pica and Developmental-Disabilities

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

Topics: Anemia, Iron-Deficiency; Child; Child, Preschool; Developmental Disabilities; Diagnosis, Differential; Epithelium; Humans; Infant; Infant, Newborn; Intestinal Absorption; Italy; Pica; Respiration; Restless Legs Syndrome; Risk Factors; Stroke

Pica, the repeated ingestion of nonfood items, can be life-threatening. Although case reports describe pica in children with autism spectrum disorder (ASD) or intellectual disability (ID), there has been little systematic study of pica prevalence. We assessed pica in children 30 to 68 months of age (median = 55.4 months) with and without ASD.. Compared with the prevalence of pica among POPs (3.5%), pica was higher in children with ASD (23.2%) and DD (8.4%), and in the following subgroups: ASD with ID (28.1%), ASD without ID (14.0%), DD with ID (9.7%), DD with ASD characteristics (12.0%), and DD with both ID and ASD characteristics (26.3%); however, pica prevalence was not elevated in children with DD with neither ID nor ASD characteristics (3.2%). Between-group differences remained after adjustment (adjusted prevalence ratio range 1.9-8.0, all. Pica may be common in young children with ASD, ASD characteristics, and ID. These findings inform the specialized health care needs of these children.

Topics: Adult; Autism Spectrum Disorder; Case-Control Studies; Child, Preschool; Developmental Disabilities; Female; Humans; Intellectual Disability; Male; Pica; Young Adult

Children with autism spectrum disorder (ASD) have a high prevalence of co-occurring medical conditions, including speech, sleep, and gastrointestinal disorders (constipation and feeding difficulties); developmental delay; attention deficit/hyperactivity disorder; hypotonia; epilepsy; anxiety; disruptive behavior; pica; and eczema. Less is known about whether these commonly coexist in the same children. We sought to determine clinically meaningful, statistically significant associations among co-occurring medical conditions in children with ASD that could lead to better understanding, identification, and treatment of these disorders.. We studied 2114 children with ASD aged 17 months to 5years and 1221 children aged 6 to 17years at 15 Autism Speaks Autism Treatment Network Registry sites. Clinician-reported diagnoses and problems were grouped into 12 core conditions. We determined the observed prevalence (O) of co-occurring conditions and the estimated expected prevalence (E) across the network, adjusting for sitevariability in the prevalence of individual conditions. Pvalues were calculated using a Cochran-Mantel-Haenszel test stratified by site. We identified pairs of conditions co-occurring more frequently than expected (O/E >1) and less frequently than expected (O/E <1) and highlighted statisticallysignificant differences.. Among the 66 condition pairs for each age group, we confirmed previously identified associations, such as sleep disorders and anxiety symptoms, in older children. We found some associations not previously described, including feeding with sleep disorders (younger children only), constipation with sleep disorders, feeding with speech disorders, and constipation with speech disorders.. We have identified new associations among co-occurring medical conditions in children with ASD, offering the potential to examine common pathways.

Topics: Adolescent; Anxiety; Attention Deficit and Disruptive Behavior Disorders; Attention Deficit Disorder with Hyperactivity; Autism Spectrum Disorder; Child; Child, Preschool; Comorbidity; Constipation; Developmental Disabilities; Eczema; Epilepsy; Feeding and Eating Disorders; Female; Humans; Infant; Male; Muscle Hypotonia; Pica; Prevalence; Sleep Wake Disorders; Speech Disorders; United States

To determine the relationship between geophagy (mouthing of dirt, sand, clay, or mud) and growth faltering in young children.. We examined linear growth as height and weight standardized by age and sex, and weight standardized by height, in a cohort of children aged 6-36 months in rural Mirzapur, Bangladesh. We determined geophagy behavior at baseline through caregiver report. Anthropometric measurements were assessed at baseline and at a 1-year follow-up.. We found that among children not stunted at baseline, those with caregiver-reported geophagy at baseline grew less over 1 year compared with their peers, with a difference in the change of standardized height for age and sex of -0.31 (95% CI, -0.61 to -0.01).. These findings show that caregiver-reported geophagy was associated with growth faltering in a pediatric population in rural Bangladesh. Future studies are needed to learn more about this exposure pathway and its relevance to child growth.

Topics: Anthropometry; Bangladesh; Child Development; Child, Preschool; Developmental Disabilities; Female; Humans; Infant; Male; Nutritional Status; Pica; Rural Population

Pica is a potentially deadly form of self-injurious behavior most frequently exhibited by individuals with developmental and intellectual disabilities. Research indicates that pica can be decreased with behavioral interventions; however, the existing literature reflects treatment effects for small samples (n = 1-4) and the overall success of such treatments is not well-understood. This study quantified the overall effect size by examining treatment data from all patients seen for treatment of pica at an intensive day-treatment clinical setting (n = 11), irrespective of treatment success. Results demonstrate that behavioral interventions are highly effective treatments for pica, as determined by the large effect size for individual participants (i.e., NAP scores ≥ .70) and large overall treatment effect size (Cohen's d = 1.80).

Topics: Adolescent; Behavior Therapy; Child; Developmental Disabilities; Female; Humans; Male; Pica; Treatment Outcome; Young Adult

Pica is characterized by the persistent eating of non-nutritive substances over some time that is inappropriate for the maturation stage of the individual and is not culturally sanctioned. A 9-year-old boy with Goldenhar syndrome, significant developmental delay and pica, collapsed and died after a short history of diarrhea and vomiting. Death was due to a sigmoid volvulus resulting from filling of the distal colon with feces containing dirt, stones, and rice with evidence of ischemic intestinal necrosis. Lethal complications of pica include intestinal obstruction and perforation with peritonitis and generalized sepsis. Other findings at autopsy may include airway obstruction, heavy metal poisoning, and parasitic infestation. Presenting symptoms and signs of such complications may be subtle or masked given the nature of underlying conditions, and so careful evaluation of the medical histories of individuals with pica may be necessary to provide pertinent details of associated medical and psychiatric conditions.

Topics: Child; Colon, Sigmoid; Developmental Disabilities; Feces; Forensic Pathology; Goldenhar Syndrome; Humans; Intestinal Mucosa; Intestinal Volvulus; Intestine, Large; Male; Necrosis; Pica

Topics: Adult; Developmental Disabilities; Female; Humans; Lead; Lead Poisoning; Maternal Exposure; Pica; Pregnancy; Pregnancy Complications

To determine the prevalence of child behaviour problems reported by parents in rural Bangladesh.. A total of 4,003 children aged 2-9 years were identified during a population-based survey of 2,231 households. A predetermined sample of 499 was selected, of which health professionals saw 453 (90.8%) for structured physical and neurological examination, standardized testing of cognition and adaptive behaviour and parent report of developmental history and behaviour problems.. The prevalence of behaviour impairments was 14.6% (95% CI 11.4, 17.9). The majority involved somatic complaints, including nocturnal enuresis and pica. Problems such as aggression or restlessness were infrequently reported. Behaviour impairments were significantly associated with malnutrition (prevalence ratio 2.1, 95% CI 1.2, 3.6, p < 0.01) and cognitive, motor or seizure disabilities (prevalence ratio 1.8, 95% CI 1.1, 2.9, p < 0.05).. The prevalence and nature of reported behaviour impairments in rural Bangladesh have implications for public health planning and delivery of health services.

Topics: Bangladesh; Child; Child Behavior Disorders; Child, Preschool; Demography; Developmental Disabilities; Female; Humans; Male; Mass Screening; Motor Skills Disorders; Nocturnal Enuresis; Pica; Prevalence; Rural Population; Socioeconomic Factors; Surveys and Questionnaires

Topics: Child; Developmental Disabilities; Humans; Lead Poisoning; Male; Pica

Topics: Administration, Oral; Anemia, Hypochromic; Brain Diseases; Canada; Child, Preschool; Developmental Disabilities; Female; Humans; Iron Chelating Agents; Lead; Lead Poisoning; Male; Paint; Pica

Every child with failure to thrive has at least one organic medical disease: malnutrition. It is well documented that lead and other heavy metals are absorbed more readily in the presence of both malnutrition and iron deficiency anemia. Malnutrition and lead exposure tend to be found in the same population groups. Furthermore, lead poisoning is correlated with many of the identical intellectual and behavioral deficits demonstrated in children suffering from nonorganic failure to thrive. Because of these facts, whole blood lead levels were determined for 45 children with nonorganic failure to thrive and 45 age-, race-, and socioeconomically matched comparison subjects. Children with failure to thrive had a lead level of 22.67 +/- 10.29 (micrograms/dL (mean +/- SD); for control children, it was 14.33 +/- 5.42 (P less than .001). Children with failure to thrive were more frequently anemic (P less than .0001), a possible lead effect, and had higher free erythrocyte protoporphyrin levels. Children with failure to thrive were developmentally delayed on the Denver Developmental Screening Test (unblinded observation) with high failure rates in both language (P less than .001) and gross motor skills (P less than .02). Although failure on the Denver Developmental Screening Test within the failure to thrive group was not linearly correlated with lead level, any such effects may have been masked by the effects of malnutrition and failure to thrive per se. A number of authors have suggested that lead levels formerly thought to be inconsequential are clinically toxic.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Body Weight; Child, Preschool; Developmental Disabilities; Failure to Thrive; Humans; Infant; Lead; Pica

Topics: Child, Preschool; Developmental Disabilities; Female; Gastrointestinal Diseases; Health Surveys; Humans; India; Infant; Male; Morbidity; Pica; Respiratory Tract Infections; Urban Population

Topics: Developmental Disabilities; Humans; Pica

Topics: Adolescent; Algeria; Anemia, Hypochromic; Child Nutritional Physiological Phenomena; Developmental Disabilities; Disorders of Sex Development; Dwarfism; Endocrine System Diseases; Feeding and Eating Disorders; Feeding Behavior; Hepatomegaly; Humans; Iron; Male; Parasitic Diseases; Pica; Puberty; Zinc