Relax. It's not that loud every minute, and it's by no means careless in design. After music comes reading, comes art, comes games, comes nap time, comes all the complexity of a carefully planned program. For all its exuberance, the design is precisely, startlingly scientific -- the work of Ramey, a professor of psychology and pediatrics at the University of Alabama at Birmingham, and his wife and colleague, psychologist Sharon Landesman Ramey, also a researcher at Alabama. Together they have been working to design a kind of neuroscience-based childcare: a place that stimulates developing brains to grow, even against the odds.
Noise -- or rather communication -- is a central part of that. Children need to be talked to, it turns out, to make their brains grow properly. For example, it used to be that parents of deaf babies didn't teach them sign language or communicate with them at all (why should they, the kids can't hear), and the children's IQs took a hit. "Two generations ago, we didn't start teaching sign language until children were 5 or 6. As a consequence, many of them became permanently retarded," Sharon Ramey explains. "It's not that a 6-month-old is doing abstract reasoning, but if you don't have the tools in the brain, it's very difficult to catch up with those who do." Not surprisingly, perhaps, that turns out to be a universal principle.
The Rameys have done studies using their boisterous, engaged daycare approach to test -- and, they hope, stimulate -- brain development in children of low-IQ mothers, who are usually considered at risk for mental retardation. In one notable experiment with children from impoverished Southern families, the Rameys' approach had a dramatic result. They split the children into two groups. Both received improved nutrition, medical care, and social services. But only one set went into Ramey-style daycare: one teacher for every three kids, lots of attention, games, art, music, and a steady dose of affection. The test started when the children were 6 weeks old (earlier research had established that a baby's immune system is strong enough at that point to handle a daycare setting) and continued for at least three years. Daycare was a major part of those children's lives: five days a week, eight hours a day, 12 months a year. At the end of 36 months, the daycare-based children had clearly moved, no, leaped ahead. Their IQ scores averaged 101, compared with 84 for the control group. "We found we could cut the children's risk of retardation fully in half by giving them enrichment," says Sharon Ramey.
When scientists such as the Rameys speak of "enrichment," they're usually talking about daycare. Sure, they mean very good, very intensive childcare, but they also mean it should take place at a center. Call it another spin on the political debate over how we raise children, the debate that dwells on two-career couples, or more specifically, on whether women should stay home. That's the view that portrays daycare as cold and indifferent, the kind of gray-toned environment suitable for a Dickens orphan. The Rameys and other researchers paint daycare in much brighter colors. For them, it's not a substitute for good parenting, but a hell of a good supplement. In fact, say these advocates, the busy social arena of daycare may be a more natural environment for the brain than the isolation of the nuclear family.
"Our current living systems are disrespectful of the brain's potential," says Bruce Perry, chief of psychiatry at Texas Children's Hospital and a neuroscientist at the Baylor College of Medicine in Houston. "It's unfair to expect one or two parents to provide all of the rich opportunity that our brain is seeking."
Perry points out that we are biologically disposed to live in groups. The human brain, he says, is a social one. It evolved over hundreds of generations in communities where it was almost impossible to feel alone, indeed, to get much privacy. "For 99.9 percent of our existence, the child had three to four siblings and at least that many adult caretakers through the extended family," says Perry. "Each of those interactions was a unique opportunity to be enriched, nurtured, expanded. Now, with the compartmentalization of our culture, we've stripped that away. Rather than talking about a return to the family, we need a return to the community." If we can't return to the classic extended-kin network, then researchers suggest that perhaps we should expand on what we can do -- invest in early childhood education, starting in the very first year.
"After a while, there's only so many things a parent can do," says Craig Ramey. "When daycare is done well, we know the results are good. There's nothing mysterious about the early childhood setting or what children need." For children who don't have adults who are willing or able to spend much time with them, daycare may even provide a helpful intervention. A growing number of researchers have been willing to put that idea directly to the test.
Syracuse University, for example, developed a pilot program for the children of mostly single, low-income African American mothers, all lacking a high school education. Their babies were enrolled in a Ramey-style daycare program at the age of 6 months, and continued to kindergarten. Community workers visited the families weekly. Among the results: By seventh and eighth grades, none of the program girls was failing school. The comparison dropout rate was 16 percent. About 6 percent of the children who had attended the Syracuse daycare had a reported criminal problem; the rate among their peers was 22 percent.
This approach benefits not only the poor. It also applies to children from affluent homes, where, Perry points out, neglect may be less obvious. For example, it can be "neglectful," he argues, when overbusy parents use television as a babysitter. Craig Ramey agrees: "Whether it's a child in the inner city kept inside for safety or whether it's an only child on a suburban two acres, the effect is the same. We have to find ways of countering the isolation of families."
According to a 1997 report by the National Institute of Child Health and Human Development that compared children in daycare with stay-at-home kids, those with a daycare background showed more advanced language development. "We found that quality childcare matters, even when you take into account other family and child variables, such as income and education of the parents," says Martha Cox, a principal investigator in the NICHD study and a professor of child development at the University of North Carolina at Chapel Hill. "Children consistently performed better on measures of thinking and language development if they were in high-quality daycare."
Does this suggest an unqualified endorsement of daycare over at-home care? Absolutely not. At least not without real, across-the-board improvements. "The way we do childcare is still unacceptable," says Helen Blank, director of childcare for the Children's Defense Fund (CDF), a nonprofit lobbying group.
In the first place, Ramey-style childcare isn't that easy to find. It requires small teacher-child ratios and a stable, well-trained staff. "A sensitive caregiver is one who responds to a child's needs at a given moment," says Deborah Lowe Vandell, a professor of education at the University of Wisconsin at Madison who is working with NICHD's seven-year study of daycare. For example, she says, when a baby is crying, it's appropriate for the caregiver to pick the baby up, talk soothingly, find out why she is crying, and take care of the problem. With a 3-year-old, she will know when to be involved and when to stay back and let the child explore on her own. Recent government and university surveys, however, indicate that only about 20 percent of daycare centers in America today provide that kind of responsive care. And CDF reports that up to 40 percent of childcare environments appear unhealthy: dirty, barely supervised, relying on television to entertain the children.
Like the Rameys, Stanley Greenspan, a clinical professor of psychiatry and pediatrics at George Washington University, believes that brain development at age 3 is critical, but he remains dubious that our current childcare programs can provide what children need. In a 1997 Washington Post opinion piece, he insisted that babies not only need people who talk to them a lot, they also need people who will talk to them for a long time -- a relaxed give-and-take of coos, gurgles, and adult talk -- back. Indeed, many daycare centers are so understaffed that their employees work at too brisk a pace to allow such slow and easy relationships. And the poorly paid workers often don't stay at their jobs very long. In the Rameys' small, cozy centers, by comparison, children and teachers form close relationships.
Outside such experimental programs, many low-income people don't have access to that type of quality childcare. CDF estimates that only one out of 10 poor children receives any kind of childcare subsidy. "In most cases the assistance is so small that parents can't find providers to serve them," CDF noted in one report. In a state-by-state survey, the organization found that 43 states had no programs in place to serve even the families eligible for daycare assistance; in California some 200,000 low-income, working families were on a waiting list for help.
"I wish that I could see signs that we were investing more into this problem," says Sharon Ramey. "Think about all the childcare options being offered as mothers are moved off welfare and into the job market. Wouldn't it make sense to make those very good, instead of very basic?"
Funding the improvements wouldn't be cheap. CDF is lobbying the federal government for a $20 billion increase in block grants for childcare programs, so far without success. But Blank says there are some encouraging signs. The White House, last year, indicated strong support for childhood programs; and more states are investing in pre-kindergarten programs. "A decade ago, there was almost no state support for pre-kindergarten," she says. "Now states are spending about $1.5 billion on such programs across the country, and about 800,000 children are enrolled." Most of these are preschool-age programs. Ohio, for instance, provides Head Start classes for every eligible 3- and 4-year-old in the state. "There's still no infant childcare support in many situations," Blank says. "And the states vary enormously. Some pay a lot of attention to the quality of programs; some don't at all."
All this is extraordinarily frustrating to someone like Sharon Ramey, who minds very much that children can be born with so much potential and lose much of it in a few years. "If we'd really do it, we could fix some of these learning disability problems overnight," she says.
And yet, there's one more argument to be heard. How much assurance is there, based on a scattering of very good, but very small and select, research programs, that early intervention will, indeed, so radically improve lives? "One thing I've worried about is this emphasis on birth to [age] 3," says Dr. John Bruer, president of the James S. McDonnell Foundation and author of the forthcoming book The Myth of the First Three Years. "Think about what it would take to institutionalize at that level. Wouldn't it make more sense to figure out exactly what really has to be done in those years and what can wait until later, when we already have institutions in place?"
First, he argues, the brain is still enough of a mystery that it's misleading to suggest that scientists can perform some kind of neuro-magic, effortlessly improving IQs. Second, a child's brain doesn't suddenly lose its potential at age 3. And third, as much as he admires the Rameys' work, he says their results are more about acculturation than neurological improvement. "If you look at the Ramey data, most of these interventions seem to have an impact primarily on verbal IQ," Bruer says. "I'm not arguing that those scores are merely a proxy for cultural knowledge. But you need cultural knowledge to do well in the middle-class world of schools."
Craig Ramey remains unfazed by such arguments. Calls for caution are expected -- and needed -- in any scientific discipline, he says. But he believes enough is known about the value of early intervention to move forward with the improvement of daycare. If acculturation results, then that's all right too. And while Ramey acknowledges Bruer's other point, that the age of 3 is not some magic cutoff, he believes Bruer overemphasizes it. "To some extent, he's setting up a straw man," Ramey says. "No one in neuroscience argues that neuroplasticity ends at age 3. Of course, there's no point at which you want to quit on a child. All we're saying is that early seems best."
In fact, Perry has been tackling the question of whether the same kinds of enrichment techniques can benefit older children. Recently, he led a program that tested each child who came into Houston's Child Protective Services. Normally only those with severe behavioral problems, about 25 percent, get tested. But Perry's team put every child through the works -- with revealing results. More than 70 percent had developmental disabilities, primarily language delays. "For instance, we may have a 4-year-old who, because of a chaotic early life, never had repetitive learning patterns," Perry says. "When we do the developmental evaluation, we find we should be interacting with them as if they were 2 or 3. And then we have to try to target the appropriate parts of the brain, to bring them up to where they should be."
He's working with a 12-year-old girl who was adopted at age 6, and then, to the shock of her new family, fell apart. The child, her adoptive parents later learned, had been abandoned by her single mother and sent through a series of foster homes, some truly terrible. By the time the girl was 11, they were ready to have her institutionalized. Perry combined conventional therapy with, well, the unconventional. "A year ago," muses her mother, "if you'd told me we'd be treating our daughter with music classes and reflexology...." But reflexology -- a massage therapy based on patterned touch -- has been shown to stimulate neuron growth in the brain. Music, particularly its repetitions and patterns, also promotes brain growth, as can structured dance and art, explains Perry.
"We have our daughter finally," the girl's mother says. "This summer, she had her very first slumber party. We're starting to believe in a future together."