Examining the Association Between Food Insecurity and Pediatric Irritability

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Wilner, Eileen Lee, Emma Cho, Angela E. Salisbury, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6413845/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Feb, 2026 Read the published version in Child Psychiatry & Human Development → Version 1 posted 11 You are reading this latest preprint version Abstract Irritability is a transdiagnostic construct associated with diverse psychiatric disorders in youth. This study examined the association between food insecurity and irritability in a clinically and community-recruited sample of children aged 8–16 (N = 183). Participants and their parents completed structured interviews and measures assessing irritability, food security, and socioeconomic status (SES). Child-reported food insecurity was significantly associated with greater irritability, whereas parent-reported food insecurity was not. Regression analyses identified child-reported food insecurity as a unique predictor of irritability, independent of SES indicators. These findings underscore the clinical importance of assessing food insecurity from the child’s perspective and suggest that subjective experiences of food insecurity may have a stronger emotional impact than previously recognized. Results highlight the need for multi-informant assessments and targeted interventions addressing basic needs within pediatric mental health care. child mental health social determinants of health irritability Figures Figure 1 Figure 2 Background Irritability, defined as increased proneness to anger, is the most common reason children are brought for psychiatric evaluation, accounting for over 40% of pediatric emergency department visits and over 20% of outpatient mental health visits (Collishaw et al., 2010 ; Kelly et al., 2010 ; Peterson et al., 1996 ; Stringaris et al., 2009 ). Often, irritability is understood to be the result of blocked goal attainment (Dickstein, 2015 ; Leibenluft, 2011 ; Leibenluft, Blair, et al., 2003 ; Leibenluft, Charney, et al., 2003), and in conjunction with the reduced ability to adapt to social rewards, can increase feelings of frustration and may lead to aggressive behaviors (Blair, 2000, Blair 2001, Blair 2004, Blair, 2010). Irritability is listed as a diagnostic criterion or associated symptom for multiple Diagnostic and Statistical Manual (DSM) psychiatric disorders including bipolar disorder, generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), and disruptive mood dysregulation disorder (DMDD) (American Psychiatric Association [APA], 2013). Despite irritability being a common transdiagnostic symptom across pediatric mental health disorders, there is limited research on the risk factors for irritability. A greater understanding of irritability in children and adolescents has been identified as a high priority by the National Institute of Mental Health and also a recent American Academy of Child and Adolescent Psychiatry (AACAP) Presidential Initiative (Althoff, 2018 ; Carlson et al., 2023 ). There is increasing recognition that social determinants of health (SDOH; i.e., conditions in which individuals are born, raised, and live), may play an important role in adolescent mental health and behavioral outcomes (Shim & Compton, 2018 ). Among the various factors of social determinants, food insecurity—defined as limited availability and unassured access to nutritionally adequate food for a healthy and active lifestyle—has become a national public health concern. It is estimated that nearly 11.2 million children living in households experience food insecurity (Hartline-Grafton & Hassink, 2021a ), exacerbated by the COVID-19 pandemic (Bauer, 2020 ; Karpman et al., 2020 ,) and food price inflation (Adjemian et al., 2024 ; U.S. Department of Agriculture (USDA), 2025 ). Food insecurity, even at marginal levels, is associated with children’s behavioral and emotional problems, including impairment in self-regulation (Park et al., 2022 ), as well as higher levels of aggressive, destructive, withdrawn, and distressed behaviors (Reid, 2000 ). Preschoolers from food-insecure households are at increased risk for aggressive behavior, anxiety and depressed mood, and attention-deficit/hyperactivity problems (Whitaker et al., 2006 ). Indeed, children from food-insecure households have been identified as having a two-fold increase in likelihood of having seen a psychologist due to emotional and behavioral difficulties (Alaimo et al., 2001a ). Given the unique role that food insecurity can play in the development and maintenance of irritability in children beyond other SDOH, it is important to comprehensively assess food security status amongst families whose children are struggling with irritability or related mental health concerns to understand children’s clinical presentations better, and to connect families with resources if needed. However, a challenge facing such efforts is that reporting of food insecurity is often only made by one parent, without input from children themselves (e.g., the U.S. Adult Food Security Survey Module questionnaire), despite data suggesting that children perceive themselves as less food secure than their parents 70% of the time (Landry et al., 2019a ). Critically, we may be missing the full picture of real or perceived food insecurity by not directly asking children. In this study, we investigate the relationship between both child/parent perceptions of food insecurity and irritability in a sample of children with the full range of irritability rather than being limited to a single diagnosis. We hypothesized: (1) children reporting higher food insecurity would exhibit greater irritability than children reporting little to no food insecurity, and (2) children’s report of food insecurity would be more strongly associated with irritability than would parent’s report of food insecurity. Methods Participants Children aged 8–16 years old participated in an Institutional Review Board (IRB) approved study examining clinical and psychosocial factors of irritability. The sample was recruited from clinical (e.g., psychiatric outpatient and inpatient) and community settings (e.g., flyers at local businesses, postings on social media). Inclusion criteria consisted of any amount of irritability (including none), as measured by the Affective Reactivity Index (ARI; Stringaris et al., 2012 ), a six-item child (about self, ARI-C) and parent (about child, ARI-P) measure of the irritability dimension of Oppositional Defiant Disorder (vs. “spiteful/vindictive” or “headstrong/defiant”) with a single factor structure. Items such as “Is easily annoyed by others” were rated on a three-point scale (“ not true” [0], “somewhat true” [1], and “certainly true” [2]). Total scores ranged from 0–12, with higher scores indicating greater irritability, completed by parents on a phone screen. To ensure a wide distribution of scores, effort was made to recruit participants with a wide range of scores based on tertiles of the ARI parent report of low (ARI score 0–4), medium (ARI score 5–8), and high irritability (ARI score 9–12). ARI child report was obtained at the study visit. Given that irritability is a diagnostic criterion or associated feature of more than 10 different Diagnostic and Statistical Manual (DSM-5) disorders, we sought to recruit and study a transdiagnostic sample of children and adolescents experiencing a range of irritability, rather than any specific DSM disorder, so we might advance what is known about pediatric irritability. Exclusion criteria were: (1) active psychosis or autism spectrum disorder due to potential interference with understanding of study procedures, and (2) Full Scale Intelligence Quotient (FSIQ) < 80 and/or intellectual disability or other neurological impairments due to possible misunderstanding of the study procedures. Given that this study was derived from a larger project which included brain/behavior mechanisms, other exclusion criteria included non-removable metal (e.g., braces, metal screws or pins, permanent retainers, devices, or piercings) and color blindness. After obtaining informed parent consent and child assent, participants meeting inclusion criteria completed a clinician-administered diagnostic psychiatric interview, the Wechsler Abbreviated Scale of Intelligence (WASI), and child/parent self-report measures described below. Families were compensated for their time participating in the study. Measures In addition to ARI as above, participants completed the following assessments. Demographic Information. Participants reported their age, race, ethnicity, and biological sex at the time of enrollment. Wechsler Abbreviated Scale of Intelligence (WASI; Wechsler, 2011 ) The WASI was used as a measure of cognitive functioning to ensure understanding of study procedures. The WASI consists of two subtests, Vocabulary (31-item) and Matrix Reasoning (30-item), which yields the Full-Scale IQ-2 (FSIQ-2). Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version for DSM-5 (KSADS ; Kaufman et al., 1997 ) The KSADS is a semi-structured diagnostic interview administered by a trained doctoral-level clinician with established inter-rater reliability (kappa > 0.85) to child participants and their parents separately to evaluate psychiatric diagnoses. Affective Reactivity Index (ARI ; Stringaris et al., 2012 ). The ARI is a six-item child (about self, ARI-C) and parent (about child, ARI-P) measure of the irritability dimension of Oppositional Defiant Disorder (vs. “spiteful/vindictive” or “headstrong/defiant”) with a single factor structure. Items such as “Is easily annoyed by others” were rated on a three-point scale (“ not true” [0], “somewhat true”[1] and, “certainly true” [2]). Total scores ranged from 0–12, with higher scores indicating greater irritability. U.S. Adult Food Security Survey Module (AFSSM ; Coleman-Jensen, 2012 ). The AFSSM is a nine-item measure of situations and behaviors that may have occurred in the last 12 months of difficulty meeting basic household food needs. In response to questions (e.g., “We couldn't afford to eat balanced meals”), the sum of affirmative responses (“yes,” “often,” “almost every month,” and “some months but not every month”) was assigned as the total raw score and used to classify participants’ households into four categories: (1) high food security (no affirmative responses on the survey); (2) marginal food security (1–2 affirmative responses); (3) low food security (3–5 affirmative responses); and (4) very low food security (8 or more affirmative responses). Due to the overall sample size, the last three categories were further combined into a food insecure (FI) group, while the first group remained as the food secure (FS) group. The U.S. adult food security module is reliable and valid in assessing the prevalence of food insecurity in adults (Anuar et al., 2016 ). Self-Administered Food Security Survey Module for Youth (SFSSM-Y ; Connell et al., 2004 ). The Self-Administered Food Security Survey Module for Youth (SFSSM-Y) is a nine-item child self-report of household food insecurity. The asks questions about the food situation in the household within the last month, including “Did you worry that food at home would run out?” or “Did you have to eat less?” Responses of “a lot” and “sometimes" were coded as affirmative. The sum of affirmative responses to the nine questions on the SFSSM-Y were used identify participant food security status into four categories: (1) high food security (no affirmative responses on the survey); (2) marginal food security (1 affirmative response); (3) low food security (2–5 affirmative responses); and (4) very low food security (6–9 affirmative responses). Similar to the AFSSM, the last three categories were grouped into one FI group. The measure has been shown to be valid and reliable in children and adolescents (Maia et al., 2020 ). Hollingshead Four Factor Index (Hollingshead, 1975 ). The Hollingshead four-factor index measures SES using parent education and occupation. Education scores for parents range from 1 (less than seventh grade) to 7 (graduate training), and occupation scores range from 1 (e.g., farm laborer/menial service worker) to 9 (e.g., executives, professionals). These scores are combined into a single SES score per parent, ranging from 8 to 66. For families with multiple working parents, scores are averaged. If job titles did not match the listed codes, study staff identified comparable occupations and verified scores for reliability through double-coding and verbal discussion until agreement was reached. Data Analytic Strategy Statistical Package for Social Sciences (SPSS, version 28, IBM Corporation) was used to conduct all analyses. Regarding our primary hypotheses, given the categorical nature of the food security group membership variable, Spearman correlations were used to examine the relationship between irritability (based on ARI total scores) and food security group membership (based on the AFSSM and SFSSM-Y scores). We also report on the agreement between parent- and child-reported irritability and food security. We conducted independent sample t-tests to compare child- and parent-reported irritability for participants in the food-secure versus food-insecure groups based on the AFSSM and SFSSM-Y. An Analysis of Variance (ANOVA) was used to evaluate if there were significant differences between parent-reported irritability and food insecurity. To test if other indicators of SES (e.g., income), were associated with pediatric irritability, in a post-hoc exploratory analysis, we performed a multiple regression to assess the strength of the association between irritability, food insecurity, and SES, and the possible direct effects of food insecurity and SES on irritability. Results Demographics. Demographic data from N = 183 study participants are reported in Table 1 . The final sample was 55.2% male and 44.8% female, with a mean age of 11.92 ± 2.3years. The sample consisted of participants identifying as White (77%), Black (10.4%), Other (7.7%), Asian (3.3%), and 1.6% chose not to report their race. The majority of participants identified as Non-Hispanic/Latino (82.5%). At the time of participation, participants met current psychiatric diagnostic criteria for the following diagnoses: Attention-Deficit/Hyperactivity Disorder (ADHD; 42.1%), Oppositional Defiant Disorder (ODD; 33.3%), Generalized Anxiety Disorder (GAD; 29%), Major Depressive Disorder (MDD; 26.2%), Social Anxiety Disorder (SAD; 9.8%), Disruptive Mood Dysregulation Disorder (DMDD; 8.7%), Specific Phobia (6.0%), Post-Traumatic Stress Disorder (PTSD; 6.6%), and Conduct Disorder (4.4%). About 27% of participants did not meet diagnostic criteria for any psychiatric disorder. The mean IQ for the sample was 106 ± 13.43. Table 1. Participant Demographics Full Sample ( n = 183) FI No ( n = 143) FI Yes ( n = 40) Age (years) 11.92 ± 2.63 12.06 ± 2.73 11.42 ± 2.20 Sex Male 55.2% ( n = 101) 42.6% ( n = 78) 12.6% ( n = 23) Female 44.8 % ( n = 82) 35.5% ( n = 65) 9.3% ( n = 17) Full-Scale IQ 106 ± 13.43 107 ± 13.37 103 ± 13.28 Race White 77.0% ( n = 141) 62.3% ( n = 114) 14.8% ( n = 27) Black 10.4% ( n = 19) 7.1% ( n = 13) 3.3% ( n = 6) Asian 3.3% ( n = 6) 2.7% ( n = 5) 0.5% ( n = 1) Other 7.7% ( n = 14) 26.2% ( n = 48) 0.5% ( n = 1) Not Reported 1.6% ( n = 3) 1.6% ( n = 3) 0.0% ( n = 0) Ethnicity Non-Hispanic 82.5% ( n = 151) 68.9% ( n = 126) 13.7% ( n = 25) Hispanic/Latino 13.7% ( n = 25) 6.6% ( n = 12) 7.1% ( n = 13) Not Reported 3.8% ( n = 7) 2.7% ( n = 5) 1.1% ( n = 2) Current Diagnoses Major Depressive Episode 26.2% ( n = 48) 19.1% ( n = 35) 7.1% ( n = 13) DMDD 8.7% ( n = 16) 5.5% ( n = 10) 3.3% ( n = 6) Social Anxiety 9.8% ( n = 18) 9.8% ( n = 18) 0.0% ( n = 0) Specific Phobia 6.0% ( n = 11) 2.7% ( n = 5) 3.3% ( n = 6) GAD 29.0% ( n = 53) 21.9% ( n = 40) 7.1% ( n = 13) PTSD 6.6% ( n = 12) 4.4% ( n = 8) 2.2% ( n = 4) ADHD (any type) 42.1% ( n = 77) 30.1% ( n = 55) 12.0% ( n = 22) ODD 33.3% ( n = 61) 24.6% ( n = 45) 8.7% ( n = 16) Conduct Disorder 4.4% ( n = 8) 3.3% ( n = 6) 1.1% ( n = 2) No Diagnoses 27.3% ( n = 50) 23.5% ( n = 43) 3.8% ( n = 7) Abbreviations. FI, Food Insecurity a Designation of participants affirmative or negative for experiences of food insecurity identified using parent responses on the U.S. Adult Food Security Survey module (AFSSM). Descriptive measures of interest. The mean ARI Child (ARI-C) was 4.48 + 3.20, falling in between the low and medium irritability tertiles, and mean ARI Parent (ARI-P) was 5.56 ± 3.82, falling into the medium irritability tertile. Figure 1 illustrates mean ARI scores and break down among children and parents who agreed vs. disagreed on their food security status as a household. Eighteen participants were excluded due to missing or insufficient SES data (e.g., missing data from both parents, missing education or occupation information required for SES calculations). Relationship Between Irritability and Agreement Between Parent- and Child-Reported Food Insecurity . To examine the differences between parent- and child-reported irritability and perception of food insecurity, we identified four different agreement groups: (Group 1) both child/parent endorsed “no” food insecurity; (Group 2) child endorsed “yes” and parent endorsed “no” food insecurity; (Group 3) child endorsed “no” and parent endorsed “yes” food insecurity; (Group 4) both child/parent endorsed “yes” food insecurity. The distribution of parents and children who agreed vs. on household food security status is presented in Table 2 . A one-way ANOVA revealed a statically significant difference between parent irritability scores across food insecurity agreement groups [ F (3, 179) = 2.89, p = 0.037]. However, there was no statistically significant difference in ARI-C scores across food insecurity agreement groups [ F (3, 176) = 1.35, p = 0.26]. The exploratory Tukey post hoc analysis revealed a significant difference in parent-reported irritability scores between Groups 1 and 2, with parent-reported irritability scores higher in Group 2. Table 2 Distribution of Participants by Agreement Between Child & Parent Endorsements of Food Security Parent Food Security Endorsement Child Food Security Endorsement No FI (N = 156) Yes FI (N = 27) % Agreement in Endorsement with Child No FI (N = 148) 136 12 91.892 Yes FI (N = 35) 20 15 42.857 % Agreement in Endorsement with Parent 87.179 55.556 -- a Percent agreement for each row/column was calculated by dividing the number of parent/child dyads that agreed on their FI endorsement by the total number of participants in that row/column and multiplying by 100. Associations Between Irritability and Food Insecurity. Spearman correlations to determine the relationship between child/parent irritability scores and food insecurity groups, we found a significant positive correlation between child rating of food insecurity and both child/parent irritability scores, [ r s (180) = 0.15, p = 0.05 and r s (183) = 0.21, p = 0.005], respectively. There was no significant correlation between parent rating of food insecurity and either ARI-C or ARI-P irritability scores. To evaluate any differences between child/parent food insecure and food secure groups with child versus parent irritability scores, we used independent samples t-test. We found a significant difference in parent-reported irritability scores between children endorsing food security vs. children endorsing food insecurity [ t (181) = -2.85, p = 0.005). However, there was no significant difference found in child-reported irritability scores between children endorsing food security vs. children endorsing food insecurity [ t (178) = -1.79, p = 0.075). Furthermore, there were no significant differences in either ARI-C or ARI-P irritability scores between parents endorsing food security vs. parents endorsing food insecurity [ t (178) = -0.57, p = 0.572; t (181) = -0.70, p = .485], respectively. Irritability and SES. The mean SES score on the Hollingshead measure for the sample was 48.36 [ SD = 13.43], falling into the “medium business, minor professional, technical” social strata. With respect to the relationship between ARI-C/-P and SES (Fig. 2 ), we found a significant, positive Pearson correlation between SES and ARI-P, [ r s (180) = 0.22, p = 0.003], but not ARI-C [ r s (180) = 0.11, p = 0.155]. Relative Effects of Food Insecurity and SES on Irritability. The distribution of participants by SES classification and child/parent endorsements of food insecurity is presented in Table 3 . To test if food insecurity and SES were uniquely associated with irritability, our multiple regression analysis showed a significant effect of SES on ARI-P [ β = 0.23, p = 0.003], however, neither child- nor parent-endorsed food insecurity were significantly associated with ARI-P [ β = 0.18, p = 0.060; β = − .054, p = 0.566]. Food insecurity and SES explained 8.5% of the variance in ARI-P [ R 2 = 0.085, F (3,153) = 4.742, p = 0.003]. Furthermore, we found a significant effect of child-endorsed food insecurity on ARI-C [ β = 0.200, p = 0.042], however, this was not true for parent-endorsed food insecurity [ β = -0.098, p = 0.314], or SES [ β = 0.121, p = 0.134]. While food insecurity and SES did explain 4.5% of the variance in ARI-C, this was not significant [ R 2 = 0.045, F (3,150) = 2.379, p = 0.072]. Table 3 Distribution of Participants by SES Classification and Child & Parent Endorsements of Food Security Hollingshead SES Classification Low SES (N = 22) High SES (N = 147) Incomplete SES Data (N = 18) Child Food Security Endorsement No FI (N = 118) 12 106 12 Yes FI (N = 33) 5 28 5 % FI/SES Concordance 22.727 72.109 Parent Food Security Endorsement No FI (N = 146) 17 129 4 Yes FI (N = 23) 5 18 4 % FI/SES Concordance 22.727 87.755 a Low SES ≤ 33, High SES > 33 b Percent concordance for Low SES was calculated by dividing the number of participants that endorsed experiencing FI by the total number of participants classified as Low SES and multiplying by 100. c Percent concordance for High SES was calculated by dividing the number of participants that endorsed no experiences of FI by the total number of participants classified as High SES and multiplying by 100. Discussion In our study examining the relationship between food insecurity and irritability, our primary finding supports our hypothesis that child endorsement of food insecurity was significantly associated with increased child/parent-reported irritability. This association was not found between parent-endorsement of food insecurity and child or parent-reported irritability. Furthermore, when categorized into food-insecure and food-secure groups, we found a significant difference between parent-reported irritability and child endorsement of food insecurity, but there was no such significant relationship using either parent-reported irritability and parent endorsement of food insecurity or child-reported irritability and either child- or parent- endorsement of food insecurity. Taken as a whole, this suggests that parents and children may not be aligned in their perceptions about their family’s food security status. Additionally, results indicate that parents may perceive their children as more irritable in cases where the child perceives food insecurity, even when the parent does not report such food insecurity, as compared to when child/parent agree about their food security status. These findings are consistent with prior research showing children often perceive themselves as less food secure than their parents report (Landry et al., 2019b ). Such misalignment has important implications for how clinicians and researchers assess of food security, irritability, and related mental health concerns in children and their families, and how food security is discussed within families more broadly. For example, clinicians working with children with irritability may benefit from adding a question or two to their intake and follow-up clinical assessments to not only inquire about symptoms of DSM-5 psychiatric disorders, academic/social functioning etc. but also food security. Importantly, and perhaps unexpectedly, income alone does not entirely account for household food insecurity. According to the U.S. Department of Agriculture, in 2023, 13.5% of all U.S. households experienced food insecurity at some point during the year (Rabbitt et al., 2024). Prior work has found that middle- and high-income households represent 20% of food-insecure households (Alaimo et al., 2001b ). Those 20% of food-insecure households struggle with unexpected economic challenges during the year, such as loss of employment, sudden illness, or death. Food insecurity, in contrast, is experienced through four domains: the quantity of food available, the quality of food, psychological worry and uncertainty regarding food security, and social acceptability (Webb et al., 2006 ). These four domains allow us to better conceptualize the experiences of food insecurity at both the household and individual levels. Our post-hoc analysis shed light on how SES and food security may not be synonymous. It is well-recognized that SES as measured by the Hollingshead four-factor index is a valuable predictor of psychiatric disorders (Cuffe et al., 1995 ). However, data from national surveys indicate that nearly half of all families who report food insecurity have income above the official poverty line (Boushey, 2001 ; Fremstad, 2010 ; Gundersen et al., 2011 ), citing the need for more nuanced, longitudinal, and comprehensive indicators of income to explain food insecurity (Gundersen & Gruber, 2001 ; Ribar & Hamrick, 2003 ). Given our findings suggesting that SES and food insecurity were both associated with childhood irritability, future studies should consider assessing both constructs as they seek to address SDOH related to irritability. For example, given the discrepancy between child/parent ratings of food insecurity, it might be important for childhood mental health providers not only to assess food insecurity from children and parents but also to consider facilitation of conversations between parents and children about food security. The present study has several limitations, including sample size and participant diversity. A larger and more diverse sample of families from different socioeconomic and ethnic backgrounds would allow for more generalizability of our findings. Specifically, recruitment of families from underserved communities at increased risk of experiencing food insecurity and less available resources for food assistance, such as immigrant families (Crowe et al., 2018 ; Sharkey & Elwert, 2011 ), would provide greater insight into the role of food insecurity in children’s irritability. As this study was part of a larger parent study, we unfortunately were limited to the sample already recruited. Furthermore, the measure used to assess SES has its own limitations as not all reported occupations fit within the pre-determined categories and thus relied on manual coding by authors. While efforts were made to address this (e.g., double coding), there may be a risk of bias in some cases. While our study emphasizes the importance of food insecurity as one of the many factors encompassing SDOH in pediatric mental health, there are several directions for future research. Future studies could explore other possible factors that could play a role in children’s irritability in home environments such as parent-child interactions and parent stress. Prior work has found that child endorsement of food insecurity was grounded in immediate household social and food environment, including quality of child/parent interactions and parent affect and behavior (Fram et al., 2011 ). Thus, it would be valuable to examine how parental stress and their own mental health may in turn affect their child's irritability. Furthermore, given recent findings that children in households that participated in the Supplemental Nutrition Assistance Program (SNAP) were approximately one-third less likely to be food-insecure after six months than those who did not (Hartline-Grafton & Hassink, 2021b ), it would be helpful to observe how SNAP, school meal programs, or related initiatives could possibly affect or improve children’s irritability and mood over time. Our results highlight the important role that children’s experiences of food insecurity play on pediatric irritability and suggest the importance of using multi-informant (i.e., children as well as parents) measures of both mental health and food security. As clinicians assess and treat children with irritability and related psychiatric symptoms, it is important to ensure a comprehensive assessment of social determinants of health, such as food insecurity. More research on the evaluation of interventions targeting food insecurity’s effect on irritability is critical. Declarations Author Contribution J.G.W. wrote the main manuscript text. J.G.W., E.L., and E.C. contributed to the conceptualization of the project, data analysis, and visualization. A.E.S., E.G.A., K.P., N.P.S., C.K., and M.N completed data curation. J.M.R, J.A., and L.R. contributed to review and editing. D.P.D. was responsible for funding acquisition, supervision, methodology, and review and editing. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. References Adjemian, M. K., Arita, S., Meyer, S., & Salin, D. (2024). Factors affecting recent food price inflation in the United States. 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Journal of the American Academy of Child & Adolescent Psychiatry , 34 (11), 1536–1543. https://doi.org/10.1097/00004583-199511000-00021 Dickstein, D. P. (2015). The Path to Somewhere: Moving Toward a Better Biological Understanding of Irritability. American Journal of Psychiatry , 172 (7), Article 7. https://doi.org/10.1176/appi.ajp.2015.15040517 Fram, M. S., Frongillo, E. A., Jones, S. J., Williams, R. C., Burke, M. P., DeLoach, K. P., & Blake, C. E. (2011). Children Are Aware of Food Insecurity and Take Responsibility for Managing Food Resources. The Journal of Nutrition , 141 (6), Article 6. https://doi.org/10.3945/jn.110.135988 Fremstad, S. (2010, April). A Modern Framework for Measuring Poverty and Basic Economic Security. Center for Economic and Policy Research . https://www.cepr.net/report/a-modern-framework-for-measuring-poverty-and-basic-economic-security/ Gundersen, C., & Gruber, J. (2001). The dynamic determinants of food insufficiency. (No. Second food security measurement and research conference). 2 (Second food security measurement and research conference), Article Second food security measurement and research conference. Gundersen, C., Kreider, B., & Pepper, J. (2011). The Economics of Food Insecurity in the United States. Applied Economic Perspectives and Policy , 33 (3), Article 3. https://doi.org/10.1093/aepp/ppr022 Hartline-Grafton, H., & Hassink, S. G. (2021a). Food Insecurity and Health: Practices and Policies to Address Food Insecurity among Children. Academic Pediatrics , 21 (2), 205–210. https://doi.org/10.1016/j.acap.2020.07.006 Hartline-Grafton, H., & Hassink, S. G. (2021b). Food Insecurity and Health: Practices and Policies to Address Food Insecurity among Children. Academic Pediatrics , 21 (2), Article 2. https://doi.org/10.1016/j.acap.2020.07.006 Hollingshead, A. B. (1975). Four factor index of social status. Karpman, M., Zuckerman, S., Gonzalez, D., & Kenney, G. M. (2020). The COVID-19 Pandemic Is Straining Families’ Abilities to Afford Basic Needs: Low-Income and Hispanic Families the Hardest Hit. Urban Institute. Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., Williamson, D., & Ryan, N. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): Initial Reliability and Validity Data. Journal of the American Academy of Child & Adolescent Psychiatry , 36 (7), 980–988. https://doi.org/10.1097/00004583-199707000-00021 Kelly, C., Molcho, M., Doyle, P., & Gabhainn, S. N. (2010). Psychosomatic symptoms among schoolchildren. International Journal of Adolescent Medicine and Health , 22 (2), Article 2. https://doi.org/10.1515/IJAMH.2010.22.2.229 Landry, M. J., Van Den Berg, A. E., Asigbee, F. M., Vandyousefi, S., Ghaddar, R., & Davis, J. N. (2019a). Child Compared with Parent Perceptions of Child-Level Food Security. Current Developments in Nutrition , 3 (10), nzz106. https://doi.org/10.1093/cdn/nzz106 Landry, M. J., Van Den Berg, A. E., Asigbee, F. M., Vandyousefi, S., Ghaddar, R., & Davis, J. N. (2019b). Child Compared with Parent Perceptions of Child-Level Food Security. Current Developments in Nutrition , 3 (10), Article 10. https://doi.org/10.1093/cdn/nzz106 Leibenluft, E. (2011). Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. The American Journal of Psychiatry , 168 (2), Article 2. https://doi.org/10.1176/appi.ajp.2010.10050766 Leibenluft, E., Blair, R. J. R., Charney, D. S., & Pine, D. S. (2003). Irritability in pediatric mania and other childhood psychopathology. Annals of the New York Academy of Sciences , 1008 , 201–218. https://doi.org/10.1196/annals.1301.022 Leibenluft, E., Charney, D. S., & Pine, D. S. (2003). Researching the pathophysiology of pediatric bipolar disorder. Biological Psychiatry , 53 (11), Article 11. https://doi.org/10.1016/s0006-3223(03)00069-6 Maia, I., Severo, M., & Santos, A. C. (2020). Application of the mixture item response theory model to the Self-Administered Food Security Survey Module for Children. PLOS ONE , 15 (1), e0228099. https://doi.org/10.1371/journal.pone.0228099 Park, Y. R., Nix, R. L., Gill, S., & Hostetler, M. L. (2022). What kind of parenting is associated with early self-control among toddlers living in poverty? The importance of learning support. Developmental Psychology , 58 (3), 425–437. https://doi.org/10.1037/dev0001312 Peterson, B. S., Zhang, H., Lucia, R. S., King, R. A., & Lewis, M. (1996). Risk Factors for Presenting Problems in Child Psychiatric Emergencies. Journal of the American Academy of Child & Adolescent Psychiatry , 35 (9), 1162–1173. https://doi.org/10.1097/00004583-199609000-00014 Reid, L. (2000). The Consequences of Food Insecurity for Child Well-Being: An Analysis of Children’s School Achievement, Psychological Well-Being, and Health. Northwestern University/University of Chicago Joint Center for Poverty Research, JCPR Working Papers . Ribar, D. C., & Hamrick, K. S. (2003). DYNAMICS OF POVERTY AND FOOD SUFFICIENCY . https://doi.org/10.22004/AG.ECON.33851 Sharkey, P., & Elwert, F. (2011). The Legacy of Disadvantage: Multigenerational Neighborhood Effects on Cognitive Ability. American Journal of Sociology , 116 (6), Article 6. https://doi.org/10.1086/660009 Shim, R. S., & Compton, M. T. (2018). Addressing the Social Determinants of Mental Health: If Not Now, When? If Not Us, Who? Psychiatric Services , 69 (8), 844–846. https://doi.org/10.1176/appi.ps.201800060 Stringaris, A., Cohen, P., Pine, D. S., & Leibenluft, E. (2009). Adult Outcomes of Youth Irritability: A 20-Year Prospective Community-Based Study. American Journal of Psychiatry , 166 (9), 1048–1054. https://doi.org/10.1176/appi.ajp.2009.08121849 Stringaris, A., Goodman, R., Ferdinando, S., Razdan, V., Muhrer, E., Leibenluft, E., & Brotman, M. A. (2012). The Affective Reactivity Index: A concise irritability scale for clinical and research settings. Journal of Child Psychology and Psychiatry , 53 (11), 1109–1117. https://doi.org/10.1111/j.1469-7610.2012.02561.x U.S. Department of Agriculture (USDA). (2025). Food Price Outlook [Economic Research Service (ERS)]. https://www.ers.usda.gov/data-products/food-price-outlook/summary-findings Webb, P., Coates, J., Frongillo, E. A., Rogers, B. L., Swindale, A., & Bilinsky, P. (2006). Measuring Household Food Insecurity: Why It’s So Important and Yet So Difficult to Do. The Journal of Nutrition , 136 (5), 1404S-1408S. https://doi.org/10.1093/jn/136.5.1404S Wechsler, D. (2011). Wechsler Abbreviated Scale of Intelligence—Second Edition . NCS Pearson. https://doi.org/10.1037/t15171-000 Whitaker, R. C., Phillips, S. M., & Orzol, S. M. (2006). Food Insecurity and the Risks of Depression and Anxiety in Mothers and Behavior Problems in their Preschool-Aged Children. Pediatrics , 118 (3), e859–e868. https://doi.org/10.1542/peds.2006-0239 Additional Declarations No competing interests reported. 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Dickstein","email":"","orcid":"","institution":"McLean Hospital","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"P.","lastName":"Dickstein","suffix":""}],"badges":[],"createdAt":"2025-04-09 16:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6413845/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6413845/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10578-026-01981-0","type":"published","date":"2026-02-18T15:57:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82309349,"identity":"2e9731ed-b14b-4bca-96f6-a867b2da7451","added_by":"auto","created_at":"2025-05-09 01:43:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23053,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMean ARI Scores by Agreement Between Child \u0026amp; Parent Endorsements of Food Security\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6413845/v1/9707e4af34a5c6a4d6da2016.png"},{"id":82309345,"identity":"5476d27d-a418-4f56-a743-dad97647c45f","added_by":"auto","created_at":"2025-05-09 01:43:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54389,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eCorrelation Between Hollingshead SES Score and ARI-C \u0026amp; ARI-P Scores\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6413845/v1/700ed12c6ad28332bb365b76.png"},{"id":103252291,"identity":"5533fbf5-b038-48da-a558-9bc90dd1b4d1","added_by":"auto","created_at":"2026-02-23 16:14:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":899163,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6413845/v1/88374571-55a6-4cb2-ac6f-6193e5d6dfe4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Examining the Association Between Food Insecurity and Pediatric Irritability","fulltext":[{"header":"Background","content":"\u003cp\u003eIrritability, defined as increased proneness to anger, is the most common reason children are brought for psychiatric evaluation, accounting for over 40% of pediatric emergency department visits and over 20% of outpatient mental health visits (Collishaw et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Kelly et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Peterson et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e1996\u003c/span\u003e; Stringaris et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Often, irritability is understood to be the result of blocked goal attainment (Dickstein, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Leibenluft, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Leibenluft, Blair, et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Leibenluft, Charney, et al., 2003), and in conjunction with the reduced ability to adapt to social rewards, can increase feelings of frustration and may lead to aggressive behaviors (Blair, 2000, Blair 2001, Blair 2004, Blair, 2010). Irritability is listed as a diagnostic criterion or associated symptom for multiple Diagnostic and Statistical Manual (DSM) psychiatric disorders including bipolar disorder, generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), and disruptive mood dysregulation disorder (DMDD) (American Psychiatric Association [APA], 2013). Despite irritability being a common transdiagnostic symptom across pediatric mental health disorders, there is limited research on the risk factors for irritability. A greater understanding of irritability in children and adolescents has been identified as a high priority by the National Institute of Mental Health and also a recent American Academy of Child and Adolescent Psychiatry (AACAP) Presidential Initiative (Althoff, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Carlson et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is increasing recognition that social determinants of health (SDOH; i.e., conditions in which individuals are born, raised, and live), may play an important role in adolescent mental health and behavioral outcomes (Shim \u0026amp; Compton, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Among the various factors of social determinants, food insecurity\u0026mdash;defined as limited availability and unassured access to nutritionally adequate food for a healthy and active lifestyle\u0026mdash;has become a national public health concern. It is estimated that nearly 11.2\u0026nbsp;million children living in households experience food insecurity (Hartline-Grafton \u0026amp; Hassink, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021a\u003c/span\u003e), exacerbated by the COVID-19 pandemic (Bauer, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Karpman et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e,) and food price inflation (Adjemian et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; U.S. Department of Agriculture (USDA), \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFood insecurity, even at marginal levels, is associated with children\u0026rsquo;s behavioral and emotional problems, including impairment in self-regulation (Park et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), as well as higher levels of aggressive, destructive, withdrawn, and distressed behaviors (Reid, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Preschoolers from food-insecure households are at increased risk for aggressive behavior, anxiety and depressed mood, and attention-deficit/hyperactivity problems (Whitaker et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Indeed, children from food-insecure households have been identified as having a two-fold increase in likelihood of having seen a psychologist due to emotional and behavioral difficulties (Alaimo et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2001a\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the unique role that food insecurity can play in the development and maintenance of irritability in children beyond other SDOH, it is important to comprehensively assess food security status amongst families whose children are struggling with irritability or related mental health concerns to understand children\u0026rsquo;s clinical presentations better, and to connect families with resources if needed. However, a challenge facing such efforts is that reporting of food insecurity is often only made by one parent, without input from children themselves (e.g., the U.S. Adult Food Security Survey Module questionnaire), despite data suggesting that children perceive themselves as less food secure than their parents 70% of the time (Landry et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2019a\u003c/span\u003e). Critically, we may be missing the full picture of real or perceived food insecurity by not directly asking children.\u003c/p\u003e \u003cp\u003eIn this study, we investigate the relationship between both child/parent perceptions of food insecurity and irritability in a sample of children with the full range of irritability rather than being limited to a single diagnosis. We hypothesized: (1) children reporting higher food insecurity would exhibit greater irritability than children reporting little to no food insecurity, and (2) children\u0026rsquo;s report of food insecurity would be more strongly associated with irritability than would parent\u0026rsquo;s report of food insecurity.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eChildren aged 8\u0026ndash;16 years old participated in an Institutional Review Board (IRB) approved study examining clinical and psychosocial factors of irritability. The sample was recruited from clinical (e.g., psychiatric outpatient and inpatient) and community settings (e.g., flyers at local businesses, postings on social media).\u003c/p\u003e \u003cp\u003eInclusion criteria consisted of any amount of irritability (including none), as measured by the Affective Reactivity Index (ARI; Stringaris et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), a six-item child (about self, ARI-C) and parent (about child, ARI-P) measure of the irritability dimension of Oppositional Defiant Disorder (vs. \u0026ldquo;spiteful/vindictive\u0026rdquo; or \u0026ldquo;headstrong/defiant\u0026rdquo;) with a single factor structure. Items such as \u0026ldquo;Is easily annoyed by others\u0026rdquo; were rated on a three-point scale (\u0026ldquo;\u003cem\u003enot true\u0026rdquo; [0], \u0026ldquo;somewhat true\u0026rdquo; [1], and \u0026ldquo;certainly true\u0026rdquo; [2]).\u003c/em\u003e Total scores ranged from 0\u0026ndash;12, with higher scores indicating greater irritability, completed by parents on a phone screen. To ensure a wide distribution of scores, effort was made to recruit participants with a wide range of scores based on tertiles of the ARI parent report of low (ARI score 0\u0026ndash;4), medium (ARI score 5\u0026ndash;8), and high irritability (ARI score 9\u0026ndash;12). ARI child report was obtained at the study visit. Given that irritability is a diagnostic criterion or associated feature of more than 10 different Diagnostic and Statistical Manual (DSM-5) disorders, we sought to recruit and study a transdiagnostic sample of children and adolescents experiencing a range of irritability, rather than any specific DSM disorder, so we might advance what is known about pediatric irritability.\u003c/p\u003e \u003cp\u003eExclusion criteria were: (1) active psychosis or autism spectrum disorder due to potential interference with understanding of study procedures, and (2) Full Scale Intelligence Quotient (FSIQ)\u0026thinsp;\u0026lt;\u0026thinsp;80 and/or intellectual disability or other neurological impairments due to possible misunderstanding of the study procedures. Given that this study was derived from a larger project which included brain/behavior mechanisms, other exclusion criteria included non-removable metal (e.g., braces, metal screws or pins, permanent retainers, devices, or piercings) and color blindness.\u003c/p\u003e \u003cp\u003eAfter obtaining informed parent consent and child assent, participants meeting inclusion criteria completed a clinician-administered diagnostic psychiatric interview, the Wechsler Abbreviated Scale of Intelligence (WASI), and child/parent self-report measures described below. Families were compensated for their time participating in the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eIn addition to ARI as above, participants completed the following assessments.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDemographic Information.\u003c/b\u003e Participants reported their age, race, ethnicity, and biological sex at the time of enrollment.\u003c/p\u003e \u003cp\u003e \u003cb\u003eWechsler Abbreviated Scale of Intelligence (WASI;\u003c/b\u003e Wechsler, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) The WASI was used as a measure of cognitive functioning to ensure understanding of study procedures. The WASI consists of two subtests, Vocabulary (31-item) and Matrix Reasoning (30-item), which yields the Full-Scale IQ-2 (FSIQ-2).\u003c/p\u003e \u003cp\u003e \u003cb\u003eKiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version for DSM-5 (KSADS\u003c/b\u003e; Kaufman et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e1997\u003c/span\u003e) The KSADS is a semi-structured diagnostic interview administered by a trained doctoral-level clinician with established inter-rater reliability (kappa\u0026thinsp;\u0026gt;\u0026thinsp;0.85) to child participants and their parents separately to evaluate psychiatric diagnoses.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAffective Reactivity Index (ARI\u003c/b\u003e; Stringaris et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The ARI is a six-item child (about self, ARI-C) and parent (about child, ARI-P) measure of the irritability dimension of Oppositional Defiant Disorder (vs. \u0026ldquo;spiteful/vindictive\u0026rdquo; or \u0026ldquo;headstrong/defiant\u0026rdquo;) with a single factor structure. Items such as \u0026ldquo;Is easily annoyed by others\u0026rdquo; were rated on a three-point scale (\u0026ldquo;\u003cem\u003enot true\u0026rdquo; [0], \u0026ldquo;somewhat true\u0026rdquo;[1] and, \u0026ldquo;certainly true\u0026rdquo; [2]).\u003c/em\u003e Total scores ranged from 0\u0026ndash;12, with higher scores indicating greater irritability.\u003c/p\u003e \u003cp\u003e \u003cb\u003eU.S. Adult Food Security Survey Module (AFSSM\u003c/b\u003e; Coleman-Jensen, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The AFSSM is a nine-item measure of situations and behaviors that may have occurred in the last 12 months of difficulty meeting basic household food needs. In response to questions (e.g., \u0026ldquo;We couldn't afford to eat balanced meals\u0026rdquo;), the sum of affirmative responses (\u0026ldquo;yes,\u0026rdquo; \u0026ldquo;often,\u0026rdquo; \u0026ldquo;almost every month,\u0026rdquo; and \u0026ldquo;some months but not every month\u0026rdquo;) was assigned as the total raw score and used to classify participants\u0026rsquo; households into four categories: (1) high food security (no affirmative responses on the survey); (2) marginal food security (1\u0026ndash;2 affirmative responses); (3) low food security (3\u0026ndash;5 affirmative responses); and (4) very low food security (8 or more affirmative responses). Due to the overall sample size, the last three categories were further combined into a food insecure (FI) group, while the first group remained as the food secure (FS) group. The U.S. adult food security module is reliable and valid in assessing the prevalence of food insecurity in adults (Anuar et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eSelf-Administered Food Security Survey Module for Youth (SFSSM-Y\u003c/b\u003e; Connell et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). The Self-Administered Food Security Survey Module for Youth (SFSSM-Y) is a nine-item child self-report of household food insecurity. The asks questions about the food situation in the household within the last month, including \u0026ldquo;Did you worry that food at home would run out?\u0026rdquo; or \u0026ldquo;Did you have to eat less?\u0026rdquo; Responses of \u0026ldquo;a lot\u0026rdquo; and \u0026ldquo;sometimes\" were coded as affirmative. The sum of affirmative responses to the nine questions on the SFSSM-Y were used identify participant food security status into four categories: (1) high food security (no affirmative responses on the survey); (2) marginal food security (1 affirmative response); (3) low food security (2\u0026ndash;5 affirmative responses); and (4) very low food security (6\u0026ndash;9 affirmative responses). Similar to the AFSSM, the last three categories were grouped into one FI group. The measure has been shown to be valid and reliable in children and adolescents (Maia et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eHollingshead Four Factor Index\u003c/b\u003e (Hollingshead, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1975\u003c/span\u003e). The Hollingshead four-factor index measures SES using parent education and occupation. Education scores for parents range from 1 (less than seventh grade) to 7 (graduate training), and occupation scores range from 1 (e.g., farm laborer/menial service worker) to 9 (e.g., executives, professionals). These scores are combined into a single SES score per parent, ranging from 8 to 66. For families with multiple working parents, scores are averaged. If job titles did not match the listed codes, study staff identified comparable occupations and verified scores for reliability through double-coding and verbal discussion until agreement was reached.\u003c/p\u003e\n\u003ch3\u003eData Analytic Strategy\u003c/h3\u003e\n\u003cp\u003eStatistical Package for Social Sciences (SPSS, version 28, IBM Corporation) was used to conduct all analyses. Regarding our primary hypotheses, given the categorical nature of the food security group membership variable, Spearman correlations were used to examine the relationship between irritability (based on ARI total scores) and food security group membership (based on the AFSSM and SFSSM-Y scores). We also report on the agreement between parent- and child-reported irritability and food security. We conducted independent sample t-tests to compare child- and parent-reported irritability for participants in the food-secure versus food-insecure groups based on the AFSSM and SFSSM-Y. An Analysis of Variance (ANOVA) was used to evaluate if there were significant differences between parent-reported irritability and food insecurity. To test if other indicators of SES (e.g., income), were associated with pediatric irritability, in a post-hoc exploratory analysis, we performed a multiple regression to assess the strength of the association between irritability, food insecurity, and SES, and the possible direct effects of food insecurity and SES on irritability.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eDemographics.\u003c/b\u003e Demographic data from \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;183 study participants are reported in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The final sample was 55.2% male and 44.8% female, with a mean age of 11.92\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.3years. The sample consisted of participants identifying as White (77%), Black (10.4%), Other (7.7%), Asian (3.3%), and 1.6% chose not to report their race. The majority of participants identified as Non-Hispanic/Latino (82.5%). At the time of participation, participants met current psychiatric diagnostic criteria for the following diagnoses: Attention-Deficit/Hyperactivity Disorder (ADHD; 42.1%), Oppositional Defiant Disorder (ODD; 33.3%), Generalized Anxiety Disorder (GAD; 29%), Major Depressive Disorder (MDD; 26.2%), Social Anxiety Disorder (SAD; 9.8%), Disruptive Mood Dysregulation Disorder (DMDD; 8.7%), Specific Phobia (6.0%), Post-Traumatic Stress Disorder (PTSD; 6.6%), and Conduct Disorder (4.4%). About 27% of participants did not meet diagnostic criteria for any psychiatric disorder. The mean IQ for the sample was 106\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;13.43.\u003c/p\u003e \n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003e\u003cem\u003eParticipant\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003eDemographics\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"552\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull Sample\u0026nbsp;\u003cbr\u003e (\u003cem\u003en\u003c/em\u003e = 183)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFI No\u003cbr\u003e (\u003cem\u003en\u003c/em\u003e = 143)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFI Yes\u003cbr\u003e (\u003cem\u003en\u003c/em\u003e = 40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e11.92 \u0026plusmn; 2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e12.06 \u0026plusmn; 2.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e11.42 \u0026plusmn; 2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e55.2% (\u003cem\u003en\u003c/em\u003e = 101)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e42.6% (\u003cem\u003en\u003c/em\u003e = 78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e12.6% (\u003cem\u003en\u003c/em\u003e = 23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e44.8 % (\u003cem\u003en\u003c/em\u003e = 82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e35.5% (\u003cem\u003en\u003c/em\u003e = 65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e9.3% (\u003cem\u003en\u003c/em\u003e = 17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull-Scale IQ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e106 \u0026plusmn; 13.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e107 \u0026plusmn; 13.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e103 \u0026plusmn; 13.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e77.0% (\u003cem\u003en\u003c/em\u003e = 141)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e62.3% (\u003cem\u003en\u003c/em\u003e = 114)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e14.8% (\u003cem\u003en\u003c/em\u003e = 27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e10.4% (\u003cem\u003en\u003c/em\u003e = 19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e7.1% (\u003cem\u003en\u003c/em\u003e = 13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e3.3% (\u003cem\u003en\u003c/em\u003e = 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e3.3% (\u003cem\u003en\u003c/em\u003e = 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e2.7% (\u003cem\u003en\u003c/em\u003e = 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e0.5% (\u003cem\u003en\u003c/em\u003e = 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e7.7% (\u003cem\u003en\u003c/em\u003e = 14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e26.2% (\u003cem\u003en\u003c/em\u003e = 48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e0.5% (\u003cem\u003en\u003c/em\u003e = 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eNot Reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e1.6% (\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e1.6% (\u003cem\u003en\u003c/em\u003e = 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e0.0% (\u003cem\u003en\u003c/em\u003e = 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eNon-Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e82.5% (\u003cem\u003en\u003c/em\u003e = 151)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e68.9% (\u003cem\u003en\u003c/em\u003e = 126)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e13.7% (\u003cem\u003en\u003c/em\u003e = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eHispanic/Latino\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e13.7% (\u003cem\u003en\u003c/em\u003e = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e6.6% (\u003cem\u003en\u003c/em\u003e = 12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e7.1% (\u003cem\u003en\u003c/em\u003e = 13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eNot Reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e3.8% (\u003cem\u003en\u003c/em\u003e = 7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e2.7% (\u003cem\u003en\u003c/em\u003e = 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e1.1% (\u003cem\u003en\u003c/em\u003e = 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent Diagnoses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eMajor Depressive Episode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e26.2% (\u003cem\u003en\u003c/em\u003e = 48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e19.1% (\u003cem\u003en\u003c/em\u003e = 35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e7.1% (\u003cem\u003en\u003c/em\u003e = 13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eDMDD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e8.7% (\u003cem\u003en\u003c/em\u003e = 16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e5.5% (\u003cem\u003en\u003c/em\u003e = 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e3.3% (\u003cem\u003en\u003c/em\u003e = 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eSocial Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e9.8% (\u003cem\u003en\u003c/em\u003e = 18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e9.8% (\u003cem\u003en\u003c/em\u003e = 18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e0.0% (\u003cem\u003en\u003c/em\u003e = 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eSpecific Phobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e6.0% (\u003cem\u003en\u003c/em\u003e = 11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e2.7% (\u003cem\u003en\u003c/em\u003e = 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e3.3% (\u003cem\u003en\u003c/em\u003e = 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eGAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e29.0% (\u003cem\u003en\u003c/em\u003e = 53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e21.9% (\u003cem\u003en\u003c/em\u003e = 40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e7.1% (\u003cem\u003en\u003c/em\u003e = 13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003ePTSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e6.6% (\u003cem\u003en\u003c/em\u003e = 12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e4.4% (\u003cem\u003en\u003c/em\u003e = 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e2.2% (\u003cem\u003en\u003c/em\u003e = 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eADHD (any type)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e42.1% (\u003cem\u003en\u003c/em\u003e = 77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e30.1% (\u003cem\u003en\u003c/em\u003e = 55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e12.0% (\u003cem\u003en\u003c/em\u003e = 22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eODD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e33.3% (\u003cem\u003en\u003c/em\u003e = 61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e24.6% (\u003cem\u003en\u003c/em\u003e = 45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e8.7% (\u003cem\u003en\u003c/em\u003e = 16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eConduct Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e4.4% (\u003cem\u003en\u003c/em\u003e = 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e3.3% (\u003cem\u003en\u003c/em\u003e = 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e1.1% (\u003cem\u003en\u003c/em\u003e = 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eNo Diagnoses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e27.3% (\u003cem\u003en\u003c/em\u003e = 50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e23.5% (\u003cem\u003en\u003c/em\u003e = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e3.8% (\u003cem\u003en\u003c/em\u003e = 7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations.\u003c/em\u003e FI, Food Insecurity\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Designation of participants affirmative or negative for experiences of food insecurity identified using parent responses on the U.S. Adult Food Security Survey module (AFSSM).\u003c/p\u003e\n\u003cp\u003e \u003cb\u003eDescriptive measures of interest.\u003c/b\u003e The mean ARI Child (ARI-C) was 4.48\u0026thinsp;+\u0026thinsp;3.20, falling in between the low and medium irritability tertiles, and mean ARI Parent (ARI-P) was 5.56\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.82, falling into the medium irritability tertile. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates mean ARI scores and break down among children and parents who agreed vs. disagreed on their food security status as a household. Eighteen participants were excluded due to missing or insufficient SES data (e.g., missing data from both parents, missing education or occupation information required for SES calculations).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eRelationship Between Irritability and Agreement Between Parent- and Child-Reported Food Insecurity\u003c/em\u003e. To examine the differences between parent- and child-reported irritability and perception of food insecurity, we identified four different agreement groups: (Group 1) both child/parent endorsed \u0026ldquo;no\u0026rdquo; food insecurity; (Group 2) child endorsed \u0026ldquo;yes\u0026rdquo; and parent endorsed \u0026ldquo;no\u0026rdquo; food insecurity; (Group 3) child endorsed \u0026ldquo;no\u0026rdquo; and parent endorsed \u0026ldquo;yes\u0026rdquo; food insecurity; (Group 4) both child/parent endorsed \u0026ldquo;yes\u0026rdquo; food insecurity. The distribution of parents and children who agreed vs. on household food security status is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. A one-way ANOVA revealed a statically significant difference between parent irritability scores across food insecurity agreement groups [\u003cem\u003eF\u003c/em\u003e(3, 179)\u0026thinsp;=\u0026thinsp;2.89, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.037]. However, there was no statistically significant difference in ARI-C scores across food insecurity agreement groups [\u003cem\u003eF\u003c/em\u003e(3, 176)\u0026thinsp;=\u0026thinsp;1.35, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.26]. The exploratory Tukey post hoc analysis revealed a significant difference in parent-reported irritability scores between Groups 1 and 2, with parent-reported irritability scores higher in Group 2.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDistribution of Participants by Agreement Between Child \u0026amp; Parent Endorsements of Food Security\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eParent Food Security Endorsement\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eChild Food Security Endorsement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo FI\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;156)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes FI\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e% Agreement in Endorsement with Child\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo FI (N\u0026thinsp;=\u0026thinsp;148)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes FI (N\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.857\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% Agreement in Endorsement with Parent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e Percent agreement for each row/column was calculated by dividing the number of parent/child dyads that agreed on their FI endorsement by the total number of participants in that row/column and multiplying by 100.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eAssociations Between Irritability and Food Insecurity.\u003c/em\u003e Spearman correlations to determine the relationship between child/parent irritability scores and food insecurity groups, we found a significant positive correlation between child rating of food insecurity and both child/parent irritability scores, [\u003cem\u003er\u003c/em\u003e\u003csub\u003es\u003c/sub\u003e(180)\u0026thinsp;=\u0026thinsp;0.15, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05 and \u003cem\u003er\u003c/em\u003e\u003csub\u003es\u003c/sub\u003e(183)\u0026thinsp;=\u0026thinsp;0.21, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005], respectively. There was no significant correlation between parent rating of food insecurity and either ARI-C or ARI-P irritability scores.\u003c/p\u003e \u003cp\u003eTo evaluate any differences between child/parent food insecure and food secure groups with child versus parent irritability scores, we used independent samples t-test. We found a significant difference in parent-reported irritability scores between children endorsing food security vs. children endorsing food insecurity [\u003cem\u003et\u003c/em\u003e(181) = -2.85, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005). However, there was no significant difference found in child-reported irritability scores between children endorsing food security vs. children endorsing food insecurity [\u003cem\u003et\u003c/em\u003e(178) = -1.79, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.075). Furthermore, there were no significant differences in either ARI-C or ARI-P irritability scores between parents endorsing food security vs. parents endorsing food insecurity [\u003cem\u003et\u003c/em\u003e(178) = -0.57, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.572; \u003cem\u003et\u003c/em\u003e(181) = -0.70, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.485], respectively.\u003c/p\u003e \u003cp\u003e \u003cem\u003eIrritability and SES.\u003c/em\u003e The mean SES score on the Hollingshead measure for the sample was 48.36 [\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13.43], falling into the \u0026ldquo;medium business, minor professional, technical\u0026rdquo; social strata. With respect to the relationship between ARI-C/-P and SES (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), we found a significant, positive Pearson correlation between SES and ARI-P, [\u003cem\u003er\u003c/em\u003e\u003csub\u003es\u003c/sub\u003e(180)\u0026thinsp;=\u0026thinsp;0.22, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003], but not ARI-C [\u003cem\u003er\u003c/em\u003e\u003csub\u003es\u003c/sub\u003e(180)\u0026thinsp;=\u0026thinsp;0.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.155].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eRelative Effects of Food Insecurity and SES on Irritability.\u003c/em\u003e The distribution of participants by SES classification and child/parent endorsements of food insecurity is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. To test if food insecurity and SES were uniquely associated with irritability, our multiple regression analysis showed a significant effect of SES on ARI-P [\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.23, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003], however, neither child- nor parent-endorsed food insecurity were significantly associated with ARI-P [\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.18, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.060; β = \u0026minus;\u0026thinsp;.054, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.566]. Food insecurity and SES explained 8.5% of the variance in ARI-P [\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.085, \u003cem\u003eF\u003c/em\u003e(3,153)\u0026thinsp;=\u0026thinsp;4.742, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003]. Furthermore, we found a significant effect of child-endorsed food insecurity on ARI-C [\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.200, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.042], however, this was not true for parent-endorsed food insecurity [\u003cem\u003eβ\u003c/em\u003e = -0.098, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.314], or SES [\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.121, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.134]. While food insecurity and SES did explain 4.5% of the variance in ARI-C, this was not significant [\u003cem\u003eR\u003c/em\u003e \u003csup\u003e2\u003c/sup\u003e= 0.045, \u003cem\u003eF\u003c/em\u003e(3,150)\u0026thinsp;=\u0026thinsp;2.379, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.072].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDistribution of Participants by SES Classification and Child \u0026amp; Parent Endorsements of Food Security\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eHollingshead SES Classification\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow SES\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh SES\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;147)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIncomplete SES Data\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eChild Food Security Endorsement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo FI\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;118)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes FI\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% FI/SES Concordance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eParent Food Security Endorsement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo FI\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes FI\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% FI/SES Concordance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.755\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e Low SES\u0026thinsp;\u0026le;\u0026thinsp;33, High SES\u0026thinsp;\u0026gt;\u0026thinsp;33\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eb\u003c/sup\u003e Percent concordance for Low SES was calculated by dividing the number of participants that endorsed experiencing FI by the total number of participants classified as Low SES and multiplying by 100.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ec\u003c/sup\u003e Percent concordance for High SES was calculated by dividing the number of participants that endorsed no experiences of FI by the total number of participants classified as High SES and multiplying by 100.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study examining the relationship between food insecurity and irritability, our primary finding supports our hypothesis that child endorsement of food insecurity was significantly associated with increased child/parent-reported irritability. This association was not found between parent-endorsement of food insecurity and child or parent-reported irritability. Furthermore, when categorized into food-insecure and food-secure groups, we found a significant difference between parent-reported irritability and child endorsement of food insecurity, but there was no such significant relationship using either parent-reported irritability and parent endorsement of food insecurity or child-reported irritability and either child- or parent- endorsement of food insecurity. Taken as a whole, this suggests that parents and children may not be aligned in their perceptions about their family\u0026rsquo;s food security status. Additionally, results indicate that parents may perceive their children as more irritable in cases where the child perceives food insecurity, even when the parent does not report such food insecurity, as compared to when child/parent agree about their food security status. These findings are consistent with prior research showing children often perceive themselves as less food secure than their parents report (Landry et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2019b\u003c/span\u003e). Such misalignment has important implications for how clinicians and researchers assess of food security, irritability, and related mental health concerns in children and their families, and how food security is discussed within families more broadly. For example, clinicians working with children with irritability may benefit from adding a question or two to their intake and follow-up clinical assessments to not only inquire about symptoms of DSM-5 psychiatric disorders, academic/social functioning etc. but also food security.\u003c/p\u003e \u003cp\u003eImportantly, and perhaps unexpectedly, income alone does not entirely account for household food insecurity. According to the U.S. Department of Agriculture, in 2023, 13.5% of all U.S. households experienced food insecurity at some point during the year (Rabbitt et al., 2024). Prior work has found that middle- and high-income households represent 20% of food-insecure households (Alaimo et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2001b\u003c/span\u003e). Those 20% of food-insecure households struggle with unexpected economic challenges during the year, such as loss of employment, sudden illness, or death. Food insecurity, in contrast, is experienced through four domains: the quantity of food available, the quality of food, psychological worry and uncertainty regarding food security, and social acceptability (Webb et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). These four domains allow us to better conceptualize the experiences of food insecurity at both the household and individual levels.\u003c/p\u003e \u003cp\u003eOur post-hoc analysis shed light on how SES and food security may not be synonymous. It is well-recognized that SES as measured by the Hollingshead four-factor index is a valuable predictor of psychiatric disorders (Cuffe et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1995\u003c/span\u003e). However, data from national surveys indicate that nearly half of all families who report food insecurity have income above the official poverty line (Boushey, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Fremstad, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Gundersen et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), citing the need for more nuanced, longitudinal, and comprehensive indicators of income to explain food insecurity (Gundersen \u0026amp; Gruber, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Ribar \u0026amp; Hamrick, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Given our findings suggesting that SES and food insecurity were both associated with childhood irritability, future studies should consider assessing both constructs as they seek to address SDOH related to irritability. For example, given the discrepancy between child/parent ratings of food insecurity, it might be important for childhood mental health providers not only to assess food insecurity from children and parents but also to consider facilitation of conversations between parents and children about food security.\u003c/p\u003e \u003cp\u003eThe present study has several limitations, including sample size and participant diversity. A larger and more diverse sample of families from different socioeconomic and ethnic backgrounds would allow for more generalizability of our findings. Specifically, recruitment of families from underserved communities at increased risk of experiencing food insecurity and less available resources for food assistance, such as immigrant families (Crowe et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Sharkey \u0026amp; Elwert, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), would provide greater insight into the role of food insecurity in children\u0026rsquo;s irritability. As this study was part of a larger parent study, we unfortunately were limited to the sample already recruited. Furthermore, the measure used to assess SES has its own limitations as not all reported occupations fit within the pre-determined categories and thus relied on manual coding by authors. While efforts were made to address this (e.g., double coding), there may be a risk of bias in some cases.\u003c/p\u003e \u003cp\u003eWhile our study emphasizes the importance of food insecurity as one of the many factors encompassing SDOH in pediatric mental health, there are several directions for future research. Future studies could explore other possible factors that could play a role in children\u0026rsquo;s irritability in home environments such as parent-child interactions and parent stress. Prior work has found that child endorsement of food insecurity was grounded in immediate household social and food environment, including quality of child/parent interactions and parent affect and behavior (Fram et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Thus, it would be valuable to examine how parental stress and their own mental health may in turn affect their child's irritability. Furthermore, given recent findings that children in households that participated in the Supplemental Nutrition Assistance Program (SNAP) were approximately one-third less likely to be food-insecure after six months than those who did not (Hartline-Grafton \u0026amp; Hassink, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021b\u003c/span\u003e), it would be helpful to observe how SNAP, school meal programs, or related initiatives could possibly affect or improve children\u0026rsquo;s irritability and mood over time.\u003c/p\u003e \u003cp\u003eOur results highlight the important role that children\u0026rsquo;s experiences of food insecurity play on pediatric irritability and suggest the importance of using multi-informant (i.e., children as well as parents) measures of both mental health and food security. As clinicians assess and treat children with irritability and related psychiatric symptoms, it is important to ensure a comprehensive assessment of social determinants of health, such as food insecurity. More research on the evaluation of interventions targeting food insecurity\u0026rsquo;s effect on irritability is critical.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJ.G.W. wrote the main manuscript text. J.G.W., E.L., and E.C. contributed to the conceptualization of the project, data analysis, and visualization. A.E.S., E.G.A., K.P., N.P.S., C.K., and M.N completed data curation. J.M.R, J.A., and L.R. contributed to review and editing. D.P.D. was responsible for funding acquisition, supervision, methodology, and review and editing.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdjemian, M. K., Arita, S., Meyer, S., \u0026amp; Salin, D. (2024). Factors affecting recent food price inflation in the United States. \u003cem\u003eApplied Economic Perspectives and Policy\u003c/em\u003e, \u003cem\u003e46\u003c/em\u003e(2), 648\u0026ndash;676. https://doi.org/10.1002/aepp.13378\u003c/li\u003e\n\u003cli\u003eAlaimo, K., Olson, C. M., \u0026amp; Frongillo, E. A., Jr. (2001a). Food Insufficiency and American School-Aged Children\u0026rsquo;s Cognitive, Academic, and Psychosocial Development. \u003cem\u003ePediatrics\u003c/em\u003e, \u003cem\u003e108\u003c/em\u003e(1), 44\u0026ndash;53. https://doi.org/10.1542/peds.108.1.44\u003c/li\u003e\n\u003cli\u003eAlaimo, K., Olson, C. M., \u0026amp; Frongillo, E. A., Jr. (2001b). Food Insufficiency and American School-Aged Children\u0026rsquo;s Cognitive, Academic, and Psychosocial Development. \u003cem\u003ePediatrics\u003c/em\u003e, \u003cem\u003e108\u003c/em\u003e(1), Article 1. https://doi.org/10.1542/peds.108.1.44\u003c/li\u003e\n\u003cli\u003eAlthoff, R. R. (2018). Pediatric Irritability Comes of Age. \u003cem\u003eJournal of the American Academy of Child \u0026amp; Adolescent Psychiatry\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(3), 149\u0026ndash;150. https://doi.org/10.1016/j.jaac.2017.12.014\u003c/li\u003e\n\u003cli\u003eAmerican Psychiatric Association. 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Children Are Aware of Food Insecurity and Take Responsibility for Managing Food Resources. \u003cem\u003eThe Journal of Nutrition\u003c/em\u003e, \u003cem\u003e141\u003c/em\u003e(6), Article 6. https://doi.org/10.3945/jn.110.135988\u003c/li\u003e\n\u003cli\u003eFremstad, S. (2010, April). A Modern Framework for Measuring Poverty and Basic Economic Security. \u003cem\u003eCenter for Economic and Policy Research\u003c/em\u003e. https://www.cepr.net/report/a-modern-framework-for-measuring-poverty-and-basic-economic-security/\u003c/li\u003e\n\u003cli\u003eGundersen, C., \u0026amp; Gruber, J. (2001). \u003cem\u003eThe dynamic determinants of food insufficiency.\u003c/em\u003e (No. Second food security measurement and research conference). \u003cem\u003e2\u003c/em\u003e(Second food security measurement and research conference), Article Second food security measurement and research conference.\u003c/li\u003e\n\u003cli\u003eGundersen, C., Kreider, B., \u0026amp; Pepper, J. (2011). 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L., Swindale, A., \u0026amp; Bilinsky, P. (2006). Measuring Household Food Insecurity: Why It\u0026rsquo;s So Important and Yet So Difficult to Do. \u003cem\u003eThe Journal of Nutrition\u003c/em\u003e, \u003cem\u003e136\u003c/em\u003e(5), 1404S-1408S. https://doi.org/10.1093/jn/136.5.1404S\u003c/li\u003e\n\u003cli\u003eWechsler, D. (2011). \u003cem\u003eWechsler Abbreviated Scale of Intelligence\u0026mdash;Second Edition\u003c/em\u003e. NCS Pearson. https://doi.org/10.1037/t15171-000\u003c/li\u003e\n\u003cli\u003eWhitaker, R. C., Phillips, S. M., \u0026amp; Orzol, S. M. (2006). Food Insecurity and the Risks of Depression and Anxiety in Mothers and Behavior Problems in their Preschool-Aged Children. \u003cem\u003ePediatrics\u003c/em\u003e, \u003cem\u003e118\u003c/em\u003e(3), e859\u0026ndash;e868. https://doi.org/10.1542/peds.2006-0239\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"child-psychiatry-and-human-development","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"chud","sideBox":"Learn more about [Child Psychiatry \u0026 Human Development](http://link.springer.com/journal/10578)","snPcode":"10578","submissionUrl":"https://submission.nature.com/new-submission/10578/3","title":"Child Psychiatry \u0026 Human Development","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"child mental health, social determinants of health, irritability","lastPublishedDoi":"10.21203/rs.3.rs-6413845/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6413845/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIrritability is a transdiagnostic construct associated with diverse psychiatric disorders in youth. This study examined the association between food insecurity and irritability in a clinically and community-recruited sample of children aged 8\u0026ndash;16 (N\u0026thinsp;=\u0026thinsp;183). Participants and their parents completed structured interviews and measures assessing irritability, food security, and socioeconomic status (SES). Child-reported food insecurity was significantly associated with greater irritability, whereas parent-reported food insecurity was not. Regression analyses identified child-reported food insecurity as a unique predictor of irritability, independent of SES indicators. These findings underscore the clinical importance of assessing food insecurity from the child\u0026rsquo;s perspective and suggest that subjective experiences of food insecurity may have a stronger emotional impact than previously recognized. Results highlight the need for multi-informant assessments and targeted interventions addressing basic needs within pediatric mental health care.\u003c/p\u003e","manuscriptTitle":"Examining the Association Between Food Insecurity and Pediatric Irritability","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 01:43:08","doi":"10.21203/rs.3.rs-6413845/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-07T12:14:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-26T16:17:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-20T15:02:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115746958254607403109729179424715538756","date":"2025-06-12T03:33:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174621442094581571520023824060886246208","date":"2025-06-10T17:08:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-10T20:43:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191436830766111510108659259806727038981","date":"2025-05-05T15:53:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-02T11:19:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-11T16:48:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-10T02:00:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Child Psychiatry \u0026 Human Development","date":"2025-04-09T16:43:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"child-psychiatry-and-human-development","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"chud","sideBox":"Learn more about [Child Psychiatry \u0026 Human Development](http://link.springer.com/journal/10578)","snPcode":"10578","submissionUrl":"https://submission.nature.com/new-submission/10578/3","title":"Child Psychiatry \u0026 Human Development","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"36f8a32f-d83f-4750-aefb-3d4e1de692d8","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:10:27+00:00","versionOfRecord":{"articleIdentity":"rs-6413845","link":"https://doi.org/10.1007/s10578-026-01981-0","journal":{"identity":"child-psychiatry-and-human-development","isVorOnly":false,"title":"Child Psychiatry \u0026 Human Development"},"publishedOn":"2026-02-18 15:57:23","publishedOnDateReadable":"February 18th, 2026"},"versionCreatedAt":"2025-05-09 01:43:08","video":"","vorDoi":"10.1007/s10578-026-01981-0","vorDoiUrl":"https://doi.org/10.1007/s10578-026-01981-0","workflowStages":[]},"version":"v1","identity":"rs-6413845","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6413845","identity":"rs-6413845","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}