research articles about infants

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here .

Loading metrics

Open Access

Peer-reviewed

Research Article

Infants Learn What They Want to Learn: Responding to Infant Pointing Leads to Superior Learning

* E-mail: [email protected]

Affiliation Centre for Brain and Cognitive Development, Birkbeck College, University of London, London, United Kingdom

• Katarina Begus, 
• Teodora Gliga, 
• Victoria Southgate

• Published: October 7, 2014
• https://doi.org/10.1371/journal.pone.0108817
• Reader Comments

The majority of current developmental models prioritise a pedagogical approach to knowledge acquisition in infancy, in which infants play a relatively passive role as recipients of information. In view of recent evidence, demonstrating that infants use pointing to express interest and solicit information from adults, we set out to test whether giving the child the leading role in deciding what information to receive leads to better learning. Sixteen-month-olds were introduced to pairs of novel objects and, once they had pointed to an object, were shown a function for either the object they had chosen, or the object they had ignored. Ten minutes later, infants replicated the functions of chosen objects significantly more than those of un-chosen objects, despite having been equally visually attentive during demonstrations on both types of objects. These results show that offering information in response to infants’ communicative gestures leads to superior learning (Experiment 1) and that this difference in performance is due to learning being facilitated when infants’ pointing was responded to, not hindered when their pointing was ignored (Experiment 2), highlighting the importance of infants’ own active engagement in acquiring information.

Citation: Begus K, Gliga T, Southgate V (2014) Infants Learn What They Want to Learn: Responding to Infant Pointing Leads to Superior Learning. PLoS ONE 9(10): e108817. https://doi.org/10.1371/journal.pone.0108817

Editor: Juliane Kaminski, University of Portsmouth, United Kingdom

Received: May 14, 2014; Accepted: August 27, 2014; Published: October 7, 2014

Copyright: © 2014 Begus et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.

Funding: The authors have no funding or support to report.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The majority of current developmental models prioritise a pedagogical approach to knowledge acquisition in infancy. According to this approach, infants are on the receptive side of the pedagogical exchange, having evolved mechanisms enabling them to identify when and what adults intend for them to learn [1] [2] . Taking the leading role in learning, knowledgeable adults ensure efficient transmission of vast amounts of culturally relevant information. However, while infants appear to be well equipped to learn from adults’ teaching, and sometimes indiscriminately acquire information accompanied by ostensive cues [3] [4] , it is increasingly clear that infants play a more active and solicitous role in their learning. For example, infants are selective in what they attend to [5] and in whose gaze they follow [6] , as well as whose actions they imitate [7] , all of which are likely to be important mechanisms in the process of cultural learning. Even during infancy, adult-led learning may not always be the optimum strategy, especially in situations where exploration and innovation are required [8] .

Recent work suggests not only that infants are selective recipients, but that they also have means of actively expressing interest, eliciting communication and soliciting information, even prior to the emergence of explicit verbal questioning. Early pointing is one such means by which infants elicit information from adults. Studies have shown infants’ pointing gestures perform the function of provoking adults to comment on the referent [9] and they do so more efficiently than object-directed babbling [10] . Begus and Southgate [11] recently demonstrated that 16-month-old infants are motivated to point because they expect others to provide them with information about the referents of their gestures. In the latter study, the amount of pointing depended on an experimenter’s perceived competence to provide infants with information. Specifically, infants pointed significantly less towards novel objects when the experimenter had previously shown themselves to be unknowledgeable (i.e. had mislabeled common objects) than when the experimenter was either demonstrably knowledgeable, or the infant had no evidence of the experimenter’s competence. Infants were equally willing to interact with the experimenter irrespective of her competence, and thus it was concluded that infants expect their pointing to be responded to with reliable information, and use it only when they perceive their expectations can be met.

In adults, much work exists, which demonstrates a relationship between epistemic interest and learning, with desired information being more likely to be assimilated (e.g. [12] ). While there has been no direct test of the existence of the same relationship early in life, there is some indirect evidence that infant learning might also be driven by interest. For example, there is a positive relationship between amount of pointing and vocabulary growth [13] and it has also been shown that it is the referents of infants’ points, which the caregiver likely names in response [9] , that are most likely to enter the child’s vocabulary [14] . These data could be interpreted as suggesting that infants are more likely to learn the labels of referents about which they had expressed their interest in through pointing. In the current study, we aimed to directly test the hypothesis that infants will better assimilate information that is provided in response to their expressions of interest, than information that is provided in the absence of any expression of interest by the infant. Specifically, we asked whether 16-month-old infants would show superior learning when they were provided with information about a referent which they had expressed their interest in through pointing.

Ethics Statement

All participants were recruited from a database of infants whose parents had volunteered to participate in infant studies at Centre for Brain and Cognitive Development, Birkbeck College, University of London. Written informed consent was obtained from the infants’ caregiver before the experiment was conducted. The procedure was approved by the ethics committee of the Department of Psychological Sciences, Birkbeck College, University of London.

Participants

Fifty 16-month-olds (20 female, range 15.2–16.2 months) participated in the study. Infants were randomly assigned to either Experiment 1 ( N  = 16) or one of the two conditions of Experiment 2 ( N  = 17 each). An additional 14 infants (8 from Experiment 1 and 6 from Experiment 2) were tested but excluded from analysis due to parental interference (4), fussiness (4), equipment failure (3) and absence of pointing (3). Because the aim of the study was to establish how responding to infants’ pointing affects their learning, only infants, who pointed at least twice during the experiment, were included in the final sample. This criterion did not apply to No Choice condition of Experiment 2.

Experiment 1

Teaching phase . Infants were presented with 4 pairs of novel objects ( Fig. 1a ) held at a distance until the infant pointed to one of the objects ( Fig. 1b ). Once infants had made their choice, the experimenter demonstrated an action either with the object the infant had chosen ( Chosen condition, 2 trials) or with the un-chosen object ( Unchosen condition, 2 trials), while the other object was removed from view. Each action was demonstrated a single time, with the experimenter announcing the demonstration and commenting on the action (i.e. “Let me show you how it works! Look, I can brush my hair with it!” ). After the demonstration, the object was removed without the infant handling it.

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

(a) Photographs of the 8 novel objects used in the study. (b) Schematic representation of the experimental scene.

https://doi.org/10.1371/journal.pone.0108817.g001

Infants saw the same 4 actions demonstrated regardless of which object they chose. Which action was performed with which object, whether an action was performed on a chosen or un-chosen object, and whether the infant first saw a demonstration on a chosen or un-chosen object, was counterbalanced across 4 conditions (see Table S1 ). In order to ensure equal cognitive load, an action was demonstrated even if an infant did not point to either of the objects (which occurred on 2 trials in Chosen and 1 in Unchosen condition), however these trials were not included in further analysis.

Testing phase. After a 10 minute break, infants were handed each of the previously acted upon objects individually and were prompted to perform the previously demonstrated actions (i.e. “Can you show me how it works?” ). The first 60 seconds of each trial was analysed for correctly replicated actions and other infant behaviour.

Data analysis.

All trials, in which the infants have touched the object in the test phase, were included in the analyses. Number of trials, in which the infant refused to interact with the object for 60 seconds and were terminated earlier, did not differ between conditions ( N(Chosen)  = 10, N(Unchosen)  = 11; Mann-Whitney U , z  = 0.162; p  = 0.871). Data was coded from video recordings of the testing sessions by 2 independent coders, one of whom was naïve to the experimental hypothesis. An action was scored as correctly replicated if both coders agreed the infant had performed the target action. Trials in which no target or an incorrect target action was performed were scored as incorrect. Infants had to contribute one trial of each condition ( Chosen and Unchosen ) to be included in the final sample (11 infants contributed 4 trials; 4 contributed 3 trials; and 1 contributed 2 trials).

Non-parametric tests, comparing average proportions of correctly replicated actions across infants, revealed that infants replicated significantly more of the actions demonstrated on objects they had pointed to ( M  = 40.6%, a total of 13 actions across infants) than actions demonstrated on the objects they had not pointed to ( M  = 12.5%, a total of 4 actions across infants) [ Related-Samples Friedman’s Two-Way Analysis of Variance by Ranks , χ 2 ( 2 )  =  4.455, p =  0.035, two-tailed].

In order to rule out that infants learned less about the Unchosen objects because they were attending less, we measured the time infants visually attended to the demonstrations (as a proportion of the total demonstration time), which revealed no significant difference between the conditions (time attending to demonstrations in Chosen : M  = 98.9% and Unchosen condition: M  = 97.0%; t ( 55 ) = 1.605; p  = 0.114). In addition, on trials when the correct actions were not replicated, infants were equally willing to explore both Chosen and Unchosen objects in the test phase (time spent handling Chosen : M  = 46.89 sec and Unchosen objects: M  = 42.82 sec; t ( 38 ) = 0.898; p  = 0.374). This suggests the number of replicated actions in Unchosen condition did not result from them having less visual exposure during demonstrations or less opportunities to demonstrate their knowledge during test.

Furthermore, due to the fact that the experimenter could not be blind to infants’ choice, we took some additional measures to ensure the experimenter’s behavior did not differ between conditions, which could have affected infants’ learning. We found no effect of condition on any of the measures which included the number of times, during demonstration, the experimenter a) attempted to get the infant’s attention, b) positively commented on the object/action, c) provided information; as well as d) prosody of the experimenter’s speech and e) duration of the demonstrations (see Table S2 online for statistical details).

Finally, an analysis of number of times each object was chosen confirmed that objects were distributed similarly in the Chosen and Unchosen conditions (Chi-Square comparisons for each pair: χ 2  = 0.6, p  = 0.439; χ 2  = 1.0, p  = 0.317; χ 2  = 1.923, p  = 0.166; χ 2  = 0.692, p  = 0.405). Thus differences in learning performance cannot be explained by differences in the objects themselves.

Experiment 2

Although different rates of learning for Chosen and Unchosen objects suggest that responding to infants’ points affected their knowledge acquisition, it is unclear whether infants’ learning in Experiment 1 was facilitated when their pointing was responded to appropriately, or hindered when their pointing was ignored. To address this question, we ran Experiment 2, a between-subject control experiment, to establish how much infants learned when they did not have a choice in what they are taught ( No Choice condition) and compared it to learning when they are given a choice of objects, and all their choices are responded to ( Chosen Only condition). If the experimenter’s failure to respond to infants’ pointing on Unchosen trials of Experiment 1 is responsible for infants’ comparatively inferior learning, we should expect no difference in learning between No Choice and Chosen Only conditions, since neither involve trials in which the experimenter ignores infants’ points. However, if the provision of information in response to infants’ points on Chosen trials facilitates learning, we would expect infants to learn more of the object functions in the Chosen Only than in the No Choice condition.

The procedure was identical to Experiment 1 except that in the Chosen Only condition, the experimenter always responded to infants’ points by demonstrating an action on the object the infant had chosen, and in the No Choice condition, instead of being presented with pairs of objects, infants were presented with single objects and subsequent demonstrations of their functions. Only infants who contributed the minimum of 2 trials were included in the final sample (29 infants contributed 4 trials, 4 contributed 3 trials, and 1 contributed 2 trials).

To ensure the conditions of Experiment 2 were equally engaging and demanding for infants, the two conditions were closely matched in all measures of the experimenter’s behaviour analysed in Experiment 1, as well as in the amount of time infants saw the objects before the demonstrations (see Table S2 online for statistical details). Number of trials, in which the infant refused to interact with the object for 60 seconds and were terminated earlier, did not differ between conditions ( N(Chosen Only)  = 10, N(No Choice)  = 15; Mann-Whitney U , z  = 0.635; p  = 0.526).

When presented with single objects and their functions ( No Choice ), infants on average correctly replicated 12.2% (total of 8 actions across all infants) of all demonstrated functions, which was significantly lower than the average of 26.0% (total of 16 actions across all infants) of correctly replicated actions in the Chosen Only condition ( Mann-Whitney U Test , z = 1.759 , p = 0.039 , 1-tailed). The total number of replicated actions in the Chosen Only condition (16 across all infants) is similar to the total number or replicated actions in the Chosen condition of Experiment 1 (13 across all infants). Furthermore, the total number of replicated actions in the No Choice condition (8 across all infants) is similar to the total number of replicated actions in the Unchosen condition of Experiment 1 (4 across all infants).

As in Experiment 1, measures of attention during the demonstrations and time spent handling objects during the Testing phase revealed no differences between the two conditions of Experiment 2, ruling out visual exposure or lack of opportunity to demonstrate knowledge as an explanation of the found result (see Table S2 online for statistical details).

Previous work has shown a positive relationship between amount of pointing, and vocabulary growth [13] in infancy, but left unanswered the question about the mechanisms driving the relationship between gestures and learning. Our finding that 16-month-old infants replicated significantly more of the actions previously demonstrated on objects they had pointed to, than actions demonstrated on objects they had not pointed to, provides the first direct evidence that responding to infants’ gestures with appropriate information results in superior learning.

While infants’ learning was affected by whether they received information about the object they had pointed to, no other measure of behavior revealed any differences between conditions. Infants visually attended to the demonstrations equally, regardless of which object was demonstrated, and were equally willing to handle all objects. All demonstrations, regardless of condition, were equally rich in pedagogical cues (i.e. ostensive cues like mutual gaze, infant-directed speech), suggesting that the presence of ostensive cues alone was not sufficient for learning in this paradigm. Previous research has revealed that information received contingently with other infant behavior, like object-directed babbling, is learned better than information received non-contingently [15] , [16] and that individual differences in parental responsiveness to infant vocalizations are reliably related to language outcomes [16] . However it remained unknown what mechanisms mediated this relationship and whether following-in on a child’s attention has a beneficial effect, or whether redirecting infants’ attention has a detrimental effect on learning. Our control Experiment 2 provides a first step towards answering this question, demonstrating that it was not the fact that the experimenter ignored infants’ pointing in the Unchosen trials that drove the effect in Experiment 1, but rather it is something about the situation in which infants’ pointing is appropriately responded to, that drives superior learning.

What mechanisms might mediate the relationship between pointing and learning? One possibility is that the act of making a choice is itself a factor, as suggested by findings that having a choice in the stimuli to be learned increases the learners’ perception of control and consequently enhances motivation and learning performance [18] . An alternative possibility is that what drove the superior learning in our paradigm was the same drive that motivated infants to point in the first place, namely interest. It is well established that, in adults, a positive relationship exists between interest and learning. Epistemic curiosity, as a trait, can explain individual differences in academic achievement [19] , and experimental manipulations have demonstrated that degree of interest or motivation for receiving particular information determines whether that information is subsequently retained [12] [20] . For example, in Kang et al. [12] , self-reported curiosity about a particular piece of information correlated with its recall 1 to 2 weeks later. We propose that a similar relationship between interest and learning may exist early in life, that interest can be expressed through pointing, and that responding to these expressions of interest plays an important role in infant learning.

Some of the earliest accounts of infant pointing suggested that the initial function of pointing is to focus infants’ own attention on interesting events [17] . Several studies since have shown that infants also use pointing to communicate their interest to others [21] . While there is still debate on what motivates infants to share their interest with others, we believe the current findings, that infants learn better when they receive information in response to their pointing, provides further evidence that one of the reasons infants express their interest is in order to obtain information about the object of interest, and that, when doing so, they may be in an optimal state for assimilating information.

However, while we believe that existing data support the conclusion that pointing is both interrogative (i.e. used to gain information, [11] ) and communicative (i.e. aimed at others as information sources), it is ultimately not possible to know exactly what motivated infant pointing in this particular paradigm. Nonetheless, our conclusion, that there exists a relationship between expressions of interest and learning, even early in life, still holds even if infants were merely requesting the object that they were more interested in, and were not requesting information per se, as both kinds of pointing are motivated by interest. Regardless of what motivated infants’ pointing in this experiment, our data suggest that the extent to which infants learn information in everyday life depends, in part, on the extent to which caregivers both detect and appropriately respond to infants’ expressions of interest, such as pointing. Understanding the factors involved in learning in infancy, and the potential importance of caregiver responsiveness, may be especially relevant in situations where infants are competing for caregiver’s attention, such as in a nursery or kindergarten setting.

By presenting the first direct evidence that responding to infants’ communicative gestures affects their knowledge acquisition, we hope to open new opportunities for the study of learning in preverbal infants, with the focus on infants’ own active engagement in acquiring information.

Supporting Information

https://doi.org/10.1371/journal.pone.0108817.s001

Additional Analysis.

https://doi.org/10.1371/journal.pone.0108817.s002

Author Contributions

Conceived and designed the experiments: KB TG VS. Performed the experiments: KB. Analyzed the data: KB. Contributed reagents/materials/analysis tools: KB. Contributed to the writing of the manuscript: KB TG VS.

• View Article
• Google Scholar
• 10. Wu Z, Gros-Luis J (2014) Caregivers provide more labeling responses to infants’ pointing than to infants’ object-directed vocalizations. J Child Lang.

InBrief: The Science of Early Childhood Development

This brief is part of a series that summarizes essential scientific findings from Center publications.

Content in This Guide

Step 1: why is early childhood important.

• : Brain Hero
• : The Science of ECD (Video)
• You Are Here: The Science of ECD (Text)

Step 2: How Does Early Child Development Happen?

• : 3 Core Concepts in Early Development
• : 8 Things to Remember about Child Development
• : InBrief: The Science of Resilience

Step 3: What Can We Do to Support Child Development?

• : From Best Practices to Breakthrough Impacts
• : 3 Principles to Improve Outcomes

The science of early brain development can inform investments in early childhood. These basic concepts, established over decades of neuroscience and behavioral research, help illustrate why child development—particularly from birth to five years—is a foundation for a prosperous and sustainable society.

Brains are built over time, from the bottom up.

The basic architecture of the brain is constructed through an ongoing process that begins before birth and continues into adulthood. Early experiences affect the quality of that architecture by establishing either a sturdy or a fragile foundation for all of the learning, health and behavior that follow. In the first few years of life, more than 1 million new neural connections are formed every second . After this period of rapid proliferation, connections are reduced through a process called pruning, so that brain circuits become more efficient. Sensory pathways like those for basic vision and hearing are the first to develop, followed by early language skills and higher cognitive functions. Connections proliferate and prune in a prescribed order, with later, more complex brain circuits built upon earlier, simpler circuits.

The interactive influences of genes and experience shape the developing brain.

Scientists now know a major ingredient in this developmental process is the “ serve and return ” relationship between children and their parents and other caregivers in the family or community. Young children naturally reach out for interaction through babbling, facial expressions, and gestures, and adults respond with the same kind of vocalizing and gesturing back at them. In the absence of such responses—or if the responses are unreliable or inappropriate—the brain’s architecture does not form as expected, which can lead to disparities in learning and behavior.

The brain’s capacity for change decreases with age.

The brain is most flexible, or “plastic,” early in life to accommodate a wide range of environments and interactions, but as the maturing brain becomes more specialized to assume more complex functions, it is less capable of reorganizing and adapting to new or unexpected challenges. For example, by the first year, the parts of the brain that differentiate sound are becoming specialized to the language the baby has been exposed to; at the same time, the brain is already starting to lose the ability to recognize different sounds found in other languages. Although the “windows” for language learning and other skills remain open, these brain circuits become increasingly difficult to alter over time. Early plasticity means it’s easier and more effective to influence a baby’s developing brain architecture than to rewire parts of its circuitry in the adult years.

Cognitive, emotional, and social capacities are inextricably intertwined throughout the life course.

The brain is a highly interrelated organ, and its multiple functions operate in a richly coordinated fashion. Emotional well-being and social competence provide a strong foundation for emerging cognitive abilities, and together they are the bricks and mortar that comprise the foundation of human development. The emotional and physical health, social skills, and cognitive-linguistic capacities that emerge in the early years are all important prerequisites for success in school and later in the workplace and community.

Toxic stress damages developing brain architecture, which can lead to lifelong problems in learning, behavior, and physical and mental health.

Scientists now know that chronic, unrelenting stress in early childhood, caused by extreme poverty, repeated abuse, or severe maternal depression, for example, can be toxic to the developing brain. While positive stress (moderate, short-lived physiological responses to uncomfortable experiences) is an important and necessary aspect of healthy development, toxic stress is the strong, unrelieved activation of the body’s stress management system. In the absence of the buffering protection of adult support, toxic stress becomes built into the body by processes that shape the architecture of the developing brain.

Policy Implications

• The basic principles of neuroscience indicate that early preventive intervention will be more efficient and produce more favorable outcomes than remediation later in life.
• A balanced approach to emotional, social, cognitive, and language development will best prepare all children for success in school and later in the workplace and community.
• Supportive relationships and positive learning experiences begin at home but can also be provided through a range of services with proven effectiveness factors. Babies’ brains require stable, caring, interactive relationships with adults — any way or any place they can be provided will benefit healthy brain development.
• Science clearly demonstrates that, in situations where toxic stress is likely, intervening as early as possible is critical to achieving the best outcomes. For children experiencing toxic stress, specialized early interventions are needed to target the cause of the stress and protect the child from its consequences.

Suggested citation: Center on the Developing Child (2007). The Science of Early Childhood Development (InBrief). Retrieved from www.developingchild.harvard.edu .

Related Topics: toxic stress , brain architecture , serve and return

Explore related resources.

• Reports & Working Papers
• Tools & Guides
• Presentations
• Infographics

Videos : Serve & Return Interaction Shapes Brain Circuitry

Reports & Working Papers : From Best Practices to Breakthrough Impacts

Briefs : InBrief: The Science of Neglect

Videos : InBrief: The Science of Neglect

Reports & Working Papers : The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain

Reports & Working Papers : Young Children Develop in an Environment of Relationships

Tools & Guides , Briefs : 5 Steps for Brain-Building Serve and Return

Briefs : 8 Things to Remember about Child Development

Partner Resources : Building Babies’ Brains Through Play: Mini Parenting Master Class

Podcasts : About The Brain Architects Podcast

Videos : FIND: Using Science to Coach Caregivers

Videos : How-to: 5 Steps for Brain-Building Serve and Return

Briefs : How to Support Children (and Yourself) During the COVID-19 Outbreak

Videos : InBrief: The Science of Early Childhood Development

Partner Resources , Tools & Guides : MOOC: The Best Start in Life: Early Childhood Development for Sustainable Development

Presentations : Parenting for Brain Development and Prosperity

Videos : Play in Early Childhood: The Role of Play in Any Setting

Videos : Child Development Core Story

Videos : Science X Design: Three Principles to Improve Outcomes for Children

Podcasts : The Brain Architects Podcast: COVID-19 Special Edition: Self-Care Isn’t Selfish

Podcasts : The Brain Architects Podcast: Serve and Return: Supporting the Foundation

Videos : Three Core Concepts in Early Development

Reports & Working Papers : Three Principles to Improve Outcomes for Children and Families

Partner Resources , Tools & Guides : Training Module: “Talk With Me Baby”

Infographics : What Is COVID-19? And How Does It Relate to Child Development?

Partner Resources , Tools & Guides : Vroom

Infants and toddlers

Infants come into the world with cognitive, emotional, and social capacities that enable them to seek stimulation actively and regulate their own behavior through environmental interactions. They are able to integrate information across the senses, recognize their parents and other caregivers, imitate facial expressions, and manifest distress, contentment, and interest.

At around 18 months, language development and symbolic play enable toddlers to have complex negotiations with caregivers, develop true interactive play with peers, and develop moral emotions such as embarrassment and empathy and, a few months later, guilt, pride, and shame.

Adapted from the Encyclopedia of Psychology

Resources from APA

Nurturing children through grief with Elmo

New Sesame Workshop resources guided by psychological science help caregivers support children as they navigate the grieving process

Climate change and youth mental health: 2023 report

Impacts of climate change intersect with and compound other factors that threaten youth mental health, which is already precarious, according to the 2023 report from APA and ecoAmerica

Building biases in infancy: The influence of race on face and voice emotion matching

Researchers investigate whether infants’ ability to recognize emotions on faces is influenced by race and age

Who can speak that language? Eleven-month-old infants have language-dependent expectations regarding speaker ethnicity

Study reveals infants make connections between the faces they see and the language they hear

More resources about infants and toddlers

What APA is doing

Children, youth, and families

APA Services advocates for policies to prevent children’s exposure to violence and expand access to treatment and essential services for children who have experienced violence.

Children, youth, and families portfolio

The Children, Youth, and Families office aims to advance the creation, communication, and application of psychological knowledge on child development issues to benefit society and improve the lives of all children and their families.

Society for Child and Family Policy and Practice

APA’s Division 37 is committed to the application of psychological knowledge to advocacy, social justice, service delivery, and public policies affecting children, youth, and families in a diverse and inclusive society.

Society for Couple and Family Psychology

APA’s Division 43 provides a home for psychologists interested in families in their many forms. Clinical, scientific, educational, and public policy perspectives are well represented in the wide range of divisional activities.

Becoming a Calm Mom

Gender Typing of Children's Toys

The Science and Clinical Practice of Attachment Theory

Treating Infants and Young Children Impacted by Trauma

Magination Press children’s books

Sleepy Time

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Review Article
• Open access
• Published: 09 June 2022

The significance of infant research for psychoanalysis

• Wei Zhang   ORCID: orcid.org/0000-0001-8933-9788 1 ,
• Qi Pan 2 &
• Benyu Guo 3  

Humanities and Social Sciences Communications volume  9 , Article number:  194 ( 2022 ) Cite this article

8468 Accesses

2 Citations

4 Altmetric

Metrics details

Psychoanalysis and infant research have strengthened cooperation in the current interdisciplinary dialog. The theoretical significance of infant research for psychoanalysis includes the consideration of individual “sociality” from birth, as opposed to the traditional psychoanalytic hypothesis of the “autistic” infant; such research creates openness in existing psychoanalytic mental models. It can also provide reliable evidence for the early development of various abilities and childhood amnesia, support psychoanalysis beyond linear causality, and create a framework for the theoretical integration of psychoanalysis. Infant research for psychoanalysis may present evidence of the healing effect of analyst–client relationships, encourage analysts to prioritize nonverbal information during treatment, and create opportunities for new psychoanalytic therapy technologies.

Similar content being viewed by others

Similarities and differences in the functional architecture of mother- infant communication in rhesus macaque and British mother-infant dyads

Autism spectrum disorder

Integrating neuropsychological research on autism and psychosis to improve clinical outcomes

“marriage” of psychoanalysis and infant research.

Childhood is the most wonderful period in one’s life. The child then is a flower, a fruit, dim intelligence, an endless activity and a burst of strong desire. --Honoré de Balzac

Childhood plays a crucial role in the theory and practice of psychoanalysis. Sigmund Freud associated childhood trauma with the joys and sorrows of adults, arguing that childhood is a decisive factor in individual development and thus reveals human personalities and culture (Seligman, 2018 ). Almost all analysts Footnote 1 agree with Freud regarding childhood as a core issue of theory and practice. For example, for Virginia Ungar, “without the notion of the infantile, psychoanalysis simply would not exist” (Tanis, 2021 , p. 572). Some analysts have focused on the preoedipal phase Footnote 2 , believing that the preverbal infant determines the construction of adulthood development (Mitchell, 1988 ). Some terms in psychotherapy, such as the “family of origin” and the “child within,” are closely related to the tradition of psychoanalysis. Accordingly, many treatment techniques (e.g., the exploration and interpretation of transference, resistance, and defense) are based on this hypothesis (Lichtenberg, 2013 ).

Notably, research on infants in developmental psychology has not been paid adequate attention by analysts for a considerable time; however, several researchers (e.g., John Bowlby and René Spitz) have played a pioneering role in the dialog between the two fields. This kind of interdisciplinary communication increased in popularity in the 1970s and has been researched extensively since (Seligman, 2018 ). Today, infant research is an indispensable part of psychoanalysis. Scholars such as Daniel Stern, Louis Sander, Joseph Lichtenberg, Allan Schore, Beatrice Beebe, Frank Lachmann, and Peter Fonagy have effectively combined achievements across cognitive neuroscience, dynamic system theory, and other fields to create an in-depth interdisciplinary dialog of psychoanalysis.

Why is the “marriage” between the two fields so tortuous? An important reason is that developmental psychology emphasizes empirical research, whereas psychoanalysis focuses on the significance of subjective experiences (Fonagy, 2001 ). In this context, Stern’s ( 1998 ) distinction between the clinical infant and the observed infant is important. The clinical infant emerges from a co-construction of the analyst and the client--the materials presented by the client during treatment (e.g., dreams, free association, transference, and resistance), and the analyst’s interpretation. The “story” told by the client is not factually accurate as much as it is discovered and modified by the client and the analyst in tandem (Stern, 1998 ). While subjective experience (particularly fantasy/phantasy) is given great importance, the internal worlds of clinical infants can be described as “full of drama” by psychoanalysts. A prominent example is the baby conceived by Melanie Klein, who suffers from aggressive drives and destructive impulses; in the “tug of war” of paranoid–schizoid and depressive positions, he or she is afraid of the “bad breast,” close to the “good breast,” extremely disappointed in the “good and bad mother,” hates and seeks revenge on the mother, and takes the initiative to repair objects after regretful actions (Mitchell and Black, 1995 ). Consequently, this retrospective method verbalizes many “thoughts” for “speechless” babies (Canestri, 2021 ) and is highly speculative. Even when utilizing the same clinical materials, analysts with different theoretical backgrounds apply various techniques to obtain the life histories of their clients (Stern, 1998 ).

By contrast, the observed infant originates from researchers’ direct observations and descriptions of an individual’s early life, including infant limb movement, head-shaking, smiling, and crying. The observed infant is largely a collection of external observations (Stern, 1998 ). Lichtenberg ( 2013 ) regarded this method of studying infants as a “bottom-up” approach as opposed to the “top-down” model of the clinical infant (i.e., inferring infants from adults). Fewer components of speculation and construction and more consistent data across various researchers exist about the observed infant than the clinical infant, although researchers cannot obtain wholly neutral and objective observations according to “observance [is] permeated by theory” Footnote 3 (Hanson, 1958 ). However, the observed infant cannot live the subjective experience of infants; thus, revealing the psychological structure at a higher organizational level poses a challenge (Stern, 1998 ).

Despite these differences, the observed infant and the clinical infant can form a complementary relationship: the former provides the basis for theoretical construction, whereas the latter gives subjective life to the former. When analysts are more familiar with the observed infant, they can help their clients establish more appropriate life narratives. Conversely, infant researchers are more likely to discover new observational perspectives when they are more familiar with the clinical infant (Stern, 1998 ). This complementary view can be regarded as an organic combination of first- and third-person perspectives. However, as mentioned by Stephen Mitchell, some researchers refuse to contradict Freud and instead attempt to reconcile with his strategy by placing the modern baby (i.e., the observed infant) simply before Freud’s bestial baby Footnote 4 and then dividing the development process into two parts—the preoedipal and oedipal phases. In the preoedipal phase, individuals follow the developmental logic of the observed infant and strive to seek relations; in the oedipal phase and beyond, individuals follow the developmental path of the bestial baby and struggle with instinctive impulses and inner conflicts. Representative examples include the remolding of the ego by Hartmann, the remolding of the id by Jacobson and Kernberg, and the selective use of diagnosis by Kernberg, Kohut, Stolorow, and Lachman. However, this approach creates contradictions within the theory (Mitchell, 1988 ). Many contemporary analysts agree that an openness to the achievements of infant research, alongside the deft integration of the two fields, can facilitate the most effective psychoanalysis.

This article starts with the current infant research outcomes, elaborates on their theoretical and clinical significance for psychoanalysis, and promote the dialog and communication between the two fields.

Theoretical significance of infant research for psychoanalysis

Studies vary in focus, but infant research generally influences the theory of psychoanalysis in the following aspects.

First, infant research reveals that individuals are socialized from birth, instead of the traditional psychoanalytic hypothesis that babies are “autistic.” Both Freud’s “stimulus barrier” (Freud, 1920 ) and Mahler’s “normal autism” (Mahler et al., 2000 ) emphasize that the baby maintains a relatively isolated state from the outside world for about one month after birth. In their view, infants have no psychological ability to manage large numbers of external stimuli; thus, this autistic state protects them from harassment as they focus on their inner world. Meltzoff and Brooks ( 2007 ) referred to this view as “the myth of the asocial infant” (p. 150). However, infant research shows that babies have multiple abilities to adapt to the world from birth (even before birth) (Dornes, 1993/ 2018 ; Trevarthen, 2011 ). Consequently, individuals show great interest in the world shortly after birth and use various periods of “gap time” to learn and actively obtain stimulation to achieve growth (Palombo, 2013 ). Erikson even used the word “fierce” to describe the eager eyes of infants encountering the world. Briefly stated, this “stimulus barrier” or “normal autism” does not actually exist (Stern, 1998 ). Footnote 5

With their openness to the world, new babies are immediately connected with others. According to Winnicott ( 1964 ), “There is no such thing as a baby… A baby cannot exist alone, but is essentially part of a relationship” (p. 88), and according to Benjamin, for an infant, “I am who makes mommy smile; mommy is who makes me smile” (Magid and Shane, 2017 , p. 5). This perspective is supported by numerous infant researchers. Meltzoff, Trevarthen, and others indicated that babies interact with other humans by tongue extension, mouth opening, pouting, finger-pointing, smiling, and showing surprised expressions; further, they control these actions in time, form, and intensity within only a few hours after birth (Beebe et al., 2003 ). This innate ability to relate to others is called “primary intersubjectivity,” which can be realized without mastering language (Meltzoff and Brooks, 2007 ; Meltzoff et al., 1999 ; Trevarthen, 2011 ; Trevarthen and Aitken, 2001 ). Stern ( 1998 ) considered this type of matching as not merely an explicit behavior but rather one corresponding to affective states—that is, “affect attunement.” The infant can understand the internal emotional states of others and assess whether the states can be shared. With the maturation of the infant physiological function and the accumulation of parent–child interaction experience, secondary intersubjectivity has gradually developed (see Fig. 1 ). This ability involves a “person–person–object” game in which people share objects with one another (Trevarthen, 2011 ; Trevarthen and Aitken, 2001 ). In this process, if the baby starts using language, the process of sharing intentions in a dyadic interaction increases in complexity and diversity (Stern, 1998 ). On this basis, Beebe and Lachmann ( 2002 , 2014 , 2020 ) further found that infants experience interactive regulation with their mothers from birth, with expectation as the intermediary variable. At this point, even some one-person psychology-oriented analysts (i.e., those focusing on the intrapersonal rather than interpersonal dimension) in contemporary psychoanalysis use this dyadic view of infant research to modify their theoretical assumptions (Litowitz, 2021 ). In the words of Fonagy ( 2001 ), the sociality of infants has become a self-evident truth of developmental psychology.

a Top (several main transition periods from primary intersubjectivity to secondary Intersubjectivity). b Below (the alphabets A to G illustrate the specific performance of infants in motor coordination, perception and communication during these transitions).

Second, infant research provides a basis for openness in the psychoanalytic model of the mind. Freud repeatedly referred to the unconscious communication between two individuals as “telepathy” (Gerson, 2004 ); his descriptions of transference and countertransference also imply this kind of information transmission at the unconscious level. However, his mental model has no actual place for such a mode of communication because consciousness is the outer shell of contact with the outside world—information from the outside world must pass through consciousness to enter the unconscious. “In Freud’s concept, before material could be repressed, it had to be in the explicit domain, that is, in the preconscious or conscious domains” (BCPSG, 2007 , p. 13) Footnote 6 . In this way, the unconscious communication between different individuals cannot be explained. At this point, Stolorow et al.’s criticism of Freud’s mental model as a Cartesian “isolated mind” is understandable (Jaenicke, 2008 ; Stolorow et al., 2002 ). To a certain extent, Freud can be said to have “missed” the unconscious level of communication.

Unlike Freud’s ( 1917 ) conception, direct communication at the unconscious level does not replace phylogenetic evolution; instead, it is preserved as a very important form of interacting with others throughout one’s life. This approach is roughly equivalent to nonverbal communication in infant research (BCPSG, 2010 ; Beebe and Lachmann, 2020 ) and is supported by significant evidence, including the previously described matching and affect attunement. Correspondingly, what Sullivan ( 1953 ) calls “empathic linkage” and what Mitchell ( 2000 ) refers to as “affective permeability” result from emotional communication at the unconscious level. Some researchers call this “mind-to-mind communication” (de Peyer, 2016 ) or “right brain-to-right brain communication” (Schore, 2011 ). As is common in mother–child interactions, “Between infant and parent in the first year, there is a dance of right-brain-to-right-brain communication essential to optimal neural development and the achievement of secure attachment, affect tolerance, and affect regulation” (McWilliams, 2004 , p. 45). Similarly, in interactions between adults, more than 50% of interpersonal communication is nonverbal (Matsumoto et al., 2016 ; Westland, 2015 ).

The openness of the mind is the factor that allows different individuals to co-share experiences. In the current intersubjective turn Footnote 7 of psychoanalysis, many two-person psychology-oriented analysts emphasize the “in-between” area, which belongs neither solely to the analyst nor solely to the client but is co-created by the analyst and the client (or the mother and the infant), such as bi-personal phantasy , bi-personal field , intersubjective field , relational unconscious , and the third (Bohleber, 2013 ). This series of terms describe the co-created and co-shared experiences of both sides, which are inevitably intertwined. The concept has provided an impetus for psychoanalytic therapy; infant research supports these views and plays an essential role in the modern switch toward intersubjectivity.

Third, infant research provides evidence for acquiring various abilities in interaction. Among Freud’s successors, some analysts (e.g., object relations theorists, self psychologists, and interpersonal analysts) paid attention to the importance of the acquired environment—that is, only if the baby requires certain basic environmental conditions and parental functions (e.g., holding, containment, mirroring, and the opportunities for a symbiotic merger, separateness, and idealization) can he grow and develop healthily (Mitchell, 1988 ). In this regard, infant research provides a large volume of vital evidence. The following are several important aspects: (1) Body management skill . In the traditional view of psychoanalysis, the development of the individual’s internal world is the primary. Physiological needs, such as hunger, excretion, and sleep, have their own periodicity and are only regarded as the physiological basis of attachment motivation or sexual drive (Lichtenberg, 2013 ). However, studies have shown that the day–night differentiation and the sleep–wake cycle of infants are usually formed within 10 days after birth; by contrast, those abandoned after birth have difficulty forming these patterns. This physiological cycle cannot be formed within 10 days until they interact with their caregivers after adoption (Beebe and Lachmann, 2002 ). In addition, the development of abilities to adjust physical activities (e.g., nutrients, elimination, breathing, equilibrium, and proprioceptive movements) entirely depend on the careful feeding of caregivers. In Lichtenberg’s theory, this body management skill depends on “the motivational system based on the psychic regulation of physiological requirements,” which is inseparable from the overall operation of “infant–caregiver” (Lichtenberg, 1989 , 2013 ). (2) Emotional regulation ability . Some analysts have discussed the development of emotion regulation ability. In Bion’s conception, initially, babies cannot regulate emotions. A baby carrying negative emotions (e.g., pain and anxiety) can learn self-regulation only when the mother acts as a container, plays the function of containment, and returns the processed experience to the baby (Bion, 1962 ). Similarly, Kohut ( 1977 , 1984 ) emphasized that only when the caregiver empathically responds and appropriately meets the needs of mirroring and idealization can the baby develop the ability to endure and adjust to shame. On the basis of Kohut’s work, Stolorow cited that the mother’s attuned response promotes the integration of the infant’s emotional experience and symbolic thinking, allowing the infant to express this experience in the language (Stolorow, 2006 ). He then described the process with “emotional dwelling” (Stolorow, 2013 , 2014 ). In this regard, a large amount of evidence from infant research shows that individuals’ emotional regulation ability is learned from parent–child interaction (Beebe and Lachmann, 2002 , 2014 ; Schore, 2011 ). Moreover, a key point is that the mother’s response to the baby is not a simple “copy” or “imitation” but must contain a personal mark to convey “I understand you” and “I respond to you.” For instance, when the baby expresses anxiety, the mother gives back to the baby both the emotion corresponding to anxiety (e.g., fear, which means “I understand you”) and another incompatible emotion (e.g., ridicule, which means “there’s nothing to worry about”). This experience, both similar to and different from infants’ emotions, helps infants develop the ability to represent anxiety and further self-regulation (Fonagy, 2001 ; Wallin, 2007 ). (3) Ability to transform nonverbal experience into language . Some analysts have significantly contributed to describing nonverbal experiences. For example, in Bion’s conception, nonverbal experience is described as a beta-element—a sensory impression derived from the original emotional experience generated by internal and external environmental stimuli, and a sensory impression of emotional experience rejected for processing due to psychological catastrophe. Beta-elements are in a state that cannot be thought, bear no meaning, and cannot be expressed by language. They can be transformed into alpha-elements that can think and convey meaning only through the mother’s containment (or alpha function). Bion also describes this process by using the digestive tract as a metaphor—that is, food (beta-elements) can only be transformed into nutritional raw materials (alpha-elements) for various functions of the body after being digested, and the processes of “digestion” and “absorption” are processes of alpha function operation (Bion, 1962 ). Similarly, Stern ( 2019 ) uses “unformulated experience” to describe an individual’s nonverbal experience, which consists of a huge space of feelings, perceptions, and thoughts. These experiences are comparable to a figure emerging from a thick fog; despite the presence of an outline, the figure is considerably vague. If the individual fails to express these experiences in an appropriate language, they cannot be perceived by the individual, which is a defense mechanism; if the individual finds appropriate words to describe these experiences, the experiences can be elaborated and formed into the individual’s awareness, thus providing an opportunity for the transformation of traumatic experiences. In addition, terms such as “unvalidated unconscious” (Atwood and Stolorow, 2014 ; Stolorow and Atwood, 1992 ), “the under-represented” (Busch, 2013 ), “unsymbolized experience” (Bromberg, 1998 ), and “unmentalized experience” (Mitrani, 1995 ) also express similar meanings. In infant research, terms such as “presymbolic representations” (Beebe and Lachmann, 2002 , 2014 ), “implicit relational knowing” (BCPSG, 2010 ), “emotion schemas” (Bucci, 2011 ), “internal working models” (Fonagy, 2001 ; Wallin, 2007 ) and “representations of interactions that have been generalized” (RIGS) (Stern, 1998 ) express similar meanings. On the basis of experimental evidence, these infant researchers indicated that infants initially have presymbolic and nonverbal representations. In the interaction between the infant and the caregiver, these experiences are gradually endowed with meaning, thus transforming preverbal experiences into symbolic and verbal representations.

Fourth, infant research provides a reliable answer to questions regarding childhood amnesia, a common phenomenon whereby individuals fail to recall early-life events (usually before the age of 3–5 years). Clinical experiences wherein children could not remember their experiences before they turned 6–8 years were referred to by Freud ( 1916 ) as suppression of the sexual experience before the latency period or “screen[ed] memories”. He thought that through analytic sessions, repression could be relieved and recalled to the level of consciousness. Other analysts have further linked this memory loss to various childhood traumas (Christianson and Lindholm, 1998 ). However, studies have shown that childhood amnesia may not be due to repression. The hippocampus of a child younger than 1 year old is not yet active; thus, previous experiences can only be implicitly encoded (Rustin, 2013 ; Siegel, 2012 ). Therefore, this part of human experience does not readily reach the level of consciousness even as individuals mature. As a baby’s explicit memory gradually develops, numerous experiences do indeed rise to the level of consciousness. With the maturity of all aspects of body and mind (e.g., the use of language) and the elucidation of the world and others, the duration of memory is gradually extended. Individuals around the age of 2 years can even remember what they experienced more than 1 year prior. However, in the early stages of growth, a portion of brain neurons is more closely connected than it will be later in life, and numerous less commonly used neurons are cut to optimize brain function. Under the effect of this “sweeping,” the early immature brain drastically changes, and many experiences are abandoned because of their “uselessness” (Shaw, 2016 ). Compared with Freud’s “repression theory,” this “simplification theory” is more likely the root cause of childhood amnesia.

Research on memory also supports the effect of childhood trauma on adulthood. The unconscious memory is influenced by several factors in accessing consciousness: (1) whether the memory was originally created via explicit processing, as memories that begin with explicit attention are more accessible to consciousness; (2) the age of encoding, as being too young or too old is not conducive to extracting relevant memories; (3) the intensity of affects, as too low or too high intensity impedes extracting memory; (4) the frequency of repetition, as repeatedly and skillfully extracted memories are easier to continue to extract; (5) dissociation, which affects conscious perceptions; and (6) the intersubjective context, as a similar intersubjective background is conducive to awareness (Fosshage, 2011 ). As previously mentioned, early infants primarily rely on bodily movements to complete their exchanges with others. Even after gradually mastering the language, procedural memory still considers the majority. In addition, children have limited cognitive ability and a reflective ability (or metacognition) often weaker than that of adults. These qualities imply that if immature children are traumatized during this period, the traumatic memories cannot be reflected upon, mitigated, or healed through conscious reflection. Therefore, trauma is more severe and causes more harm to the individual the earlier it occurs. This claim has been substantiated by a number of retrospective studies and prospective infant research (Schore, 2011 ; Seligman, 2018 ).

Fifth, infant research supports the quest of psychoanalysis to transcend linear causality. Numerous traces of classical physics are found in Freud, endowing his theory with considerable linear causality (Palombo, 2013 ). To illustrate, Freud believes that in individual development, unresolved conflicts in the oral stage lead to problems of diet or alcohol abuse; conflicts in anal-stage development lead to obsessive–compulsive disorder, stinginess, and anal erotism; if the phallic phase does not pass smoothly, symptoms such as masturbation, pregnancy fantasy, and the concept of sadistic intercourse related to parents arise (Delgado et al., 2015 ). This theory of predetermination has influenced many analysts, yielding different forms of developmental stage theory (e.g., the normal autistic, symbiotic, and separation–individuation stages as classified by Mahler; the origins of schizophrenia, psychosomatic disorders, borderline personality organization, learning disabilities, and homosexuality) where babies mature over a fixed developmental trajectory (Gilmore, 2008 ). In addition, Freud’s psychological determinism and the viewpoint that the Oedipal conflict is the repetition of human ancestral behaviors reflect a linear, causal relationship (Palombo, 2013 ).

Today, many infant researchers prefer a more complex nonlinear causality. In their view, interactive partners form an inseparable dynamic system. In the interrelated feedback loop, each party is both the “cause” affecting the other party and the “result” affected by the other party. This link was referred to as “co-constructing interactions” by Beebe and Lachmann, who analyzed the interactive regulation in mother–infant relationships from different dimensions—time (e.g., turn-taking), space (e.g., chasing and dodging), and emotion (e.g., facial mirroring) (Beebe and Lachmann, 2020 , 2002 ). They further described the complex interactive landscape of dyads with different attachment styles from five dimensions (i.e., visual attention, facial and voice affect, facial visual participation, touch, and orientation) (Beebe and Lachmann, 2014 ). Similarly, BCPSG ( 2010 ) used various terms in dynamic system theory, such as attractor , repellor , self-organization , emergence , chaos , and bifurcation , to describe these complex interactions and their new attributes (e.g., interactive modes and subjective experiences). This sloppiness involves redundancy, variability, improvisation, unpredictability, and co-creativity in interactions. In the specific space–time context, child development is intertwined with other factors and becomes more complex and diverse with age. Consequently, individuals do not develop along a specific progression and instead constantly generate changes through processes (e.g., self-regulation and interactive regulation). Various “maladjustment symptoms” in adulthood do not precisely correspond to early-childhood defects (Palombo, 2016 ) but are based on the continuous reconstruction of early experiences (Gilmore, 2008 ).

Finally, infant research provides a compatible framework for the theoretical integration of psychoanalysis. In the context of the intersubjective turn, some analysts advocate a “both/and” position, considering the intrapersonal and interpersonal dimensions; others support an “either/or” position, mainly ignoring the intrapersonal dimension while attaching importance to the interpersonal dimension (Schwartz, 2012 ; Wallerstein, 1998 ). On the basis of Mitchell’s theory, Beebe and Lachmann proposed a dyadic system model that considers the intrapersonal and interpersonal dimensions (Beebe and Lachmann, 2002 ). As shown in Figs. 1 , 2 the model includes (1) two subjects, the mother and the infant (or the analyst and the patient); (2) two modes of influence, self-regulation and interactive regulation; (3) two kinds of communication, verbal and nonverbal; and (4) two tenses, historical and current modes. The model incorporates the views of several analysts. Among the analysts, Benjamin mainly emphasizes the subjective experience of the client to the analyst; Jacobs, Stolorow, and others stress the subjective experience of the analyst to the client; Ogden focuses on the analyst’s own subjective experience; and Ehrenberg emphasizes an experience whereby the two sides “break through the boundary” during more intense interactions (Beebe et al., 2005 ). Thus, the Beebe and Lachmann model is arguably a foundation for the further theoretical integration of psychoanalysis.

Graphic: a Self-regulation (arrow pointing at oneself). b Interactive regulation (arrow from a subject to the other subject). c Current mode of regulation (solid line), historical mode of regulation (dotted line). d “Verbal” and “nonverbal” roughly corresponding to “explicit” and “implicit”. e Verbal and nonverbal areas that can be converted back and forth if necessary, with a connection that may be blocked when communication is difficult (severed two-way arrow).

Practical significance of infant research for psychoanalysis

Infant research has also affected the clinical practice of psychoanalytic treatment. First, it has provided evidence for the healing effects of the therapist–patient relationship. Freud’s theory suggests that the content of the unconscious does not change with the passage and has “timelessness” (Noel-Smith, 2016 ). Therefore, in the analytic session, transference is regarded as a complete repetition of the past. This view was referred to by Wachtel ( 2003 ) as the “woolly mammoth model” in which the early traumatic experiences of the client “are…essentially frozen in time, preserved in their original form like woolly mammoths buried in the arctic ice, prevented from changing and evolving over the course of development” (p. 22). Accordingly, only when the content of the unconscious is brought to the level of consciousness can one lift timelessness from their experience to reshape it (Delgado et al., 2015 ).

However, whether it is the implicit affect regulation between the mother and the infant (Schore, 2011 ), the interactive regulation described by Beebe and Lachmann ( 2002 , 2020 ), or interactions changing the implicit relational knowing as described by BCPSG ( 2010 ), individuals are indeed shaped by current interactions. The changes brought about by such interactions are particularly obvious in special moments, such as moments of meeting (BCPSG, 2010 ), heightened affective moments, and moments of rupture and repair (Beebe and Lachmann, 2002 ). Research on cognitive neuroscience also suggests that memory does not entirely “copy” a group of contents into the “internal storage” and “hard disk” of the brain but encompasses a dynamic constructive process. In the process of recall, we do not simply “read” the fixed information stored in the brain beforehand; we reshape the neural network and reorganize the memory (Rustin, 2013 ; Siegel, 2012 ). “This is particularly likely to happen when affective arousal is strong, but not too strong” (Seligman, 2018 , p. 102). The present, to this effect, is not a complete repetition of the past. Transference and countertransference are reshaped in the current interaction. In a solid therapeutic relationship, the former nonadaptive interaction mode of the client can thus be changed.

Second, infant research has also led analysts to carefully consider nonverbal information in the treatment. In classical psychoanalysis, the analytic session is regarded as a kind of “talking cure”: the client mainly carries out activities (e.g., free association) on the couch and reports the materials emerging in his or her mind to the analyst. In this process, little nonverbal communication occurs between the analyst and the client (Delgado et al., 2015 ). In the long history of psychoanalytic movement, the role of nonverbal information in theory and practice has been generally ignored although sporadically mentioned by some researchers (Jacobs, 2005 ). However, driven by infant research, the “non-talking cure” has drawn increased attention and become a major trend in contemporary psychoanalysis (Kirshner, 2017 ). In this regard, Schore ( 2005 ) suggested that the “communicating” cure is more suitable than the “taking” cure—that is, the analytic session covers a broader range of verbal and nonverbal parts. In summary, the main ways to promote psychoanalytic therapy through nonverbal information includes the following: (1) The analyst can increase face-to-face communication with the client, where the client reveals thoughts and feelings to the analyst nonverbally. For instance, stiffness, shivering, and pallor may indicate the fear of speaking out or the desire to prevent “re-experiencing” the trauma under analysis. (2) Analysts can also express themselves nonverbally and create a safe environment for therapist–patient interaction by using nonverbal cues, such as a warm, gentle smile (Rustin, 2013 ). (3) The analyst may also encourage clients to perceive their own nonverbal behaviors and provide materials accordingly. For instance, Busch ( 2017 ) helped a client, “Ms. A,” to connect her physical symptoms with emotional states and stressors to realize implicit anger and understand internal conflict, ultimately allowing her to meaningfully express herself. (4) The analyst can also understand his or her own countertransference experiences via their own nonverbal information, thus laying a foundation for interaction. For example, Abbasi ( 2018 ) obtained a deep understanding of a client by factoring in the physical discomfort (e.g., nausea) underlying his anger and provocative behavior, thus strengthening the empathetic response with the latter.

Finally, infant research has contributed new techniques for psychoanalysis. Advancements in science and technology have allowed researchers to utilize video technology for a microanalysis of therapist–patient interactions. Real-time changes in therapy are difficult to capture and explain, but noteworthy information can be easily gathered by reviewing video footage with the permission of the client. At this point, Beebe et al. conducted experiments during treatment to analyze the nonverbal communication between the analyst and the client. In Beebe’s treatment of “Dolores,” facial expressions observed on video indicated that she was closed-off and overly dependent on self-regulation at certain points during treatment. Analysis of the video laid a foundation for enhancing Dolores’s interactions with the analyst, after which she began to address her maladptive interaction mode (Beebe, 2005 ). Similarly, BCPSG ( 2010 ) used videos to analyze micro-interactions in child clients, promote reflection in the children, and enhance the supervisory skills of the analyst.

The significance of infant research in psychoanalysis is discussed in this paper from the dual perspectives of theory and practice. However, some analysts do not support the role of infant research in psychoanalysis (Ackerman, 2010 ). Particularly for those who cling to classical theory, the object of psychoanalysis is the unconscious process that cannot be directly observed (Lichtenberg, 2013 ; Zeuthen et al., 2010 ) despite the fact that empirical research supports the role of early-childhood experiences in a way different from classical psychoanalysis. However, with the historical rise and fall of psychoanalysis in mental health in the United States (see Safran, 2012 ) considered, cooperation and communication between psychoanalysis and other fields should be strengthened. In this regard, infant research undoubtedly provides an important source of interdisciplinary dialog. As to the direction that these resultant force of these forces will take, we need to wait and see.

In this paper, the terms “analyst” and “therapist” are used interchangeably as are the terms “client” and “patient.”

The Oedipal phase is a key period in Freud’s theory during which children are involved in a triangular relationship with their parents. If boys successfully overcome the Oedipus complex and girls successfully overcome the Electra complex, they form a well-functioning superego and lay the foundation for the subsequent smooth development.

“Observance permeated by theory” is a proposition by Norwood Hanson, a philosopher of science. He points out that when we do not have the relevant knowledge of biology, we see only messy lines and strange shapes under the microscope; with a biological background, we see the cell membrane, nucleus, and cytoplasm. Similarly, philosophers such as Martin Heidegger and subsequently, Wittgenstein, assert that we are inevitably within our specific space–time background, unable to achieve absolute neutrality and objective observation.

Freud attached great importance to the shaping of babies by instinctive impulses (i.e., the “animal side”), which Mitchell ( 1988 ) called the “bestial baby”.

Mahler’s “normal autism” and “symbiosis” are conceptually helpful to understand some clinical materials; that is, some clients cannot distinguish themselves from others, desire to eliminate the boundary with others, and “merge” with others (Auchincloss and Samberg, 2012 ; Gergely, 2000 ). This situation can be understood as one in which an individual dynamically interacts with others. For example, a person hopes to overcome some negative emotions (e.g., anxiety and shame) through defense mechanisms (e.g., idealization and fantasy). In the normal life of an individual, the ability to distinguish between others and themselves, an important manifestation of reality testing, is necessary. However, that it must correspond to an early stage is not a necessary assumption. The idea that maladjustment symptoms in adulthood precisely correspond to early-childhood defects is a linear view of development (Gilmore, 2008 ).

The Boston Change Process Study Group (BCPSG) is a research group with multidisciplinary backgrounds of which Daniel Stern and Louis Sander are important members.

There has been an intersubjective turn in the field of psychoanalysis since the late 1970s, in short, from one-person psychology focusing on the intrapersonal dimension (e.g., classical psychoanalysis and ego psychology) to two-person psychology focusing on the interpersonal dimension (e.g., relational/intersubjective psychoanalysis) (Bohleber, 2013 ; Kirshner, 2017 ; Schwartz, 2012 ).

Abbasi A (2018) The analyst’s bodily sensations as important information in clinical work. Psychoanal Inq 38(7):530–540. https://doi.org/10.1080/07351690.2018.1504582.

Article   Google Scholar  

Ackerman S (2010) Is infant research useful in clinical work with adults? J Am Psychoanal Ass 58(6):1201–1211. https://doi.org/10.1177/0003065110391664.

Article   PubMed   Google Scholar  

Atwood GE, Stolorow RD (2014) Structures of subjectivity: Explorations in psychoanalytic phenomenology and contextualism, 2nd edn. Routledge, New York.

Auchincloss EL, Samberg E (eds) (2012) Psychoanalytic terms and concepts. Yale University Press, New York.

BCPSG (2007) The foundational level of psychodynamic meaning: implicit process in relation to conflict, defense and the dynamic unconscious. Int J Psychoanal 88(4):843–860. https://doi.org/10.1516/T2T4-0X02-6H21-5475 .

BCPSG (2010) Change in psychotherapy: a unifying paradigm. W. W. Norton & Company, New York.

Beebe B (2005) Faces-in-relation: Forms of intersubjectivity in an adult treatment of early trauma. In: Beebe B, Knoblauch S, Rustin J, Sorter D, Jacobs TJ Pally R (eds) Forms of intersubjectivity in infant research and adult treatment. Other Press, New York, pp. 165–191.

Beebe B, Knoblauch S, Rustin J, Sorter D (2005) Forms of intersubjectivity in infant research and adult treatment: a systems view. In: Beebe B, Knoblauch S, Rustin J, Sorter D, Jacobs TJ Pally R (eds) Forms of intersubjectivity in infant research and adult treatment. Other Press, New York, pp. 1–28.

Beebe B, Lachmann FM (2020) Infant research and adult treatment revisited: cocreating self- and interactive regulation. Psychoanal Psychol 37(4):313–323. https://doi.org/10.1037/pap0000305.

Beebe B, Lachmann FM (2002) Infant research and adult treatment: co-constructing interactions. The Analytic Press, New York.

Beebe B, Lachmann FM (2014) The origins of attachment: infant research and adult treatment. Routledge, New York.

Beebe B, Sorter D, Rustin J, Knoblauch S (2003) A comparison of Meltzoff, Trevarthen, and Stern. Psychoanal Dialogues 13(6):777–804. https://doi.org/10.1080/10481881309348768.

Bion WR (1962) Learning from experience. Karnac Books, London.

Bohleber W (2013) The concept of intersubjectivity in psychoanalysis: taking critical stock. Int J Psychoanal 94(4):799–823. https://doi.org/10.1111/1745-8315.12021.

Bromberg PM (1998) Standing in the spaces: Essays on clinical process, trauma, and dissociation. Psychology Press, New York.

Bucci W (2011) The role of subjectivity and intersubjectivity in the reconstruction of dissociated schemas; converging perspectives from psychoanalysis, cognitive science and affective neuroscience. Psychoanal Psychol 28(2):247–266. https://doi.org/10.1037/a0023170.

Busch F (2013) Transforming the under-repreented: the unacknowledged influence of ego psychology. Can J Psychoanal 21(2):292–312.

Google Scholar  

Busch FN (2017) A model for integrating actual neurotic or unrepresented states and symbolized aspects of intrapsychic conflict. Psychoanal Q 86(1):75–108. https://doi.org/10.1002/psaq.12127.

Canestri J (2021) The infantile: which meaning? Int J Psychoanal 102(3):560–571. https://doi.org/10.1080/00207578.2021.1893995.

Christianson SÅ, Lindholm T (1998) The fate of traumatic memories in childhood and adulthood. Dev Psychopath 10(4):761–780. https://doi.org/10.1017/S0954579498001850.

Article   CAS   Google Scholar  

de Peyer J (2016) Uncanny communication and the porous mind. Psychoanal Dialogues 26(2):156–174. https://doi.org/10.1080/10481885.2016.1144978.

Delgado SV, Strawn JR, Pedapati EV (2015) Contemporary psychodynamic psychotherapy for children and adolescents: Integrating intersubjectivity and neuroscience. Springer-Verlag Publishing, New York.

Dornes M (1993/2018) Der kompetente Säugling: Die präverbale Entwicklung des Menschen. Fischer e-books.

Fonagy P (2001) Attachment theory and psychoanalysis. Other Press, New York.

Fosshage JL (2011) How do we ‘know’ what we ‘know?’ And change what we ‘know?’. Psychoanal Dialogues 21(1):55–74. https://doi.org/10.1080/10481885.2011.545328.

Freud S (1916) Introductory lectures on psycho-analysis. In Strachey J (ed & trans) The standard edition of the complete psychological works of Sigmund Freud, vol 15. Hogarth Press, London.

Freud S (1917) New introductory lectures on psycho-analysis. In Strachey J (ed & trans) The standard edition of the complete psychological works of Sigmund Freud, vol 16. Hogarth Press, London.

Freud S (1920) Beyond the pleasure principle. In Strachey J (ed & trans) The standard edition of the complete psychological works of Sigmund Freud, vol 18. Hogarth Press, London, pp. 1–64.

Gergely G (2000) Reapproaching Mahler: new perspectives on normal autism, symbiosis, splitting and libidinal object constancy from cognitive developmental theory. J Am Psychoanal Ass 48(4):1197–1228. https://doi.org/10.1177/00030651000480040801.

Article   CAS   PubMed   Google Scholar  

Gerson S (2004) The relational unconscious: a core element of intersubjectivity, thirdness, and clinical rocess. Psychoanal Q 73(1):63–98. https://doi.org/10.1002/j.2167-4086.2004.tb00153.x.

Gilmore K (2008) Psychoanalytic developmental theory: a contemporary reconsideration. J Am Psychoanal Ass 56(3):885–907. https://doi.org/10.1177/0003065108323074.

Hanson NR (1958) Patterns of discovery: An inquiry into the conceptual foundations of science. Cambridge University Press, London.

Jacobs TJ (2005) Discussion of forms of intersubjectivity in infant research and adult treatment. In: Beebe B, Knoblauch S, Rustin J, Sorter D, Jacobs TJ Pally R (eds) Forms of intersubjectivity in infant research and adult treatment. Other Press, New York, pp. 165–191.

Jaenicke C (2008) The risk of relatedness: Intersubjectivity theory in clinical practice. Jason Aronson, Lanham.

Kirshner L (2017) Intersubjectivity in psychoanalysis: a model for theory and practice. Routledge, New York.

Kohut H (1977) The restoration of the self. University of Chicago Press, Chicago.

Kohut H (1984) How does analysis cure? University of Chicago Press, Chicago.

Lichtenberg JD (1989) Psychoanalysis and motivation. The Analytic Press, Hillsdale.

Lichtenberg JD (2013) Development and psychoanalysis: then and now-the influence of infant studies. Psychoanal Rev 100(6):861–880. https://doi.org/10.1521/prev.2013.100.6.861.

Litowitz BE (2021) Constructing the infantile. Int J Psychoanal 102(3):588–594. https://doi.org/10.1080/00207578.2021.1893993.

Magid B, Shane E (2017) Relational self psychology. Psychoanal Self Context 12(1):3–19. https://doi.org/10.1080/15551024.2017.1251176.

Mahler MS, Pine F, Bergman A (2000) The psychological birth of the human infant: Symbiosis and individuation. Basic Books, New York.

Matsumoto D, Hwang HC, Frank MG (eds) (2016) APA handbook of nonverbal communication. American Psychological Association, Washington.

McWilliams N (2004) Psychoanalytic psychotherapy: a practitioner’s guide. The Guilford Press, New York.

Meltzoff AN, Brooks R (2007) Intersubjectivity before language: three windows on preverbal sharing. In: Bråten S (ed) On being moved: From mirror neurons to empathy. John Benjamins Publishing Company, Amsterdam, pp. 149–174.

Meltzoff AN, Gopnik A, Repacholi BM (1999) Toddlers’ understanding of intentions, Desires and emotions: explorations of the Dark Ages. In: Zelazo PD, Astington JW Olson DR (eds) Developing theories of intention. Social understanding and self-control. Lawrence Earlbaum, Mahwah, pp. 17–42.

Mitchell SA (1988) Relational concepts in psychoanalysis: an integration. Harvard University Press, Cambridge.

Mitchell SA (2000) Relationality: From attachment to intersubjectivity. The Analytic Press, Mahwah.

Mitchell SA, Black MJ (1995) Freud and beyond: A history of modern psychoanalytic thought. Basic Books, New York.

Mitrani JL (1995) Toward an understanding of unmentalized experience. Psychoanal Q 64(1):68–112. https://doi.org/10.1080/21674086.1995.11927444.

Noel-Smith K (2016) Freud on time and timelessness. Palgrave Macmillan, New York.

Palombo J (2013) The self as a complex adaptive system, Part I: Complexity, metapsychology, and developmental theories. Psychoanal Soc Work 20(1):1–25. https://doi.org/10.1080/15228878.2012.749184.

Palombo J (2016) The self as a complex adaptive system, Part III: A revised view of development. Psychoanal Soc Work 23(2):145–164. https://doi.org/10.1080/15228878.2016.1210523.

Rustin J (2013) Infant research and neuroscience at work in psychotherapy: Expanding the clinical repertoire. W. W. Norton & Company, New York.

Safran JD (2012) Psychoanalysis and psychoanalytic therapies. American Psychological Association, Washington.

Schore AN (2005) A neuropsychoanalytic viewpoint: commentary on paper by Steven H. Knoblauch. Psychoanal Dialogues 15(6):829–854. https://doi.org/10.2513/s10481885pd1506_3.

Schore AN (2011) The right brain implicit self lies at the core of psychoanalysis. Psychoanal Dialogues 21(1):75–100. https://doi.org/10.1080/10481885.2011.545329.

Schwartz HP (2012) Intersubjectivity and dialecticism. Int J Psychoanal 93(2):401–425. https://doi.org/10.1111/j.1745-8315.2011.00543.x.

Seligman S (2018) Relationships in development: Infancy, intersubjectivity, and attachment. Routledge, New York.

Shaw J (2016) The memory illusion: Remembering, forgetting, and the science of false memory. Random House Books, New York.

Siegel DJ (2012) The developing mind: How relationships and the brain interact to shape who we are. Guilford Press, New York.

Stern DB (2019) The infinity of the unsaid: Unformulated experience, language, and the nonverbal. Routledge, New York.

Stern DN (1998) The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. Karnac Books, New York.

Stolorow RD (2006) Autobiographical and theoretical reflections on the ‘ontological unconscious’. Contem Psychoanal 42(2):233–241. https://doi.org/10.1080/00107530.2006.10745884.

Stolorow RD (2013) Intersubjective-systems theory: a phenomenological-contextualist psychoanalytic perspective. Psychoanal Dialogues 23(4):383–389. https://doi.org/10.1080/10481885.2013.810486.

Stolorow RD (2014) Undergoing the situation: emotional dwelling is more than empathic understanding. Int J Psychoanal Self Psychol 9(1):80–83. https://doi.org/10.1080/15551024.2014.857750.

Stolorow RD, Atwood GE (1992) Contexts of being: The intersubjective foundations of psychological life. The Analytic Press, Hillsdale.

Stolorow RD, Atwood GE, Orange DM (2002) Worlds of experience: Interweaving philosophical and clinical dimensions in psychoanalysis. Basic Books, New York.

Sullivan HS (1953) The interpersonal theory of psychiatry. W. W. Norton & Company, New York.

Tanis B (2021) The infantile: its multiple dimensions. Int J Psychoanal 102(3):572–587. https://doi.org/10.1080/00207578.2021.1893991 .

Trevarthen C (2011) The generation of human meaning: how shared experience grows in infancy. In: Seemann A (ed) Joint attention: new developments in psychology, philosophy of mind, and social neuroscience. MIT Press, Cambridge, pp. 73–113.

Trevarthen C, Aitken KJ (2001) Infant intersubjectivity: research, theory, and clinical applications. J Child Psychol Psyc 42(1):3–48. https://doi.org/10.1111/1469-7610.00701.

Wachtel PL (2003) The surface and the depths: the metaphor of depth in psychoanalysis and the ways in which it can mislead. Contem Psychoanal 39(1):5–26. https://doi.org/10.1080/00107530.2003.10747197.

Wallerstein RS (1998) The new American psychoanalysis: a commentary. J Am Psychoanal Ass 46(4):1021–1043. https://doi.org/10.1177/00030651980460041501.

Wallin DJ (2007) Attachment in psychotherapy. Guilford Press, New York.

Westland G (2015) Verbal and non-verbal communication in psychotherapy. W. W. Norton & Company, New York.

Winnicott DW (1964) The child, the family, and the outside world. Penguin Books, Oxford.

Zeuthen K, Pedersen S, Gammelgaard J (2010) Attachment and the driving force of development: a critical discussion of empirical infant research. Int Forum Psychoanal 19(4):230–239. https://doi.org/10.1080/0803706X.2010.497163.

Download references

Acknowledgements

We would like to express our thinks to Yayun Liu for her support.

Author information

Authors and affiliations.

Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China

Hubei Three Gorges Technician College, Yichang, China

School of Psychology, Nanjing Normal University, Nanjing, China

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Wei Zhang .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Additional information.

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Zhang, W., Pan, Q. & Guo, B. The significance of infant research for psychoanalysis. Humanit Soc Sci Commun 9 , 194 (2022). https://doi.org/10.1057/s41599-022-01219-z

Download citation

Received : 15 March 2022

Accepted : 30 May 2022

Published : 09 June 2022

DOI : https://doi.org/10.1057/s41599-022-01219-z

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

• NAEYC Login
• Member Profile
• Hello Community
• Accreditation Portal
• Online Learning
• Online Store

Popular Searches:   DAP ;  Coping with COVID-19 ;  E-books ;  Anti-Bias Education ;  Online Store

Caring For and About Infants and Toddlers

You are here

It might be difficult to imagine today, but in 1918, a journal offering the latest thinking on infants and toddlers would advise forms of caregiving that, by today’s standards, seem like emotional neglect. Most doctors believed that infants could not feel pain, and new parents were told to provide physical care on a set schedule while avoiding the cuddling, cooing, and nuzzling of emotional care.

Widespread change did not come about until two pediatricians had the courage to challenge their colleagues’ assumptions. The first of these pioneers was Benjamin Spock, a bestselling author who reassured new mothers that they should trust their instincts and nurture their babies physically and emotionally. The second was T. Berry Brazelton.

Building on Spock’s insights, Brazelton sought to understand infants and toddlers through medical and social lenses and was dedicated to supporting parents—and educators—in fostering healthy child development. Renowned for his ability to connect with infants, Brazelton was driven by his love for infants’ humanity, individuality, and complexity. He saw their behavior as a form of language—a language he wanted all of us to understand.

Berry Brazelton passed away on March 15, 2018, at the age of 99. This issue of  Young Children  is dedicated to him and to spreading his insights.

*These paintings came from Mila, the infant niece of an NAEYC staff member, diving into art play.

For educators, Brazelton’s call to action—in addition to understanding child development and using that knowledge to observe and be responsive to children’s needs—was to support families as warmly and intentionally as we support children. He explained in the March 2001 issue of  Young Children,

Teachers can try to build parents’ . . . confidence in their ability to know and guide the child. . . . They can be generous in their appreciation and support of parents and talk with them about how important it is for both parents and teachers to appreciate and support children. We need to nurture parents.

As you read this cluster, I hope you will consider how the ideas inform your work and how you might use them to nurture families.

The cluster begins with “ Berry Brazelton’s Contributions to Research, Policy, and Practice: Improving Contexts and Conditions for Families with Infants ,” by Joshua Sparrow, discussing Brazelton’s concept of Touchpoints.  Touchpoints  are times when infants and toddlers are making developmental advances, but the advances are preceded by behavioral regressions. By sharing these predictable developmental patterns with parents, educators can reduce families’ stress and improve their caregiving.

Understanding, as Brazelton did, that each infant is a complex individual in need of care and autonomy, Toni Christie describes unobtrusive ways to be nurturing in “ Respect: The Heart of Serving Infants and Toddlers .” Then, Ellen Galinsky explains the importance of being responsive to babies’ attempts to communicate in “Helping Young Children Learn Language: Insights from Research.” (Galinsky had the honor of working with Brazelton for four decades. To read her remembrance of him, visit bit.ly/2qbFbor .)

In “ Enhancing the Diapering Routine: Caring, Communication, and Development ,” Deborah E. Laurin and Carla B. Goble reflect on how diapering can be a time to deepen relationships, increase independence, and develop language.

Also emphasizing language development, Julia Luckenbill recounts the challenges and benefits of bringing more mathematics into her curricula. In “ Mathematizing with Toddlers and Coaching Undergraduates: Foundations for Intentional Math Development ,” Luckenbill describes how essential techniques like parallel talk highlight the mathematical aspects of playful exploration.

The rest of this cluster addresses the challenges of meeting infants’ and toddlers’ relationship needs as they progress through center-based care. In “ Building Empathy, Strengthening Relationships: The Benefits of Multiage Classrooms for Young Children and Their Caregivers ,” Linda S. Anderson explores how the challenges of multiage classrooms can be overcome.

Another option is  looping  (in which teachers and a group of children stay together for two to three years), as explained by Mary Benson McMullen in “ The Many Benefits of Continuity of Care for Infants, Toddlers, Families, and Caregiving Staff .” What’s critical is having consistent, warm, responsive caregivers throughout the first few years of life. The benefits include better behavior and easier transitions to preschool for children and more teacher knowledge of and responsiveness to children’s needs.

If continuity of care is not feasible, how can educators ease transitions? In “ Moving from an Infant to a Toddler Child Care Classroom: Embracing Change and Respecting Individual Differences ,” Susan L. Recchia and Kamila Dvorakova offer strategies to help children navigate changes in caregivers, peers, and environments.

Throughout this cluster, the articles emphasize respecting infants and toddlers and their families, which is central to Brazelton’s approach. As he wrote in these pages in September 1978,

I am convinced that only if parents feel good about themselves can they pass on a good self-image to the baby. . . . We must give new parents purposeful, positively supportive information . . . so that they in turn can provide an optimistic, warmly supportive environment for their infants to develop the solid assurance that they are loved and can love in return.

—Lisa Hansel

Is your classroom full of children’s artwork? 

We would love to feature it in Young Children ! See our photograph submission guidelines  or email  [email protected]  for details.  

We’d love to hear from you!

Send your thoughts on this issue, and on topics you’d like to read about in future issues of  Young Children , to  [email protected] .

Would you like to see your children’s artwork featured in Young Children ? For guidance on submitting print-quality photos (as well as details on permissions and licensing), see  NAEYC.org/resources/pubs/authors-photographers/photos .

Lisa Hansel, EdD, is the editor in chief of NAEYC's peer-reviewed journal, Young Children .

Vol. 73, No. 3

Print this article

• Subscribe to journal Subscribe
• Get new issue alerts Get alerts

Secondary Logo

Journal logo.

Colleague's E-mail is Invalid

Your message has been successfully sent to your colleague.

Save my selection

Research Informing Practice in Early Childhood Intervention

How hard can it be.

Kemp, Coral PhD

School of Education, Macquarie University, Sydney, Australia.

Correspondence: Coral Kemp, PhD, School of Education, Macquarie University, Balaclava Rd, North Ryde NSW, 2109, Australia ( [email protected] ).

The author declares no conflict of interest.

This article was based on a keynote address presented at the International Society on Early Intervention conference, Sydney, Australia, June 2019.

The adoption of interventions for infants and young children with disabilities/delays or at risk of disability/delay is likely to be influenced by sources other than research evidence. Where the available research evidence does influence the choice of intervention, there may be difficulties translating research that has been implemented in a controlled environment to an intervention that can be successfully applied in natural settings. Such settings include the family home as well as early childhood education and care centers. Incentives for the use of evidence-based interventions in early intervention settings include improved outcomes for infants and young children, service credibility, and program accountability. Barriers to using evidence-based practice (EBP) in natural settings include difficulties with identifying EBP and in reliably implementing evidence-based interventions. Lack of quality professional training and absence of support from competent coaches/mentors can also compromise the adoption and effective implementation of EBP. Collaborative partnerships between researchers and practitioners, where the goals of both parties have equal value, may assist with bridging the research-to-practice gap. Incentives, barriers, and opportunities are explored in this article.

THE INTERNATIONAL COMMUNITY recognizes that early childhood intervention (ECI) addresses the development of infants and young children who are at risk of delay because of environmental disadvantage or biological risk as well as the population of children with established disabilities ( Guralnick, 2019 ). Some children with established disabilities will have delays in one developmental domain (e.g., physical or sensory), whereas others will have delays across multiple domains. Children at biological risk (e.g., children with very low birth weight, children exposed to alcohol or other drugs in utero) or those at environmental risk due to unresponsive parenting, families living in poverty, or families subjected to domestic violence may demonstrate delays in cognitive, language, or social emotional development at some point before entering the school system. For all, there will be a threat to optimal growth and development. The importance of family, specifically carer–infant/carer–child interactions, is recognized to be of vital importance as children develop ( Bailey, Raspa, & Fox, 2012 ; Guralnick, 2011 ; Innocenti, Roggman, & Cook, 2013 ). In addressing the needs of vulnerable infants and young children, therefore, supporting these interactions is important for all who work in the field of early intervention.

Following vulnerable children's participation in early childhood settings, early interventionists also strive to assist early childhood educators to use their interactions with children to promote child development. Early childhood education and care (ECEC) settings, such as long day care and preschools, offer important educational opportunities for children at environmental risk of delay in situations in which families may have difficulty in supporting their children's development. For children at biological risk or those with established disabilities, early childhood educators can also support families by providing opportunities for peer interaction and additional opportunities for functional practice of skills. In these settings, early childhood educators promote engagement and participation in activities that have the potential to promote development. Respite for families is also an important function of early childhood services.

In this article, I address the following issues: (a) definitions of evidence-based practice (EBP); (b) the contributions of research, clinical practice, and stakeholder values to EBP; (c) incentives for using research-based practice; and (d) barriers to the effective implementation of research-based practice. An argument for researcher–practitioner partnerships is made and examples of successful partnerships in the Australian context provided.

DIFFERENTIATING LEVELS OF EBP

When discussing EBP, it is important to differentiate two levels of practice: The first includes broad approaches (e.g., family-centered practice, embedded practice, inclusive practice, and response to intervention) and manualized programs. The second includes the very specific interventions and strategies used within those approaches/programs—for example, task analysis, time delay, prompting hierarchies, and reinforcement strategies.

For the broad approaches, although there is evidence for the efficacy of family-centered practice and embedded practice, both are multifaceted and it may be difficult to isolate components of these practices that make them effective. For example, what one person regards to be acceptable family-centered practice might be rejected by another as service directed. There have been discrepancies between family and service responses to surveys relating to the implementation of family-centered practice (e.g., Dempsey & Keen, 2008 ). Embedded practice requires that the interventions/instructional strategies included in this practice have demonstrated effectiveness ( McBride & Schwartz, 2003 ; Vanderheyden, Snyder, Smith, Sevin, & Longwell, 2005 ). Response to intervention relies on a high-quality universal program and effective interventions for the children who need more support ( Jackson, Pretti-Frontczak, Harjusola-Webb, Grisham-Brown, & Romani, 2009 ; Spencer, Petersen, Slocum, & Allen, 2015 ). Inclusion works best for both children with and without disabilities in high-quality early childhood programs ( Barton & Smith, 2015 ; Buysse & Hollingsworth, 2009 ).

EVIDENCE-BASED PRACTICE: SOURCES FOR DECISION MAKING

The terms “evidence-based” and “research-based” are often used synonymously; however, sources of evidence other than research also contribute to EBP and are, therefore, considered to be important when selecting interventions. Evidence-based practice has its origins in clinical medicine ( Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996 ; Snow, 2019 ), with the suggestion that each of the following be used to guide the selection of programs/approaches or specific interventions/strategies: (a) research evidence, (b) stakeholder values, and (c) practice evidence.

A range of practices/interventions, some of which may have little or no support in the scientific research literature, has been used over the years in services for infants and young children with delays/disabilities or at risk of delay. Of course, not every practice that we implement in our service system will have strong research supporting it. For example, some practices are implemented because they are linked to cultural differences of children and families or other factors unique to the family's circumstances. Embedded practice, which does have research evidence to support it, is also supported by practice evidence. A program implemented once a week (or even more often) by an early intervention professional in a clinical setting will not be as powerful as the practice of skills through the routines and activities in which the child is engaged on a regular basis within the family unit or early childhood center (distributed, functional practice). Similarly, we believe in family-centered practice, again not just because we have research evidence to support it but because we understand that families will be better able to meet the needs of their vulnerable infants and young children if they have their needs for information, guidance, respite, and overall support met. It is clear, also, that families and carers have a deep knowledge of their children and a vested interest in their long-term growth and development. Those who advocate EBP acknowledge the importance of stakeholder values and practitioner expertise. However, they also believe that, where possible, these two sources are underpinned by research evidence.

WHAT RESEARCH EVIDENCE SHOULD GUIDE OUR PRACTICE?

Research is one of the most overused and, in many cases, misused terms. For example, the term is frequently used to indicate that more information is needed before a decision can be made ( Bair & Enomoto, 2013 ). It is not unusual to search the web or find a book on the topic in the local library or perhaps ask a friend or acquaintance. When it comes to interventions for children with disabilities/delays or at risk of delay, this approach can be problematic, considering that friends and acquaintances are likely to have inadequate knowledge and that much of the information on the Internet is unreliable or incomplete, even information provided on professional web pages ( Stephenson, Carter, & Kemp, 2012 ).

So, does every intervention promoted for vulnerable infants and young children have an acceptable evidence base? Clearly, not every intervention will have substantial research evidence to support it. Some interventions that we will likely avoid would have been shown to be ineffective or even harmful. Other practices might have been the subject of little or no research. Although they may seem to be harmless, there is harm to children's optimal development if these interventions are used instead of interventions that do have research evidence to support them—especially if the interventions supported by research lead to better child outcomes or if the non–research-based interventions interfere with more functional and inclusive interventions.

Some practices might seem to be effective because there are testimonials supporting them and/or because they appear to be medical or pseudomedical (e.g., some therapies and diets). How can there be such glowing testimonials supporting these dubious practices? If you think that you are getting an effective treatment, you are likely to perceive that it is working for you or, in this case, your child. In these circumstances, the measures of change are likely to be parent reports or provider reports.

When searching for evidence to support an approach that interventionists are prepared to recommend to families, weight should be given to (a) quality of research design; (b) number of studies supporting the approach; (c) generalizability of the evidence; and (d) published research findings that are independent and reported in peer-reviewed journals. To be considered research based, researchers agree that a practice or an intervention should be supported by multiple, high-quality, experimental, or quasi-experimental studies demonstrating that the intervention/approach has a meaningful impact on outcomes for the individual ( Cook & Odom, 2013 ; Slocum et al., 2014 ). The standards that are applied to the quantity and quality of research needed for a practice or program to qualify as research-based vary for different circumstances ( Cook & Cook, 2013 ). For example, researchers have nominated a level of research support needed to demonstrate the efficacy of a practice or intervention for use with children with autism spectrum disorder (ASD; Johnson, Fleury, Ford, Rudolph, & Young, 2018 ). They suggest that there should be a minimum of two high-quality experimental or quasi-experimental studies conducted by at least two different research groups. If the research uses a single case methodology, these authors recommend that there be a minimum of five high-quality studies conducted by at least three research groups with a total of 20 or more participants or at least one high-quality group or quasi-experimental design and at least three high-quality single case studies reported by a minimum of two research groups. Other resources, for example, the What Works Clearinghouse ( https://ies.ed.gov/ncee/wwc/ ) and the Cochrane Library ( https://www.cochranelibrary.com ), apply different standards. Studies that use group designs, both randomized controlled trials and quasi-experimental designs with quality design features, and single case experimental designs are included when evaluating the evidence for interventions reviewed by the What Works Clearinghouse. Standardized information that allows the person accessing the information to compare results is provided on this site. The Cochrane Library provides research reviews covering a range of medical, educational, and therapy interventions. The databases used and the criteria for including studies for review are provided for each intervention as is an overview of the recommendations.

In Australia, there is a government website that can be accessed by all who are interested in the services available to families and practitioners. The Raising Children Network ( https://raisingchildren.net.au ) specifically targets families and provides information of interest to parents who are dealing with the day-to-day challenges of raising children. There is also information relating to children with disabilities including information about services. Interestingly, there is a guide relating to specific interventions and therapies for children with ASD but not children with other types of disability. Interventions for the population of children with ASD are rated as (a) established, (b) promising, (c) yet to be determined, (d) ineffective or harmful, or (e) unratable. There is no clear information about how these ratings are applied but the focus appears to be on the expertise of those reviewing the interventions—experts, however, who are not specifically named as providing evidence for individual interventions.

Although not all researchers will employ the same standards when applying a rating system, the take-home message is that one study with limited participants should not be sufficient to convince practitioners to change their practice. There is likely to be general agreement for using the following to describe levels of support regardless of who applies these standards and how they are applied: (a) strong support from research published in peer-reviewed journals (multiple experimental/quasi-experimental studies with strong design features and findings that can be generalized across populations and settings); (b) emerging support from published research (some experimental/quasi-experimental studies); (c) no support, limited support, and no research; and (d) evidence of negative or harmful outcomes. Clearly, practitioners will be favoring the first two levels of evidence. However, it is also important to consider further developments in research. An intervention that currently has limited support may gather more support in time. It is valuable, therefore, for practitioners to keep up to date with the research.

RESEARCH EVIDENCE CONFIRMED BY PRACTICE EVIDENCE

Research-supported approaches/interventions are often identified in controlled, clinical conditions, conditions that may not exist in the environments in which practitioners provide services. This includes single case experimental research as well as group designs. Randomized controlled trials are considered to be the gold standard in research and have strong internal validity ( Sackett et al., 1996 ). However, they are sometimes difficult to implement, given the number and diversity of research participants commonly included in research in the disability area. Nowadays, there are also ethical restrictions that may limit the use of these designs, especially with vulnerable populations. There is also a diverse range of outcomes and outcome measures identified, which may make a summary and ultimately an evaluation of research findings difficult to achieve.

Researchers continue to emphasize the need for intervention effectiveness rather than efficacy research, that is, proof that the intervention works in the real world with practitioners rather than researchers implementing the interventions with extensive resources. This provides us with practice-based or clinical evidence. Ideally, we select practices based on efficacy research and determine whether or not these can work in practice. Researchers (e.g., Cook & Odom, 2013 ; Fixsen, Blasé, Metz, & Van Dyke, 2013 ; Strain, 2018 ) have suggested that in order to have an influence on child outcomes, EBPs need to be implemented and evaluated in natural environments such as ECEC settings, the family home, and the community.

Although early intervention research is sometimes implemented in natural settings, where this occurs, the intervention is commonly implemented by researchers rather than practitioners ( Katz & Girolametto, 2013 ). If we are to have research-based interventions validated through practitioner implementation (practice-based evidence), and for this practice to be sustained, it is important to ensure that practitioners themselves are able to implement the practice/intervention under investigation. Of note, many of the studies included in the 2018 review by Johnson et al. (2018) for children with ASD were implemented in naturalistic settings. However, the primary interventionists were generally members of the research team and there were often multiple interventionists. A relatively smaller number of studies involved early childhood personnel as the primary interventionist (4% of studies), caregivers (7% of studies), and private specialists (4% of studies).

Practitioners determine the programs/interventions that are used in their services. They can select/recommend those that come with recommendations from other practitioners or from parents or they can seek out the interventions that have research evidence supporting them and work from there. Not all interventions that have research support will be easily implemented in a service and not all will work for every child and family. However, knowing that an intervention has efficacy data to support it is an important starting point.

DATA-BASED DECISION MAKING

In the absence of strong research-based evidence, practitioners can still consider the evidence that is available to them (best available evidence). A valuable source is the data that they collect on the children with whom they are working. These data do not need to be discrete trial events, which can be difficult or inappropriate to collect in family homes or early childhood settings. However, ignoring the importance of data in various forms or determining that collecting data in a systematic way is somehow discriminatory is to deny a valuable way of deciding whether the program selected is meeting the needs of the young children in their care. Slocum et al. (2014) refer to data-based decision making as the “ultimate hedge against the inherent uncertainties of imperfect knowledge derived from research” (p. 50), stating further that as the quality of research evidence decreases, so “the importance of frequent direct measurement of client progress increases” (p. 50). Indeed, practitioner-implemented, data-based decision making is a way of conducting one's own research with the focus being on the individual receiving the intervention.

INCENTIVES FOR IMPLEMENTING RESEARCH-BASED APPROACHES/INTERVENTIONS

There are incentives for using research-based approaches/interventions with infants and young children with disabilities/delays or those at risk of delay. Of course, this must be research evidence that is ultimately confirmed in practice. The most important incentive would have to be the desire to make a difference to short- and long-term outcomes for vulnerable children and their families. However, there are also more pragmatic incentives, for example, the need to be accountable for the funding of the service, whether it be government or private funding, and finally the professional credibility to which all interventionists would aspire. Fixsen et al. (2013 , p. 214) have devised an impressive formula for ensuring that an intervention makes a difference to outcomes: Effective interventions × Effective implementation = Improved outcomes. If either the measure of effective intervention or that of effective implementation is low, the proposed outcomes will not be achieved.

BARRIERS TO IMPLEMENTING RESEARCH-BASED APPROACHES/INTERVENTIONS

Failure to identify research-based practice.

Practitioners may not have ready access to databases that will allow them to read the relevant research. Even if able to access research literature, they may not have a strong background in reading and interpreting research or may not be willing or able to spend the time to keep abreast of the research. This is not a problem pertaining only to educators or therapists working in the field of ECI or disability. Indeed, Sackett et al. (1996) reported that in order to keep up with advances in research in the medical profession at that time, general practitioners would need to read 19 articles a day for each of 365 days a year. The number of articles produced more than 20 years later is considerably greater. Although the number of studies that early interventionists would need to read is likely to be fewer, it is probably unrealistic to think that they would be reading the research literature on a daily or even weekly basis. If this is the case, interventionists are likely to rely on practices that they have identified on the basis of professional judgment/opinion and experiences. These practices may be based on theory and/or professional wisdom but may not have been validated more objectively by measuring child outcomes following the implementation of the practice.

Interventions that are difficult to implement in natural settings

Working to improve outcomes that families value is likely to involve coaching and support in the family home and the community (including ECEC settings). Even so, there will be some interventions with strong supportive evidence that will be just too difficult to include in naturalistic environments largely due to lack of funding and available time and/or limited staff qualifications and experience. Indeed, Fixsen et al. (2013) have suggested that insufficient funding needed to support the effective implementation of an intervention may also help explain what they refer to as the “science-to-service gap” (p. 214). Paucity of time may very well be connected to funding. Time is needed to discuss research-based practice with colleagues to determine if/how an intervention can be implemented in the practice of the service.

Limited staff qualifications and experience

Service provision, including the implementation of EBP, will be influenced by the quality of the preservice and in-service education accessed by those supporting infants and young children with disabilities and their families in early childhood settings and other community settings and in the family home. The question is as follows: How well does preservice training prepare early intervention practitioners to implement research-supported interventions? Perhaps they are well prepared for interventions specifically related to their initial area of study, which may be much broader than early childhood or disability. However, ECI crosses many disciplines, involves working collaboratively with families and a range of professions, and should focus on measurable outcomes across all developmental domains for infants and young children as well as measureable outcomes for their family members. In the United States, the establishment of the Early Childhood Personnel Center has led to the identification of core competencies for those working in the ECI field, competencies that cross disciplinary boundaries ( Bruder et al., 2019 ). In Australia, we are a long way from achieving this, as employers of early interventionists rarely ask for specific early intervention qualifications and there are few preservice courses that specifically cover the essential skills required to work in the field.

Early interventionists in Australia who do complete preservice courses in early childhood and allied health and who subsequently work to update their knowledge and skills through in-service training may not access courses that include a strong focus on scientific research or that equip preservice early interventionists with the competencies needed to work in the field. One of the failures of preservice courses is the lack of adequate practicum/internship programs specifically relating to the area of ECI. In-service courses are offered through a variety of sources, often provided by practitioners. For in-service courses, therefore, there is the issue of the quality of content and the approach to adult learning. Who monitors quality? What qualifications are needed for this?

RESEARCHER–PRACTITIONER PARTNERSHIPS

What then do early interventionists rely on for information about EBP? Professional reading is one way of keeping up with advances in the field. Do they/are they able to read the research? Do they know which practices have sufficient evidence to support/refute them? In fact, failure to engage in professional reading of any kind has been identified as a problem, especially among education professionals ( Rudland & Kemp, 2004 ).

Fixsen et al. (2013) refer to three approaches to translating evidence-based programs into practice: (a) Letting it happen: Researchers publish their research and hope that practitioners will read the research and use it in their practice; (b) Helping it happen: Creating manuals and running in-service programs; and (c) Making it happen: Program developers/researchers support practitioners/managers to implement the practice. The latter involves a researcher/practitioner partnership. One might also include the families here and call this researcher/practitioner/family partnerships.

Some service providers in Australia most definitely have very productive partnerships already in operation. These services generally employ a research officer who has practical experience in the field combined with knowledge of and interest in research. Some practitioners in these organizations are enrolled in research degrees and have strong ties with one or more universities. The role of the research team/officer (perhaps a research committee) is to (a) filter requests from researchers to approach their clients for inclusion as research participants; (b) agree to direct involvement by the service provider in the research (i.e., research designed outside the service); (c) design research (in partnership with researchers and families) that can be implemented by the practitioners for the service; and (d) monitor/guide the professional reading of service practitioners. There are advantages to each of the partners in the researcher/practitioner partnerships approach. The advantages to early intervention services include support in testing the effectiveness of interventions in real-world settings (i.e., practice-based evidence) and professional development for program staff. These include access to expertise from researchers investigating EBP in the field, university funding, and participation of university interns/practicum students. For the researchers, such a partnership provides opportunities to implement research in partnership with practitioners and families, keep in touch with the practical side of their field, apply for funding in partnership with services, and investigate the social validity of interventions. An added incentive for researchers is the possibility of publications and/or conference presentations. Finally, and most importantly, are the advantages for children and families? Children are likely to benefit from access to interventions that have proven to be effective in naturalistic environments and families have access to informed advice when deciding what programs/interventions to choose.

As acknowledged, many services offering early intervention support to infants and young children and their families have research committees within their organizations. Such organizations should be encouraged to more closely link these committees with the day-to-day operation of the organization, that is, the interventions implemented by their staff. Single case research can provide a valuable tool for investigating the effects of specific interventions on priority outcomes in early intervention settings. Involving interventionists in identifying priority outcomes in consultation with families and, where a child is included in an ECEC setting, early childhood educators would be central to this approach.

EXAMPLES OF PRACTITIONER–RESEARCHER PARTNERSHIPS IN IDENTIFYING PRACTICE-BASED EVIDENCE

Single case research projects can illustrate the effectiveness of specific interventions when implemented with children in ECEC services (e.g., Hong & Kemp, 2007 ; Kemp, Stephenson, Cooper, & Hodge, 2016 , 2019 ). Two studies included program staff in the delivery of the interventions, with a member of the program staff assisting with the collection of data for the third study. Of the three studies, one was implemented in a university-affiliated program; the others were implemented in community programs in partnership with university researchers (see Kemp et al., 2016 , 2019 ). For these studies, the selection of priority goals was made by parents and those working closely with the children, whereas decisions relating to the design of the research were led by university researchers.

The research design, including all components of the studies, was developed in close consultation with service staff; acknowledging that all procedures involved in the research had to be feasibly implemented in real-world settings. The Kemp et al. (2016 , 2019 ) studies were conducted in ECEC settings with center educators implementing the interventions. In the 2016 study, families provided information with regard to their children's interests and use of mobile devices, both of which informed the conduct of the research. Educators participating in both studies were coached in the delivery of the program. Coaching in situ has been identified as an effective way of ensuring that EBPs are implemented with a high level of fidelity ( Artman-Meeker, Fettig, Barton, Penney, & Zeng, 2015 ; Ledford et al., 2017 ).

To illustrate the level of practitioner involvement in the research, the modification to the intervention for a second phase for one of the children in the study by Kemp et al. (2019) was made collaboratively with the special educator and the educator who worked within the center program. Staff from the ECI program, including the research manager, were coauthors in the publication of the 2016 and 2019 studies.

SUMMARY AND CONCLUSIONS

Although a range of types of evidence is needed to guide our practice, research-based evidence is still an essential component. For EBP to be supported, systems and services need to employ staff with knowledge about evidence-based programs in management positions. Fixsen et al. (2013) refer to statewide management. This does not occur in New South Wales and in other states in Australia where the ECI system has generally developed through community programs rather than being a state-organized system implemented through human services and later education. This might be the same in other countries. Furthermore, skilled and knowledgeable interventionists (i.e., special educators and therapists) are needed in ECI. To ensure that there is a good supply of qualified and skilled interventionists, the quality of preservice and in-service courses needs to be addressed and opportunities for practitioners to partner with researchers organized so that they can continue to examine research and update their skills and knowledge.

An important bridge in the research-to-practice gap is achieved by encouraging practitioners to use data as part of their decision-making process. In this way, practitioners gather data on proposed outcomes, evaluate the data, and either continue the practice/intervention or make changes to their practice. This data-based decision making can be used to validate the current practice but better still can be used to evaluate the effectiveness of a practice/intervention that has been demonstrated to have efficacy when researched in a controlled setting. The practitioner needs to know how well it can work in his or her setting with his or her children (i.e., the real world).

Research-informing practice in early intervention—How hard can it be? Certainly, it is not easy but if there is a will to have the very best practice for the infants and young children and their families in need of early intervention, we must find the means by which this can be achieved.

• Cited Here |
• PubMed | CrossRef |
• Google Scholar
• View Full Text | PubMed | CrossRef |

collaborative partnerships; evidence-based practice; professional training

• + Favorites
• View in Gallery

Readers Of this Article Also Read

Implementation of australia's national disability insurance scheme: experiences ....

Why Are Kids Struggling with Anxiety More than Ever?

The pandemic’s lingering effects and chronic screen time make it hard for anxious kids to stay in school, but parents can help by “praising instances of bravery”

A clinician at BU’s Center for Anxiety & Related Disorders says that youth anxiety went up during the COVID-19 pandemic, and has yet to come back down to pre-COVID levels. Photo via iStock/fstop123

The pandemic’s lingering effects and chronic screen time make it hard for anxious kids to stay in school, says BU researcher, but parents can help by “praising instances of bravery”

Jessica colarossi.

For children and adolescents who have anxiety, going to school can feel like a nightmare. Anxiety is the most common mental health disorder in the United States for adults. And since the COVID-19 pandemic, anxiety that interferes with daily life has risen in young people, making everyday activities like going to school and socializing difficult and more stressful.

In Massachusetts, the upward trend in anxiety-related disorders has led to more students missing school , sometimes labeled chronic absenteeism or school refusal. This leaves parents, families, and caregivers scrambling for solutions, like education accommodations and mental health counseling—all of which are limited , with long waiting lists to even get in front of a healthcare provider.

“The mechanisms underlying anxiety—like intolerance of uncertainty, changes, and distress—all went up during 2020, and they haven’t come back down to pre-COVID levels,” says Alyssa Farley , a BU College of Arts & Sciences research assistant professor of psychological and brain sciences. “This raises the question about whether children have really recovered from the experiences of those years.”

Farley is a clinician and supervisor at BU’s Center for Anxiety & Related Disorders (CARD) Child & Adolescent program , where she and her colleagues treat children ages 3 to 17 for various clinical anxiety disorders, such as separation anxiety, phobias, and selective mutism, which is when a child will not speak in certain settings—commonly school—but will speak comfortably in other environments. The clinic also offers guidance for caregivers to help kids succeed.

“I think a lot of the things that we recommend can feel counterintuitive to parents,” Farley says. “For example, instead of accommodating avoidance or enabling children to escape a situation that’s causing them anxiety, we say to gradually work with them to face their fears.” Farley wishes there was better understanding of anxiety both at home and in schools, since it can be overlooked until a child starts missing school.

The Brink sat down with Farley to discuss why anxiety in children is interfering with school, why it’s so difficult for parents and kids to access resources, and how to support an anxious child.

with Alyssa Farley

The brink: based on your work at card, how do you make sense of the heightened levels of anxiety among kids and rising school absenteeism.

Farley: There are a lot of different factors that contribute to that. There was the period of the COVID pandemic, 2020 to 2021, where kids weren’t in school, and they weren’t facing things that might be challenging for them under normal circumstances. So, for example, a child predisposed to social anxiety could have spent critical developmental years without having any playdates and not going to school in person. Now school is back to normal, but some kids missed out on key opportunities to practice facing social challenges. For kids that were in their preschool years during the COVID lockdown, they would have started practicing talking with teachers and other kids, and they have really struggled due to missing out on that time.   Another element is screen time. I hear a lot of parents saying their child is completely addicted to their phone or tablet, and that it’s really hard to get them to do other things. For that same period during COVID, daylong screen use became normalized. I think that might be another contributor to school absenteeism now. If school is a factor that causes a child to feel extreme and impairing levels of anxiety, then of course they want to avoid it and stay home instead. Screen time is just another pull to avoid anxiety—it can be very hard to put aside and go to school instead. A lot of times when we’re trying to get families to help their child attend school more regularly, we have to ask them to remove that reinforcement at home.

The Brink: How is missing school addressed in the clinic and what are the options families have?

Farley: A lot of times, we work with families to remove the enabling patterns that contribute to school refusal and build skills to help the child attend school more consistently. For example, an anxious child might say they have a stomachache every week and start staying home a lot. Over time, we might realize that anxiety is making them feel physically unwell, or there is something making them really nervous about school that they’re trying very hard to avoid. The source of this anxiety should be addressed, and the family should help the child make it to school as consistently as possible. We’re always trying to prevent school refusal from becoming a more persistent pattern, because the longer you’re not doing something, the harder it is to jump back into it. When we see children with persistent school refusal, we’re often recommending more intensive treatment than standard outpatient therapy, since that typically won’t be sufficient for a child who has long-term, chronic school refusal.

The Brink: There have been reports of parents struggling to get accommodations and support for their children who are refusing to go to school because of impairing anxiety. Why do you think that is the case? 

Farley: It’s typically thought about in terms of internalizing versus externalizing. Externalizing disorders cause behaviors that are disruptive to the class and interfere with the teacher’s flow of the day. Internalizing disorders like anxiety and mood disorders cause inward distress, and are less likely to affect the classroom. For example, we treat kids who are highly perfectionistic and afraid of making mistakes. They’re at school every day, handing in perfect assignments, which can be positively perceived by teachers and school staff. But, that can actually be driven by a significant underlying anxiety, one that doesn’t call out for a need for help. As another example, a student with social anxiety or selective mutism might struggle to participate or speak in class. While those are signs of impairment, they can still be easy to overlook because they are not disruptive in nature.

The Brink: Is there a fear that those students could fall through the cracks, because it’s not behavior that is disrupting the classroom?

Farley: Absolutely. With school refusal, it’s common to see that schools will start intervening and making plans when it gets to the point that there is concern about educational neglect. Then measures and steps that need to be taken can seem quite punitive to families. I have worked with kids who have gone to court because they’ve missed too many days of school. But that’s not addressing the underlying problem.

The Brink: How would you like to see schools improve the way students are supported?

Farley: I would wish for greater awareness of what anxiety looks like and the ways that it can interfere. Anxiety can actually be really impairing and prevent a child from reaching their potential in a range of ways. I’d like to see more training on how to identify signs of anxiety for both families and school staff. There’s a lot of misidentification and misunderstanding of anxiety disorders that, until a child is not showing up for school, can cause them to be overlooked. Teachers are often well-positioned to identify a mental health concern. To address this, we have made efforts to support them, such as through the development of online trainings designed in our team’s collaboration with Jennifer Greif Green , a professor in special education and a child clinical psychologist at BU’s Wheelock College of Education & Human Development. The training helps with identifying the different signs that a child might be struggling with their mental health and how to check in with the child in an effective and supportive way—and also how to refer them to school- or community-based mental health services if needed.

The Brink: Is there similar training for parents and caregivers who have a child struggling with anxiety?

Farley: That’s something I would like to develop. At the clinic, we provide parents with education around ways they interact with their child, so that they can be more effective in helping their child overcome anxiety. And it’s oftentimes not intuitive. Maybe they’re providing their child with a lot of reassurance all the time, or they’re jumping in whenever they see their child starting to feel a little bit anxious, or they’re saving them from hard situations or allowing them to avoid them. We call those the “parent traps,” since that is what parents often naturally do when they have the very best intentions. It’s in the effort to protect your child and can be helpful in the short run, but it can maintain and exacerbate anxiety in the long run.

The Brink: If you were to give general tips for parents and caregivers, what would they be?

Farley: Acknowledge your child’s feelings and express confidence in their ability to do hard things. There can be a tendency to minimize anxiety by saying things like, “Oh it’s going to be so easy, nothing to worry about, relax it’s fine”—but that language doesn’t really help. We encourage parents to label their child’s feelings, empathize with their emotions, and provide encouragement. You might say, “I can tell that you’re feeling really scared and I get it. I know that this is really hard. But you’ve got this. You can do it.”  I would also say, help your child to challenge their own anxious thoughts. Support your child in gradually facing their fears. Notice and praise instances of bravery, and practice modeling bravery—kids pick up on all their parents’ cues!

This interview has been edited for length and clarity.

Student Health Services has resources available for any BU student seeking support; BU’s Faculty & Staff Assistance Office is available for employees and their family members to access help with work and life challenges.

Explore Related Topics:

• Coronavirus
• Share this story
• 0 Comments Add

Science Writer Twitter Profile

Jessica Colarossi is a science writer for The Brink . She graduated with a BS in journalism from Emerson College in 2016, with focuses on environmental studies and publishing. While a student, she interned at ThinkProgress in Washington, D.C., where she wrote over 30 stories, most of them relating to climate change, coral reefs, and women’s health. Profile

Comments & Discussion

Boston University moderates comments to facilitate an informed, substantive, civil conversation. Abusive, profane, self-promotional, misleading, incoherent or off-topic comments will be rejected. Moderators are staffed during regular business hours (EST) and can only accept comments written in English. Statistics or facts must include a citation or a link to the citation.

Post a comment. Cancel reply

Your email address will not be published. Required fields are marked *

Latest from The Brink

Getting their hands dirty in the lab—and in the charles river, 2024 ignition awards aim to bring bu science and tech to market, bu team wins major national science foundation grant to help phd students attack climate change, liberation through rhythm: bu ethnomusicologist studies history and present of african beats, oxygen produced in the deep sea raises questions about extraterrestrial life, the histories of enslaved people were written by slavers. a bu researcher is working to change that, making mri more globally accessible: how metamaterials offer affordable, high-impact solutions, “i love this work, but it’s killing me”: the unique toll of being a spiritual leader today, feeling the heat researchers say heat waves will put more older adults in danger, what the history of boston’s harbor can teach us about its uncertain future, eng’s mark grinstaff one of six researchers to receive nsf trailblazer engineering impact awards, how do we solve america’s affordable housing crisis bu research helps inspire a federal bill that suggests answers, missile defense won’t save us from growing nuclear arsenals, this ai software can make diagnosing dementia easier and faster for doctors, suicide now the primary cause of death among active duty us soldiers, state laws banning abortion linked to increases in mental health issues, scuba diving safely for marine biology research, heat waves are scorching boston, but are some neighborhoods hotter than others, six bu researchers win prestigious early-career award to advance their work, new ai program from bu researchers could predict likelihood of alzheimer’s disease.

• Share full article

Advertisement

Supported by

Surprising New Research Links Infant Mortality to Crashing Bat Populations

Without bats to eat insects, farmers turned to more pesticides, a study found. That appears to have increased infant deaths.

By Catrin Einhorn

The connections are commonsense but the conclusion is shocking.

Bats eat insects. When a fatal disease hit bats, farmers used more pesticides to protect crops. And that, according to a new study, led to an increase in infant mortality.

According to the research, published Thursday in the journal Science , farmers in affected U.S. counties increased their use of insecticides by 31 percent when bat populations declined. In those places, infant mortality rose by an estimated 8 percent.

“It’s a seminal piece,” said Carmen Messerlian, a reproductive epidemiologist at Harvard who was not involved with the research. “I actually think it’s groundbreaking.”

The new study tested various alternatives to see if something else could have driven the increase: Unemployment or drug overdoses, for example. Nothing else was found to cause it.

Dr. Messerlian, who studies how the environment affects fertility, pregnancy and child health, said a growing body of research is showing health effects from toxic chemicals in our environment, even if scientists can’t put their fingers on the causal links.

“If we were to reduce the population-level exposure today, we would save lives,” she said. “It’s as easy as that.”

We are having trouble retrieving the article content.

Please enable JavaScript in your browser settings.

Thank you for your patience while we verify access. If you are in Reader mode please exit and  log into  your Times account, or  subscribe  for all of The Times.

Thank you for your patience while we verify access.

Already a subscriber?  Log in .

Want all of The Times?  Subscribe .

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• HHS Author Manuscripts

Infant and Toddler Child-Care Quality and Stability in Relation to Proximal and Distal Academic and Social Outcomes

Mary e. bratsch-hines.

University of North Carolina at Chapel Hill

Robert Carr

Duke University

Michael Willoughby

RTI International

This study considered the quality and stability of infant and toddler nonparental child care from 6 to 36 months in relation to language, social, and academic skills measured proximally at 36 months and distally at kindergarten. Quality was measured separately as caregiver-child verbal interactions and caregiver sensitivity, and stability was measured as having fewer sequential child-care caregivers. This longitudinal examination involved a subsample ( N = 1,055) from the Family Life Project, a representative sample of families living in rural counties in the United States. Structural equation modeling revealed that children who experienced more positive caregiver-child verbal interactions had higher 36-month language skills, which indirectly led to higher kindergarten academic and social skills. Children who experienced more caregiver stability had higher kindergarten social skills.

Children’s early supportive relationships with adults during the first 3 years of life are instrumental to the development of their language and social skills, which, in turn, are strongly related to later achievement and success into adolescence ( Landry & Smith, 2011 ; Suggate, Schaughency, McAnally, & Reese, 2018 ; Vandell, Belsky, Burchinal, Steinberg, & Vandergrift, 2010 ). Parent-child relationships are particularly strong predictors of children’s language and social skills ( NICHD Early Childcare Research Network, 2002 ). Nonetheless, a large percentage of children in the United States enter nonparental child care as infants and toddlers and spend a significant portion of time with caregiving adults in infant and toddler (IT) child-care settings. Young children may have limited access to promotive IT child-care environments because, despite high demand, IT child care tends to be of low to moderate quality ( Schmit & Matthews, 2013 ). Even when high-quality IT child care is available, it is often prohibitively expensive, particularly for families who have low incomes. Publicly funded child-care subsidies have been created to help low-income families access IT child care, but many child-care subsidy programs have long waiting lists ( Schulman & Blank, 2004 ). Furthermore, families frequently change IT child-care settings for a variety of reasons, including subsidy availability ( Chaudry, 2004 ). Taken together, these challenges prohibit families from accessing high-quality and stable IT child-care settings and caregivers ( Sandstrom & Chaudry, 2012 ). The extent to which IT child care contributes to children’s development of language, social, and academic skills is not well understood because it has been less studied than child care during the preschool period ( Recchia & Fincham, 2019 ). This study will help fill this gap by examining child-care quality (caregiver-child verbal interactions and caregiver sensitivity) and caregiver stability measured from 6 to 36 months in relation to child outcomes measured proximally at 36 months and distally at the spring of kindergarten.

Caregiver-child verbal interactions, measured in this study by observations of positive verbal interactions between a caregiver and individual child, can motivate children to attend to verbal cues and make connections with language through their verbal exchanges with others, as supported by the social interactive framework ( Bruner, 1975 ; Girolametto & Weitzman, 2002 ; Snow, 1999 ). In one study, children whose child-care caregiver provided more language stimulation from 15 to 36 months had higher expressive language skills at 36 months ( NICHD Early Childcare Research Network, 2000 ). Another study found that more caregiver-child positive verbal interactions from 6 to 36 months was associated with expressive language at 36 months and served as a buffer for lower maternal language input when predicting to receptive language at 36 months and prekindergarten (pre-K; Vernon-Feagans, Bratsch-Hines, & Family Life Project Key Investigators, 2013 ).

Caregiver sensitivity, measured in this study by observer ratings of caregiver responsivity to and acceptance of all children in the child-care setting, is important because young children have inherent affinities for social connections and learning through sensitive interactions, as supported by ecological frameworks ( Bronfenbrenner & Morris, 2006 ; Burchinal, 2018 ; Mortensen & Barnett, 2015 ). Caregivers who engage in reciprocal, supportive, and adaptive caregiving behaviors help children gain important early language and social skills ( Shin, 2015 ). Having more sensitive caregivers from 6 to 36 months was associated with fewer behavior problems at 36 months ( NICHD Early Childcare Research Network, 1998 ), higher receptive vocabulary at 36 months ( NICHD Early Childcare Research Network, 2000 ), and higher preacademic and language skills at 54 months ( NICHD Early Childcare Research Network, 2002 ). After accounting for maternal sensitivity, having a child-care caregiver with high versus low sensitivity prior to age four was associated with higher social competence and math skills 1 year later ( Vesely, Brown, & Mahatmya, 2013 ).

Caregiver stability, measured in this study as having fewer sequential child-care caregivers over the first 3 years of life, is more likely to expose children to repeated and predictable interactions, which helps children build trusting relationships with adults, as supported by attachment theory ( Ainsworth, 1989 ; Horm et al., 2018 ). These stable relationships help children develop attachment security, which in turn has been related to children’s development and learning ( Burchinal, Magnuson, Powell, & Hong, 2015 ). Prior work has primarily examined caregiver stability in relation to attachment security and social outcomes. In early studies, children from 12 to 24 months who experienced more caregiver changes had lower attachment security with caregivers ( Howes & Hamilton, 1992 ) and poorer observed and teacher-reported social competence with peers at 48 months ( Howes & Hamilton, 1993 ). Having a larger number of different sequential caregivers from 6 to 36 months was related to higher parent-reported externalizing problems at 36 months ( Pilarz & Hill, 2014 ), lower teacher-reported social skills at pre-K ( Bratsch-Hines, Mokrova, Vernon-Feagans, & Family Life Project Key Investigators, 2015 ), and lower teacher-reported social-emotional adjustment at 6 years ( Love et al., 2003 ). Finally, in other studies, child-care stability from 4 to 36 months was not associated with mother- or teacher-reported social competence at 36 months, 58 months, or kindergarten ( NICHD ECCRN, 1998 , 2003 ).

Limited work has associated caregiver stability during the IT period with language and academic outcomes. One study found that more stability was related to higher cognitive skills at age four ( Loeb, Fuller, Kagan, & Carrol, 2004 ), whereas others did not find associations with cognitive or language skills at 15 months ( Tran & Weinraub, 2006 ) or receptive vocabulary at pre-K ( Lee, 2016 ), suggesting a need for further study.

Three recent studies have examined both caregiver quality and stability for infants and toddlers in center-based care ( Choi, Horm, Jeon, & Ryu, 2018 ; Horm et al., 2018 ; Ruprecht, Elicker, & Choi, 2016 ). Based on a nationally representative sample of Early Head Start programs, caregiver instability from 12 to 36 months was not related to receptive language skills at 36 months, but was related to higher levels of teacher-reported problem behaviors and lower social competence at 36 months. The latter effect was mitigated by being in a more emotionally and behaviorally supportive classroom ( Choi et al., 2018 ). Conversely, for children in Educare programs, having the same Early Head Start teacher from birth to 36 months was associated with lower teacher-reported behavioral concerns and higher self-control and initiative at 36 months, but these associations were no longer significant after children transitioned to Head Start ( Horm et al., 2018 ). Ruprecht et al. (2016) purposefully sampled child-care centers that either did or did not promote the practice of child-care continuity (e.g., toddlers staying with the same caregivers for longer than is considered typical). Children aged 12–24 months in continuity classrooms had higher levels of observed interactive involvement with caregivers and were rated as having fewer problem behaviors by their caregivers.

Although useful, these recent studies had limitations. For example, children were exclusively in formal center-based care (e.g., Early Head Start, Educare), which has tended to be of higher quality than other care types ( Bassok, Fitzpatrick, Greenberg, & Loeb, 2016 ; Yazejian et al., 2017 ). Small sample sizes further reduced the representative nature of the findings. In addition, social outcomes were reported by the same child-care caregivers whose classrooms were observed for quality. This study extended previous work using longitudinal data from a large representative sample of children living in the rural United States who were reported to be in a range of formal and/or informal child-care settings from 6 to 36 months and whose outcomes were reported or assessed at 36 months and in kindergarten. Furthermore, this is the only known study to relate caregiver stability during the IT period to both proximal developmental outcomes prior to school entry and distal developmental outcomes after the transition to elementary school. Our research questions were as follows: (a) Were caregiver-child verbal interactions, caregiver sensitivity, and caregiver stability associated with children’s language and parent-reported social skills at 36 months and/or children’s academic achievement and teacher-reported social skills in the spring of kindergarten? (b) Did 36-month language and social skills mediate the associations between verbal interactions, sensitivity, and stability and children’s kindergarten outcomes? Building on prior research, we hypothesized that higher levels of verbal interactions, sensitivity, and stability would be associated with better child outcomes at 36 months, which in turn would mediate children’s kindergarten outcomes.

Participants

Data for this study were drawn from the Family Life Project (FLP), a longitudinal study of families living in two high-poverty rural regions of North Carolina (NC) and Pennsylvania (PA). FLP used epidemiological sampling procedures, whereby all families in three NC counties and three PA counties who had a child born between September 15, 2003 and September 14, 2004 were recruited to participate in the study. The full representative FLP sample included 1,292 families and oversampled for African American families in NC and low-income families in both regions (for more information about the FLP, including early child-care experiences, see Vernon-Feagans, Cox, & Family Life Project Key Investigators, 2013 ). FLP children who were reported to be in nonmaternal child care during at least one of four time points at 6, 15, 24, and 36 months ( N = 1,055) were included in this study. We only excluded children who had parent-only care across the four time points, who differed from the included subsample in that they were less likely to be male, χ 2 (1) = 4.36, p = .04; African American, χ 2 (1) = 65.62, p < .001; or from NC, χ 2 (1) = 51.19, p < .001. The subsample included in this study was comprised of 52.23% males and 47.77% African American children. Families had an income-to-needs ratio of 1.81, signifying that families on average were living below 200% of the federal poverty threshold.

FLP data were collected through home and/or child-care visits at 2, 6, 15, 24, and 36 months and school visits in the spring of kindergarten. In homes, research assistants (RAs) conducted parent interviews and child assessments and administered questionnaires. In child-care settings, RAs conducted caregiver interviews, child assessments, observed classrooms, and administered questionnaires, and caregivers completed questionnaires about the classroom and individual target children. In kindergarten classrooms, RAs administered spring child assessments and teachers completed questionnaires about the classroom and individual target children.

Child-Care Quality

Child-care quality was measured as caregiver–child verbal interactions and caregiver sensitivity.

Caregiver-child verbal interactions.

At the 6-, 15-, 24-, and 36-month child-care visits, RAs completed two 10-min observations using the Childcare Verbal Interaction (CVI) observation, which is a time-sampling live-coding system ( Vernon-Feagans & Manlove, 2005 ). Coders used continuous coding in 10-s blocks to identify behaviors occurring between a caregiver and target child (6- to 36-month interrater reliability = 0.77). The categories were coded one time per 10-s segment if they occurred, regardless if they were observed additional times in a segment. Positive verbal interactions, which included affirmative vocalizations such as cooing and talking, were either initiated by the caregiver with the target child or by the target child with the caregiver. A composite variable, caregiver-child verbal interactions (α = .90), was derived at each time point by summing the proportion of child-caregiver and caregiver-child verbal interactions across the 10-s blocks and then was averaged across 6–36 months.

Caregiver sensitivity.

At the 6-, 15-, 24-, and 36-month child-care visits, RAs completed the Home Observation for Measurement of the Environment (HOME; Caldwell & Bradley, 1984 ), which has been used in child-care settings ( Bradley, Caldwell, & Corwyn, 2003 ). Each scale item was scored in a yes/no fashion, with an overall average considered as the proportion of items scored as present during the observation of the child-care setting. A composite variable, caregiver sensitivity (α = .65), was derived at each time point by averaging two HOME subscales of responsivity (e.g., caregiver’s voice conveys positive feelings toward children ) and acceptance of the child (e.g., caregiver shouts at children , reverse-scored) and then was averaged across 6–36 months.

Caregiver Stability

At the 6-, 15-, 24-, and 36-month home visits, parents were asked to provide contact information for their child’s primary child-care caregiver, who was contacted shortly after the parent interview. Unique numeric identifiers were assigned to each caregiver who participated in a child-care visit, with caregivers visited at multiple time points retaining the same unique identifiers across time. From 6 to 36 months, caregiver stability was calculated by adding the number of unique numeric identifiers, which represented the child’s number of different sequential caregivers, and ranged from 1 to 4. This variable was reverse-scored to represent caregiver stability rather than instability.

Child Skills at 36 Months

Language and social skills at 36 months were included as outcomes and mediators in inferential models.

Expressive language.

Research assistants administered the Expressive Communication subscale (α = .91) of the Preschool Language Scale, 4th ed. (PLS; Zimmerman, Steiner, & Pond, 2002 ). Items assessed rudimentary aspects of expressive language and more advanced items that required the child to demonstrate verbal understanding of language concepts. Standard scores were calculated.

Receptive vocabulary.

Research assistants administered the Receptive Vocabulary subscale (α = .89) of the Wechsler Preschool and Primary Scale of Intelligence, 3rd ed. (WPPSI; Wechsler, 2002 ). Items assessed how children were able to identify picture stimuli. Standard scores were calculated.

Social skills.

The child’s parent completed the Strengths and Difficulties Questionnaire (SDQ; Goodman, 2001 ). Each of 25 items were scored on a scale of 0–2 ( not true , somewhat true , or certainly true ). Scores were calculated for the Prosocial (α = .73) and Total Problems (reverse-scored and comprised of Conduct Problems, Emotional Symptoms, Hyperactive Behaviors, and Peer Problems; α = .68) subscales.

Child Skills at Kindergarten

Academic and social skills at the spring of kindergarten were included as outcomes in inferential models.

Academic skills.

Woodcock Johnson (WJ; Woodcock, McGrew, & Mather, 2001 ) subtests were administered by RAs in the spring of kindergarten. Picture Vocabulary (α = .81) measured expressive language and word knowledge. Letter-Word Identification (α = .94) measured children’s ability to distinguish letter sounds and words. Applied Problems (α = .93) measured children’s ability to solve mathematics problems. Standard scores were calculated.

Kindergarten teachers completed two questionnaires of children’s behaviors. As reported earlier with the parent SDQ measure ( Goodman, 2001 ), scores from the Prosocial (α = .70) and Total Problems (reverse-scored; α = .84) subscales were calculated. Additional items from the Social Competence Scale (SCS; Conduct Problems Prevention Research Group, 1995 ; Werthamer-Larsson, Kellam, & Wheeler, 1991 ) were used, with 14 SCS items scored on a scale of 1–6 ( almost never , rarely , sometimes , often , very often , and almost always ). Scores were calculated from Social Competence (α = .88), Emotion Regulation (α = .87), and Aggressive-Oppositional Behaviors (reverse-scored; α = .87) subscales.

Child, family, child care, and school variables were included as covariates to account for potential selection bias.

Child covariates.

Child gender (0 = girls; 1 = boys) and race (0 = non-African American, 1 = African American) were reported by the child’s parent at 2 months. Child mental development index (MDI) was assessed at 6 months using the Bayley Scales of Infant Development ( Bayley, 1993 ). MDI (α = .73) is a standard series of developmental tasks that measures children’s cognitive development. Standardized scores were calculated.

Family covariates.

State (0 = PA; 1 = NC) was included to account for site differences among FLP families. Family poverty status was measured as the income-to-needs ratio reported by the mother at 6, 15, 24, and 36 months and was averaged across 6–36 months (α = .93). Maternal sensitivity was measured using the same HOME subscales ( Caldwell & Bradley, 1984 ) as reported earlier for child care at 6, 15, 24, and 36 months and was averaged across 6–36 months (α = .74). Maternal education was reported by the mother at 6, 15, 24, and 36 months and included as the number of years of highest education achieved by 36 months.

Child care and kindergarten covariates.

Because children were not consistently reported to be in child care, the number of observed time points in child care was calculated as the number of CVI observations that were conducted from 6 to 36 months. Child-care quantity was reported by the child-care caregiver (or parents, if caregivers were not interviewed) as the number of hours target children were in care each week at 6, 15, 24, and 36 months. Quantity, which included values of 0 for children who were not in child care, was averaged across 6–36 months (α = .62). Child-care type (0 = informal; 1 = formal) was reported by child-care caregivers (or parents, if caregivers were not interviewed). Informal care primarily included relative care, but also included a small proportion of families using family child-care homes (4%–7% across time points). Formal care included nonhome, center-based environments. Type was calculated as the proportion of formal care across 6–36 months (α = .77). Kindergarten classroom quality was measured using the Classroom Assessment Scoring System ( Pianta, La Paro, & Hamre, 2008 ) and was the average of Instructional Support, Classroom Organization, and Classroom Emotional Support domains (α = .80).

Analysis Plan

Structural equation modeling was conducted using Mplus (Version 7; Muthén & Muthén, 1998–2013 ) employing models that used weights and stratification variables to account for the complex sampling design. To account for missing data on the outcome variables (20%–25%), we used full information maximum likelihood estimation. To account for missing data on the independent variables (0%–28%), we brought covariates into the model as dependent variables in order to make distributional assumptions about covariates ( Muthén & Muthén, 1998–2013 ). Prior to conducting inferential analyses, we examined fit indices of the measurement model.

Analyses considered two latent constructs as kindergarten outcomes: (a) academic skills, comprised of WJ Picture Vocabulary, Letter-Word Identification, and Applied Problems; and (b) teacher-reported social skills, comprised of SDQ and SCS subscales. Both latent outcomes were regressed on the primary predictors, including caregiver-child verbal interactions, caregiver sensitivity, and caregiver stability; the covariates; and the mediators. Two latent constructs served as 36-month outcomes/mediators: (a) language skills, comprised of PLS expressive language and WPPSI receptive vocabulary; and (b) parent-reported social skills, comprised of SDQ subscales. These 36-month outcomes/mediators were also regressed on caregiver–child verbal interactions, caregiver sensitivity, caregiver stability, and covariates. For all models, standardized regression coefficients were reported and model fit was assessed from the chi-square test, root mean square error of approximation (RMSEA), and comparative fit index (CFI). Tests of mediation were conducted by examining indirect effect estimates ( MacKinnon, 2008 ).

Descriptive information is presented in Table 1 and results are presented in Figure 1 .

Structural equation model predicting kindergarten academic and social skills from direct and indirect effects of 6- to 36-month caregiver-child verbal interactions, caregiver sensitivity, and caregiver stability. Model fit statistics: χ 2 (159, N = 1,055) = 396.15, p < .001; RMSEA = .04 (CI [.03, .04]), CFI = .94. Significant indirect effects: verbal interactions → language → academic skills, β = .11, p = .002; verbal interactions → language → social skills, β = .04, p = .01.

Note . Boldface standardized path coefficients (interpretable as effect sizes) on solid lines indicate p < .05. Dashed gray lines indicate nonsignificant relations. PLS = Preschool Language Scale; WPPSI = Wechsler Preschool and Primary Scale of Intelligence; CVI = Child-care Verbal Interaction; HOME = Home Observation for Measurement of the Environment; SDQ = Strengths and Difficulties Questionnaire; WJ = Woodcock Johnson; SCS = Social Competence Scale.

Descriptive Data ( N = 1,055)

Note . CVI = Childcare Verbal Interaction; HOME = Home Observation for Measurement of the Environment; PLS = Preschool Language Scale; WPPSI = Wechsler Preschool and Primary Scale of Intelligence; SDQ = Strengths & Difficulties Questionnaire; WJ = Woodcock Johnson; SCS = Social Competence Scale; CLASS = Classroom Assessment Scoring System.

Model fit was found to be good, χ 2 (159, N = 1,055) = 396.15, p < .001; RMSEA = .04 (CI = .03–.04), CFI = .94. Overall, the model explained 39% of the variance in language and 33% of parent-reported social skills at 36 months, and 57% of academic skills and 25% of teacher-reported social skills in kindergarten. Caregiver-child verbal interactions were correlated with caregiver sensitivity, r = .31, p < .001, and with caregiver stability, r = .23, p < .001.

Caregiver-child verbal interactions had a direct association with language skills at 36 months (β = .16, p < .001), but not social skills at 36 months nor academic nor social skills at kindergarten. Caregiver-child verbal interactions also had indirect associations with kindergarten academic skills (verbal interactions → language → academic skills, β = .11, p = .002) and social skills (verbal interactions → language → social skills, β = .04, p = .01) through its direct association with 36-month language skills. Caregiver sensitivity was not directly associated with 36-month language and social skills nor directly or indirectly associated with kindergarten academic and social skills. Caregiver stability had a direct association with social skills in kindergarten (β = .18, p = .01), but was not directly associated with 36-month language and social skills or kindergarten academic skills, and no indirect associations emerged.

Infants and toddlers in the United States tend to experience nonparental child care that varies in terms of quality and stability, particularly in rural areas where economic and employment insecurity lead to fewer high-quality child-care options ( Bratsch-Hines, Baker, & Vernon-Feagans, 2016 ). This study sought to add to the limited literature on IT child care using a sample of children living in high-poverty rural areas. We concentrated on two key aspects of IT child care, quality and stability, in association with children’s proximal and distal academic and social outcomes. Of particular note, this was the first known study to consider the association between caregiver stability during the IT years and academic outcomes after the transition to elementary school. In filling these gaps, our study found that (a) caregiver-child verbal interactions was positively associated with children’s 36-month language skills and this association fully mediated associations between caregiver-child verbal interactions and children’s kindergarten academic and social skills; (b) caregiver sensitivity was not associated with 36-month or kindergarten outcomes; and (c) caregiver stability from 6 to 36 months was positively associated with kindergarten social skills, but was not associated with 36-month outcomes or kindergarten academic skills.

An important feature of child-care quality is children’s access to a responsive caregiver with whom children are more likely to engage in back-and-forth interactions, learn how to elicit responses from adults, and learn language and vocabulary ( Girolametto & Weitzman, 2002 ). Moreover, early language skills facilitate children’s successful engagement in the academic and social context of school ( Dickinson, McCabe, & Essex, 2006 ). We found that more verbal interactions between an individual child and child-care caregiver was positively associated with language skills at 36 months. Furthermore, 36-month language skills fully mediated the association between caregiver-child verbal interactions and children’s kindergarten academic and social skills. Previous studies that have measured the frequency of children’s language interactions with their child-care caregiver likewise found an association with children’s language skills ( NICHD Early Childcare Research Network, 2000 ; Vernon-Feagans, Bratsch-Hines, et al., 2013 ). This study extends previous work by documenting evidence of the association between IT caregiver-child interactions and child outcomes as late as kindergarten. Ensuring that infants and toddlers have access to caregivers who engage with them using positive verbal interactions may help children learn key language skills that promote subsequent academic and social development in elementary school.

Additionally, we found no evidence to indicate that caregiver sensitivity, when measured at the global classroom level, was related to child outcomes, even though other studies have documented the importance of caregiver sensitivity in child-care settings for children’s academic and social competence (e.g., Vesely et al., 2013 ). Our measure of caregiver sensitivity was consistent with prior research on child-care quality, which has typically focused on general caregiving behaviors and/or structural and environmental characteristics of child care as experienced by groups of children. However, these global quality measures provide relatively weak predictive power to children’s concurrent and later academic and social skills ( Burchinal, 2018 ), in part because global indicators may not represent the quality experienced by individual children ( Jeon et al., 2010 ). Although caregiver sensitivity, measured in this study as having more responsive and accepting caregivers, is undoubtedly important for children, additional research is needed to explore methods of capturing how individual children are exposed to these caregiving behaviors.

This study was potentially the first to examine caregiver stability in relation to both academic and social skills assessed at 36 months and in elementary school. Caregiver stability was related to children’s social skills as reported by kindergarten teachers, such that children with more stability from 6 to 36 months were rated by their kindergarten teacher as having higher social skills, which is a similar finding to other studies (e.g., Love et al., 2003 ). Although we expected caregiver stability likewise to be associated with 36-month outcomes, our findings suggested a delayed effect of caregiver stability on social skills, which only began to emerge after school entry. This may have been due to differences between parent- and teacher-report of social skills. Nonetheless, there appeared to be something unique about the experience of having stable child-care caregivers that led to increased competence in the social sphere of kindergarten classrooms. For young children whose relationships with their caregivers were disrupted, there may have been greater potential for difficulty forming attachments to future caregivers and, in turn, forming strong relationships with peers and other adults ( Ahnert, Pinquart, & Lamb, 2006 ). Conversely, other work has shown that caregiver stability from 36 to 48 months was not related to literacy or math outcomes prior to kindergarten entry ( Ansari & Purtell, 2018 ). Given limited evidence, however, additional prospective research is needed in order to understand the long-term effects of child-care stability on a range of child outcomes.

These findings should be considered in light of several limitations. First, despite our use of several covariates, the observational nature of the data could not fully account for family selection bias. Investigating the quality and stability of children’s family experiences could strengthen future studies. Second, only four data collection time points captured children’s child-care experiences and thus were likely not sufficient to capture “true” caregiver-child verbal interactions, caregiver sensitivity, or caregiver stability. Third, the time spent observing child-care settings at each time point was relatively short, which also may have limited the magnitude of the findings. Fourth, the experiences of day-to-day caregiver instability or multiple concurrent caregivers were not considered, which have implications for children’s developmental outcomes ( De Schipper, Tavecchio, Van IJzendoorn, & Linting, 2003 ). Finally, we were unable to capture the potential bidirectional nature of our variables of interest. That is, children with higher language skills may have elicited more positive verbal interactions with caregivers and children’s behavior problems may have led to parents to change care arrangements.

Many families in the United States and across the world face significant barriers to accessing high-quality and stable child care, particularly in rural areas, where low population density can lead to an insufficient supply of child-care programs that meet state quality standards ( Henly & Adams, 2018 ; Rao & Wong, 2018 ). The potential for high-quality child care to enhance the development of children’s academic and social skills is significant, especially for children from low-income or otherwise socioeconomically disadvantaged backgrounds ( Love et al., 2003 ; Yazejian et al., 2017 ), and particularly for infants and toddlers whose experiences with caregivers during their first 3 years of life are integral to subsequent optimal development ( Mortensen & Barnett, 2015 ). Our study suggests that children in rural communities stand to benefit from exposure to high-quality child care that is individualized and stable over time. However, the magnitude of these child-care quality and stability findings were modest, suggesting that children’s child-care experience may be a necessary, but insufficient, means to ameliorate the substantial socioeconomic achievement gaps that begin to emerge as early as infancy ( Burchinal, 2018 ). In-depth studies during children’s first 3 years are needed to understand the true magnitude of IT child-care quality and stability. Furthermore, policy initiatives that support families’ access to preferred, affordable, stable, and high-quality child care are needed. Finally, IT child-care caregivers across diverse settings need key strategies to interact with children in positive ways, which can help build a workforce of caregivers to set the foundation for infants’ and toddlers’ optimal development.

Acknowledgments

The study was supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development (1PO1HD39667, 2PO1HD039667, and R01HD080786).

Contributor Information

Robert Carr, Duke University.

Michael Willoughby, RTI International.

• Ahnert L, Pinquart M, & Lamb ME (2006). Security of children’s relationships with nonparental care providers: A meta-analysis . Child Development , 77 , 664–679. 10.1111/j.1467-8624.2006.00896.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ainsworth MS (1989). Attachments beyond infancy . American Psychologist , 44 , 709–716. 10.1037/0003-066X.44.4.709 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ansari A, & Purtell KM (2018). Continuity and changes in classroom age composition and achievement in Head Start . Journal of Applied Developmental Psychology , 58 , 86–95. 10.1016/j.appdev.2018.07.002 [ CrossRef ] [ Google Scholar ]
• Bassok D, Fitzpatrick M, Greenberg E, & Loeb S (2016). Within- and between-sector quality differences in early childhood education and care . Child Development , 87 , 1627–1645. 10.1111/cdev.12551 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bayley N (1993). Bayley II scales of infant development . New York, NY: Psychological Corporation. [ Google Scholar ]
• Bradley RH, Caldwell BM, & Corwyn RF (2003). The child care HOME inventories: Assessing the quality of family child care homes . Early Childhood Research Quarterly , 18 , 294–309. 10.1016/S0885-2006(03)00041-3 [ CrossRef ] [ Google Scholar ]
• Bratsch-Hines ME, Baker C, & Vernon-Feagans L (2016). Minority families in the rural United States: Family processes, child care, and early schooling In Crockett L & Carlo G (Eds.), Rural ethnic minority youth and families in the United States: Theory, research, and applications (pp. 143–164). Cham, Switzerland: Springer International. [ Google Scholar ]
• Bratsch-Hines ME, Mokrova I, Vernon-Feagans L; Family Life Project Key Investigators. (2015). Child care instability from 6 to 36 months and the social adjustment of children at prekindergarten . Early Childhood Research Quarterly , 30 , 106–116. 10.1016/j.ecresq.2014.09.002 [ CrossRef ] [ Google Scholar ]
• Bronfenbrenner U, & Morris PA (2006). The bioecological model of human development In Lerner RM (Ed.), Theoretical models of human development. Handbook of child psychology (Vol. 1 , 6th ed., pp. 793–828). Hoboken, NJ: Wiley. [ Google Scholar ]
• Bruner JS (1975). From communication to language: A psychological perspective . Cognition , 3 , 255–287. 10.1016/0010-0277(74)90012-2 [ CrossRef ] [ Google Scholar ]
• Burchinal MR (2018). Measuring early care and education quality . Child Development Perspectives , 12 , 3–9. 10.1111/cdep.12260 [ CrossRef ] [ Google Scholar ]
• Burchinal M, Magnuson K, Powell D, & Hong SS (2015). Early childcare and education In Bornstein MH, Leventhal T, & Lerner RM (Eds.), Handbook of child psychology and developmental science: Ecological settings and processes (pp. 223–267). Hoboken, NJ: Wiley. [ Google Scholar ]
• Caldwell BM, & Bradley RH (1984). Home observation for measurement of the environment . Little Rock, AR: University of Arkansas at Little Rock. [ Google Scholar ]
• Chaudry AJ (2004). Putting mothers first: How low-wage working mothers manage child care . New York, NY: Russell Sage Foundation. [ Google Scholar ]
• Choi JY, Horm D, Jeon S, & Ryu D (2018). Do stability of care and teacher-child interaction quality predict child outcomes in Early Head Start? Early Education and Development , 30 , 337–356. 10.1080/10409289.2018.1546096 [ CrossRef ] [ Google Scholar ]
• Conduct Problems Prevention Research Group (CPPRG). (1995). Teacher social competence scale technical report . Retrieved from http://www.fasttrackproject.org
• De Schipper JC, Tavecchio LWC, Van IJzendoorn MH, & Linting M (2003). The relation of flexible child care to quality of center day care and children’s socio-emotional functioning: A survey and observational study . Infant Behavior and Development , 26 , 300–325. 10.1016/S0163-6383(03)00033-X [ CrossRef ] [ Google Scholar ]
• Dickinson DK, McCabe A, & Essex MJ (2006). A window of opportunity we must open to all: The case for preschool with high-quality support for language and literacy In Dickinson DK & Neuman SB (Eds.), Handbook of early literacy research (Vol. 2 , pp. 11–28). New York, NY: Guilford. [ Google Scholar ]
• Girolametto L, & Weitzman E (2002). Responsiveness of child care providers in interactions with toddlers and preschoolers . Language, Speech, and Hearing Services in Schools , 33 , 268–281. 10.1044/0161-1461(2002/022) [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Goodman R (2001). Psychometric properties of the Strengths and Difficulties Questionnaire . Journal of the American Academy of Child and Adolescent Psychiatry , 40 , 1337–1345. 10.1097/00004583-200111000-00015 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Henly JR, & Adams G (2018). Increasing access to quality child care for four priority populations: Challenges and opportunities with the CCDBG reauthorization . Washington, DC: Urban Institute; Retrieved from https://www.urban.org/research/publication/increasing-access-quality-child-care-four-priority-populations [ Google Scholar ]
• Horm DM, File N, Bryant D, Burchinal M, Raikes H, Forestieri N, … Cobo-Lewis A (2018). Associations between continuity of care in infant-toddler classrooms and child outcomes . Early Childhood Research Quarterly , 42 , 105–118. 10.1016/j.ecresq.2017.08.002 [ CrossRef ] [ Google Scholar ]
• Howes C, & Hamilton CE (1992). Child relationships with child care teachers: Stability and concordance with parental attachments . Child Development , 63 , 859–866. 10.1111/j.1467-8624.1992.tb01667.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Howes C, & Hamilton CE (1993). The changing experience of child care: Changes in teachers and in teacher-child relationships and children’s social competence with peers . Early Childhood Research Quarterly , 8 , 15–32. 10.1016/S0885-2006(05)80096-1 [ CrossRef ] [ Google Scholar ]
• Jeon H-J, Langill CC, Peterson CA, Luze GJ, Carta JJ, & Atwater JB (2010). Children’s individual experiences in early care and education: Relations with overall classroom quality and children’s school readiness . Early Education and Development , 21 , 912–939. 10.1080/10409280903292500 [ CrossRef ] [ Google Scholar ]
• Landry SH, & Smith KE (2011). Maternal sensitivity and responsiveness: A conceptual framework with empirical evidence In Davis DW & Logsdon MC (Eds.), Maternal sensitivity: A scientific foundation for practice (pp. 31–44). Hauppauge, NY: Nova Science. [ Google Scholar ]
• Lee K (2016). Impact of child care arrangements on Australian children’s cognitive outcome: Moderation effects of parental factors . Child & Family Social Work , 21 , 176–187. 10.1111/cfs.12127 [ CrossRef ] [ Google Scholar ]
• Loeb S, Fuller B, Kagan SL, & Carrol B (2004). Child care in poor communities: Early learning effects of type, quality, and stability . Child Development , 75 , 47–65. 10.1111/j.1467-8624.2004.00653.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Love JM, Harrison L, Sagi-Schwartz A, van IJzendoorn MH Ross C, Ungerer JA, … Chazan-Cohen R (2003). Child care quality matters: How conclusions may vary with context . Child Development , 74 , 1021–1033. 10.1111/1467-8624.00584 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• MacKinnon DP (2008). Introduction to statistical mediation analysis . Mahwah, NJ: Erlbaum. [ Google Scholar ]
• Mortensen JA, & Barnett MA (2015). Teacher-child interactions in infant/toddler child care and socioemotional development . Early Education and Development , 26 , 209–229. 10.1080/10409289.2015.985878 [ CrossRef ] [ Google Scholar ]
• Muthén LK, & Muthén BO (1998–2013). Mplus user’s guide (7th. ed.). Los Angeles, CA: Author. [ Google Scholar ]
• NICHD Early Childcare Research Network. (1998). Early childcare and self-control, compliance, and problem behavior at twenty-four and thirty-six months . Child Development , 69 , 1145–1170. 10.1111/j.1467-8624.1998.tb06165.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• NICHD Early Childcare Research Network. (2000). The relation of childcare to cognitive and language development . Child Development , 71 , 960–980. 10.1111/1467-8624.00202 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• NICHD Early Childcare Research Network. (2002). Early child care and children’s development prior to school entry: Results from the NICHD Study of Early Child Care . American Educational Research Journal , 39 , 133–164. 10.3102/00028312039001133 [ CrossRef ] [ Google Scholar ]
• NICHD Early Childcare Research Network. (2003). Does amount of time spent in child care predict socioemotional adjustment during the transition to kindergarten? Child Development , 74 , 976–1005. 10.1111/1467-8624.00582 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pianta RC, La Paro KM, & Hamre BK (2008). Classroom Assessment Scoring System (CLASS) . Baltimore, MD: Paul H. Brooks. [ Google Scholar ]
• Pilarz AR, & Hill HD (2014). Unstable and multiple child care arrangements and young children’s behavior . Early Childhood Research Quarterly , 29 , 471–483. 10.1016/j.ecresq.2014.05.007 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rao N, & Wong JMS (2018). Early childhood development In Bornstein MH (Ed.), The SAGE encyclopedia of lifespan human development (pp. 688–691). Thousand Oaks, CA: Sage. [ Google Scholar ]
• Recchia SL, & Fincham EN (2019). The significance of infant/toddler care and education In Brown CP, McMullen MB, & File N (Eds.), The Wiley handbook of early childhood care and education (pp. 197–218). Hoboken, NJ: Wiley. [ Google Scholar ]
• Ruprecht K, Elicker J, & Choi JY (2016). Continuity of care, caregiver-child interactions, and toddler social competence and problem behaviors . Early Education and Development , 27 , 221–239. 10.1080/10409289.2016.1102034 [ CrossRef ] [ Google Scholar ]
• Sandstrom H, & Chaudry A (2012). ‘You have to choose your childcare to fit your work’: Childcare decision-making among low-income working families . Journal of Children and Poverty , 18 , 89–119. 10.1080/10796126.2012.710480 [ CrossRef ] [ Google Scholar ]
• Schmit S, & Matthews H (2013). Better for babies: A study of state infant and toddler child care policies . Retrieved from https://www.clasp.org/sites/default/files/public/resources-and-publications/publication-1/BetterforBabies2.pdf
• Schulman K, & Blank H (2004). Child care assistance policies 2001–2004: Families struggling to move forward, states going backward [National Women’s Law Center Issue Brief] . Washington, DC: National Women’s Law Center. [ Google Scholar ]
• Shin M (2015). Enacting caring pedagogy in the infant classroom . Early Child Development and Care , 185 , 496–508. 10.1080/03004430.2014.940929 [ CrossRef ] [ Google Scholar ]
• Snow CE (1999). Social perspectives on the emergence of language In MacWhinney B (Ed.), The emergence of language (pp. 126–133). Mahwah, NJ: Psychology Press. [ Google Scholar ]
• Suggate S, Schaughency E, McAnally H, & Reese E (2018). From infancy to adolescence: The longitudinal links between vocabulary, early literacy skills, oral narrative, and reading comprehension . Cognitive Development , 47 , 82–95. 10.1016/j.cogdev.2018.04.005 [ CrossRef ] [ Google Scholar ]
• Tran H, & Weinraub M (2006). Child care effects in context: Quality, stability, and multiplicity in nonmaternal child care arrangements during the first 15 months of life . Developmental Psychology , 42 , 566–582. 10.1037/0012-1649.42.3.566 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Vandell DL, Belsky J, Burchinal M, Steinberg L, Vandergrift N; NICHD Early Child Care Research Network. (2010). Do effects of early child care extend to age 15 years? Results from the NICHD Study of Early Child Care and Youth Development . Child Development , 81 , 737–756. 10.1111/j.1467-8624.2010.01431.x [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Vernon-Feagans L, Bratsch-Hines ME; Family Life Project Key Investigators. (2013). Caregiver-child verbal interactions in child care: A buffer against poor language outcomes when maternal language input is less . Early Childhood Research Quarterly , 28 , 858–873. 10.1016/j.ecresq.2013.08.002 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Vernon-Feagans L, Cox M; Family Life Project Key Investigators. (2013). The Family Life Project: An epidemiological and developmental study of young children living in poor rural communities . Monographs of the Society for Research in Child Development , 78 , 1–150. 10.1111/mono.12046 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Vernon-Feagans L, & Manlove E (2005). Otitis media, the quality ofchild care, and the social/communicative behavior of toddlers: A replication and extension . Early Childhood Research Quarterly , 20 , 306–328. 10.1016/j.ecresq.2005.07.003 [ CrossRef ] [ Google Scholar ]
• Vesely CK, Brown EL, & Mahatmya D (2013). It takes two: Sensitive caregiving across contexts and children’s social, emotional, and academic outcomes . Early Education & Development , 24 , 960–978. 10.1080/10409289.2013.825185 [ CrossRef ] [ Google Scholar ]
• Wechsler D (2002). Wechsler Preschool and Primary Scale of Intelligence, third edition (WPPSI–III) administration and scoring manual . San Antonio, TX: The Psychological Corporation. [ Google Scholar ]
• Werthamer-Larsson L, Kellam SG, & Wheeler L (1991). Effect of first-grade classroom environment on shy behavior, aggressive behavior, and concentration problems . American Journal of Community Psychology , 19 , 585–602. 10.1007/BF00937993 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Woodcock RW, McGrew K, & Mather N (2001). The Woodcock-Johnson Tests of Achievement (3rd ed.). Itasca, IL: Riverside. [ Google Scholar ]
• Yazejian N, Bryant DM, Hans S, Horm D, St. Clair L, File N, & Burchinal M (2017). Child and parenting outcomes after 1 year of educare . Child Development , 88 , 1671–1688. 10.1111/cdev.12688 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Zimmerman IL, Steiner VG, & Pond RE (2002). Preschool Language Scale (4th ed.). San Antonio, TX: The Psychological Corporation. [ Google Scholar ]