences…experiences…

Quality of Care in the Quality of Care in the U.S.U.S.

PoorPoor 8% 8%

FairFair 53%53%

GoodGood 30%30%

ExcellentExcellent 9% 9%

---Booth et al., 1999---Booth et al., 1999

““Ira’s Discount Day Ira’s Discount Day Care”Care”

My RecommendationsMy Recommendations

Let’s stop making parents feel guilty Let’s stop making parents feel guilty and focus on supporting themand focus on supporting them

Let’s stop thinking that staying at Let’s stop thinking that staying at home with mom is the “gold standard”home with mom is the “gold standard”

More recommendations…More recommendations…

Family leave policiesFamily leave policies Flexible employment; re-entry Flexible employment; re-entry

strategiesstrategies Improve child-care quality and choicesImprove child-care quality and choices Educate parents about their Educate parents about their

importance; practical strategiesimportance; practical strategies Pay attention to what is going on in Pay attention to what is going on in

child carechild care

More science…More science…

What is the role of stress?What is the role of stress? Given the small effect sizes for Given the small effect sizes for

childcare quality, weighing of costs childcare quality, weighing of costs and benefits of specific improvementsand benefits of specific improvements

More data about “daily life”More data about “daily life” Classroom effectsClassroom effects Age 15 resultsAge 15 results Relationship study—Age 17.5Relationship study—Age 17.5