Michelle Little

Hunger in Children in the United States: Potential Behavioral and Emotional Correlates

Objective. Results from a recent series of surveys from 9 states and the District of Columbia by the Community Childhood Hunger Identification Project (CCHIP) provide an estimate that 4 million American children experience prolonged periodic food insufficiency and hunger each year, 8% of the children under the age of 12 in this country. The same studies show that an additional 10 million children are at risk for hunger. The current study examined the relationship between hunger as defined by the CCHIP measure (food insufficiency attributable to constrained resources) and variables reflecting the psychosocial functioning of low-income, school-aged children. Methods. The study group included 328 parents and children from a CCHIP study of families with at least 1 child under the age of 12 years living in the city of Pittsburgh and the surrounding Allegheny County. A two-stage area probability sampling design with standard cluster techniques was used. All parents whose child was between the ages of 6 and 12 years at the time of interview were asked to complete a Pediatric Symptom Checklist, a brief parent-report questionnaire that assesses childrens emotional and behavioral symptoms. Hunger status was defined by parent responses to the standard 8 food-insufficiency questions from the CCHIP survey that are used to classify households and children as “hungry,” “at-risk for hunger,” or “not hungry.” Results. In an area probability sample of low-income families, those defined as hungry on the CCHIP measure were significantly more likely to have clinical levels of psychosocial dysfunction on the Pediatric Symptom Checklist than children defined as at-risk for hunger or not hungry. Analysis of individual items and factor scores on the Pediatric Symptom Checklist showed that virtually all behavioral, emotional, and academic problems were more prevalent in hungry children, but that aggression and anxiety had the strongest degree of association with experiences of hunger. Conclusion. Children from families that report multiple experiences of food insufficiency and hunger are more likely to show behavioral, emotional, and academic problems on a standardized measure of psychosocial dysfunction than children from the same low-income communities whose families do not report experiences of hunger. Although causality cannot be determined from a cross-sectional design, the strength of these findings suggests the importance of greater awareness on the part of health care providers and public health officials of the role of food insufficiency and hunger in the lives of poor children.

Relationship Between Hunger and Psychosocial Functioning in Low-Income American Children

OBJECTIVE Using large-scale surveys from nine states, the Community Childhood Hunger Identification Project (CCHIP) estimates that 8% of American children under the age of 12 years experience hunger each year. CCHIP operationalizes child hunger as multiple experiences of parent-reported food insufficiency due to constrained resources. The current study examined the relationship between food insufficiency and school-age, low-income childrens psychosocial functioning. The study also assessed the interinformant (parent versus child) reliability and time-to-time reliability of the CCHIP measure. METHOD Two hundred four school-age children and their parents from four inner-city public schools were interviewed using parent, teacher, and clinician report measures of psychosocial functioning. Ninety-six children and their parents were reinterviewed 4 months later. RESULTS Hungry and at-risk for hunger children were twice as likely as not-hungry children to be classified as having impaired functioning by parent and child report. Teachers reported higher levels of hyperactivity, absenteeism, and tardiness among hungry/at-risk children than not-hungry children. Parent and child reports of hunger were significantly related to each other, and time-to-time reliability of the CCHIP measure was acceptable. CONCLUSIONS Results of this study suggest that intermittent experiences of food insufficiency and hunger as measured by CCHIP are associated with poor behavioral and academic functioning in low-income children. The current study also supports the validity and reliability of the CCHIP measure for assessing hunger in children.

IDENTIFYING PSYCHOSOCIAL DYSFUNCTION IN SCHOOL-AGE CHILDREN: THE PEDIATRIC SYMPTOM CHECKLIST AS A SELF-REPORT MEASURE.

The Pediatric Symptom Checklist (PSC) is a brief, well-validated parent-report questionnaire designed to detect psychosocial dysfunction in school-age children during pediatric primary care visits. This study assessed the utility of the PSC when completed by children (PSC-Y) ages 9-14 in a public school when parents are not available (n = 173). The PSC-Y identified 20% of children as having psychosocial problems, a rate similar to other low-income samples. When compared with teacher ratings of attention and behavior problems, the PSC-Y showed a sensitivity of 94% and a specificity of 88%. The PSC-Y correlated significantly with teacher and parent measures of child dysfunction, and with child-reported symptoms of depression and anxiety. Three quarters of the children identified by the PSC-Y were not identified by parents on the PSC. These children had impairment on all other measures, but fewer than one in five had received mental health services, suggesting the PSC-Y identified children with unmet mental health needs. The PSC-Y has the potential to be a rapid, easily administered tool for large-scale mental health screening in schools.

Screening 4- and 5-year-old children for psychosocial dysfunction: A preliminary study with the Pediatric Symptom Checklist

The validity and reliability of the Pediatric Symptom Checklist (PSC), a parent-completed psychosocial screening questionnaire, was examined in a sample of 115 four-to five-year-old pediatric outpatients. The current study assessed agreement between the PSC and the Child Behavior Checklist. These results in the preschool sample were compared with results obtained in a sample of 6− to 12-year-old patients in the same practices. Levels of agreement between the PSC and the Child Behavior Checklist were found to be acceptable and approximately equal to those obtained with older children. Rates of reliability were also equivalent. Results provide preliminary support for the validity of the PSC for screening 4− and 5-year-old children. J Dev Behav Pediatr 15:191–197, 1994. Index terms: Pediatric Symptom Checklist, psychosocial screening, preschool children.