pica and Autistic-Disorder

Pica is a very serious problem in which an individual ingests substances without nutrition value, such as paper and paint. As this behavior is often life-threatening resulting in surgery, pica has received attention from researchers for several decades. During that time, a number of interventions have been devised, such as behavioral methods (e.g., aversive stimuli, overcorrection, time-out, reinforcement) and biological interventions (e.g., pharmacotherapy, nutritional supplements). This paper is a broad review of the research on treatment studies for this problem, with a focus on persons with autism and/or intellectual disability (ID), which constitutes almost all of the published treatment papers. In addition, strengths and weaknesses of different pica treatments are discussed. Upon review, applied behavior analysis (ABA) was found to have the most robust empirical support to treat this behavior. Most clinicians are drifting away from aversive techniques and relying on more positive procedures to guide their treatment plans. The implications of current status and future directions for research are also addressed.

Topics: Autistic Disorder; Behavior Therapy; Developmental Disabilities; Humans; Intellectual Disability; Pica

The pica phenomenon, where non-edible substances are repeatedly consumed, has been linked with developmental and behavioural disorders, particularly autism. The clinical presentation of foreign body ingestion in patients with autism is discussed, and recommendations for caregivers are provided based on the available literature. An 18-year-old man with severe autism and behavioural difficulties presented with a vague history of decreased appetite and melaena of eight months duration. Foreign body ingestion commonly occurs in individuals with autism spectrum disorders and should be suspected in patients who present with vague gastrointestinal symptoms. The adverse medical and surgical consequences of foreign body ingestion emphasize the need for early recognition. Surgical intervention for foreign body ingestion can prevent complications. Magnetic substances can cause considerable gastrointestinal morbidity and require urgent endoscopic or surgical removal. Primary prevention is also vital.

Topics: Abdominal Pain; Adolescent; Autistic Disorder; Caregivers; Foreign Bodies; Humans; Magnetics; Male; Metals; Pica; Stomach; Tomography, X-Ray Computed

Children diagnosed with autism or autism spectrum disorders (ASD) are more likely than other children to exhibit behaviors characteristic of a feeding or sleeping disorder. Parents of children with these disorders may be extremely concerned about the health and safety of their child. Sleeping and feeding problems can cause a great deal of stress to parents and other family members. Behavioral assessment and treatment procedures have been developed to address behavior problems related to sleeping and feeding disorders. This article reviews the literature about assessment and treatment, and provides recommendations regarding services to family members of individuals diagnosed with ASD and feeding or sleeping disorders.

Topics: Adolescent; Autistic Disorder; Behavior Therapy; Child; Extinction, Psychological; Feeding and Eating Disorders of Childhood; Humans; Pica; Reinforcement Schedule; Sleep Initiation and Maintenance Disorders

Topics: Achievement; Autistic Disorder; Behavior Therapy; Brain Damage, Chronic; Child; Child, Institutionalized; Child, Preschool; Counseling; Family; Humans; Hyperkinesis; Intellectual Disability; Intelligence; Language Disorders; Mental Disorders; Personality; Pica; Play Therapy; Psychotherapy; Psychotic Disorders; Social Isolation; Stereotyped Behavior; Temperament

Problem behavior exhibited by individuals with autism can be disruptive to family traditions, such as decorating for the holidays. We present data for a 6-year-old girl who engaged in automatically reinforced pica and destruction of holiday decorations. Treatment was evaluated within an ABCDCD reversal design. During baseline (Phases A and B), we observed elevated rates of problem behavior. We implemented differential reinforcement of alternative behavior in Phase C to teach a response to compete with problem behavior. Little change in toy play or problem behavior occurred. In Phase D, we added a facial screen to the differential reinforcement procedures, which resulted in increases in toy play and decreases in problem behavior. Findings are discussed in terms of how interventions for problem behavior can promote alternative behavior while they facilitate household activities and traditions.

Topics: Aggression; Autistic Disorder; Behavior Therapy; Child; Facial Expression; Female; Humans; Intellectual Disability; Pica; Reinforcement, Psychology; Social Behavior; Treatment Outcome

Topics: Adult; Autistic Disorder; Bezoars; Colon, Sigmoid; Dilatation, Pathologic; Humans; Male; Pica; Rectum; Tomography, X-Ray Computed

Topics: Acute Kidney Injury; Adolescent; Adrenal Gland Neoplasms; Autistic Disorder; Child, Preschool; Diagnosis, Differential; Female; Heart Arrest; Humans; Hypertension; Male; Nephritis, Interstitial; Pheochromocytoma; Pica; Status Epilepticus; Tachycardia; Tachycardia, Ventricular

Topics: Adolescent; Autistic Disorder; Bezoars; Female; Humans; Pica; Stomach; Vomiting

Bezoars and foreign bodies are frequently encountered in children with psychiatric disorders. Eating disorder (called pica) occurs predominantly in some high-risk patients such as psychiatric and mentally disabled children. Small-bowel obstruction is an uncommon complication of ingested foreign body because the foreign body is able to cross the whole small intestine and be excreted in the feces.We present the case history of an autistic adolescent who was operated on because of bowel obstruction due to an unusual foreign body.

Topics: Adolescent; Autistic Disorder; Bezoars; Cardia; Cellulitis; Diagnosis, Differential; Duodenum; Emergencies; Enterostomy; Foreign Bodies; Gastroscopy; Humans; Ileal Diseases; Intestinal Obstruction; Laparoscopy; Laparotomy; Male; Pica; Plant Structures; Umbilicus

An 11 year old boy with autism presented with a 2-month history of agitated behaviour with associated weight loss. On examination he was wasted and distressed. He had severe hypoalbuminaemia. Gastrointestinal imaging revealed a gastric bezoar. At operation a large phytobezoar extending into the jejunum was identified and removed. Postoperatively he required intensive nutritional resuscitation and support, including treatment of multiple micronutrient deficiencies. Malnutrition is common in children with developmental disabilities, with a number of possible contributing factors. Gastric bezoar is a rare cause, which should be considered in mobile children who may engage in pica.

Topics: Autistic Disorder; Bezoars; Child; Humans; Male; Pica; Psychomotor Agitation; Victoria; Weight Loss

Assessment results indicated that pica exhibited by two boys with developmental disabilitieswas not associated with environmental contingencies. Consistent with previous research, an oral stimulation function was hypothesized. A related intervention that taught participants to exchange inedible items for edibles was developed. Findings showed that the intervention resulted in reductions in pica for both participants. When the interventionwas introduced across settings, reductions in pica were observed for one participant. However, additional training with alternative pica itemswas necessary to produce reductions in pica across settings with the second participant. Reductions in pica were maintained as the intervention was systematically thinned.

Topics: Adolescent; Autistic Disorder; Behavior Therapy; Child; Choice Behavior; Food Preferences; Humans; Intellectual Disability; Male; Motivation; Pica; Transfer, Psychology

Food aversion was shown to be effective in the reduction of plastic pica by a 4-year-old boy with autism. The participant was suffering from digestive complications due to the ingestion of plastic from a variety of toys. The intervention was initially conducted in the child's preschool classroom during instructional periods and was systematically generalized to the entire preschool classroom, and eventually to both classrooms within the preschool and across 25 teachers. The success of the intervention in decreasing pica was enhanced by its achievement in not reducing interactions with toys, considering appropriate play skills were a target goal.

Topics: Association Learning; Autistic Disorder; Avoidance Learning; Behavior Therapy; Child, Preschool; Early Intervention, Educational; Education of Intellectually Disabled; Food Preferences; Generalization, Psychological; Humans; Male; Pica; Play and Playthings; Reinforcement, Psychology; Taste

Topics: Adult; Autistic Disorder; Humans; Learning Disabilities; Male; Pica

Several childhood neurological conditions can lead to problems with unintended access to the mouth. Earlier workers have demonstrated benefits in the use of a helmet restricting mouth access, within a behavioural modification programme. Conventionally, such headgear is very obtrusive. This paper presents a simple technique using conventional plaster-based moulding, which has been successfully used in making secure, minimally obtrusive masks. Masks produced for two children have been readily accepted and have been successful. Any such headgear should be used only within a managed behavioural modification programme.

Topics: Adolescent; Autistic Disorder; Cerebral Palsy; Child; Equipment Design; Female; Fingersucking; Humans; Male; Masks; Pica

A series of analyses was conducted to assess and treat the pica of cigarette butts by a young man with mental retardation and autism. First, we demonstrated that pica was maintained in a condition with no social consequences when the available cigarettes contained nicotine but not when the cigarettes contained herbs without nicotine. Second, a choice assessment (Fisher et al., 1992) confirmed that tobacco was preferred over the other components of the cigarette (e.g., paper, filter, etc.). Third, an analogue functional analysis (Iwata, Dorsey, Slifer, Bauman & Richman, 1982/1994) demonstrated that cigarette pica was maintained independent of social consequences. Fourth, a treatment designed to interrupt the hypothesized response-reinforcer relationship reduced consumption of cigarettes to zero. Finally, because cigarette pica occurred primarily when the individual was alone or under minimal supervision, a procedure based on stimulus control was developed to improve the effectiveness of the intervention in these situations.

Topics: Adolescent; Autistic Disorder; Behavior Therapy; Choice Behavior; Humans; Intellectual Disability; Male; Nicotine; Pica

Topics: Adolescent; Ammonia; Autistic Disorder; Aversive Therapy; Female; Humans; Pica; Water

The usefulness of differential reinforcement of incompatible behavior was examined in the treatment of pica in a young man severely disabled by autism in a nonsheltered place of employment. The results indicated that a reduction in pica could be achieved by differential reinforcement of other behavior (DRO). Behaviors which were reinforced included remaining in this assigned location, keeping his hands on his work, working quickly and keeping his mouth clear. Reinforcements included favorite drinks, snacks, activities and praise. Treatment procedures were implemented by direct care paraprofessional staff. Withdrawal of treatment resulted in an increase in pica, with renewed reduction on reinstatement of the reinforcement schedule.

Topics: Adult; Autistic Disorder; Behavior Therapy; Humans; Male; Pica; Reinforcement, Psychology

Topics: Adolescent; Adult; Aged; Autistic Disorder; Child; Down Syndrome; Female; Humans; Male; Middle Aged; Pica; Retrospective Studies

Children with severely atypical development often display pica, habitual mouthing, and odd food preferences as symptoms from the first year of life. Such children can ingest dangerous amounts of lead even in environments that are usually considered safe. Mean blood lead concentration was notably higher in 18 autistic children than in 16 nonautistic psychotic children or in ten normal siblings. Fifteen (44%) of the psychotic children (autistic and nonautistic) had blood lead levels greater than two standard deviations above the mean for normal controls. Behavioral and neurological sequelae of elevated blood lead level may be obscured in severely disorganized children. Screening for blood lead should be part of the medical care of these vulnerable children with pica.

Topics: Adolescent; Autistic Disorder; Cerebrospinal Fluid Proteins; Child; Child, Preschool; Dimercaprol; Edetic Acid; Female; Haloperidol; Hemoglobins; Humans; Lead; Lead Poisoning; Male; Pica; Psychotic Disorders