When I was 11 months old, I was extremely malnourished and weighed only 11 pounds. I was taken away from my birth mother by social services and placed in a foster home with amazing people who adopted me soon after. As a child, I hoarded food and I never really understood why. I was fed meals regularly and we always had snacks around the house. Despite that, I found a way to keep a stash of candy bars and Little Debbie snacks in a drawer in my bedroom. I was told I was an extremely picky eater. I remember waking up early, sneaking downstairs and raiding the freezer or fridge with calorie dense foods, and getting caught on only a few occasions. There was another time where I ate pizza at a friends house, came home and discovered we were having pizza, too; I ate two dinners. I hated being hungry, no matter how temporary the feeling was. For the most part, I think my parents were oblivious to my habits. Before I was three, I had my stomach pumped several times for climbing up on counters and getting into med cabinets and drinking Dimetapp. I thought it tasted like grape juice.
As I got older, I remember talking to a woman with several kids of her own who then ended up adopting a girl from another country. She was talking to me about how her daughter sneaks around, lies, hides food in her bedroom and is a very picky eater. I heard more stories about how kids who have spent time in foster care tend to hoard food- that this is a common thing! I started connecting the dots and realized this had me written all over it. The missing piece for me was that I could not have remembered the time in my life where I was malnourished. I didn't spend any marked amount of time in foster care or spent time needing to provide for myself. My best guess is that it doesn't matter. Somehow, my body, my psyche, whatever remembered that time in my life, and I developed, even as young as I was, ways of getting what I needed: calorie dense foods.
Now as an adult, I look back on my food habits and see a common theme. I can eat healthy, and I do love some very healthy foods, however, I find that I will eat in excess if there is something I love. I tend to gravitate towards buttery, sugary, horrible-for-you foods. Sometimes I eat as if I'm not sure I will ever eat again.
Thoughts? Cares? Concerns? Learn something new? Let me know.
Food
Hoarding Behavior in Foster Children
Emmylou
Strathman
English
1020
Larimer
County Community College
Abstract
Food hoarding among foster children is a common problem many
foster and adoptive parents are aware of, but accurately diagnosing and
effectively treating the behavior remains difficult. In existence are few
studies and articles to explore solutions to giving case workers and foster
families the necessary tools for success with the children in foster care who
come with multiple physical and mental health problems. The research conducted
was an attempt to identify the scope of food hoarding by describing who it
affects and how they are affected, by gaining a better understanding of the
experiences and history of children entering foster care. As I conducted research,
the scope of attention was expanded to include why children enter foster care,
how they handle the transition, and health care availability. Other topics I
explored included hoarding and food behaviors lacking a connection to the
foster system. Sources obtained and cited were collected with the highest
scrutiny for their validity, reputation, and amount of useful information.
Food
Hoarding Behavior in Foster Children
Most individuals in child welfare are
aware that many foster and adopted children have a tendency or history of
hoarding food. It is important to know how to properly diagnose food hoarding
and seek out treatment for the child to avoid a lifetime of poor diet and
eating behaviors. Children hoard food for a variety of reasons and barriers to
treatment can be numerous. Foster and adoptive parents can implement many
useful tactics and practices to help calm anxieties related to food hoarding.
In regards to child welfare and government intervention, there are gaps in the
system that affect children’s access to services they need to thrive. Food-hoarding
research is shedding new light on diagnosis, etiology, treatment and long-term
consequences. Many foster children have experienced traumatic events and have
been found to hoard food; thus, additional research and distribution of information
about food hoarding is essential to its diagnosis and treatment.
Discussion
There is currently little literature
available about hoarding disorders in children and adolescents. Burton, Arnold
and Soreni explain how “there is very little published research into hoarding
in youth” (2015, p. 128), and Storch et al. (2011) offer that there is
“relatively scant attention devoted to compulsive hoarding among youth” (p.
507). Casey, Cook-Cottone and Beck-Joslyn (2012) state that the elevated risk
for foster children having issues with physical and mental health is “well
established” (p. 307), yet the research for prevention and intervention is
“limited” (p. 320). Stiegler (2005) believes that the benefits of further
research would be helpful to clinicians and people interacting with individuals
with developmental disabilities in regards to pica behavior (p. 27). Burton et
al (2015) wrote an article titled Three
Reasons why Studying Hoarding in Children and Adolescents is Important. In
it, they explained that if hoarding
symptoms are present in childhood, there is a high likelihood of it continuing
into adulthood when left untreated. Hoarding individuals have reported that the
onset of their behavior usually began in childhood. Researchers believe that
although this is usually the case, it can be difficult to see the behavior in
children due to lack of access to money, mixed with parental intervention to
prevent excess accumulation of clutter (p. 129). The path of hoarding can
produce unhealthy outcomes, which have the potential to affect family members
and endanger people close to the individual hoarder (p. 130).
Common
Problems with Foster Kids
Evidence shows that the majority of
children come into foster care with a range of problems in physical, mental and
emotional health. Of these, food disorders and bad food behavior are commonly
discovered after placement has been made with a new family who may be more
observant. Some children may have experienced periods without adequate food
provision or nutrition while others come with memories of extreme abuse or
neglect. Still others might arrive in foster care tired, sick, and dirty with
experience in stressful situations at a young age. These listed scenarios imply
that children involved with child protective services are at a greater risk for
mental and physical health problems. Food may have been used as a control
mechanism and withheld as a form of punishment. With poverty stricken families,
a child may have experienced hunger. Beam (2012) placed the connection that in
her interactions with foster children, she observed that “the poorer you are,
the more likely you are to get entangled with child welfare” (p. 262).
Regardless of the circumstances
surrounding removal from a biological family, the experience itself is usually a
traumatic event for the child. In many cases, children are removed from their
homes at a moment’s notice, sometimes arriving in a stranger’s home with only
the clothes they are wearing. They may have been faced with many stressful
events including malnutrition, recent abuse and neglect. Simms, Dubowitz,
and Szilagyi (2000) commented that the Adoption
and Safe Families Act of 1997 was focused so much on the reunification of
children with their biological families and less concerned with the actual
safety and protection of those children. The idea of being reunited with birth
families may give some children hope while others may experience
anxiety about returning to an unsafe environment (Simms et al, 2000). On
occasion, some foster children may be placed in up to 20 different homes while
waiting for their parents to gain back custody, moving around more often if
they exhibit behavior foster families dislike (Beam, 2013, p. 11). Landau et al
(2010) discovered that the prevalence of traumatic life events typically
precede a diagnosis of hoarding disorders (p. 201).
Why
Children Enter Foster Care
It may not be clear to a child why they
are being removed from their home and placed into foster care. DeGarmo (2013)
discussed in his book The Foster
Parenting Manual, that the move from home can be traumatizing and the effects
may last a lifetime. It may be easy for those children to internalize and blame
themselves with the thinking that they did something to cause the separation
from their family. Often times, the trauma of being ripped from their familial
homes and placed in an unfamiliar setting with new people, new rules, and new
expectations can be so overwhelming that foster children struggle to deal with
the adjustment. This can result in an array of disorders, symptoms and
struggles such as anxiety, depression, obsessive-compulsive disorder, panic
attacks, hoarding and social disorders (pp. 49-51).
Regarding the placement of newborns in
foster care, in her book To the End of
June, Beam (2013) briefly explained that if birth parents seem capable to
remedy their situation, the newborn may be placed in the care of experienced
foster parents who are taught and do well with not becoming attached, whereas a
newborn who is removed from parents who may fail at or have no interest in
retaining custody may be placed with foster parents who want to adopt and might
form attachments deliberately. Essentially, Beam (2013) exclaims, “…its all
guesswork and hope” (p. 15).
Hoarding,
Food Hoarding, and OCD With Hoarding
There are several types of hoarding, which
include hoarding, Obsessive-Compulsive Disorder (OCD) with hoarding, and food
hoarding. Often the lines between those three forms of hoarding are easily
blurred as each can include elements of the other. Research and studies have
been conducted to draw more definable borders for each disorder for the sake of
diagnosis and treatment.
Hoarding is simply defined as a
difficulty in discarding items, which may or may not have any actual monetary
or sentimental value. If left alone, the accumulation of these items may become
a significant risk and endanger the individual and those living with them. OCD
is a set of behaviors that can be broken down into groupings of symptoms, one
of which contains “hoarding” (Storch et al, 2011, p. 507). Other symptoms
associated with OCD-like behavior include obsession with cleaning, caloric
restriction (anorexia), counting, repetition, symmetry, checking (i.e., making
sure doors are locked multiple times), and collecting. In regards to possessions,
hoarders typically place a large amount of emotional attachment to objects for
sentimental purposes (pp. 507-509). Food hoarding may be a large component of
hoarding with and without OCD. However, food hoarding as a stand-alone
diagnosis is the acquisition and storage of excess food, mostly out of fear of
going hungry.
Hoarding is compulsive behavior that
may have stemmed as a survival tactic to ensure resources are present in times
of need. Hoarders tend to have extreme difficulty and anxiety related to
letting go and discarding possessions (Storch et al, 2011). The assumption is
often made that those who hoard must also have OCD, but there is evidence to
suggest that this is not always the case (Landau et al, 2010, p. 193). Both
hoarding and OCD with hoarding may come from a time period of lack, trauma, or
unreasonable fears. For food hoarding in children, especially those who have
been in foster care, a period of deprivation, hunger or stress related to food
is typically the cause.
Food hoarding occurs when a child
demonstrates behavior that indicates an uncertainty about when and if they will
eat again, even if they are currently in a safe home where they are well
provisioned. The effects of food hoarding on these children can last throughout
a lifetime if the symptoms are not properly acknowledged, diagnosed and treated
early on.
Food Hoarding: Causes and Behavior
Because of the traumatic history
trailing behind some children in foster care, there may be an elevated sense of
anxiety surrounding food. With food hoarding, what appears to be bad behavior
to caregivers might be a subconscious habit of instinct and survival to the
child. It is my belief that most foster children do not hoard food
intentionally, and in some cases, may not even be aware that they are doing
anything wrong. Child food hoarders have learned to acquire what they need to
ward off hunger. A case study presented by Storch et al (2011) focused on a ten-year
-old girl named “Abby.” When Abby hoarded food, she would often forget to
account for a nearly constant supply of food in her home and would become
anxious with fears of hunger. In her bedroom, Abby’s parents would find up to
20 food items hidden, stashed and sometimes rotting in her bedroom (p. 511). Forgotten
hiding places have the potential to become hosts to rotten, infested and moldy
food items, which can have dangerous consequences if consumed when found.
If a child has had to instinctively
hoard food as a means of survival but is no longer in that situation, it can be
difficult to convey that stealing, hoarding and hiding food is considered bad
behavior. It is suggested by Purvis and Cross (2007) that caregivers give
discipline in a gentle manner while also encouraging foster parents to set
compassionate limits for children (cited in Casey et al, 2012, p. 318).
Although food hoarding can be a very
useful tool for survival, that skill becomes problematic when obtaining and consuming
calorie or fat dense food is no longer necessary. After a time of unreliable
food supply, a child’s relationship to food can develop into one of distrust
and anxiety. These habits and fears can be hard to let go of. In the child’s
mind, it might be difficult to comprehend and understand that there will be
enough food available once they are placed in a stable home (Rowell, 2013). Children
may develop irrational thoughts that once food is out of sight, it will be gone
forever. Overeating habits may develop when uncertainty exists, whether real or
imagined, about when and if they will eat again (Rowell, 2013).
In pursuit of food, children might
become engaged in behavior that can put them in danger by stealing, lying, and
sneaking around. Food hoarding children may hide or save food in their bedrooms
in locations such as under pillows, under beds, in drawers and in closets.
Other risk factors associated with food hoarding may include obesity, comorbid
diseases, personality disorders, anxiety, depression, as well as susceptibility
to other food disorders (Casey et al, 2012, p. 310). Sometimes a child will
become emotional when food is controlled, portioned or taken away, or be picky
with what will be eaten as well as consuming a large amount of food beyond the
point of being full (Rowell, 2013). DeGarmo (2013) adds that the tendency to
over-eat may be due to an insecurity many foster children experience, in which
gorging on food may be of comfort (p. 78). The foods sought after tend to be of
high caloric and fat value, or something familiar and comforting. Jessica Good
recalls how her adopted 3 year-old twin boys became “dangerously adept at
getting over safety gates, past doorknob covers and child-locked cupboards, and
into just about anything without even waking us” (Good, 2014).
Diagnosis
Steele and Buchi (2008) discovered that
35% of children over 3 years of age in foster care had “A Body Mass Index (BMI)
at or above the 85th percentile” (cited in Casey et al, 2012, p.
309). A high BMI is not a good indicator of food hoarding, as many children who
have food-related concerns and disorders are not overweight (Casey et al, 2012,
p. 313). Although food hoarding is a common and well-known set of behaviors
that foster parents have become acquainted with, awareness does not necessarily
mean foster parents are fully prepared to properly treat food hoarding. Many
researchers have expressed concern that caregivers and social workers are ill
prepared when it comes to recognizing, diagnosing and treating food-hoarding
behavior. Many children who hoard food are not overweight and have become
skilled at acquisition and storage of food without raising suspicion. It is
recommended that with any changes in weight or appetite, especially with foster
children, a pediatrician and a mental health professional be contacted for
further evaluation (p. 319).
Problems
Acquiring Health Care and Assistance
According to the US Department of
Health and Human Services Administration for Children and Families (ACF), it
was estimated that in 2014 over 264,000 children entered foster care with a total
of 415,000 in foster homes (2015, p. 1). With numbers that high, it might be wise
to know as much as possible in order to understand common problems foster
children are faced with. As a first line of defense, caseworkers are in a
position to help find and acquire resources for foster parents to get foster
children proper treatment. Simms, Dubowitz and Szilagyi (2000) stated that
despite having multiple interactions by a range of qualified adults in the lives
of foster children, many go without health services, such as basic
immunizations and yearly checkups. With the state governments removing children
for the sake of their protection and health, it would seem appropriate that the
same governing body then have an obligation to provide even better care. This
is not always the case, as sometimes children fare even worse than they began with
declining health and sometimes death while wards of the state (p. 2). Simms et
al (2000) said that this “points to the need to clarify roles these individuals
should play to ensure that children receive needed services” (p. 8).
The use of Medicaid is one of the contributing
factors to the problems of acquiring healthcare for foster children, according
to Simms et al (2000). Medicaid
has been supplied as a free government issued health insurance for poor
children, which many foster families accept and use. Reimbursement to practitioners
has not increased at a rate that accounts for inflation since the inception of
Medicaid. Because of this, some healthcare providers refuse to take Medicaid,
making it difficult for children to acquire medical attention. Since foster
children may frequently move from house to house, many receive poor continuity
of healthcare (p. 7). One of the barriers to the provision of physical and
mental healthcare for foster kids is their biological parents; When consent
from birth parents is required for treatment (as in some jurisdictions), it may
be hard to obtain if they are upset, unwilling or unavailable (p. 9).
Dangers
of Food Hoarding
The dangers
of food hoarding mostly involve those of personal health. As a child, the
effects of obesity and unhealthy eating habits may be hard to observe.
Consequences such as incarceration due to stealing may be obvious, but one of
the biggest dangers caused by food hoarding is when it creates a situation
where the child’s safety is at risk, especially in the pursuit of finding and
gathering food (Casey et al, 2012, p. 308).
Childhood Hoarding Outside of Foster Care
There are several
reasons worth discussion, other than trauma or being in foster care, that can
result in food obsessive behavior. Hoarding, pica behavior, bingeing, or
abstaining from food can be caused by chemical and hormonal imbalances. Poor
food habits and hoarding may be triggered due to anxiety, depression, traumatic
life events and insatiable appetites.
Prader-Willis
causes physical developmental delays and mental retardation and is
characterized in part by a short stature, underdeveloped extremities and
lowered hormone production (Casey et al, 2012, p.509). These individuals are sometimes
found to have insatiable appetites and an inability to feel full, which can
cause them to consume three to six time more calories than necessary and can lead
to dangerous weight gain (Stiegler, 2005, p. 28; Storch et al, 2011, p. 509). Pica
behavior is commonly found with sufferers of Prader-Willis Syndrome, autism and
other forms of developmental disability although it has been seen among a wide
spectrum of developmental ability, including children in foster care. Pica
behavior is the habitual and recurring consumption of non-nutritive substances
that persists beyond 18 months of age. For some, the desire to eat
non-nutritive substances stems from a desire to satisfy sensory sensitivities
(as with an oral fixation), but can also be used to acquire attention (Casey et
al, 2012, p. 310). The danger of pica behavior occurs when non-food substances
such as plastic, metal, or sharp objects are consumed which can lead to
malnutrition, toxicity, infection, bowel perforation, and death if untreated
(pp. 29-31). Some cultures believe in a pic-like practice of eating dirt and
clay for fertility enhancing benefits (Stiegler, 2005, p. 27).
Treatment
and Ideas for Recovery
The role of a foster parent or
caregiver can go a long way in the treatment of food hoarding. In his book The Foster Parenting Manual, DeGarmo
(2013) discusses how the life of a foster child completely changes once they
are placed with a family either temporarily or permanently. The need for rules
and expectations must be provided, as some children may have never been
introduced to them. Patience and kindness will be required of the foster
parents when expressing expectations of the child, while also letting the child
know what can be expected of the parents (p. 59-60). Foster parents “Shannon”
and “Jim” explain that with their food-hoarding foster children they “constantly
reinforced with words that we will not harm them in any way; we will provide
them with meals every day and also snacks if they are hungry,” and continues
that, “having food is a huge concern for them” (p. 60). Sometimes enforcing
rules in regards to nutrition and portion control can have an effect of driving
the child deeper into food hoarding. Attempting to restrict or control food
intake may only heighten the anxiety a child feels about their supply of food.
Despite obvious signs such as being an appropriate or excessive weight, a child
may still believe that they may starve or not have enough to eat (Rowell,
2013).
Allowing children to hold on to or
carry food (snacks) with them all day is a method that tends to work, and the
child can be weaned from it as they develop a stronger sense of trust that food
will continue to be available to them (Rowell, 2013). To encourage diversity in
food consumption with picky eaters, allowing children the option to politely
spit out food they don't like the taste of may be useful for trying new options
(Rowell, 2013). Caregivers can help by offering reassurance of a constant food
supply mixed with proof by providing snacks and options as well as a consistent
schedule for meals. Encouraging the child to exercise while placing limitations
on the amount of time spent watching television and electronic devices may also
be beneficial in shaping healthy lifestyles. Caregivers should place an
emphasis on providing healthy nutrition and not merely empty calories (Casey et
al, 2012, p. 315-317). When dealing with pica behavior, one suggested strategy
is to create an association of the non-nutritive item with something unpleasant.
A taste of lemon juice or the smell of ammonia is a useful at the time when
ingestion is desired (Casey et al, 2012, p. 318).
Pacifici
(1996) put together and tested a training program intended for use by foster
parents that was “designed to give parents a neutral, practical, and effective
way of understanding and responding to noncompliant behavior” (p. 2). The
videos teach appropriate ways to discipline and interact with children in order
to change undesirable behavior. Most participants found the videos and training
to be useful, helpful and informative; However, when it came to an actual
change in behavior from children, the results were less inspiring. Most participants
in the study determined no difference in behavior as a result of watching and
implementing discipline tactics being taught (p. 10). It may be necessary that
foster parents seek out professional help from psychologists, nutritionists,
and pediatricians. Cognitive Behavioral Therapy has been a useful form of
treatment in conjunction with parental and child participation at home. Casey
et al (2012) offer that “information on evidenced-based interventions” for a
child dealing with food-related behaviors is “sparse” (p.317).
In most cases, the best advice for
caregivers is to be consistent in regularly providing food to children who
hoard (Rowell, 2013). Snacks or meals do not need to be high in sugar or
caloric value but should be offered with repeated assurance that there is more
food available and the child will not go hungry. This is believed to help calm
the child and relieve any pressure they may have about providing food for
themselves. Several studies have been conducted to illustrate and test the
importance of families coming together for mealtime. When good examples are presented,
it has been found that problematic eating behaviors such as anorexia and
bulimia may be reduced. There has been a push by organizations such as WIC to
promote families of all socioeconomic backgrounds to come together for meals
(Casey et al, 2012, p.316). Eating food together usually results in a positive
bonding experience (Rowell, 2013).
It is difficult to pinpoint one
solution or method for treating food hoarding because it deals with individuals
who may have unique circumstances, past experiences, and levels of dedication
in treating it. The treatment needs to be appropriately fitted to the cause of
the food anxiety and hoarding (Rowell, 2013). It may be necessary to tailor
treatment of food hoarding to the specific needs and situations of the child
and caregivers (Casey et al, 2012, p. 318).
Problems
Programs such as Women, Infants, and
Children (WIC) and Thrifty Food Plan (TFP) exist to help low income households
provide quality nutrition and education about nutrition (United States
Department of Agriculture). WIC focuses on children and expecting mother while
TFP is helpful for families who are already receiving the maximum food stamp
allowance. Despite help from agencies and governmental programs, some children
still go hungry (Casey et al, 2012, p. 315).
Awareness among social workers and
caretakers is on the rise but it is difficult to quantify. As a first line of
defense, Casey et al (2012) recommended that child welfare workers obtain a
better understanding of eating disorders so they can quickly recognize these
behaviors and seek help for the child in collaboration with foster and
biological parents (p. 308).
Consistency
and Stability
At the epilogue of To the End of June, Beam suggests the idea of having one parental
figure to remain through a child’s formative years may be the answer to a shift
in a healthier foster care system. In reality the goal of child welfare
agencies is to reunification of children with their parents (p. 259). Some psychologists offer that in order for a
child to thrive, they need to bond with at
least one “parental figure or caregiver” (DeGarmo, 2013, p. 49). “Children
who experience long-term, stable placement show significant improvements in
health status, physical growth, and educational achievement” (Simms et al 2000,
p. 6).
Conclusion
The more
that is known about the causes, symptoms, diagnosis and treatment of food
hoarding in children, the better the outcomes are as those foster children enter
adulthood. The behavior associated with food hoarding can carry negative
consequences such as obesity and other dangers to physical health. Treatment can
be as simple as redirection and assurance from a caregiver who consistently attends
to the dietary needs of a child, or it can be extensive and intensive therapy
sessions with a psychologist or psychiatrist. Foster children come with and develop
enough problems naturally through circumstances outside of their control. The
concern of having enough food in a home where there is plenty should be
addressed with constant reassurance and proof in an effort to spare children
the stress of providing for themselves at any cost.
References
Beam,
C. (2013). To the end of June: The
intimate life of American foster care. New York, NY. Houghton Mifflin
Harcourt.
Burton,
C. L. PhD, Arnold, P. D. MD, Soreni, N. MD. (2015). Three reasons why studying
hoarding in children and adolescents is important. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 24(2),
128–130.
Casey,
C.M., Cook-Cottone, C., & Beck-Joslyn, M. (2012, May 26). An overview of
problematic eating and food-related behavior among foster children:
Definitions, etiology and intervention. Department
of Counseling, School, and Educational Psychology. University at Buffalo, The
State University of New York. DOI: 10.1007/s10560-012-0262-4
DeGarmo,
J. (2013). The foster parenting manual: A practical guide to creating a loving,
safe and stable home. London and Philadelphia, PA: Jessica Kingsley.
Good,
J. (2014). When foster or adopted children hoard food: Overcoming food
insecurity and feeding problems with our foster children. Retrieved from http://adoption.com/foster-adopted-children-hoard-food
Landau,
D., Iervolino, A.C., Pertusa, A., Santo, S., Singh, S., & Mataix-Cols,
D. (2010, September 2). Stressful life
events and material deprivation in hoarding disorder. Journal of Anxiety Disorders. 20(2011)192-202.
DOI:10.1015/j.janxdis.2010.09.002
Pacifici,
Caesar. (1996). Foster parent training:
Managing child behavior problems (Phase I). Retrieved from Northwest Media,
Inc. website: http://northwestmedia.com/research/fpbeh-i-pdf
Rowell,
K. (2013). Healing from food insecurity: Beyond the stash. North American Counsil on Adoptable Children. Retrieved from
https://nacac.org/adoptalk/beyondthestash.html
Simms,
M. D., Dubowitz, H., & Szilagyi, M. A. (2000, October). Health Care Needs
of Children in the Foster Care System. Pediatrics,106(4),
909. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE%7CA66665158&v=2.1&u=wylrc_laramiecc&it=r&p=AONE&asid=b230e12494b012a92faeee2dd44268ca
Stiegler,
L.N. (2005). Understanding pica behavior: A review for clinical and educational
professsionals. Focus on Autism and Other
Developmental Disabilities, 20(1), 27-38. Retrieved from
http://search.proquest.com/docview/205003823?accountid=29648
Storch,
E. A., Rahman, O., Park, J. M., Reid, J., Murphy, T. K., & Lewin, A. B.
(2011). Compulsive hoarding in children. Journal
of Clinical Psychology, 67(5), 507-516. doi:10.1002/jclp.20794
United
States Department of Health and Human Services. Administration for Children and
Families. Children’s Bureau. 2015, July. Preliminary
estimates for FY 2014 as of July 2015. Retrieved December 8, 2015, from http://www.acf.hhs.gov/sites/default/files/cb/afcarsreport22.pdf
United States Department of
Agriculture. Food and Nutrition Services. Women, Infants and Children (WIC). WIC at a glance. Retrieved December 8,
2015, from http://www.fns.usda.gov/wic/women-infants-and-children-wic
