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Developmental Psychology Copyright 2008 by the American Psychological Association

2008, Vol. 44, No. 1, 155–168 0012-1649/08/$12.00 DOI: 10.1037/0012-1649.44.1.155

Nonmaternal Care in Infancy and Emotional/Behavioral Difficulties at 4


Years Old: Moderation by Family Risk Characteristics

Sylvana M. Côté Anne I. Borge


University of Montreal University of Oslo

Marie-Claude Geoffroy Michael Rutter


University of Montreal Royal King’s College

Richard E. Tremblay
University of Montreal

The authors examined the role of familial risk and child characteristics in the association between the type
of child care in infancy (maternal care [MC]) versus nonmaternal care [NMC]) and emotional/behavioral
difficulties at 4 years old. Canadian families (N ⫽ 1,358) with children between 1 and 12 months old
were followed over 4 years. Family risks were found to moderate the association between type of child
care and physical aggression. MC in infancy was associated with lower levels of physical aggression
among children from a low-risk family background but not among those from a high-risk family
background. The effect size was small (d ⫽ – 0.16; confidence interval [CI] ⫽ – 0.3, – 0.01). Family risk
and the sex of the child moderated the association between child care and emotional problems. MC in
infancy was associated with a lower level of emotional difficulties among girls from low-risk families but
not among boys or among children from high-risk families. The effect size was moderate (d ⫽ – 0.44;
CI ⫽ – 0.65, – 0.23). The study indicates that the effect of child care type in infancy varies by family and
child characteristics.

Keywords: physical aggression, emotional problems, child care, temperament, infancy

The majority of children in industrialized countries receive NMC as the various forms of child care by someone other than the
nonmaternal care (NMC) during the preschool years (Shpancer, mother, including care in someone else’s home, care at home by a
2002). In North America, more than half of infants and toddlers relative or nonrelative, and care in a day care center.
receive NMC on a regular basis (Lemay, Lefebvre, & Merrigan, Although NMC has become a normative experience for pre-
2002; NICHD Early Child Care Research Network, 2005; National school children, the debate about potential mental health risks
Research Council and Institute for Medicine, 2000). We refer to associated with it continues (NICHD Early Child Care Research
Network, 2003). Early research suggested that NMC could inter-
fere with children’s secure attachments and represent risk for
Sylvana M. Côté, Department of Social and Preventive Medicine, Uni- maladjustment (Belsky, 1988, 1990; Belsky & Rovine, 1988).
versity of Montreal, Montreal, Quebec, Canada; Anne I. Borge, Depart- Subsequent studies showed that intense NMC experiences from
ment of Psychology, University of Oslo, Oslo, Norway; Marie-Claude infancy to 54 months carried risk for aggressive behaviors regard-
Geoffroy, Department of Psychology, University of Montreal; Michael less of NMC quality (NICHD Early Child Care Research Network,
Rutter, Social, Genetic & Developmental Psychiatry Research Centre, 2003).
Institute of Psychiatry, Royal King’s College, London, United Kingdom;
Several studies examined how various features of child care
Richard E. Tremblay, Departments of Psychology and Psychiatry, Univer-
sity of Montreal. (such as the intensity and, to a lesser extent, quality) impact
This research was supported by research grants from Quebec’s Fonds children’s development (e.g., Loeb, Fuller, Kagan, & Carrol, 2004;
québécois de la recherche sur la société et la culture (FQRSC) and the NICHD & Duncan, 2003; NICHD Early Child Care Research
Centre interuniversitaire québécois de statistiques sociales (CIQSS), the Network, 2003, 2004). But, there has been little attention paid to
Canadian Institutes of Health Research (CIHR) and the Social Sciences and the possibility that the type of child care influences children from
Humanities Research Council (SSHRC), the Canadian Institute for Ad- different family contexts in different ways. For instance, young
vanced Research, the Molson foundation, St-Justine Hospital’s Research children growing up in high-risk family environments may benefit
Center, and the University of Montréal. We thank Franck Larouche (Sta-
from a child care experience outside the home, whereas those in
tistics Canada) for his sustained commitment to assist us in managing the
data. low-risk environments may not. Furthermore, few studies have
Correspondence concerning this article should be addressed to Sylvana examined the possibility that child care experiences differentially
M. Côté, GRIP, Université de Montréal, 3050 Edouard-Montpetit, Mon- impact children with different personal characteristics. For in-
tréal, Québec H3T 1J7, Canada. E-mail: sylvana.cote@umontreal.ca stance, children who are difficult, fussy, and irritable may have

155
156 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY

more negative experiences in a group day care setting than do among children from high-risk families, physical aggression was
children who have an easy temperament. Studies testing for the significantly less common among those in NMC. In addition to the
moderating role of family circumstances and children’s character- type of sample, one of this study’s strengths resided in the use of
istics are rare, especially when it concerns care that begins in the a family risk index that included several features of family risk
1st year of life. The aim of the present study was to fill this gap by (e.g., SES, family conflicts, size of the family). A limitation,
investigating the possible moderating role of (a) the family envi- however, was the cross-sectional nature of the design, which
ronment and (b) children’s characteristics (the sex and the tem- constrained examination of the directionality of effects. Note that
perament of the child) in the association between maternal care none of the above-mentioned studies examined whether the pro-
(MC) or NMC. tective role of NMC applied to NMC initiated in infancy.
A second possible interaction between NMC and family risk is that
AGE AT WHICH NMC IS INITIATED instead of being protective, NMC may represent an additional risk for
children from already impoverished backgrounds (Lamb & Sternberg,
We focus on child care in the 1st year of life because, whereas 1990; NICHD Early Child Care Research Network, 1997, 1998). In
there appear to be few if any detrimental effects of NMC for line with this possibility, it was shown in the National Institute of
preschool children of toddler’s age and older, the effects of NMC Child Health & Human Development (NICHD) study that infants of
on social and emotional outcomes during infancy are more equiv- insensitive and nonresponsive mothers were more likely to be inse-
ocal (Clarke-Stewart, Allhusen, & Clements, 1995). The needs of curely attached if they experienced NMC (NICHD Early Child Care
toddlers and preschoolers being different from those of infants, Research Network, 1997).
child care experiences may have different effects depending on the A third type of possible interaction is that NMC could act as a
age of the child (Clarke-Stewart et al., 1995). Studies have re- risk factor for children from well or adequately functioning fam-
ported no effects (e.g., Harvey, 1999) or positive effects (e.g., ilies. For instance, by receiving NMC, children from supportive
Greenstein, 1993) of NMC that begins in infancy, but several home environments may be deprived of the care that would be
studies found risk for insecure attachment patterns (Belsky & provided by a resourceful parent (NICHD Early Child Care Re-
Rovine, 1988; Lamb & Sternberg, 1990) and for disruptive behav- search Network, 1998). In line with this argument, Caughy, DiPi-
ior in the preschool (McCartney, Scarr, Phillips, Grajik, & etro, and Strobino (1994) reported that day care beginning in the
Schwarz, 1982; NICHD Early Child Care Research Network, 1st year of life was associated with lower reading recognition
2002) and elementary school (Egeland & Heister, 1995; Han, scores at 4 and 5 years old for children from high-income house-
Waldfogel, & Brooks-Gunn, 2001; Haskins, 1985) years. Such holds. The possibility that such a pattern is observed with regard to
findings raised concerns about the potentially detrimental effects socioemotional outcomes remains to be examined.
of early NMC for children’s socioemotional development. Taken together, these studies provide examples for three ways in
which family risk factors could moderate the association between
THE EFFECTS OF CHILD CARE TYPE MAY child care and children’s development. But, several studies have
DEPEND ON THE LEVEL OF RISK IN THE FAMILY not found any such moderation (Erel, Oberman, & Yirmiya, 2000).
In addition, different (and sometimes contradictory) patterns of
Three types of interactions between the family and child care associations have been found.
contexts have been discussed: (a) NMC may compensate for a high One possible explanation for the divergent findings relates to
family risk environment, (b) NMC may represent an additional risk differences in methods and more specifically to the fact that
for children from a high-risk family background, or (c) NMC may studies have examined different family characteristics as potential
represent a risk for children from a low-risk family background. moderators. With the exception of the Borge et al. (2004) study,
The first type of interaction, termed compensatory or protective previous research has examined the role of a single family risk
processes, suggests that a risk factor may not lead to negative out- factor, most often the SES of the family. Key aspects of family risk
comes when a compensatory child care experience mitigates the risk certainly include socioeconomic factors such as poverty and low
(Clarke-Stewart & Allhusen, 2002; NICHD Early Child Care Re- education (Nagin & Tremblay, 2001), but also factors such as
search Network, 1998; Prodromidis, Lamb, Sternberg, Hwang, & stressful family interactions and family conflicts (Côté, Vaillan-
Broberg, 1995; Scarr & Thompson, 1994)—a possibility for which court, Leblanc, Nagin, & Tremblay, 2006; Repetti, Taylor, &
there is some preliminary supporting evidence. First, in a cross- Seeman, 2002; Tremblay et al., 2004), separated parents or single
sectional study (n ⫽ 94 mother– child dyads), Crockenberg and Lit- parenthood (Pagani, Boulerice, Tremblay, & Vitaro, 1997), young
man (1991) found that toddlers from low-socioeconomic status (SES) and inexperienced mothers (Jaffee, Caspi, Moffitt, Belsky, &
families whose mothers were employed (which was virtually equiv- Silva, 2001; Nagin & Tremblay, 2001), and parental psychopa-
alent with NMC) were less defiant than their low-SES peers whose thology (e.g., maternal depression: Hammen, 2003; Kim-Cohen,
mothers were not employed. Second, Pierrehumbert, Ramstein, Kar- Moffitt, Taylor, Pawlby, & Caspi, 2005). Therefore, a more com-
maniola, and Halfon (1996) found that extensive day care involve- prehensive measure of the family environment— one that includes
ment (at least 2 days per week during the preschool years) protected multiple facets of family risk—may represent a more valid mea-
insecurely attached children (n ⫽ 47) against the risk for disruptive sure of the family context and potentially a more adequate mod-
behavior at 5 years old. erator of the child care– behavior association.
Finally, in one study conducted on a large (N ⫽ 3,431) and Another explanation for the divergent findings may be that other
representative Canadian sample, Borge, Rutter, Côté, and Trem- moderating variables besides family risk influence the associations
blay (2004) found no overall difference between the rates of between NMC and children’s behavior. In fact, in their meta-
physical aggression of children in MC versus NMC. However, analytic review of child care effects, Erel et al. (2000) concluded
CHILD CARE AND FAMILY RISK 157

that examination of multiple moderators is essential and that problems and physical aggression at 4 years old. The study ad-
“taking into account the impact of single moderators does not dresses issues raised in previous research and deals with several
provide researchers with a sufficient picture regarding the com- new questions. First, it provides information about the role of
plexity of the linkage between maternal versus nonmaternal care NMC using a prospective longitudinal design with a large and
and child development” (p. 739). representative sample of a national birth cohort. Second, it pro-
vides information about the moderating role of type of care with
THE EFFECTS OF CHILD CARE MAY DEPEND ON regard to a global measure of family risk, one that includes several
CHILDREN’S CHARACTERISTICS aspects of a risky home environment (i.e., SES, family conflicts,
family status, and maternal characteristics).
With regard to NMC that begins in infancy, infant temperament Third, it provides information about the role of type of care
may be an important moderator. It has been suggested that some while accounting for the selection of children and families into
infants, because of their temperamental makeup, may find daily NMC in the 1st year of life. There is evidence that the extent to
separations and coping associated with day care to be especially which families make use of NMC is influenced by characteristics
difficult (Belsky, 1988). NMC experiences might be particularly of the families that also represent risk for children’s development
challenging for infants who are fussy, irritable, and difficult to (see NICHD Early Child Care Research Network, 1998). How-
soothe, but there is little evidence to support this proposition. ever, the extent to which social selection operates in the 1st year of
The sex of the child may be another moderator of the association life, at a time when social status and family risk may have a lesser
between NMC and socioemotional adjustment. Because boys are influence on parents’ decision to rely on NMC, (e.g., because of
more likely to be classified as insecure and may be more vulner- opportunities for parental leave), is unclear. In the present study, we
able to psychosocial stress, it is possible that they could be affected tested whether family risk and child characteristics were associated
more adversely by potentially stressful events like early NMC with the choice of NMC versus MC in the 1st year of life with the
(Belsky & Rovine, 1988; also see Maccoby, 1998). The present objective of accounting for social selection if it was detected.
study investigated this possibility by testing for the moderating In order to examine the moderating role of type of care, we
role of temperament and sex of the child in the association between posed three research questions. First, is there social selection of
NMC in infancy and behavior problems prior to school entry. infants into NMC on the basis of family risks or child character-
istics? Second, are there associations between type of care in
WHAT ARE THE DEVELOPMENTAL OUTCOMES infancy and children’s behavioral and emotional difficulties at 4
POTENTIALLY RELATED TO NMC? years old? Third, are the associations between MC/NMC and
Few studies have examined the associations between NMC and children’s outcomes moderated by family risk, by child character-
the most serious form of aggression—physical aggression. Rather, istics, or by both family risk and child characteristics?
most studies have investigated associations with broad measures of Specifically, we hypothesized that the effects of NMC would be
behavior problems or with measures of assertiveness, rebellious- influenced by the level of psychosocial risk in the parental home.
ness, negativity, compliance, self-control, disruptiveness, or neg- We contrasted two competing possibilities for the direction of
ative interactions (see Clarke-Stewart et al., 1995; NICHD Early moderation; namely, that NMC is protective against physical ag-
Child Care Research Network, 2002, 2003). gression and/or emotional difficulties for children raised in high
The three studies that focused on physical aggression per se psychosocial risk families versus the possibility that because NMC
reported contradictory findings. First, the NICHD Early Child is intrinsically risky, it will potentiate the liability to physical
Care Research Network (2004) found that child care variables aggression/emotional disturbance in children from higher risk fam-
(such as quantity, age of entry) were not systematically associated ilies. The null hypothesis is that the effects of NMC will be
with trajectories of physical aggression during childhood. Second, uninfluenced by family risk characteristics. The first alternative
recently, NMC was found to reduce the risk of a high physical leads to the predictions that (a) children from low-risk families in
aggression trajectory (between infancy and school entry) among MC will have lower levels of physical aggression and emotional
children of mothers with low levels of education (i.e., did not difficulties at 4 years old compared with low-risk children in
graduate from high school; Côté et al., 2007). Third, Haskins NMC, and (b) children from high-risk families in MC will have
(1985) found that high-risk African American children who initi- higher levels of physical aggression and emotional difficulties at 4
ated full-time NMC in the 1st year of life were more physically years old compared with high-risk children in NMC. The second
aggressive (hitting, kicking, pushing) than were those who initi- alternative leads to the opposite set of predictions. In addition, we
ated NMC sometime after the 1st year of life. These inconsistent explored the possibility that the protective or risk effects of NMC
findings suggest that more studies are needed on the association vary by the sex and temperament of the child. Note that the aim of
between NMC and physical aggression and on the possibility that the study was not to examine how different features of NMC are
it is moderated by family risk or child characteristics. Finally, few related to child outcomes. Rather, we focused on the moderating
studies have specifically examined the associations between NMC role of family risks and child characteristics in the association
and emotional problems such as depression and anxiety. between NMC and children’s behavioral and emotional problems.

METHOD
AIMS OF THE STUDY
The overall aim was to examine the moderating role of family
Sample and Procedures
and children’s characteristics (temperament and sex) in the asso- In 1994, a random sample of 15,579 Canadian households with
ciation between type of care initiated in infancy and emotional at least one child 0 –11 years old was selected by Statistics Canada
158 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY

for a longitudinal study of children’s development, the National Dependent Variables


Longitudinal Survey of Children and Youth (Human Resources
The associations between NMC in the 1st year and two types of
Development Canada and Statistics Canada, 1996). Responses
behavior difficulties at the age of 4 years old were examined:
were obtained for 13,439 of these selected households—an overall
physical aggression and emotional problems. The interviewer
response rate of 86.3%.
asked the PMK how often (0 ⫽ never, 1 ⫽ sometimes, 2 ⫽ often)
The 13,439 children 0 –11 years of age at Cycle 1 represent 11 the child exhibited a given feature. Sum scores were computed
cohorts of children (approximately 1,500 children per cohort). For separately for each scale.
instance, Cohort 1 included children 1–12 months old at Cycle 1, The Physical Aggression scale included seven items: “child
Cohort 2 included children 13–24 months old at Cycle 1, Cohort 3 destroys his/her own things”; “gets into many fights”; “destroys
included children 25–36 months old at Cycle 1, and so forth. The things belonging to others”; “physically attacks people”; “vandal-
purpose of the present study was to examine associations between izes”; “threatens people”; “is cruel, bullies, or is mean to others.”
the type of child care in infancy and outcomes before school entry. The internal consistency (Cronbach’s alpha) was good (␣ ⫽ .76).
Therefore, we selected one cohort of children—those between 1 The Emotional Problems scale included seven items, three items
and 12 months old (n ⫽ 1,452) at the first data collection (in 1994). reflecting anxiety (“is worried”; “is too fearful or nervous”; “is
The sample included the 1,358 children for whom the family risk nervous, high strung, or tense”), and four items reflecting depres-
and child characteristics variables were available at the first as- sion (“seems to be unhappy, sad, or depressed”; “is not as happy
sessment and for whom the physical aggression and emotional as other children”; “cries a lot”; “has trouble enjoying him/
problems scores were available at 4 years old. We examined herself”). The internal consistency was .64. The anxiety and the
selection into NMC among this sample. The sample characteristics depression dimensions were analyzed separately in a first set of
are summarized in Table 1. analyses. The pattern of results was the same for both dimensions.
Statistics Canada was responsible for data collections, which Therefore, the results are presented for the overall Emotional
were undertaken every 2 years through home interviews with the Problems scale.
person most knowledgeable about the child (PMK)—the mother in
89.9% of cases (Statistics Canada and Human Resources Devel- Independent Variables
opment Canada, 1995). A combination of classroom training and Family Risk Index
self-study materials were prepared to ensure that interviewers had
a proper understanding of survey concepts. Interviewers were We created a family risk index in order to examine the moder-
under the supervision of a staff of senior interviewers who were ating role of a global measure of the level of risk in the family
responsible for periodically monitoring their interviewers and re- environment and not just moderation by specific (and correlated)
viewing their completed documents. Senior interviewers ensured risk factors. Using a global family risk measure is central to our
that prompt follow-up action was taken for refusal and other hypotheses, which involve comparing the impact of child care in
children from generally risky family backgrounds with those not
nonresponse cases. The senior interviewers were, in turn, under the
from such backgrounds. Previous studies and developmental mod-
supervision of the program managers, located in Statistics Canada
els do not provide sufficient support for formulating hypotheses
regional offices.
about the moderating role of child care with regard to specific risk
factors such as early motherhood or high levels of family conflicts.
The creation of family risk indexes has a conceptual and em-
pirical basis (Burchinal, Roberts, Hooper, & Zeisel, 2000; Samer-
Table 1
off, Seifer, Baldwin, & Baldwin, 1993) and builds on previous
Demographic Characteristics
work (Borge et al., 2004). Specifically, the family risk items were
Subsample size included in the index on the basis of three criteria. First, we
Demographic (out of 1,358) % selected items generally found to represent risk for children’s
development in the scientific literature. Second, we selected items
Sex that were significantly correlated with at least five (out of six)
Girls 665 49.0
Boys 693 51.0 behavior problems (i.e., physical aggression, emotional problems,
Maternal age (in years) hyperactivity, indirect aggression, opposition, low prosocial be-
⬍20 78 5.8 haviors). This step ensured that the risk factors were correlated
21–25 252 18.6 with several behavioral problems and that they were not specific to
ⱖ25 1,027 75.7
Maternal education
only a few outcomes. Finally, we selected items that were signif-
Less than secondary school 186 15.7 icantly correlated with each other (correlations ranged between
Secondary school diploma 221 18.6 0.12 and 0.4) and with the total family adversity score (correlations
Beyond high school 267 22.5 ranged between 0.5 and 0.71). Five family characteristics met
College or university degree 512 43.2 those criteria: (a) SES, (b) family functioning, (c) maternal depres-
Family status
Intact (married or common law union) 1,203 88.6 sion, (d) maternal age at the birth of the target child, and (e) family
Separated, divorced, widowed 155 11.4 status (intact family or separated parents). Computation of the
Type of child care in infancy index is described below.
Maternal care 972 71.5 SES. A measure of SES was derived for each household in the
Nonmaternal care 386 28.5
sample and the result assigned to each selected child in that
CHILD CARE AND FAMILY RISK 159

household. It was derived from five sources: the level of education Children’s Characteristics
of the PMK, the level of education of the spouse/partner (ranging
from 0 ⫽ no schooling to 20 ⫽ MD/PhD), the prestige of the The possible moderating role of two child characteristics—sex
PMK’s occupation, the prestige of the occupation of the spouse/ and temperament—was investigated. Temperament was assessed
partner (ranging from 0 ⫽ lowest to 16 ⫽ highest), and household with six items from the Infant Characteristics Questionnaire
(Bates, 1987) that was administered to all PMKs of children 0 –11
income (in Canadian dollars; Willms & Shields, 1996). Each of the
months old. The PMK was asked to report for each of the items by
five variables was standardized to have a mean of zero and a
assigning a frequency rating ranging between 1 (frequently dis-
standard deviation of one. The SES composite was then calculated
plays favorable behaviors) and 7 (seldom displays favorable be-
by taking the (unweighted) average of the five standardized vari-
haviors). The items were as follows: how easy it is to calm or
ables. If one of the five variables had missing data due to nonre- soothe the child when upset; how often the child gets fussy and
sponse (refusal, did not know, etc.), then the average was taken irritable; in general, how often the child cries, fusses, or whines;
over the remaining nonmissing items. If there was no spouse/ how easily the child gets upset; how changeable is the mood of
partner in the household (i.e., the PMK had no spouse/partner), child; and the overall degree of difficulty of the child. The scale
then the average was taken over the three applicable variables. In was dichotomized according to a 25th–75th percentile split. Chil-
the present study, the SES variable was split into quartiles: 25% dren scoring in the top quartile are hereafter referred to as difficult
very high SES (coded as 0), 25% high (coded as 1), 25% low (coded as 1), and children in the lower 75th percentile are referred to
(coded as 2), 25% very low (coded as 3). as easy (coded as 0). The internal consistency was good (␣ ⫽ 76).
Family functioning. A family assessment scale comprising 12
items measured the quality of family functioning (communication,
Type of Child Care in Infancy
problem resolution, control of disruptive behavior, showing and
receiving affection; Boyle et al., 1987). The scores ranged from 0 The interview provided 10 alternatives for types and contexts of
to 36 on the scale. The family functioning variable was split into child care. In order to focus on the possible risks and benefits
quartiles and was coded as 25% very good functioning (0), 25% associated with MC in the family, we dichotomized type of care.
good functioning (1), 25% poor functioning (2), 25% very poor MC (n ⫽ 972, 71.5%) represented all children cared for at home
functioning (3). by their mother (coded as 1). NMC (n ⫽ 386, 28.5%) included all
Maternal depression. Mothers reported the frequency of de- other alternative forms of child care (coded as 0). The most
pressive symptoms experienced in the past week. The scale was a frequent form of NMC was care in someone else’s home by a
short version of the Center for Epidemiological Study Depression nonrelative (39.6%), followed by care in someone else’s home
scale (CES-D; Radloff, 1977) and included 12 items scored as 0 undertaken by a relative (21.5%) and care in the child’s home by
(never) to 4 (often). The items were summed and the scale was a nonrelative (15.8%) or relative (14.1%). NMC was provided in
split into quartiles. A score of 0 reflected very low levels of a day care center for 9.1% of children. The mean number of hours
per week spent in NMC was 31.53 (SD ⫽ 17.32).
depressive symptoms (less than 2 symptoms), a score of 1 reflected
Justification for using dichotomized predictors. Using the
low levels (between 2 and 5 depressive symptoms), a score of 2
family risk index and child temperament as dichotomized variables
reflected high levels (between 5 and 10 symptoms), and a score of
is central to our study hypotheses proposing that the effect of type
3 reflected very high levels (more than 10 symptoms).
of care differs (a) for children from high-risk families versus those
Maternal age at the birth of the target child. The age of the not from high-risk families and (b) for children with a difficult
mother was coded as 0 (older than 25 years), 1 (between 21 and 25 temperament versus those without a difficult temperament or for
years old), or 2 (younger than 21 years old). boys versus girls. We did not expect linear relations between
Family status. The status of the family was dichotomized family risk and the outcomes for children in MC versus NMC. For
according to whether the family was intact (coded as 0) or instance, we did not expect the impact of type of care to be more
whether the parents had divorced, separated, remarried, or were beneficial as family risk increases. The same argument applies to
widowed (1). child temperament, where we expected differential associations for
children who do not have a difficult temperament compared with
children with a difficult temperament. Thus, our hypotheses in-
Computation of the Family Risk Index volve categories, as is often the case in the literature on risk factors
and behavioral maladjustment.
The scores on the family risk variables varied between 0 and 3
Controlling for selection factors. We searched for variables
for SES, family functioning, and maternal depression; varied be-
that could bias the results by creating differences between the MC
tween 0 and 2 for maternal age; and were dichotomous (0 or 1) for and NMC group. The variables included as controls were those
family status. The scores for the five variables were summed to associated with (a) MC/NMC and (b) one of the outcomes (phys-
compute a family adversity index that ranged between 0 and 12. A ical aggression or emotional problems). We examined these asso-
higher score reflected higher levels of family risk. We then dichot- ciations with the following variables: age of the child in months,
omized the index to distinguish high levels of family risk (1 ⫽ top poor health of the child, birth weight, premature birth, breast
quartile) from lower levels (0 ⫽ below the 75th percentile). A feeding, race, maternal smoking during pregnancy, alcohol con-
cutoff at the top quartile provides (a) identification of a high-risk sumption during pregnancy, and number of siblings. Age of the
group that can be judged reasonably small from a public policy child in months at Cycle 1 varied between 1 and 12 months and
perspective and (b) sufficient power to test our hypotheses. was used continuously in the analyses. The child health at birth
160 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY

was reported by the PMK as being good (coded as 0) or poor Testing the Moderating Role of Family Risk and Child
(coded as 1). Birth weight (in grams) for gestational age was Characteristics
represented continuously. Premature birth was coded as 0 (child
born in normal range) or 1 (child born 258 days or less). PMK We tested the moderating role of family risk, child tempera-
provided information about number of siblings from 0 to 18 years ment, and sex of the child in the association between type of care
of age living in the child’s household. The number of siblings and behavior problems. Series of multiple regression analyses
varied between 0 and 9 and was represented continuously. Breast were conducted separately for physical aggression and emotional
feeding was represented by a dummy variable that indicated problems. Three models were tested. In Model 1, the variables
whether the mothers had (coded as 0) or had not (coded as 1) identified as selection factors and the main effects were entered
breast fed the child. A dummy variable indicating whether the (i.e., control variables, type of child care, family risk, tempera-
child is Caucasian (coded as 0) or not (coded as 1) Caucasian (e.g., ment, sex of the child) as predictors of the two outcomes. In the
Black, Asian, Latino) represented child race. The mothers were second step, the two-way interactions involving child care type
asked about their smoking behavior throughout pregnancy (“Did (CCT; CCT ⫻ Temperament, CCT ⫻ Family Risk, CCT ⫻ Sex)
you smoke during pregnancy? If so, how many cigarettes did you and child characteristics (Risk ⫻ Temperament, Risk ⫻ Sex,
smoke per day?”). The scores ranged between 0 and 35 cigarettes. Temperament ⫻ Sex) were added to the variables entered in
Mothers also provided information about their alcohol consump-
Model 1. Finally, in Model 3, the three-way interactions involving
tion throughout pregnancy (“How frequently did you consume
CCT (CCT ⫻ Temperament ⫻ Family Risk, CCT ⫻ Sex ⫻
alcohol during your pregnancy?”). We created a dummy variable
Family Risk, CCT ⫻ Sex ⫻ Temperament) were added to the
indicating whether the mothers consumed alcohol during preg-
variables entered in Model 2. Follow-up analyses were then con-
nancy: 1 (never or rarely) or 2 (at least once per week).
ducted to test the differences between the groups where significant
interactions were found. In addition, effects sizes were calculated
STATISTICAL ANALYSIS according to the following equation:
The main objective of the analyses was to examine the possi-
d ⫽ (XMC – XNMC) / S pooled,
bility that associations between the type of child care in the 1st
year of life and emotional/behavioral difficulties at 4 years old
where S pooled ⫽ 公{[(nMC – 1)(sMC2) ⫹ (nNMC – 1)(sNMC2)]
were moderated by the level of family risk or by children’s
characteristics. In testing for these associations, we first examined / (nMC ⫹ nNMC – 2)}(Hedges & Olkin, 1985).
the possibility that selection factors operated with regard to the
choice of child care that began in the 1st year of life. S is the pooled standard deviations of the MC and NMC groups, X
The statistical analyses were conducted in two steps. First, we is the mean, n is the number of subjects, and s is the standard
examined the possibility that selection factors operated in this deviation of each group. Positive ds indicate more difficulties in
sample of families. The identified selection factors were used as the MC than in the NMC group, whereas negative ds indicate
control variables in the multivariate analyses. Second, we tested lower levels of difficulties in the MC than in the NMC group. We
the moderating role of family risk and child characteristics in the computed 95% confidence intervals (CIs).
association between the type of care and the two outcomes: phys- Given the objective of the study (to test the moderating role of
ical aggression and emotional problems. family and child characteristics in the care– behavior problems
association), the presentation of the results is focused on the
Identifying Selection Factors interactions between child care and family risk, between child care
and temperament, and between child care and the sex of the child.
We searched, among 18 prenatal and perinatal factors, family
In all analyses, the longitudinal data were weighted to take into
characteristics and child characteristics, the variables that could
account nonrespondents and the stratification design of the Na-
bias the results by being associated with selection in NMC and
tional Longitudinal Survey of Children and Youth. These weighted
with the outcomes. The variables tested for selection were (a) age
of the child in months at first assessment, poor health of the child, data also correspond to the ethnic and cultural composition of
birth weight, premature birth, breast feeding, race, maternal smok- Canadian citizens. The principle behind estimation in a probability
ing during pregnancy, maternal alcohol consumption during preg- sample such as the National Longitudinal Survey of Children and
nancy, and number of siblings; (b) the overall level of family risk Youth is that each person in the sample represents, besides himself
index and the family risk variables included in the index (i.e., SES, or herself, several other persons not included in the sample. For
family functioning, maternal depression, maternal age, family sta- example, in a 2% simple random sample of the population, each
tus); and (c) the temperament and the sex of the child. First, using person in the sample represents 50 persons in the population. The
chi-squares or t tests, we identified the variables significantly weighting phase is a step that calculates, for each record, the
associated with selection of children into MC and NMC. Second, number of individual in the population represented by a given
using Pearson’s product–moment correlation or analyses of vari- record. In longitudinal analyses as those done in the present study,
ance, we searched, among the same set of variables, those signif- the modeling of the trajectories included probability weights that
icantly associated with one of the outcomes. Variables were in- appropriately reflected the sampling strategy of this probability
cluded as control in the regression models if they were survey and accounted for nonresponse, attrition, rural– urban fac-
significantly associated with (a) an MC/NMC difference and (b) tor, interprovincial migration, and poststratification (Statistics
one of the outcomes (physical aggression or emotional problems). Canada, 1994 –1995).
CHILD CARE AND FAMILY RISK 161

RESULTS nine potential selection factors, (b) the overall level of family risk
and each of the risk variables included in the index, and (c) the
Testing for Selection Into Child Care temperament and the sex of the child. Table 3 presents the asso-
Table 2 presents chi-square and t tests conducted to compare the ciations with physical aggression and emotional problems. Recall
proportion of children in MC versus NMC according to (a) the that in order to be considered a selection factor, the variable needs

Table 2
Bivariate Associations Among Confounders, Family Risks, Child Characteristics, and Type of Child Care

Nonmaternal care Maternal care

Variable M SD % N M SD % N t ␹2(1) p

Potential confounders
Child age in months (n ⫽ 1,358) 5.33 2.92 6.22 2.90 ⫺5.11 .001
Number of siblings (n ⫽ 1,358) 0.66 0.93 0.87 1.00 ⫺3.51 .001
Birth weight (in grams; n ⫽ 1,328) 3,432.56 590.84 3,352.99 562.33 2.29 .02
Cigarettes smoked during pregnancy (n ⫽ 1,228) 1.79 4.60 2.45 5.43 ⫺2.15 .032
Child health (n ⫽ 1,337) 0 .59
Good health 28.3 375 71.7 949
Poor health 28.6 4 71.4 10
Premature birth (n ⫽ 1,334) 0.01 .50
Normal range 28.3 341 71.7 864
Premature 28.7 37 71.3 92
Race (n ⫽ 1,291) 4.5 .02
Caucasian 26.9 292 73.1 794
Non-Caucasian 34.1 70 65.9 135
Breast feeding (n ⫽ 1,336) 0.31 .31
Yes 27.9 283 72.1 731
No 29.5 95 70.5 227
Alcohol use during pregnancy (n ⫽ 1,230) 3.23 .07
Never–rarely 28.8 352 71.2 870
ⱖ1 per week 0 0 100 8

Overall family risk index and risks included in the index


Overall family risk (n ⫽ 1,358) 1.42 .13
Low 29.3 304 70.7 734
High 25.9 83 74.1 238
SES (n ⫽ 1,355) 7.24 .07
Very high 31.3 100 68.7 222
High 31.1 112 68.9 248
Low 28.5 99 71.5 248
Very low 23.0 75 77.0 251
Family dysfunction (n ⫽ 1,339) 24.19 .001
Very low 19.3 65 80.7 272
Low 28.3 101 71.7 256
High 35.7 142 64.3 256
Very high 28.7 71 71.3 176
Maternal depression (n ⫽ 1,339) 4.29 .23
Very low 30.1 113 69.9 263
Low 29.1 127 70.9 309
High 29.3 99 70.7 239
Very high 22.2 42 77.8 147
Maternal age (n ⫽ 1,358) 6.88 .03
⬎25 28.3 291 71.7 736
21–25 25.3 64 74.7 189
⬍20 40.5 32 59.5 47
Family status (n ⫽ 1,358) 0.52 .26
Married 28.2 339 71.8 864
Other 31.0 48 69.0 107

Child characteristics
Temperament (n ⫽ 1,358) 0.30 .32
Easy 28.9 291 71.1 717
Difficult 27.4 196 72.6 255
Sex (n ⫽ 1,358) 1.31 .14
Boys 29.9 207 70.1 486
Girls 27.7 180 72.9 485
162 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY

Table 3
Bivariate Associations Among Confounders, Family Risks, Child Characteristics, and Child Behavioral/Emotional Problems

Physical aggression Emotional difficulties

Variable r M SD F/t(df) p r M SD F/t(df) p

Potential confounders
Age of the child (n ⫽ 1,358) .06 .04 ⫺.01 .78
Siblings (n ⫽ 1,358) .10 .001 ⫺.13 .001
Birth weight (n ⫽ 1,328) ⫺.07 .01 ⫺.10 .001
Cigarettes smoked during pregnancy (n ⫽ 1,228) .15 .001 ⫺.01 .78
Child health (n ⫽ 1,337) 0.70 (1335) .48 ⫺0.67 (1335) .50
Good health 1.24 1.75 1.67 1.83
Poor health 0.90 1.47 2.01 1.50
Premature birth (n ⫽ 1,334) ⫺0.68 (1332) .50 ⫺0.90 (1335) .37
Normal range 1.22 1.74 1.66 1.82
Premature 1.33 1.84 1.82 1.93
Race (n ⫽ 1,291) 3.94 (400.52) .001 ⫺1.01 (254.42) .32
Caucasian 1.32 1.81 1.68 1.76
Non-Caucasian 0.92 1.21 1.84 2.22
Breast feeding (n ⫽ 1,336) ⫺0.75 (1334) .45 2.00 (638.55) .046
Yes 1.22 1.68 1.72 1.90
No 1.30 1.94 1.51 1.58
Alcohol use during pregnancy (n ⫽ 1,230) 1.2 (1228) .23 0.09 (1228) .93
Never–rarely 1.29 1.79 1.69 1.84
ⱖ1 per week 0.53 0.98 1.63 1.49

Overall family risk index and risks included in the index


Overall family risk (n ⫽ 1,358) ⫺2.23 (460.89) .02 ⫺0.21 (475.24) .83
Low 1.4 2.00 1.68 1.76
High 1.8 1.65 1.71 2.04
SES (n ⫽ 1,355) 1.58 (3)a .19 3.13 (3)a .025
Very high 1.26 1.90 1.77 1.73
High 1.08 1.73 1.66 1.83
Low 1.35 1.66 1.85 1.94
Very low 1.30 1.68 1.45 1.78
Family dysfunction (n ⫽ 1,339) 2.33 (3)a .07 7.12 (3)a .001
Very low 1.04 1.76 1.29 1.55
Low 1.26 1.63 1.73 1.68
High 1.30 1.78 1.81 1.87
Very high 1.40 1.84 1.90 2.20
Maternal depression (n ⫽ 1,339) 12.79 (3)a .001 13.88 (3)a .001
Very low 0.92 1.37 1.26 1.66
Low 1.12 1.59 1.69 1.71
High 1.49 1.98 1.77 1.88
Very high 1.75 2.16 2.28 2.10
Maternal age (n ⫽ 1,358) 0.08 (2)a .93 0.94 (2)a .39
⬎25 1.24 1.71 1.71 1.81
21–25 1.23 1.83 1.55 1.91
⬍20 1.32 1.92 1.82 1.78
Family status (n ⫽ 1,358) ⫺0.57 (1356) .57 2.00 (1356) .05
Married 1.23 1.74 1.72 1.82
Other 1.32 1.76 1.41 1.85

Child characteristics
Temperament (n ⫽ 1,358) ⫺2.98 (550.78) .003 ⫺4.30 (534.81) .001
Easy 1.16 1.68 1.55 1.73
Difficult 1.50 1.90 2.07 2.04
Sex (n ⫽ 1,358) 6.96 (1288.55) .001 0.02 (1356) .99
Boys 1.56 1.93 1.69 1.87
Girls 0.91 1.46 1.68 1.79

Type of child care


Nonmaternal 1.33 1.64 0.81 (1) .42 1.95 2.00 3.17 .002
Maternal 1.22 1.78 1.58 1.74

Note. Values with a superscript indicate an F statistic.


CHILD CARE AND FAMILY RISK 163

to be correlated with (a) NMC and (b) either physical aggression and a main effect of the sex of the child. Specifically, non-
or emotional problems. Caucasian status was associated with a lower physical aggression
With regard to the potential selection factors, five variables met score. Maternal smoking during pregnancy, higher number of
the selection criteria: age of the child, race of the child, maternal siblings, and being a boy were associated with higher level of
smoking, having siblings, and birth weight. Specifically, younger physical aggression. Model 2 indicates that one two-way interac-
children, children with fewer siblings, children with a higher birth tion emerged: Child care interacted with family risk. In Model 3,
weight, children of mothers who smoked fewer cigarettes during the three-way interactions among NMC, family risk, and child
pregnancy, and non-Caucasian children were more likely to re- characteristics were entered in the model. None of the three-way
ceive NMC care in infancy (see Table 2). In addition, older interactions was significant. Therefore, we present the results of
children, children with more siblings, children with lower birth Model 1 and Model 2.
weight, children of mothers who smoked more cigarettes during To follow up on the significant two-way interaction, we esti-
pregnancy, and Caucasian children were more likely to have mated the adjusted means and standard errors from the regression
higher physical aggression scores. Children with fewer siblings coefficients (after centering the variables). We then conducted a t
and lower birth weight were more likely to have higher emotional test to locate the significant differences between the groups. Two
problems (see Table 3). Therefore, these five variables were used of the four contrasts were significant. First, the results indicate that
as control variables in the multivariate analyses. children from low-risk families who received MC in infancy had
With regard to the family risk index, the results indicate that the lower physical aggression scores at 4 years old (M ⫽ 1.11, SD ⫽
proportion of high-risk infants in MC (n ⫽ 238, 74.1%) was not 1.69, n ⫽ 624) compared with low-risk children who were in NMC
significantly different from the percentage of low-risk infants in in infancy (M ⫽ 1.37, SD ⫽ 1.53, n ⫽ 261), t(883) ⫽ –2.13, p ⫽
MC (n ⫽ 734, 70.7%, p ⫽ .13). We further examined the possi- .03. The effect size (d) was – 0.16 (95% CI ⫽ – 0.3, – 0.01). Note
bility of selection effects by testing the differences between MC that high-risk children in MC had a nonsignificant higher physical
and NMC according to the five risk variables included in the aggression (M ⫽ 1.39, SD ⫽ 2.03, n ⫽ 209) than high-risk
family risk index. The only risk variable for which we found a children in NMC (M ⫽ 1.08, SD ⫽1.26, n ⫽ 66), t(179.90) ⫽
selection effect (association with both NMC and one of the out- 1.54, p ⫽ .13. The effect size (d) was 0.17 (CI ⫽ – 0.11, 0.44).
comes) was family dysfunction. Specifically, children from highly Figure 1 illustrates the (adjusted) mean levels of physical aggres-
dysfunctional families were more likely to be in NMC and they sion for children in the different family risk and child care groups.
tended to have higher scores on the emotional problem scale.
Regarding temperament and the sex of the child, there was no
indication that either of these child characteristics played any role Emotional Problems
in selection into MC or NMC (see Table 2). The same analysis was
Table 5 reports the results of the regression predicting emotional
repeated separately for the low- and the high-risk segments of the
problems. Model 1 indicates significant associations between two
family risk variable and, again, no association between tempera-
control variables (lower birth weight and lower number of sib-
ment and child care was detected.
lings) and higher emotional problems. In addition, the results show
Finally, Table 3 presents an overall comparison of rates of
that both child care and temperament had a main effect on emo-
behavior and emotional difficulties at 4 years old according to type
tional difficulties. Specifically, difficult temperament and NMC
of care in the 1st year of life. There were no significant differences
were associated with higher emotional problems. The results for
in the levels of physical aggression according to MC and NMC
Model 2 indicate that none of the two-way interactions signifi-
groups. However, the level of emotional difficulties was greater in
cantly predicted emotional difficulties. Finally, the results of
the NMC group.
Model 3 reveal that a three-way interaction among child care,
family risk, and sex was significant in predicting emotional prob-
Do Family Risk and Child Characteristics Moderate the lems.
Association Between Child Care and Behavior Problems? Follow-up analyses of the three-way interaction indicate that
girls from low-risk families in MC had lower levels of emotional
We conducted two series of multiple regressions, one for each
difficulties (M ⫽ 1.45, SD ⫽ 1.50, n ⫽ 317) than did those in
outcome. Each regression included three steps. First, we entered
NMC (M ⫽ 2.17, SD ⫽ 1.94, n ⫽ 125), t(185) ⫽ –3.73, p ⬍ .001.
the selection factors identified in the first part of the analyses and
The effect size (d) was – 0.44 (CI ⫽ – 0.23, – 0.65). Child care was
the main effect of the predictor variables. Second, we entered the
not significantly associated with emotional difficulties among girls
three possible two-way interactions that involved child care in
from high-risk families or among boys. Figure 2 illustrates these
order to test for the moderating role of family risk, child temper-
results for girls.
ament, and sex in the association between care and the outcomes.
Finally, we entered the three three-way interactions that involved
child care. DISCUSSION

Physical Aggression The aim of the present study was to investigate the role of the
family environment and of children’s characteristics (the sex and
Table 4 reports the results of the multiple regressions predicting the temperament of the child) in the association between MC/
physical aggression. Model 1 indicates significant associations NMC in the 1st year of life and behavior and emotional problems
with physical aggression for four control variables (race, birth prior to school entry (4 years old) among a large and nationally
weight, smoking during pregnancy, and the number of siblings) representative sample.
164 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY

Table 4
Multiple Regression Testing Family and Child Characteristics as Moderators of the Association Between Child Care Type (CCT) and
Physical Aggression (n ⫽ 1,159)

Model 1 Model 2

Predictor variable B SE ␤ B SE ␤

Step 1: Control variables and main effects


Control variables
Age (months) 0.02 0.02 0.04 0.03 0.02 0.05
Race (non-Caucasian ⫽ 1) ⫺0.51** 0.17 ⫺0.09 ⫺0.48** 0.17 ⫺0.08
Birth weight 0.00** 0.00 ⫺0.09 0.00** 0.00 ⫺0.09
Number of cigarettes (pregnancy) 0.03** 0.01 0.09 0.03** 0.01 0.09
Number of siblings 0.15** 0.05 0.08 0.13* 0.05 0.07
Main effects
Temperament (difficult ⫽ 1) 0.12 0.12 0.03 0.58* 0.26 0.14
Sex (female ⫽ 1) ⫺0.68*** 0.10 ⫺0.19 ⫺0.70*** 0.21 ⫺0.20
Family risk (high ⫽ 1) 0.15 0.12 0.04 ⫺0.19 0.27 ⫺0.05
CCT (maternal care ⫽ 1) ⫺0.15 0.11 ⫺0.04 ⫺0.29 0.18 ⫺0.07

Step 2: Two-way interactions


CCT ⫻ Temperament ⫺0.33 0.26 ⫺0.07
CCT ⫻ Family Risk 0.62* 0.28 0.13
CCT ⫻ Sex 0.17 0.23 0.05
Risk ⫻ Temperament ⫺0.28 0.27 ⫺0.04
Risk ⫻ Sex ⫺0.10 0.24 ⫺0.02
Temperament ⫻ Sex ⫺0.36 0.24 ⫺0.06

Note. ⌬R2 for Model 2: 0.08 for Step 1 ( p ⬍ .001) and 0.01 for Step 2 ( p ⫽ .12).
*
p ⬍ .05. ** p ⬍ .001. *** p ⬍ .0001.

Before tackling this basic question, it was essential to determine for any differences in child outcomes, but nevertheless the findings
whether there were possibly relevant social selection factors asso- did mean that it was essential to control for possible confounding
ciated with the children receiving MC or NMC. Our findings variables in our analyses.
indicated no strong social selection effect. In particular, neither The most important and novel findings of our study concern the
child’s sex nor child’s temperament nor overall family risk were moderating role of family risk and child characteristics in the
significantly associated with MC versus NMC. With respect to associations between MC/NMC and child emotional and behav-
other variables, a larger number of siblings and lower birth weight ioral problems. That is, our results show different patterns of
stood out as potential confounders, with both risk factors applying associations between child care during infancy for children from
more to the use of MC. In summary, the pattern of risk factors high- and low-risk family backgrounds and for boys and girls.
sometimes was associated with MC and sometimes with NMC. With regard to both physical aggression and emotional problems,
That means that it was unlikely that social selection would account the association with type of care was different depending on the
presence or absence of family risk.
The results indicate that, in the sample as a whole, children in
1,5 NMC in the 1st year of life did not exhibit higher levels of physical
MC aggression at 4 years old but exhibited somewhat higher levels of
NMC emotional problems. These findings are generally in keeping with
Physical aggression score

the previous literature in showing minor effects or no systematic


1 effects of NMC (NICHD Early Child Care Research Network,
2004).
In our introduction to the possible moderating role of family
risk, we noted that it might work in two opposing directions—first
0,5 by NMC being protective against family risks through a dilution of
the time it impinged on the child and, second, if NMC was in itself
risky, it could potentiate the adverse effects of high family risk.
Neither with physical aggression nor emotional disturbance did we
0 find any evidence in support of a potentiating effect. To the
Low family risk High family risk contrary, in all instances, the moderating effect worked in the
opposite direction. Specifically, children from low-risk families
Figure 1. Levels of physical aggression at 4 years old according to receiving MC in infancy exhibited less physical aggression at 4
family risk and child care in infancy. MC ⫽ maternal care; NMC ⫽ years old than did low-risk children who received NMC. The effect
nonmaternal care. size was small (d ⫽ – 0.16; Cohen, 1988) but gives support to the
CHILD CARE AND FAMILY RISK 165

Table 5
Multiple Regression Testing Family and Child Characteristics as Moderators of the Association Between Child Care Type (CCT) and
Emotional Problems (n ⫽ 1,159)

Model 1 Model 2 Model 3

Predictor variable B SE ␤ B SE ␤ B SE ␤

Step 1: Control variables and main effects


Control variables
Age (months) ⫺0.02 0.02 ⫺0.03 ⫺0.02 0.02 ⫺0.03 ⫺0.02 0.02 ⫺0.04
Race (non-Caucasian ⫽ 1) 0.03 0.17 0.01 0.04 0.18 0.01 0.01 0.18 0.00
Birth weight ⫺0.00* 0.00 ⫺0.07 0.00* 0.00 ⫺0.07 0.00* 0.00 ⫺0.07
Number of cigarettes (pregnancy) 0.01 0.01 0.02 0.00 0.01 0.01 0.00 0.01 0.01
Number of siblings ⫺0.25*** 0.05 ⫺0.14 ⫺0.26*** 0.05 ⫺0.14 ⫺0.26*** 0.05 ⫺0.14
Main effects
Temperament (difficult ⫽ 1) 0.43*** 0.12 0.10 0.63* 0.27 0.15 0.41 0.34 0.10
Sex (female ⫽ 1) ⫺0.05 0.11 ⫺0.01 0.01 0.22 0.00 0.08 0.25 0.02
Family risk (high ⫽ 1) ⫺0.16 0.13 ⫺0.04 ⫺0.60* 0.29 ⫺0.14 ⫺0.01 0.35 ⫺0.00
CCT (maternal care ⫽ 1) ⫺0.35** 0.12 ⫺0.09 ⫺0.33 0.19 ⫺0.08 ⫺0.23 0.21 ⫺0.06

Step 2: Two-way interactions


CCT ⫻ Temperament ⫺0.07 0.27 ⫺0.02 0.20 0.40 0.04
CCT ⫻ Family Risk 0.46 0.29 0.10 ⫺0.40 0.42 ⫺0.08
CCT ⫻ Sex ⫺0.21 0.24 ⫺0.06 ⫺0.33 0.30 ⫺0.09
Risk ⫻ Temperament ⫺0.45 0.28 ⫺0.06 ⫺0.88 0.58 ⫺0.12
Risk ⫻ Sex 0.46 0.25 0.08 ⫺0.72 0.50 ⫺0.12
Temperament ⫻ Sex ⫺0.09 0.25 ⫺0.02 0.56 0.46 0.09

Step 3: Three-way interactions


CCT ⫻ Temperament ⫻ Family Risk 0.67 0.67 0.08
CCT ⫻ Sex ⫻ Family Risk 1.62** 0.58 0.24
CCT ⫻ Sex ⫻ Temperament ⫺0.90 0.55 ⫺0.13

Note. ⌬R2 for Model 3: 0.05 for Step 1 ( p ⬍ .001), 0.01 for Step 2 ( p ⫽ .12), and 0.01 for Step 3 ( p ⫽ .01).
*
p ⬍ .05. ** p ⬍ .001. *** p ⬍ .0001.

suggestion that NMC starting during the 1st year after birth may be lems among low-risk families and not among high-risk families.
associated with higher levels of physical aggression at 4 years old The effect size was moderate (d ⫽ – 0.44; Cohen, 1988).
for children in low-risk families. The pattern of result for emo- Given that the key new finding concerns the moderating effect
tional problems applied only to girls and was similar to that of of family risk, it is necessary to consider how robust this finding
physical aggression: MC was associated with less emotional prob- is. As shown in Figures 1 and 2, in one important respect the
patterns for physical aggression and emotional disturbance were
similar. That is, for children from high-risk families, the levels of
both types of disturbance were higher for children in MC. Con-
2,5
versely, for children from low-risk families, the levels of both
MC
types of disturbance were higher for children in NMC. On the
NMC
2 other hand, this interaction effect applied only to girls in the case
Emotional problems score

of emotional disturbance—a sex difference that has not been


predicted and which would not be strongly expected on the basis
1,5
of previous research findings (e.g., Belsky & Rovine, 1988). Also,
the interaction effect for physical aggression was relatively weak
1 and statistically significant at only the 3% level. In short, although
statistically significant, the findings within our study are only
0,5
moderately robust. Furthermore, a recent study indicates that NMC
does not carry risk for the long-term development of physical
aggression but rather is protective for children of mothers with low
0 levels of education (Côté et al., 2007). Such results underlie the
Low family risk High family risk importance of examining the role of NMC with regard to long-
term developmental patterns.
Figure 2. Levels of emotional problems at 4 years old according to It is necessary next to consider whether the interaction could be
family risk and child care in infancy: Girls. MC ⫽ maternal care; NMC ⫽ an artifact of either social selection or the effects of the child’s
nonmaternal care. behavior on the family’s choice of NMC or MC. Neither possibil-
166 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY

ity seems at all plausible. The significant moderating effect of account for effects, a range of plausible confounding variables
family risk applies after taking account of possible confounding should be examined similarly and shown not to account for the
variables. We focused on NMC in the 1st year of life because the findings, and a variety of alternative explanations should be ex-
evidence in the literature suggested that if NMC created a psycho- amined to determine their plausibility. This last criterion is partic-
pathological risk, it was most likely to do so if it was experienced ularly important (Cochran & Chambers, 1965). All of these criteria
in the 1st year of life. However, by the same token, this meant that are met in the present study. Thus, the main alternatives of social
there was less opportunity (as compared with the situation when selection on the basis of either family risk characteristics or child
the children are older) for child features to influence the selection variables could not account for the moderating effect found. The
of NMC or MC. In any case, the findings showed that neither sex alternative of genetic mediation has no supporting evidence, but it
nor temperament were associated with social selection. The deci- could not be definitely ruled out. A further criterion is that the
sion on child care took place well before the children showed postulated causal effect should be consistent with comparable
physical aggression or emotional disturbance, and most of the mechanisms in other studies. That criterion is also met. Dealing
family risk features (such as educational attainment, occupational with a different set of outcomes in the same Canadian data set,
level, and age of the mother at the time of the child’s birth) were both Borge et al. (2004) and Geoffroy et al. (2007) found a
not of a kind that could be influenced by the child. moderating effect of family features on the effects of MC/NMC. A
At first sight, it might seem surprising that we found so little broader range of research has also given rise to similar conclusions
evidence of social selection, particularly as greater social selection (Crockenberg & Litman, 1991; Pierrehumbert et al., 1996).
was found in the same Canadian sample for children entering Nevertheless, there are criteria that are not yet met. Thus, there
NMC after 12 months old (Borge et al., 2004). is a lack of consistency within our own data set (Why is there the
One possible explanation for this difference may lie in the sex difference with respect to the moderating effect on emotional
Canadian parental leave program. Most Canadian mothers have disturbance?). Also, there is a need for adequate replication across
6 –12 months paid parental leave at the birth of a child, which makes different data sets and different social contexts, and we lack good
MC a very common choice (71.5% in our sample). In fact, in our evidence on the mediating mechanisms involved in the moderating
representative Canadian sample, only 28.5% of families use some effect. Thus, despite the significant moderating effect found, the
form of NMC for their infant. This is in sharp contrast with data from pattern observed does not comply with what would be expected if
the United States indicating that 80% of families use some form of NMC protected against family risk. Also, if NMC is a risk factor
NMC in the 1st year of life (NICHD Early Child Research Network, for emotional disturbance, why does it not apply to boys, and why
2005). Thus, selection biases may be more important in the context of does it not have that effect in high-risk families? To answer those
NMC as a normative child care choice. In such contexts, families not questions, researchers would need to have both more detailed
using NMC may present significantly more risks such as low SES measures of family risk than those available to us and also mea-
(Borge et al., 2004; Japel, Côté, & Tremblay, 2005). However, when sures of the quality of care in both NMC and MC settings.
MC is the norm, as is the case for Canadian children under 12 months Would randomized controlled trials help? Of course, they con-
old, there is little social selection, and the wide range of features stitute a powerful means of determining whether particular risk
assessed for social selection makes it unlikely that there was greater features actually can have environmentally mediated effects
selection on the basis of some unmeasured feature. (Brooks-Gunn, 2004; Cook, 2004; Cottingham, 2004; McCall,
A further possibility is that the moderating effect could reflect 2004). Would they be ethical and feasible in the case of NMC
genetic mediation. Certainly, there is good evidence that genetic cases? Possibly. Funding by different governments already pro-
factors influence both parenting behavior and sensitivity to envi- vides funding for one parent to remain at home to care for the child
ronmental features (Rutter, 2006a; Rutter, Moffitt, & Caspi, 2006). or funding for good quality alternative care. These could be pro-
Also, genetic factors are associated with individual differences in vided by random allocation to parents who accepted both options,
the liability to both physical aggression and emotional disturbance but would this be for families at high risk only or for all families?
in early childhood (Dionne Tremblay, Boivin, Laplante, & Pé- Moreover, if a key element in effects concerned the parents’
russe, 2003). On the other hand, it would require a rather complex commitment to a particular pattern of care, the randomized con-
pattern of genetic mediation to account for the specifics of the trolled trial would be problematic.
interaction found. Our findings can neither rule in nor rule out a In our view, the main implication of the research findings is that
role for genetic mediation. That would require one of the several it would be unsafe to assume that NMC and MC have effects that
varieties of genetic designs to test for environmental mediation are independent of family qualities and social context. Incisive
(Rutter, Pickles, Murray, & Eaves, 2001; Rutter, 2006b) and that research to determine the mechanisms underlying the moderating
remains a task for the future. effects of family risk is greatly needed.
Do the findings warrant a causal interpretation? On the one Are there policy implications that derive from our findings? We
hand, there is no point in studying correlations unless they have think not at the moment. It is crucial to emphasize that our findings
some possible implications for causal mechanisms. On the other do not contribute to the debate on the risks and benefits of group
hand, several stringent tests are required before causal inferences day care, because our sample included so few young children
are justified (Rutter, 2006b; Shadish, Cook, & Campbell, 2002; receiving it. The NMC almost always involved care by either a
Susser, Schwartz, Morabia, & Bromet, 2006). Thus, longitudinal relative or nonrelative, such care being in either the child’s own
data should show that the risk factor preceded the outcome being home or some other place (almost always the home of the NMC
studied, the possibility of social selection (i.e., the allocation bias caregiver). Our study was not powered to examine the effects of
created by variables associated with the outcome influencing risk these variations, but no strong effects of either place or relative/
exposure) should be thoroughly investigated and shown not to nonrelative were found.
CHILD CARE AND FAMILY RISK 167

LIMITATIONS AND CONCLUSIONS Clarke-Stewart, K., & Allhusen, V. D. (2002). Nonparental caregiving. In
M. H. Bornstein (Ed.), Handbook of parenting: Vol. 3. Being and
The study has several important strengths, including longitudi- becoming a parent (2nd ed., pp. 215–252). Mahwah, NJ: Erlbaum.
nal data with risk factors preceding the outcomes being studied, a Cochran, W. G., & Chambers, S. P. (1965). The planning of observational
representative sample, a thorough investigation of the possibility studies of human populations. Journal of the Royal Statistical Society,
of social selection, and consideration of the associations with two Series A (General), 128, 234 –266.
distinct outcomes. The study also has limitations. First, we have Cohen, J. (1988). Statistical power analysis for the behavioral sciences
already noted that no independent measures of the quality of NMC (2nd ed.). Hillsdale, NJ: Erlbaum.
and MC were available. Second, the outcomes studied were mea- Cook, T. D. (2004). Beyond advocacy: Putting history and research on
sured at a single point in time. Future studies should rely on longer research into debates about the merits of social experiments. SRCD
term measures covering both school and home contexts. Third, it Social Policy Report, 18, 5– 6.
Côté, S. M., Boivin, M., Nagin, D. S., Japel, C., Xu, Q., Zoccolillo, M., &
cannot be assumed that the findings will generalize to populations
Tremblay, R. E. (2007). The role of maternal education and non-
in which the quality of NMC differs from that available in Canada
maternal care services in the prevention of children’s physical aggres-
or in which social selection factors operate quite differently with sion. Archives of General Psychiatry, 64, 1305–1312.
respect to the choice of care in the 1st year of life. Finally, our use Côté, S., Vaillancourt, T., LeBlanc, J. C., Nagin, D., & Tremblay, R. E.
of a composite family risk index based on empirical findings (2006). The development of physical aggression during childhood: A
(Burchinal et al., 2000) provided the most appropriate approach for nation wide longitudinal study of Canadian children. The Journal of
the study of moderating effects and it avoided the problems asso- Abnormal Child Psychology,34, 71– 85.
ciated with the intercorrelations among risk variables. Neverthe- Cottingham, P. (2004). Why we need more, not fewer, gold standard
less, it inevitably meant a loss of information on the effects of evaluations. SRCD Social Policy Report, 18, 13.
individual variables that might operate in different ways. In addi- Crockenberg, S., & Litman, C. (1991). Effects of maternal employment on
tion, although the use of a family risk index best reflects the global maternal and two-year-old child behavior. Child Development, 62, 930 –
level of risk in the family, it also has restricted value for targeting, 953.
Dionne, G., Tremblay, R. E., Boivin, M., Laplante, D., & Pérusse, D.
for policy purposes, the families that may benefit or experience
(2003). Physical aggression and expressive vocabulary in 19-month-old
detrimental effects of NMC.
twins. Developmental Psychology, 39, 261–273.
In sum, the findings indicate the importance of considering the Egeland, B., & Heister, M. (1995). The long-term consequences of infant
moderating role of the family context and child characteristics in day care and mother–infant attachment. Child Development, 66, 74 – 85.
the associations between NMC/MC and emotional/behavioral dis- Erel, O., Oberman, Y., & Yirmiya, N. (2000). Maternal versus nonmaternal
turbances at 4 years old. In particular, the results show that NMC care and seven domains of children’s development. Psychological Bul-
may have opposite effects according to family risk background. letin, 126, 727–747.
Geoffroy, M.-C., Côté, S. M., Borge, A. I. H., Larouche, F., Séguin, J. R.,
References & Rutter, M. (2007). Association between nonmaternal care in the first
Bates, J. E. (1987). Temperament in infancy. In J. D. Osofsky (Ed.), year of life and children’s receptive language skills prior to school entry:
Handbook of infant development (2nd ed.) (pp. 1101–1149). New York: The moderating role of socioeconomic status. Journal of Child Psychol-
Wiley. ogy and Psychiatry, 48, 490 – 497.
Belsky, J. (1988). Infant day care and socioemotional development: The Greenstein, T. (1993). Maternal employment and child behavioral out-
United States. Journal of Child Psychology and Psychiatry and Allied comes: A household economics analysis. Journal of Family Issues, 14,
Disciplines, 29, 397– 406. 323–354.
Belsky, J. (1990). Infant day care, child development, and family policy. Hammen, C. (2003). Risks and protective factors for children of depressed
Society, 27, 10 –11. parents. In S. S. Luthar (Ed.), Resilience and vulnerability: Adaptation
Belsky, J., & Rovine, M. J. (1988). Nonmaternal care in the first year of life on the context of childhood (pp. 50 –78). Cambridge, England: Cam-
and the security of infant–parent attachment. Child Development, 59, bridge University Press.
157–167. Han, W., Waldfogel, J., & Brooks-Gunn, J. (2001). The effects of early
Borge, A. I., Rutter, M., Côté, S., & Tremblay, R. E. (2004). Early child maternal employment on later cognitive and behavioral outcomes. Jour-
care and physical aggression: Differentiating social selection and social nal of Marriage and the Family, 63, 336 –354.
causation. Journal of Child Psychology and Psychiatry, 45, 367–376. Harvey, E. (1999). Short-term and long-term effects of early parental
Boyle, M. H., Offord, D. R., Hofman, H. E., Catlin, G. P., Byles, J. A., employment on children of the National Longitudinal Survey of Youth.
Cadman, D. T., et al. (1987). Ontario child health study: I. Methodology. Developmental Psychology, 35, 445– 459.
Archives of General Psychiatry, 44, 826 – 831. Haskins, R. (1985). Public school aggression among children with varying
Brooks-Gunn, J. (2004). Don’t throw out the baby with the bathwater: day-care experience. Child Development, 56, 689 –703.
Incorporating behavioral research into evaluations. SRCD Social Policy Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis.
Report, 18, 14 –15. New York: Academic Press.
Burchinal, M. R., Roberts, J. E., Hooper, S., & Zeisel, S. A. (2000). Human Resources Development Canada & Statistics Canada (Eds.).
Cumulative risk and early cognitive development: A comparison of (1996). Growing up in Canada: National Longitudinal Survey of Chil-
statistical risk models. Developmental Psychology, 36, 793– 807. dren and Youth. Ottawa, Ontario, Canada: Statistics Canada.
Caughy, M. Q., DiPietro, J. A., & Strobino, D. M. (1994). Day-care Jaffee, S. R., Caspi, A., Moffitt, T. E., Belsky, J., & Silva, P. (2001). Why
participation as a protective factor in the cognitive development of are children born to teen mothers at risk for adverse outcomes in young
low-income children. Child Development, 65, 457– 471. adulthood. Development and Psychopathology, 13, 377–397.
Clarke-Stewart, A. K., Allhusen, V. D., & Clements, D. C. (1995). Non- Japel, C., Côté, S., & Tremblay, R. E. (2005). The quality of preschool
parental caregiving. In M. H. Bornstein (Ed.), Handbook of parenting: services: Results from the Quebec Longitudinal Study of Child Devel-
Vol. 3. Being and becoming a parent (pp. 151–176). Mahwah, NJ: opment (QLSCD). Montreal, Quebec, Canada: Institute for Research in
Erlbaum. Public Policy.
168 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY

Kim-Cohen, J., Moffitt, T. E., Taylor, A., Pawlby, S. J., & Caspi, A. Pierrehumbert, B., Ramstein, T., Karmaniola, A., & Halfon, O. (1996).
(2005). Maternal depression and children’s antisocial behavior: Nature Child care in the preschool years: Attachment, behavior problems and
and nurture effects. Archives of General Psychiatry, 62, 173–181. cognitive development. European Journal of Psychology of Education,
Lamb, M. E., & Sternberg, K. J. (1990). Do we really know how day care 11, 201–214.
affects children? Journal of Applied Developmental Psychology, 11, Prodromidis, M., Lamb, M. E., Sternberg, K. J., Hwang, C. P., & Broberg,
351–379. A. G. (1995). Aggression and noncompliance among Swedish children
Lemay, D. P., Lefebvre, P., & Merrigan, P. (2002, May). L’effet de la in centre based care, family day care and home care. International
politique québécoise de garde à 5 dollars sur les heures de garde, les Journal of Behavioral Development, 18, 23– 43.
heures travaillées et la participation des mères au marché du travail Radloff, S. L. (1977). The CES-D Scale: A self-report depression scale for
[The impact of the Québec 5$ child care service policy on child care use research in the general population. Applied Psychological Measurement,
and labour participation]. Paper presented at the 42nd Annual Congress 1, 385– 401.
of the Canadian Society for Economic Science, Aylmer, Ontario, Can- Repetti, R. L., Taylor, S. E., & Seeman, S. E. (2002). Risky families:
ada. Family social environments and the mental and physical health of
Loeb, S., Fuller, B., Kagan, S. L., & Carrol, B. (2004). Child care in poor offspring. Psychological Bulletin, 128, 330 –366.
communities: Early learning effects of type, quality, and stability. Child Rutter, M. (2006a). Genes and behaviors: Nature–nurture interplay ex-
Development, 75, 47– 65. plained. Oxford, England: Blackwell.
Maccoby, E. (1998). The two sexes: Growing up apart coming together. Rutter, M. (2006b). Proceeding from correlation to causal inference: The
Cambridge, MA: Harvard University Press. use of natural experiments. Manuscript submitted for publication.
McCall, R. B. (2004). On randomized trials and bathwater: A response to Rutter, M., Moffitt, T. E., & Caspi, A. (2006). Gene– environment interplay
Cottingham and Brooks-Gunn. SRCD Social Policy Report, 18, 16. and psychopathology: Multiple varieties but real effects. Journal of
McCartney, K., Scarr, S., Phillips, D., Grajik, S., & Schwarz, C. (1982). Child Psychology and Psychiatry, 47, 226 –261.
Environmental differences among day care centers and their effects on Rutter, M., Pickles, A., Murray, R., & Eaves, L. (2001). Testing hypotheses
children’s development. In E. Zigler & E. Gordon (Eds.), Day care: on specific environmental causal effects on behavior. Psychological
Scientific and social policy issues (pp. 126 –151). Boston: Auburn Bulletin, 127, 291–324.
House. Sameroff, A. J., Seifer, R., Baldwin, A., & Baldwin, C. (1993). Stability of
Nagin, D. S., & Tremblay, R. E. (2001). Parental and early childhood intelligence from preschool to adolescence: The influence of social and
predictors of persistent physical aggression in boys from kindergarten to family risk factors. Child Development, 64, 80 –97.
high school. Archives of General Psychiatry, 58, 389 –394. Scarr, S., & Thompson, W. (1994). Effects of maternal employment and
National Research Council and Institute for Medicine. (2000). From neu- nonmaternal infant care on development at two and four years. Early
rons to neighborhoods: The science of child development. Washington, Development and Parenting, 3, 113–123.
DC: National Academy of Science Press. Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and
NICHD & Duncan, G. J. (2003). Modeling the impact of child care quality quasi-experimental designs for generalized causal inference. Boston:
on children’s preschool cognitive development. Child Development, 74, Houghton Mifflin.
1454 –1475. Shpancer, N. (2002). The home– daycare link: Mapping children’s new
NICHD Early Child Care Research Network. (1997). The effects of infant world order. Early Childhood Research Quarterly, 17, 374 –392.
child care on infant–mother attachment security: Results of the NICHD Statistics Canada. (1994 –1995). National Longitudinal Survey of Children
study of early child care. Child Development, 68, 860 – 879. and Youth. Retrieved October 15, 2007, from http://www.statcan.ca/
NICHD Early Child Care Research Network. (1998). Early child care and english/Dli/Data/Ftp/nlscy.htm
self-control, compliance and problem behavior at twenty-four and thirty- Statistics Canada and Human Resources Development Canada. (1995).
six months. Child Development, 69, 1145–1170. National longitudinal survey of children: Overview of survey instru-
NICHD Early Child Care Research Network. (2002). Early child care and ments for 1994 –1995, data collection, Cycle 1 [Catalogue No. 95– 02].
children’s development prior to school entry: Results from the NICHD Ottawa, Ontario, Canada: Minister of Industry.
study of early child care. American Educational Research Journal, 39, Susser, E., Schwartz, S., Morabia, A., & Bromet, E. J. (2006). Psychiatric
133–164. epidemiology: Searching for the causes of mental disorders. Oxford,
NICHD Early Child Care Research Network. (2003). Does amount of time England: Oxford University Press.
spent in child care predict socioemotional adjustment during the transi- Tremblay, R. E., Nagin, D. S., Séguin, J. R., Zoccolillo, M., Zelazo, P. D.,
tion to kindergarten? Child Development, 74, 976 –1005. Boivin, M., et al. (2004). Physical aggression during early childhood:
NICHD Early Child Care Research Network. (2004). Trajectories of phys- Trajectories and predictors. Pediatrics, 114, e43– e50.
ical aggression from toddlerhood to middle childhood. Monographs of Willms, D. J., & Shields, M. (1996). A measure of socioeconomic status for
the Society for Research on Child Development, 69(4, Serial no. 278). the national longitudinal study of children (Report No. 9607). Frederic-
NICHD Early Child Care Research Network. (2005). Child care and child ton, New Brunswick, Canada: Atlantic Center for Policy Research in
development: Results from the NICHD Study of Early Child Care and Education, University of New Brunswick and Statistics Canada.
Youth Development. New York: Guilford Press.
Pagani, L., Boulerice, B., Tremblay, R. E., & Vitaro, F. (1997). Behav- Received July 27, 2004
ioural development in children of divorce and remarriage. Journal of Revision received November 6, 2006
Child Psychology and Psychiatry, 38, 769 –781. Accepted November 10, 2006 䡲