Developmental Psychology Copyright 2008 by the American Psychological Association

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

Nonmaternal Care in Infancy and Emotional/Behavioral Difficulties at 4

Years Old: Moderation by Family Risk Characteristics

Sylvana M. Côté Anne I. Borge

University of Montreal University of Oslo

Marie-Claude Geoffroy Michael Rutter

University of Montreal Royal King’s College

Richard E. Tremblay
University of Montreal

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

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

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

155
156 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY
more negative experiences in a group day care setting than do
children who have an easy temperament. Studies testing for the
moderating role of family circumstances and children’s character-
istics are rare, especially when it concerns care that begins in the
1st year of life. The aim of the present study was to fill this gap by
investigating the possible moderating role of (a) the family envi-
ronment and (b) children’s characteristics (the sex and the tem-
perament of the child) in the association between maternal care
(MC) or NMC.
AGE AT WHICH NMC IS INITIATED
We focus on child care in the 1st year of life because, whereas
there appear to be few if any detrimental effects of NMC for
preschool children of toddler’s age and older, the effects of NMC
on social and emotional outcomes during infancy are more equiv-
ocal (Clarke-Stewart, Allhusen, & Clements, 1995). The needs of
toddlers and preschoolers being different from those of infants,
child care experiences may have different effects depending on the
age of the child (Clarke-Stewart et al., 1995). Studies have re-
ported no effects (e.g., Harvey, 1999) or positive effects (e.g.,
Greenstein, 1993) of NMC that begins in infancy, but several
studies found risk for insecure attachment patterns (Belsky &
Rovine, 1988; Lamb & Sternberg, 1990) and for disruptive behav-
ior in the preschool (McCartney, Scarr, Phillips, Grajik, &
Schwarz, 1982; NICHD Early Child Care Research Network,
2002) and elementary school (Egeland & Heister, 1995; Han,
Waldfogel, & Brooks-Gunn, 2001; Haskins, 1985) years. Such
findings raised concerns about the potentially detrimental effects
of early NMC for children’s socioemotional development.
THE EFFECTS OF CHILD CARE TYPE MAY
DEPEND ON THE LEVEL OF RISK IN THE FAMILY
Three types of interactions between the family and child care
contexts have been discussed: (a) NMC may compensate for a high
family risk environment, (b) NMC may represent an additional risk
for children from a high-risk family background, or (c) NMC may
represent a risk for children from a low-risk family background.
The first type of interaction, termed compensatory or protective
processes, suggests that a risk factor may not lead to negative out-
comes when a compensatory child care experience mitigates the risk
(Clarke-Stewart & Allhusen, 2002; NICHD Early Child Care Re-
search Network, 1998; Prodromidis, Lamb, Sternberg, Hwang, &
Broberg, 1995; Scarr & Thompson, 1994)—a possibility for which
there is some preliminary supporting evidence. First, in a cross-
sectional study (n ⫽ 94 mother– child dyads), Crockenberg and Lit-
man (1991) found that toddlers from low-socioeconomic status (SES)
families whose mothers were employed (which was virtually equiv-
alent with NMC) were less defiant than their low-SES peers whose
mothers were not employed. Second, Pierrehumbert, Ramstein, Kar-
maniola, and Halfon (1996) found that extensive day care involve-
ment (at least 2 days per week during the preschool years) protected
insecurely attached children (n ⫽ 47) against the risk for disruptive
behavior at 5 years old.
Finally, in one study conducted on a large (N ⫽ 3,431) and
representative Canadian sample, Borge, Rutter, Côté, and Trem-
blay (2004) found no overall difference between the rates of
physical aggression of children in MC versus NMC. However,
among children from high-risk families, physical aggression was
significantly less common among those in NMC. In addition to the
type of sample, one of this study’s strengths resided in the use of
a family risk index that included several features of family risk
(e.g., SES, family conflicts, size of the family). A limitation,
however, was the cross-sectional nature of the design, which
constrained examination of the directionality of effects. Note that
none of the above-mentioned studies examined whether the pro-
tective role of NMC applied to NMC initiated in infancy.
A second possible interaction between NMC and family risk is that
instead of being protective, NMC may represent an additional risk for
children from already impoverished backgrounds (Lamb & Sternberg,
1990; NICHD Early Child Care Research Network, 1997, 1998). In
line with this possibility, it was shown in the National Institute of
Child Health & Human Development (NICHD) study that infants of
insensitive and nonresponsive mothers were more likely to be inse-
curely attached if they experienced NMC (NICHD Early Child Care
Research Network, 1997).
A third type of possible interaction is that NMC could act as a
risk factor for children from well or adequately functioning fam-
ilies. For instance, by receiving NMC, children from supportive
home environments may be deprived of the care that would be
provided by a resourceful parent (NICHD Early Child Care Re-
search Network, 1998). In line with this argument, Caughy, DiPi-
etro, and Strobino (1994) reported that day care beginning in the
1st year of life was associated with lower reading recognition
scores at 4 and 5 years old for children from high-income house-
holds. The possibility that such a pattern is observed with regard to
socioemotional outcomes remains to be examined.
Taken together, these studies provide examples for three ways in
which family risk factors could moderate the association between
child care and children’s development. But, several studies have
not found any such moderation (Erel, Oberman, & Yirmiya, 2000).
In addition, different (and sometimes contradictory) patterns of
associations have been found.
One possible explanation for the divergent findings relates to
differences in methods and more specifically to the fact that
studies have examined different family characteristics as potential
moderators. With the exception of the Borge et al. (2004) study,
previous research has examined the role of a single family risk
factor, most often the SES of the family. Key aspects of family risk
certainly include socioeconomic factors such as poverty and low
education (Nagin & Tremblay, 2001), but also factors such as
stressful family interactions and family conflicts (Côté, Vaillan-
court, Leblanc, Nagin, & Tremblay, 2006; Repetti, Taylor, &
Seeman, 2002; Tremblay et al., 2004), separated parents or single
parenthood (Pagani, Boulerice, Tremblay, & Vitaro, 1997), young
and inexperienced mothers (Jaffee, Caspi, Moffitt, Belsky, &
Silva, 2001; Nagin & Tremblay, 2001), and parental psychopa-
thology (e.g., maternal depression: Hammen, 2003; Kim-Cohen,
Moffitt, Taylor, Pawlby, & Caspi, 2005). Therefore, a more com-
prehensive measure of the family environment— one that includes
multiple facets of family risk—may represent a more valid mea-
sure of the family context and potentially a more adequate mod-
erator of the child care– behavior association.
Another explanation for the divergent findings may be that other
moderating variables besides family risk influence the associations
between NMC and children’s behavior. In fact, in their meta-
analytic review of child care effects, Erel et al. (2000) concluded
 CHILD CARE AND FAMILY RISK
that examination of multiple moderators is essential and that
“taking into account the impact of single moderators does not
provide researchers with a sufficient picture regarding the com-
plexity of the linkage between maternal versus nonmaternal care
and child development” (p. 739).
THE EFFECTS OF CHILD CARE MAY DEPEND ON
CHILDREN’S CHARACTERISTICS
With regard to NMC that begins in infancy, infant temperament
may be an important moderator. It has been suggested that some
infants, because of their temperamental makeup, may find daily
separations and coping associated with day care to be especially
difficult (Belsky, 1988). NMC experiences might be particularly
challenging for infants who are fussy, irritable, and difficult to
soothe, but there is little evidence to support this proposition.
The sex of the child may be another moderator of the association
between NMC and socioemotional adjustment. Because boys are
more likely to be classified as insecure and may be more vulner-
able to psychosocial stress, it is possible that they could be affected
more adversely by potentially stressful events like early NMC
(Belsky & Rovine, 1988; also see Maccoby, 1998). The present
study investigated this possibility by testing for the moderating
role of temperament and sex of the child in the association between
NMC in infancy and behavior problems prior to school entry.
WHAT ARE THE DEVELOPMENTAL OUTCOMES
POTENTIALLY RELATED TO NMC?
Few studies have examined the associations between NMC and
the most serious form of aggression—physical aggression. Rather,
most studies have investigated associations with broad measures of
behavior problems or with measures of assertiveness, rebellious-
ness, negativity, compliance, self-control, disruptiveness, or neg-
ative interactions (see Clarke-Stewart et al., 1995; NICHD Early
Child Care Research Network, 2002, 2003).
The three studies that focused on physical aggression per se
reported contradictory findings. First, the NICHD Early Child
Care Research Network (2004) found that child care variables
(such as quantity, age of entry) were not systematically associated
with trajectories of physical aggression during childhood. Second,
recently, NMC was found to reduce the risk of a high physical
aggression trajectory (between infancy and school entry) among
children of mothers with low levels of education (i.e., did not
graduate from high school; Côté et al., 2007). Third, Haskins
(1985) found that high-risk African American children who initi-
ated full-time NMC in the 1st year of life were more physically
aggressive (hitting, kicking, pushing) than were those who initi-
ated NMC sometime after the 1st year of life. These inconsistent
findings suggest that more studies are needed on the association
between NMC and physical aggression and on the possibility that
it is moderated by family risk or child characteristics. Finally, few
studies have specifically examined the associations between NMC
and emotional problems such as depression and anxiety.
AIMS OF THE STUDY
The overall aim was to examine the moderating role of family
and children’s characteristics (temperament and sex) in the asso-
ciation between type of care initiated in infancy and emotional
157
problems and physical aggression at 4 years old. The study ad-
dresses issues raised in previous research and deals with several
new questions. First, it provides information about the role of
NMC using a prospective longitudinal design with a large and
representative sample of a national birth cohort. Second, it pro-
vides information about the moderating role of type of care with
regard to a global measure of family risk, one that includes several
aspects of a risky home environment (i.e., SES, family conflicts,
family status, and maternal characteristics).
Third, it provides information about the role of type of care
while accounting for the selection of children and families into
NMC in the 1st year of life. There is evidence that the extent to
which families make use of NMC is influenced by characteristics
of the families that also represent risk for children’s development
(see NICHD Early Child Care Research Network, 1998). How-
ever, the extent to which social selection operates in the 1st year of
life, at a time when social status and family risk may have a lesser
influence on parents’ decision to rely on NMC, (e.g., because of
opportunities for parental leave), is unclear. In the present study, we
tested whether family risk and child characteristics were associated
with the choice of NMC versus MC in the 1st year of life with the
objective of accounting for social selection if it was detected.
In order to examine the moderating role of type of care, we
posed three research questions. First, is there social selection of
infants into NMC on the basis of family risks or child character-
istics? Second, are there associations between type of care in
infancy and children’s behavioral and emotional difficulties at 4
years old? Third, are the associations between MC/NMC and
children’s outcomes moderated by family risk, by child character-
istics, or by both family risk and child characteristics?
Specifically, we hypothesized that the effects of NMC would be
influenced by the level of psychosocial risk in the parental home.
We contrasted two competing possibilities for the direction of
moderation; namely, that NMC is protective against physical ag-
gression and/or emotional difficulties for children raised in high
psychosocial risk families versus the possibility that because NMC
is intrinsically risky, it will potentiate the liability to physical
aggression/emotional disturbance in children from higher risk fam-
ilies. The null hypothesis is that the effects of NMC will be
uninfluenced by family risk characteristics. The first alternative
leads to the predictions that (a) children from low-risk families in
MC will have lower levels of physical aggression and emotional
difficulties at 4 years old compared with low-risk children in
NMC, and (b) children from high-risk families in MC will have
higher levels of physical aggression and emotional difficulties at 4
years old compared with high-risk children in NMC. The second
alternative leads to the opposite set of predictions. In addition, we
explored the possibility that the protective or risk effects of NMC
vary by the sex and temperament of the child. Note that the aim of
the study was not to examine how different features of NMC are
related to child outcomes. Rather, we focused on the moderating
role of family risks and child characteristics in the association
between NMC and children’s behavioral and emotional problems.
METHOD
Sample and Procedures
In 1994, a random sample of 15,579 Canadian households with
at least one child 0 –11 years old was selected by Statistics Canada
158 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY

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

Longitudinal Survey of Children and Youth (Human Resources
The associations between NMC in the 1st year and two types of
Development Canada and Statistics Canada, 1996). Responses
behavior difficulties at the age of 4 years old were examined:
were obtained for 13,439 of these selected households—an overall
physical aggression and emotional problems. The interviewer
response rate of 86.3%.
asked the PMK how often (0 ⫽ never, 1 ⫽ sometimes, 2 ⫽ often)
The 13,439 children 0 –11 years of age at Cycle 1 represent 11 the child exhibited a given feature. Sum scores were computed
cohorts of children (approximately 1,500 children per cohort). For separately for each scale.
instance, Cohort 1 included children 1–12 months old at Cycle 1, The Physical Aggression scale included seven items: “child
Cohort 2 included children 13–24 months old at Cycle 1, Cohort 3 destroys his/her own things”; “gets into many fights”; “destroys
included children 25–36 months old at Cycle 1, and so forth. The things belonging to others”; “physically attacks people”; “vandal-
purpose of the present study was to examine associations between izes”; “threatens people”; “is cruel, bullies, or is mean to others.”
the type of child care in infancy and outcomes before school entry. The internal consistency (Cronbach’s alpha) was good (␣ ⫽ .76).
Therefore, we selected one cohort of children—those between 1 The Emotional Problems scale included seven items, three items
and 12 months old (n ⫽ 1,452) at the first data collection (in 1994). reflecting anxiety (“is worried”; “is too fearful or nervous”; “is
The sample included the 1,358 children for whom the family risk nervous, high strung, or tense”), and four items reflecting depres-
and child characteristics variables were available at the first as- sion (“seems to be unhappy, sad, or depressed”; “is not as happy
sessment and for whom the physical aggression and emotional as other children”; “cries a lot”; “has trouble enjoying him/
problems scores were available at 4 years old. We examined herself”). The internal consistency was .64. The anxiety and the
selection into NMC among this sample. The sample characteristics depression dimensions were analyzed separately in a first set of
are summarized in Table 1. analyses. The pattern of results was the same for both dimensions.
Statistics Canada was responsible for data collections, which Therefore, the results are presented for the overall Emotional
were undertaken every 2 years through home interviews with the Problems scale.
person most knowledgeable about the child (PMK)—the mother in
89.9% of cases (Statistics Canada and Human Resources Devel- Independent Variables
opment Canada, 1995). A combination of classroom training and Family Risk Index
self-study materials were prepared to ensure that interviewers had
a proper understanding of survey concepts. Interviewers were We created a family risk index in order to examine the moder-
under the supervision of a staff of senior interviewers who were ating role of a global measure of the level of risk in the family
responsible for periodically monitoring their interviewers and re- environment and not just moderation by specific (and correlated)
viewing their completed documents. Senior interviewers ensured risk factors. Using a global family risk measure is central to our
that prompt follow-up action was taken for refusal and other hypotheses, which involve comparing the impact of child care in
children from generally risky family backgrounds with those not
nonresponse cases. The senior interviewers were, in turn, under the
from such backgrounds. Previous studies and developmental mod-
supervision of the program managers, located in Statistics Canada
els do not provide sufficient support for formulating hypotheses
regional offices.
about the moderating role of child care with regard to specific risk
factors such as early motherhood or high levels of family conflicts.
The creation of family risk indexes has a conceptual and em-
pirical basis (Burchinal, Roberts, Hooper, & Zeisel, 2000; Samer-
Table 1
off, Seifer, Baldwin, & Baldwin, 1993) and builds on previous
Demographic Characteristics
work (Borge et al., 2004). Specifically, the family risk items were
Subsample size included in the index on the basis of three criteria. First, we
Demographic (out of 1,358) % selected items generally found to represent risk for children’s
development in the scientific literature. Second, we selected items
Sex that were significantly correlated with at least five (out of six)
Girls 665 49.0
Boys 693 51.0 behavior problems (i.e., physical aggression, emotional problems,
Maternal age (in years) hyperactivity, indirect aggression, opposition, low prosocial be-
⬍20 78 5.8 haviors). This step ensured that the risk factors were correlated
21–25 252 18.6 with several behavioral problems and that they were not specific to
ⱖ25 1,027 75.7
Maternal education
only a few outcomes. Finally, we selected items that were signif-
Less than secondary school 186 15.7 icantly correlated with each other (correlations ranged between
Secondary school diploma 221 18.6 0.12 and 0.4) and with the total family adversity score (correlations
Beyond high school 267 22.5 ranged between 0.5 and 0.71). Five family characteristics met
College or university degree 512 43.2 those criteria: (a) SES, (b) family functioning, (c) maternal depres-
Family status
Intact (married or common law union) 1,203 88.6 sion, (d) maternal age at the birth of the target child, and (e) family
Separated, divorced, widowed 155 11.4 status (intact family or separated parents). Computation of the
Type of child care in infancy index is described below.
Maternal care 972 71.5 SES. A measure of SES was derived for each household in the
Nonmaternal care 386 28.5
sample and the result assigned to each selected child in that
 CHILD CARE AND FAMILY RISK
household. It was derived from five sources: the level of education
of the PMK, the level of education of the spouse/partner (ranging
from 0 ⫽ no schooling to 20 ⫽ MD/PhD), the prestige of the
PMK’s occupation, the prestige of the occupation of the spouse/
partner (ranging from 0 ⫽ lowest to 16 ⫽ highest), and household
income (in Canadian dollars; Willms & Shields, 1996). Each of the
five variables was standardized to have a mean of zero and a
standard deviation of one. The SES composite was then calculated
by taking the (unweighted) average of the five standardized vari-
ables. If one of the five variables had missing data due to nonre-
sponse (refusal, did not know, etc.), then the average was taken
over the remaining nonmissing items. If there was no spouse/
partner in the household (i.e., the PMK had no spouse/partner),
then the average was taken over the three applicable variables. In
the present study, the SES variable was split into quartiles: 25%
very high SES (coded as 0), 25% high (coded as 1), 25% low
(coded as 2), 25% very low (coded as 3).
Family functioning. A family assessment scale comprising 12
items measured the quality of family functioning (communication,
problem resolution, control of disruptive behavior, showing and
receiving affection; Boyle et al., 1987). The scores ranged from 0
to 36 on the scale. The family functioning variable was split into
quartiles and was coded as 25% very good functioning (0), 25%
good functioning (1), 25% poor functioning (2), 25% very poor
functioning (3).
Maternal depression. Mothers reported the frequency of de-
pressive symptoms experienced in the past week. The scale was a
short version of the Center for Epidemiological Study Depression
scale (CES-D; Radloff, 1977) and included 12 items scored as 0
(never) to 4 (often). The items were summed and the scale was
split into quartiles. A score of 0 reflected very low levels of
depressive symptoms (less than 2 symptoms), a score of 1 reflected
low levels (between 2 and 5 depressive symptoms), a score of 2
reflected high levels (between 5 and 10 symptoms), and a score of
3 reflected very high levels (more than 10 symptoms).
Maternal age at the birth of the target child. The age of the
mother was coded as 0 (older than 25 years), 1 (between 21 and 25
years old), or 2 (younger than 21 years old).
Family status. The status of the family was dichotomized
according to whether the family was intact (coded as 0) or
whether the parents had divorced, separated, remarried, or were
widowed (1).
Computation of the Family Risk Index
The scores on the family risk variables varied between 0 and 3
for SES, family functioning, and maternal depression; varied be-
tween 0 and 2 for maternal age; and were dichotomous (0 or 1) for
family status. The scores for the five variables were summed to
compute a family adversity index that ranged between 0 and 12. A
higher score reflected higher levels of family risk. We then dichot-
omized the index to distinguish high levels of family risk (1 ⫽ top
quartile) from lower levels (0 ⫽ below the 75th percentile). A
cutoff at the top quartile provides (a) identification of a high-risk
group that can be judged reasonably small from a public policy
perspective and (b) sufficient power to test our hypotheses.
159
Children’s Characteristics
The possible moderating role of two child characteristics—sex
and temperament—was investigated. Temperament was assessed
with six items from the Infant Characteristics Questionnaire
(Bates, 1987) that was administered to all PMKs of children 0 –11
months old. The PMK was asked to report for each of the items by
assigning a frequency rating ranging between 1 (frequently dis-
plays favorable behaviors) and 7 (seldom displays favorable be-
haviors). The items were as follows: how easy it is to calm or
soothe the child when upset; how often the child gets fussy and
irritable; in general, how often the child cries, fusses, or whines;
how easily the child gets upset; how changeable is the mood of
child; and the overall degree of difficulty of the child. The scale
was dichotomized according to a 25th–75th percentile split. Chil-
dren scoring in the top quartile are hereafter referred to as difficult
(coded as 1), and children in the lower 75th percentile are referred to
as easy (coded as 0). The internal consistency was good (␣ ⫽ 76).
Type of Child Care in Infancy
The interview provided 10 alternatives for types and contexts of
child care. In order to focus on the possible risks and benefits
associated with MC in the family, we dichotomized type of care.
MC (n ⫽ 972, 71.5%) represented all children cared for at home
by their mother (coded as 1). NMC (n ⫽ 386, 28.5%) included all
other alternative forms of child care (coded as 0). The most
frequent form of NMC was care in someone else’s home by a
nonrelative (39.6%), followed by care in someone else’s home
undertaken by a relative (21.5%) and care in the child’s home by
a nonrelative (15.8%) or relative (14.1%). NMC was provided in
a day care center for 9.1% of children. The mean number of hours
per week spent in NMC was 31.53 (SD ⫽ 17.32).
Justification for using dichotomized predictors. Using the
family risk index and child temperament as dichotomized variables
is central to our study hypotheses proposing that the effect of type
of care differs (a) for children from high-risk families versus those
not from high-risk families and (b) for children with a difficult
temperament versus those without a difficult temperament or for
boys versus girls. We did not expect linear relations between
family risk and the outcomes for children in MC versus NMC. For
instance, we did not expect the impact of type of care to be more
beneficial as family risk increases. The same argument applies to
child temperament, where we expected differential associations for
children who do not have a difficult temperament compared with
children with a difficult temperament. Thus, our hypotheses in-
volve categories, as is often the case in the literature on risk factors
and behavioral maladjustment.
Controlling for selection factors. We searched for variables
that could bias the results by creating differences between the MC
and NMC group. The variables included as controls were those
associated with (a) MC/NMC and (b) one of the outcomes (phys-
ical aggression or emotional problems). We examined these asso-
ciations with the following variables: age of the child in months,
poor health of the child, birth weight, premature birth, breast
feeding, race, maternal smoking during pregnancy, alcohol con-
sumption during pregnancy, and number of siblings. Age of the
child in months at Cycle 1 varied between 1 and 12 months and
was used continuously in the analyses. The child health at birth
160 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY
was reported by the PMK as being good (coded as 0) or poor
(coded as 1). Birth weight (in grams) for gestational age was
represented continuously. Premature birth was coded as 0 (child
born in normal range) or 1 (child born 258 days or less). PMK
provided information about number of siblings from 0 to 18 years
of age living in the child’s household. The number of siblings
varied between 0 and 9 and was represented continuously. Breast
feeding was represented by a dummy variable that indicated
whether the mothers had (coded as 0) or had not (coded as 1)
breast fed the child. A dummy variable indicating whether the
child is Caucasian (coded as 0) or not (coded as 1) Caucasian (e.g.,
Black, Asian, Latino) represented child race. The mothers were
asked about their smoking behavior throughout pregnancy (“Did
you smoke during pregnancy? If so, how many cigarettes did you
smoke per day?”). The scores ranged between 0 and 35 cigarettes.
Mothers also provided information about their alcohol consump-
tion throughout pregnancy (“How frequently did you consume
alcohol during your pregnancy?”). We created a dummy variable
indicating whether the mothers consumed alcohol during preg-
nancy: 1 (never or rarely) or 2 (at least once per week).
STATISTICAL ANALYSIS
The main objective of the analyses was to examine the possi-
bility that associations between the type of child care in the 1st
year of life and emotional/behavioral difficulties at 4 years old
were moderated by the level of family risk or by children’s
characteristics. In testing for these associations, we first examined
the possibility that selection factors operated with regard to the
choice of child care that began in the 1st year of life.
The statistical analyses were conducted in two steps. First, we
examined the possibility that selection factors operated in this
sample of families. The identified selection factors were used as
control variables in the multivariate analyses. Second, we tested
the moderating role of family risk and child characteristics in the
association between the type of care and the two outcomes: phys-
ical aggression and emotional problems.
Identifying Selection Factors
We searched, among 18 prenatal and perinatal factors, family
characteristics and child characteristics, the variables that could
bias the results by being associated with selection in NMC and
with the outcomes. The variables tested for selection were (a) age
of the child in months at first assessment, poor health of the child,
birth weight, premature birth, breast feeding, race, maternal smok-
ing during pregnancy, maternal alcohol consumption during preg-
nancy, and number of siblings; (b) the overall level of family risk
index and the family risk variables included in the index (i.e., SES,
family functioning, maternal depression, maternal age, family sta-
tus); and (c) the temperament and the sex of the child. First, using
chi-squares or t tests, we identified the variables significantly
associated with selection of children into MC and NMC. Second,
using Pearson’s product–moment correlation or analyses of vari-
ance, we searched, among the same set of variables, those signif-
icantly associated with one of the outcomes. Variables were in-
cluded as control in the regression models if they were
significantly associated with (a) an MC/NMC difference and (b)
one of the outcomes (physical aggression or emotional problems).
Testing the Moderating Role of Family Risk and Child
Characteristics
We tested the moderating role of family risk, child tempera-
ment, and sex of the child in the association between type of care
and behavior problems. Series of multiple regression analyses
were conducted separately for physical aggression and emotional
problems. Three models were tested. In Model 1, the variables
identified as selection factors and the main effects were entered
(i.e., control variables, type of child care, family risk, tempera-
ment, sex of the child) as predictors of the two outcomes. In the
second step, the two-way interactions involving child care type
(CCT; CCT ⫻ Temperament, CCT ⫻ Family Risk, CCT ⫻ Sex)
and child characteristics (Risk ⫻ Temperament, Risk ⫻ Sex,
Temperament ⫻ Sex) were added to the variables entered in
Model 1. Finally, in Model 3, the three-way interactions involving
CCT (CCT ⫻ Temperament ⫻ Family Risk, CCT ⫻ Sex ⫻
Family Risk, CCT ⫻ Sex ⫻ Temperament) were added to the
variables entered in Model 2. Follow-up analyses were then con-
ducted to test the differences between the groups where significant
interactions were found. In addition, effects sizes were calculated
according to the following equation:
d ⫽ (XMC – XNMC) / S pooled,
where S pooled ⫽ 公{[(nMC – 1)(sMC2) ⫹ (nNMC – 1)(sNMC2)]
/ (nMC ⫹ nNMC – 2)}(Hedges & Olkin, 1985).
S is the pooled standard deviations of the MC and NMC groups, X
is the mean, n is the number of subjects, and s is the standard
deviation of each group. Positive ds indicate more difficulties in
the MC than in the NMC group, whereas negative ds indicate
lower levels of difficulties in the MC than in the NMC group. We
computed 95% confidence intervals (CIs).
Given the objective of the study (to test the moderating role of
family and child characteristics in the care– behavior problems
association), the presentation of the results is focused on the
interactions between child care and family risk, between child care
and temperament, and between child care and the sex of the child.
In all analyses, the longitudinal data were weighted to take into
account nonrespondents and the stratification design of the Na-
tional Longitudinal Survey of Children and Youth. These weighted
data also correspond to the ethnic and cultural composition of
Canadian citizens. The principle behind estimation in a probability
sample such as the National Longitudinal Survey of Children and
Youth is that each person in the sample represents, besides himself
or herself, several other persons not included in the sample. For
example, in a 2% simple random sample of the population, each
person in the sample represents 50 persons in the population. The
weighting phase is a step that calculates, for each record, the
number of individual in the population represented by a given
record. In longitudinal analyses as those done in the present study,
the modeling of the trajectories included probability weights that
appropriately reflected the sampling strategy of this probability
survey and accounted for nonresponse, attrition, rural– urban fac-
tor, interprovincial migration, and poststratification (Statistics
Canada, 1994 –1995).
 CHILD CARE AND FAMILY RISK 161

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

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

Nonmaternal care Maternal care

Variable M SD % N M SD % N t ␹2(1) p

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

Overall family risk index and risks included in the index

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

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

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

Physical aggression Emotional difficulties

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

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

Overall family risk index and risks included in the index

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

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

Type of child care

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

Note. Values with a superscript indicate an F statistic.

 CHILD CARE AND FAMILY RISK
to be correlated with (a) NMC and (b) either physical aggression
or emotional problems.
With regard to the potential selection factors, five variables met
the selection criteria: age of the child, race of the child, maternal
smoking, having siblings, and birth weight. Specifically, younger
children, children with fewer siblings, children with a higher birth
weight, children of mothers who smoked fewer cigarettes during
pregnancy, and non-Caucasian children were more likely to re-
ceive NMC care in infancy (see Table 2). In addition, older
children, children with more siblings, children with lower birth
weight, children of mothers who smoked more cigarettes during
pregnancy, and Caucasian children were more likely to have
higher physical aggression scores. Children with fewer siblings
and lower birth weight were more likely to have higher emotional
problems (see Table 3). Therefore, these five variables were used
as control variables in the multivariate analyses.
With regard to the family risk index, the results indicate that the
proportion of high-risk infants in MC (n ⫽ 238, 74.1%) was not
significantly different from the percentage of low-risk infants in
MC (n ⫽ 734, 70.7%, p ⫽ .13). We further examined the possi-
bility of selection effects by testing the differences between MC
and NMC according to the five risk variables included in the
family risk index. The only risk variable for which we found a
selection effect (association with both NMC and one of the out-
comes) was family dysfunction. Specifically, children from highly
dysfunctional families were more likely to be in NMC and they
tended to have higher scores on the emotional problem scale.
Regarding temperament and the sex of the child, there was no
indication that either of these child characteristics played any role
in selection into MC or NMC (see Table 2). The same analysis was
repeated separately for the low- and the high-risk segments of the
family risk variable and, again, no association between tempera-
ment and child care was detected.
Finally, Table 3 presents an overall comparison of rates of
behavior and emotional difficulties at 4 years old according to type
of care in the 1st year of life. There were no significant differences
in the levels of physical aggression according to MC and NMC
groups. However, the level of emotional difficulties was greater in
the NMC group.
Do Family Risk and Child Characteristics Moderate the
Association Between Child Care and Behavior Problems?
We conducted two series of multiple regressions, one for each
outcome. Each regression included three steps. First, we entered
the selection factors identified in the first part of the analyses and
the main effect of the predictor variables. Second, we entered the
three possible two-way interactions that involved child care in
order to test for the moderating role of family risk, child temper-
ament, and sex in the association between care and the outcomes.
Finally, we entered the three three-way interactions that involved
child care.
Physical Aggression
Table 4 reports the results of the multiple regressions predicting
physical aggression. Model 1 indicates significant associations
with physical aggression for four control variables (race, birth
weight, smoking during pregnancy, and the number of siblings)
163
and a main effect of the sex of the child. Specifically, non-
Caucasian status was associated with a lower physical aggression
score. Maternal smoking during pregnancy, higher number of
siblings, and being a boy were associated with higher level of
physical aggression. Model 2 indicates that one two-way interac-
tion emerged: Child care interacted with family risk. In Model 3,
the three-way interactions among NMC, family risk, and child
characteristics were entered in the model. None of the three-way
interactions was significant. Therefore, we present the results of
Model 1 and Model 2.
To follow up on the significant two-way interaction, we esti-
mated the adjusted means and standard errors from the regression
coefficients (after centering the variables). We then conducted a t
test to locate the significant differences between the groups. Two
of the four contrasts were significant. First, the results indicate that
children from low-risk families who received MC in infancy had
lower physical aggression scores at 4 years old (M ⫽ 1.11, SD ⫽
1.69, n ⫽ 624) compared with low-risk children who were in NMC
in infancy (M ⫽ 1.37, SD ⫽ 1.53, n ⫽ 261), t(883) ⫽ –2.13, p ⫽
.03. The effect size (d) was – 0.16 (95% CI ⫽ – 0.3, – 0.01). Note
that high-risk children in MC had a nonsignificant higher physical
aggression (M ⫽ 1.39, SD ⫽ 2.03, n ⫽ 209) than high-risk
children in NMC (M ⫽ 1.08, SD ⫽1.26, n ⫽ 66), t(179.90) ⫽
1.54, p ⫽ .13. The effect size (d) was 0.17 (CI ⫽ – 0.11, 0.44).
Figure 1 illustrates the (adjusted) mean levels of physical aggres-
sion for children in the different family risk and child care groups.
Emotional Problems
Table 5 reports the results of the regression predicting emotional
problems. Model 1 indicates significant associations between two
control variables (lower birth weight and lower number of sib-
lings) and higher emotional problems. In addition, the results show
that both child care and temperament had a main effect on emo-
tional difficulties. Specifically, difficult temperament and NMC
were associated with higher emotional problems. The results for
Model 2 indicate that none of the two-way interactions signifi-
cantly predicted emotional difficulties. Finally, the results of
Model 3 reveal that a three-way interaction among child care,
family risk, and sex was significant in predicting emotional prob-
lems.
Follow-up analyses of the three-way interaction indicate that
girls from low-risk families in MC had lower levels of emotional
difficulties (M ⫽ 1.45, SD ⫽ 1.50, n ⫽ 317) than did those in
NMC (M ⫽ 2.17, SD ⫽ 1.94, n ⫽ 125), t(185) ⫽ –3.73, p ⬍ .001.
The effect size (d) was – 0.44 (CI ⫽ – 0.23, – 0.65). Child care was
not significantly associated with emotional difficulties among girls
from high-risk families or among boys. Figure 2 illustrates these
results for girls.
DISCUSSION
The aim of the present study was to investigate the role of the
family environment and of children’s characteristics (the sex and
the temperament of the child) in the association between MC/
NMC in the 1st year of life and behavior and emotional problems
prior to school entry (4 years old) among a large and nationally
representative sample.
164 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY

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

Model 1 Model 2

Predictor variable B SE ␤ B SE ␤

Step 1: Control variables and main effects

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

Step 2: Two-way interactions

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

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

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

the previous literature in showing minor effects or no systematic

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

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

Model 1 Model 2 Model 3

Predictor variable B SE ␤ B SE ␤ B SE ␤

Step 1: Control variables and main effects

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

Step 2: Two-way interactions

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

Step 3: Three-way interactions

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

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

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

of emotional disturbance—a sex difference that has not been

predicted and which would not be strongly expected on the basis
1,5
of previous research findings (e.g., Belsky & Rovine, 1988). Also,
the interaction effect for physical aggression was relatively weak
1 and statistically significant at only the 3% level. In short, although
statistically significant, the findings within our study are only
0,5
moderately robust. Furthermore, a recent study indicates that NMC
does not carry risk for the long-term development of physical
aggression but rather is protective for children of mothers with low
0 levels of education (Côté et al., 2007). Such results underlie the
Low family risk High family risk importance of examining the role of NMC with regard to long-
term developmental patterns.
Figure 2. Levels of emotional problems at 4 years old according to It is necessary next to consider whether the interaction could be
family risk and child care in infancy: Girls. MC ⫽ maternal care; NMC ⫽ an artifact of either social selection or the effects of the child’s
nonmaternal care. behavior on the family’s choice of NMC or MC. Neither possibil-
166 CÔTÉ, BORGE, GEOFFROY, RUTTER, AND TREMBLAY
ity seems at all plausible. The significant moderating effect of
family risk applies after taking account of possible confounding
variables. We focused on NMC in the 1st year of life because the
evidence in the literature suggested that if NMC created a psycho-
pathological risk, it was most likely to do so if it was experienced
in the 1st year of life. However, by the same token, this meant that
there was less opportunity (as compared with the situation when
the children are older) for child features to influence the selection
of NMC or MC. In any case, the findings showed that neither sex
nor temperament were associated with social selection. The deci-
sion on child care took place well before the children showed
physical aggression or emotional disturbance, and most of the
family risk features (such as educational attainment, occupational
level, and age of the mother at the time of the child’s birth) were
not of a kind that could be influenced by the child.
At first sight, it might seem surprising that we found so little
evidence of social selection, particularly as greater social selection
was found in the same Canadian sample for children entering
NMC after 12 months old (Borge et al., 2004).
One possible explanation for this difference may lie in the
Canadian parental leave program. Most Canadian mothers have
6 –12 months paid parental leave at the birth of a child, which makes
MC a very common choice (71.5% in our sample). In fact, in our
representative Canadian sample, only 28.5% of families use some
form of NMC for their infant. This is in sharp contrast with data from
the United States indicating that 80% of families use some form of
NMC in the 1st year of life (NICHD Early Child Research Network,
2005). Thus, selection biases may be more important in the context of
NMC as a normative child care choice. In such contexts, families not
using NMC may present significantly more risks such as low SES
(Borge et al., 2004; Japel, Côté, & Tremblay, 2005). However, when
MC is the norm, as is the case for Canadian children under 12 months
old, there is little social selection, and the wide range of features
assessed for social selection makes it unlikely that there was greater
selection on the basis of some unmeasured feature.
A further possibility is that the moderating effect could reflect
genetic mediation. Certainly, there is good evidence that genetic
factors influence both parenting behavior and sensitivity to envi-
ronmental features (Rutter, 2006a; Rutter, Moffitt, & Caspi, 2006).
Also, genetic factors are associated with individual differences in
the liability to both physical aggression and emotional disturbance
in early childhood (Dionne Tremblay, Boivin, Laplante, & Pé-
russe, 2003). On the other hand, it would require a rather complex
pattern of genetic mediation to account for the specifics of the
interaction found. Our findings can neither rule in nor rule out a
role for genetic mediation. That would require one of the several
varieties of genetic designs to test for environmental mediation
(Rutter, Pickles, Murray, & Eaves, 2001; Rutter, 2006b) and that
remains a task for the future.
Do the findings warrant a causal interpretation? On the one
hand, there is no point in studying correlations unless they have
some possible implications for causal mechanisms. On the other
hand, several stringent tests are required before causal inferences
are justified (Rutter, 2006b; Shadish, Cook, & Campbell, 2002;
Susser, Schwartz, Morabia, & Bromet, 2006). Thus, longitudinal
data should show that the risk factor preceded the outcome being
studied, the possibility of social selection (i.e., the allocation bias
created by variables associated with the outcome influencing risk
exposure) should be thoroughly investigated and shown not to
account for effects, a range of plausible confounding variables
should be examined similarly and shown not to account for the
findings, and a variety of alternative explanations should be ex-
amined to determine their plausibility. This last criterion is partic-
ularly important (Cochran & Chambers, 1965). All of these criteria
are met in the present study. Thus, the main alternatives of social
selection on the basis of either family risk characteristics or child
variables could not account for the moderating effect found. The
alternative of genetic mediation has no supporting evidence, but it
could not be definitely ruled out. A further criterion is that the
postulated causal effect should be consistent with comparable
mechanisms in other studies. That criterion is also met. Dealing
with a different set of outcomes in the same Canadian data set,
both Borge et al. (2004) and Geoffroy et al. (2007) found a
moderating effect of family features on the effects of MC/NMC. A
broader range of research has also given rise to similar conclusions
(Crockenberg & Litman, 1991; Pierrehumbert et al., 1996).
Nevertheless, there are criteria that are not yet met. Thus, there
is a lack of consistency within our own data set (Why is there the
sex difference with respect to the moderating effect on emotional
disturbance?). Also, there is a need for adequate replication across
different data sets and different social contexts, and we lack good
evidence on the mediating mechanisms involved in the moderating
effect. Thus, despite the significant moderating effect found, the
pattern observed does not comply with what would be expected if
NMC protected against family risk. Also, if NMC is a risk factor
for emotional disturbance, why does it not apply to boys, and why
does it not have that effect in high-risk families? To answer those
questions, researchers would need to have both more detailed
measures of family risk than those available to us and also mea-
sures of the quality of care in both NMC and MC settings.
Would randomized controlled trials help? Of course, they con-
stitute a powerful means of determining whether particular risk
features actually can have environmentally mediated effects
(Brooks-Gunn, 2004; Cook, 2004; Cottingham, 2004; McCall,
2004). Would they be ethical and feasible in the case of NMC
cases? Possibly. Funding by different governments already pro-
vides funding for one parent to remain at home to care for the child
or funding for good quality alternative care. These could be pro-
vided by random allocation to parents who accepted both options,
but would this be for families at high risk only or for all families?
Moreover, if a key element in effects concerned the parents’
commitment to a particular pattern of care, the randomized con-
trolled trial would be problematic.
In our view, the main implication of the research findings is that
it would be unsafe to assume that NMC and MC have effects that
are independent of family qualities and social context. Incisive
research to determine the mechanisms underlying the moderating
effects of family risk is greatly needed.
Are there policy implications that derive from our findings? We
think not at the moment. It is crucial to emphasize that our findings
do not contribute to the debate on the risks and benefits of group
day care, because our sample included so few young children
receiving it. The NMC almost always involved care by either a
relative or nonrelative, such care being in either the child’s own
home or some other place (almost always the home of the NMC
caregiver). Our study was not powered to examine the effects of
these variations, but no strong effects of either place or relative/
nonrelative were found.
 CHILD CARE AND FAMILY RISK
LIMITATIONS AND CONCLUSIONS
The study has several important strengths, including longitudi-
nal data with risk factors preceding the outcomes being studied, a
representative sample, a thorough investigation of the possibility
of social selection, and consideration of the associations with two
distinct outcomes. The study also has limitations. First, we have
already noted that no independent measures of the quality of NMC
and MC were available. Second, the outcomes studied were mea-
sured at a single point in time. Future studies should rely on longer
term measures covering both school and home contexts. Third, it
cannot be assumed that the findings will generalize to populations
in which the quality of NMC differs from that available in Canada
or in which social selection factors operate quite differently with
respect to the choice of care in the 1st year of life. Finally, our use
of a composite family risk index based on empirical findings
(Burchinal et al., 2000) provided the most appropriate approach for
the study of moderating effects and it avoided the problems asso-
ciated with the intercorrelations among risk variables. Neverthe-
less, it inevitably meant a loss of information on the effects of
individual variables that might operate in different ways. In addi-
tion, although the use of a family risk index best reflects the global
level of risk in the family, it also has restricted value for targeting,
for policy purposes, the families that may benefit or experience
detrimental effects of NMC.
In sum, the findings indicate the importance of considering the
moderating role of the family context and child characteristics in
the associations between NMC/MC and emotional/behavioral dis-
turbances at 4 years old. In particular, the results show that NMC
may have opposite effects according to family risk background.
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Accepted November 10, 2006 䡲