pica and Intellectual-Disability

Pica is a common condition in childhood that is commonly missed.. To familiarize physicians with the clinical evaluation and management of children with pica.. A PubMed search was completed in Clinical Queries using the key term "pica" OR "dirteating". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.. Pica refers to the persistent, compulsive craving for and the ingestion of substances usually considered inedible and the behavior is discordant with cultural practices and continues beyond the normal developmental phase of occasional indiscriminate and experimental mouthing and swallowing over a period of at least one month. The condition is more common among children in lower socioeconomic classes and those who are mentally handicapped or emotionally deprived. Pica is a significant cause of anemia and lead poisoning. Pica generally resolves in children of normal intelligence after they have been trained to discriminate between edible and inedible items and proper supervision is provided. While relief of family economic and housing difficulties is an adjunct, attention to the individual's emotional needs and stresses is of paramount importance. Children with iron deficiency anemia should be treated with iron replacement therapy. Complications such as gastrointestinal obstruction and lead poisoning should be promptly recognized and treated.. Pica is often an overlooked phenomenon and its association with iron deficiency and lead poisoning has been known for centuries. The underlying cause and complications should be treated if possible. Primary care physicians should be aware of pica and proactively seek information about pica in patients that belong to the high-risk groups.

Topics: Anemia, Iron-Deficiency; Animals; Child; Disease Management; Global Health; Humans; Intellectual Disability; Lead Poisoning; Malnutrition; Morbidity; Pica; Risk Assessment; Risk Factors

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

Coprophagia or the ingestion of feces has long been associated with psychiatric illness. It is considered to be a variant of pica. This behavior requires an extensive medical and psychiatric differential diagnosis. Medical disorders associated with coprophagia include seizure disorders, cerebral atrophy, and tumors. Psychiatric disorders associated with coprophagia include mental retardation, alcoholism, depression, obsessive compulsive disorder, schizophrenia, fetishes, delirium, and dementia. In animals, coprophagia is associated with boredom, thiamine deficiency, and lesions of the amygdala.. A case of coprophagia in an elderly man is reported here. A 77-year-old man with mild mental retardation was referred for urgent psychiatric evaluation due to coprophagia. The case is discussed and the literature reviewed.. Psychiatric evaluation revealed cognitive dysfunction and depression. Physical examination and laboratory evaluation were noncontributory. He was started on sertraline 25 mg daily with resolution of his coprophagia. Coprophagia has been treated using behavioral interventions, supportive psychotherapy, elemental diets, tricyclic anti-depressants, carbamazepine, haloperidol, and electroconvulsive therapy.. Use of Selective Serotonin Reuptake Inhibitors (SSRIs) may also be an effective treatment for coprophagia, particularly in the setting of depression or anxiety.

Topics: Aged; Combined Modality Therapy; Human Coprophagia; Humans; Intellectual Disability; Male; Pica; Psychotherapy; Selective Serotonin Reuptake Inhibitors; Sertraline

The consumption of nonfood items (i.e., pica) frequently occurs in persons with developmental disabilities. Pica may result in the puncture or blockage of the digestive tract, infestation by gastrointestinal parasites, and can interfere with an individual's daily learning, occupational performance, and quality of life. Twenty-six published studies have examined the efficacy of behavioral-intervention packages (e.g., differential reinforcement of other behavior, noncontingent attention, or overcorrection) on the pica of persons with developmental disabilities. This article reviews those studies and discusses the effectiveness, generality, and acceptability of the various intervention packages used to reduce pica. Additionally, this article highlights the recent clinical advancements that have been made in the treatment of the pica of persons with developmental disabilities.

Topics: Behavior Therapy; Education of Intellectually Disabled; Humans; Intellectual Disability; Pica; Reinforcement, Psychology

Pica is the collective term for any form of qualitative disorder of eating behaviour. If a patient's deviant appetite is fixated on one special object, there are quite a number of corresponding terms available (e.g. geophagia for eating dirt). Pica, although a ubiquitous phenomenon, shows heightened prevalence in certain high-risk populations, i.e. infants, pregnant women, the mentally retarded, special ethnic groups and psychiatric patients. The author briefly summarizes the medical history of the pica concept and the present state of knowledge concerning aetiology and pathogenesis. The numerous possible complications and various therapeutic approaches are pointed out.

Topics: Ethnicity; Female; Humans; Infant; Intellectual Disability; Mental Disorders; Pica; Pregnancy; Prevalence; Risk Factors

Only the organic and cryptogenic forms of frontal lobe epilepsy have been admitted by the ILAE, but according to several reports in the literature, it probably exists also an idiopathic form, at present not well recognized.. To study the differences between the organic and the cryptogenic forms of frontal epilepsy in our patients, that might indicate the presence of idiopathic cases within the presumed cryptogenic group.. All patients diagnosed of frontal lobe epilepsy, EEG registered, at the neuropediatric clinic of our hospital during 1993-1996, were selected: 30 patients under 14 years of age that were classified as organic (10 cases) or cryptogenic (20 cases) according to CT or MRI findings. The Mann-Whitney test and the Fisher exact test were performed for statistical analysis. Five patients with peculiar neurocognitive symptoms, epilepsy-related, are described in detail.. Significative differences between the organic and cryptogenic forms of frontal lobe epilepsy were not found except for the tendency of cryptogenic EEG foci to spread beyond the frontal lobe, to generalize and to be associated with foci of other localizations. Epileptic status, either convulsive or not convulsive, were a frequent complication in both groups.. The identification of an idiopathic form of frontal lobe epilepsy is difficult by its low prevalence as compared to the cryptogenic and organic forms, by the tendency of frontal seizures to become epileptic status, which predicts an intractable epilepsy, and by the clinical characteristics essential to frontal discharges: heterogeneity, frequent impairment of consciousness and specially the neurocognitive semiology, including dementia, that occurs as a critic or paracritic phenomenon, and that sometimes may develop or be accentuated by antiepileptic medication.

Topics: Anticonvulsants; Child; Child Behavior Disorders; Child, Preschool; Electroencephalography; Epilepsy, Frontal Lobe; Female; Frontal Lobe; Humans; Intellectual Disability; Learning Disabilities; Magnetic Resonance Imaging; Male; Pica

To review the general surgical management of mentally handicapped persons with pica.. A study of hospital records and a review of the current literature.. A community hospital.. Thirty-five patients from a large institution for the mentally handicapped were treated for well-documented pica on 56 occasions at the Orillia Soldiers Memorial Hospital between 1976 and 1991.. Endoscopy and laparotomy for the removal of foreign bodies or to close perforations.. Fourteen (25%) cases of pica were managed by observation only, but 42 (75%) cases required surgical intervention. There were 34 laparotomies. The complication rate was 30% and the death rate 11%.. Pica is a serious health risk for mentally handicapped patients. Diagnosis and postoperative care can be difficult. Pica should be suspected in mentally handicapped patients with gastrointestinal symptoms.

Topics: Abdomen, Acute; Adolescent; Adult; Digestive System Surgical Procedures; Disabled Persons; Female; Foreign Bodies; Gastric Outlet Obstruction; Humans; Intellectual Disability; Intestinal Obstruction; Intestinal Perforation; Intestine, Small; Laparotomy; Male; Middle Aged; Ontario; Peritonitis; Pica; Retrospective Studies; Survival Rate

This article reviewed and discussed various methodologies used for the analysis of variables maintaining aberrant behavior. Previous research had succeeded in identifying a wide variety of environmental events which may contribute to an individual's maladaptive responding. These general classes of variables are summarized and presented with relevant examples. We conclude with suggestions for conducting a comprehensive functional analysis using descriptive and experimental methods leading to the development and evaluation of analysis-derived interventions.

Topics: Behavior Therapy; Humans; Intellectual Disability; Mental Disorders; Pica; Self Mutilation; Stereotyped Behavior

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

Topics: Adult; Body Burden; Central Nervous System; Child; Demyelinating Diseases; Humans; Intellectual Disability; Lead; Lead Poisoning; Pica

Topics: Age Factors; Black or African American; Brain Chemistry; Child; Child Behavior Disorders; Child, Preschool; Humans; Infant; Intellectual Disability; Intelligence Tests; Lead; Lead Poisoning; Mental Disorders; Mother-Child Relations; Pica; Population; Research; Socioeconomic Factors

A double-blind, placebo-controlled study was conducted to assess the effects of intermittent drug therapy on stereotyped and collateral behaviors of six profoundly mentally retarded, institutionalized, adult males. The subjects, all of whom had received antipsychotic medication for more than three years, had their maintenance dosages gradually reduced by almost half during the eight-month study. A multiple baseline across subjects design was utilized to assess drug effects on object and body stereotypy and a range of collateral behaviors. While there was individual variation across behaviors and subjects, the main finding was that despite the marked reduction in medication, there were no general changes of clinical significance in any of the behaviors. This finding is of considerable therapeutic importance since a very large number of institutionalized mentally retarded persons receive similar long-term medication for behavior problems and there is some concern regarding the adverse side effects of such treatment.

Topics: Adolescent; Adult; Aggression; Antipsychotic Agents; Child; Chlorpromazine; Double-Blind Method; Humans; Intellectual Disability; Male; Methotrimeprazine; Pica; Stereotyped Behavior; Verbal Behavior

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

Topics: Adult; Anticonvulsants; Antipsychotic Agents; Bipolar Disorder; Depression; Female; Humans; Intellectual Disability; Lithium; Olanzapine; Pica; Topiramate

Even at low levels in blood, lead has been associated with reduced IQ scores, behavioural problems, learning impediments, aggression and violent behaviour. Since the 1980s, the South African Medical Research Council (SAMRC) has been investigating the sources of exposure to lead in South Africa (SA), the groups at highest risk of lead poisoning and a selection of the myriad associated health and social consequences. SAMRC research evidence contributed to the phasng out of leaded petrol, restrictions on lead in paint and other interventions. Subsequently, childhood blood lead levels in SA declined significantly. More recent studies have revealed elevated risks of lead exposure in subsistence fishing and mining communities, users of arms and ammunition, those ingesting certain traditional medicines, and users of certain ceramicware and artisanal cooking pots. Lead-related cognitive damage costs the SA economy ~USD17.7 (ZAR261.3) billion annually, justifying further SAMRC investment in lead exposure research in the country.

Topics: Academies and Institutes; Aggression; Biomedical Research; Ceramics; Cooking and Eating Utensils; Environmental Exposure; Firearms; Gasoline; Humans; Intellectual Disability; Lead; Lead Poisoning; Medicine, Ayurvedic; Mining; Paint; Pica; Puberty, Delayed; South Africa; Violence

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

Eosinophilic meningitis or encephalitis is a rare disorder and is most commonly caused by Angiostrongylus cantonensis. Humans are accidentally infected when they ingest raw snails or vegetables contaminated with the parasite larvae. Because of the improvement in sanitary food handling practices, the occurrence of A. cantonensis eosinophilic meningitis has been decreasing in Taiwan in recent decades. The common symptoms and signs of eosinophilic meningitis are severe headache, neck stiffness, paresthesia, vomiting, nausea, and fever. Acute urinary retention is a rare presentation. We report a case of A. cantonensis eosinophilic meningitis in an intellectually disabled patient who presented with acute urinary retention without any other meningeal signs. The patient received supportive treatment with corticosteroid therapy and was discharged and received urinary rehabilitation at home.

Topics: Adolescent; Angiostrongylus cantonensis; Animals; Eosinophilia; Humans; Intellectual Disability; Male; Meningitis; Pica; Strongylida Infections

Vinyl gloves when ingested will harden and develop sharp edges producing gastric bezoars; bowel obstruction; and, ultimately, perforation. We report 4 children with complications secondary to vinyl glove ingestion who required surgical intervention.. A 3-year-old boy, a 13-year-old adolescent girl with Down syndrome, a 14-year-old adolescent girl, and a 15-year-old adolescent boy presented with bowel obstruction secondary to a bezoar caused by a vinyl glove. The adolescent girl with Down syndrome presented again at age 17 years with a large vinyl glove gastric bezoar. Three of the children had mental retardation, and 1 was a victim of child abuse. Three had laparoscopic-assisted removal of the vinyl glove bezoar, and 1 had laparotomy.. The 4 children recovered uneventfully. Two of the patients had unsuspected intestinal perforation. The caretakers denied awareness of the vinyl glove ingestion.. Vinyl glove ingestion can cause intestinal obstruction and perforation. Vinyl gloves should be removed from the immediate proximity of mentally retarded patients or patients with pica. Most of the time, the finding of vinyl gloves as etiology of the obstruction or perforation is incidental. If the event is known or witnessed, prompt surgical intervention is generally recommended.

Topics: Adolescent; Bezoars; Child, Preschool; Female; Gloves, Protective; Humans; Intellectual Disability; Intestinal Obstruction; Intestinal Perforation; Intestine, Small; Laparoscopy; Laparotomy; Male; Pica; Stomach

The case of a 64-year-old patient with pica and severe mental retardation who was admitted to our hospital for treatment of recurrent cholecystitis is reported. Abdominal ultrasound showed sludge in the gallbladder, but no stones. Abdominal CT revealed a foreign body in the duodenum resembling a suction cup of the type commonly used in kitchens and bathrooms. The object could not be removed because it was deeply embedded in the hypertrophic intestinal mucosa. A nasogastric tube was inserted for feeding, since the object impeded the passage of solid foods. The patient's fever and abdominal pain subsequently resolved, and laboratory data improved. The indwelling feeding tube prevented recurrence of cholecystitis. Since pica is common not only in patients with mental retardation but also in dementia patients, the present case may also relate to the treatment of acute abdominal conditions in dementia patients.

Topics: Abdominal Pain; Cholecystitis; Duodenum; Female; Fever; Foreign Bodies; Humans; Imaging, Three-Dimensional; Intellectual Disability; Intubation, Gastrointestinal; Middle Aged; Pica; Recurrence; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Group Homes; Humans; Intellectual Disability; Olanzapine; Pica

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

Intellectually-disabled patients with acute abdominal conditions are susceptible to late diagnosis and adverse outcome due to impaired communication, altered behaviour, neurological impairment, associated congenital anomalies, variable reaction to pain and drugs and various difficulties in perioperative management. The present study aims to present the experience of surgery for acute abdominal conditions in intellectually-disabled patients. Various difficulties encountered during the management are highlighted and measures to overcome these problems are discussed.. A prospective descriptive population study was performed through the prospective collection of data on consecutive intellectually-disabled adults operated for acute abdominal conditions over a 5-year period. Study parameters included demographic details, clinical presentation, diagnostic modalities, operative findings and outcome in terms of morbidity and mortality.. Of 19 men and three women with a mean age of 28.3 years, anorexia, vomiting, and increasing abdominal distension were the most common presenting features. History of pica was available in 36.4% of patients. Intestinal obstruction, acute appendicitis, volvulus and pseudo-obstruction of the colon were the most frequently encountered conditions. Postoperative morbidity and mortality were 33 and 23%, respectively.. Intellectually-disabled patients demand particular clinical expertise owing to various difficulties inherent to their mental and physical disabilities. Short history, anorexia, vomiting and abdominal distension should make the clinician aware of the possibility of an acute abdominal condition. History of pica should be considered a serious clinical correlate. A high index of clinical suspicion, intensive perioperative care and low threshold for an early operation are recommended to reduce the higher morbidity and mortality figures.

Topics: Abdomen, Acute; Acute Disease; Adult; Appendicitis; Colonic Pseudo-Obstruction; Comorbidity; Female; Humans; Intellectual Disability; Intestinal Obstruction; Male; Pica; Postoperative Complications; Prospective Studies

Pica has rarely been reported in patients with geriatric mental illness. The authors describe 3 male patients with pica in the geriatric unit of a state mental hospital. Two of these patients had a diagnosis of developmental delay with concomitant diagnoses of schizophrenia and schizoaffective disorder, respectively. The third patient was diagnosed with paranoid schizophrenia. In all 3 cases, pica started late in life and was unrelenting and unresponsive to psychotropic medications, with limited to no response to behavioral interventions. In the 2 patients who died, pica was implicated as the direct cause of death in 1 and the likely cause of death in the other. When pica occurs in elderly patients with mental illness, the risk of mortality should be taken into account in clinical management.

Topics: Aged; Humans; Intellectual Disability; Male; Pica; Psychotic Disorders; Schizophrenia, Paranoid

Whereas small gastric bezoars may be removed endoscopically, large bezoars traditionally are removed at laparotomy. We describe a 33-year-old mentally retarded woman with pica syndrome who had experienced episodes of upper abdominal pain and distension of 10 months duration. Gastroscopy showed a large bezoar in the stomach, and attempted endoscopic removal was unsuccessful. The patient underwent laparoscopic extraction of the bezoar, which proved to be an ingested glove. She made an uneventful recovery and was discharged home on postoperative day 1. She had no wound complications, and her symptoms had not recurred at a 3-month follow up assessment. The operative technique is described, and the merits of the laparoscopic approach are discussed.

Topics: Adult; Bezoars; Clothing; Female; Humans; Intellectual Disability; Laparoscopy; Pica; Stomach

Pica is a life-threatening behavior displayed by many individuals with developmental disabilities. In the current study, automatic reinforcement maintained the pica of 3 participants. Following functional analyses of pica, response-effort manipulations were conducted in which the effort to obtain pica or alternative items was varied systematically. Several general relations emerged as a result of the study. First, levels of pica were reduced relative to baseline when alternative items were available independent of the effort required to obtain alternative items or pica. Second, increasing the effort for alternative items resulted in increases in pica relative to when effort for alternative items was low. Third, increasing response effort for pica produced reductions in pica relative to baseline when alternative items were unavailable. Fourth, the highest levels of pica occurred when the effort to engage in pica was low or medium and no alternative items were available. These findings are discussed in terms of the relative effects of quality of reinforcement and response effort on behavior.

Topics: Adult; Automatism; Choice Behavior; Female; Humans; Intellectual Disability; Pica; Reinforcement, Psychology

Although response blocking can decrease problem behavior, one potential adverse side effect is the induction of aggression. In the current study, we report on a young adult who engaged in high rates of pica maintained by automatic reinforcement. Blocking pica, however, led to aggression. When redirection to an alternative preferred food item was added to an intervention consisting of response blocking, pica was effectively treated without increasing aggression.

Topics: Adult; Aggression; Behavior Therapy; Extinction, Psychological; Humans; Intellectual Disability; Male; Pica

The effects of a common multiple vitamin on the pica of a child with severe mental retardation and anemia were evaluated. A BAB design revealed that pica was decreased by the vitamin. The results suggest that pica can be effectively treated by implementation of a simple nutritional or biological intervention. Further research investigating the generality of this finding and the effects of combining biological and behavioral interventions are discussed.

Topics: Child; Female; Humans; Intellectual Disability; Pica; Severity of Illness Index; Vitamins

To report experience with the treatment of complications of vinyl glove ingestion in mentally retarded patients with pica.. A retrospective case series.. Two university-affiliated hospitals.. Five mentally retarded patients, 4 with a history of pica, who were admitted for the management of complications resulting from the ingestion of vinyl gloves.. Type of complication, treatment and operative outcome.. The patients ranged in age from 26 to 46 years. One patient died while awaiting surgical consultation of massive gastrointestinal bleeding from a large gastric ulcer caused by a vinyl glove bezoar (VGB). Four VGBs were removed surgically. Endoscopic removal was difficult or impossible because the gloves had become hardened and matted.. VGB should be considered in institutionalized mentally retarded people with a history of pica when they present with gastrointestinal symptoms. VGBs should be removed directly by laparotomy, gastrotomy or enterotomy. Endoscopic removal is not recommended.

Topics: Adult; Bezoars; Female; Foreign Bodies; Gloves, Surgical; Humans; Intellectual Disability; Male; Middle Aged; Pica; Polyvinyls; Radiography

It has come to be generally accepted that low levels of lead exposure may result in mental deficit. This causal inference is based on claimed time precedence of the lead exposure and on biological plausibility. The objective of this study is to argue that mental deficit causes pica which causes lead exposure (i.e. to support the theory of reverse causation).. The literature since the 1930s has been interpreted in the light of our own long experience in the investigation of lead exposure in children and adults to support the arguments in favour of reverse causation.. The arguments for reverse causation are based on: (i) analogy with mental retardation which causes increased lead exposure; (ii) the results of published prospective studies that show a special relationship between blood lead levels at 24 months and intelligence tested later, exactly what would be predicted by the reverse causation theory; and (iii) on an alternative explanation for mental retardation following lead encephalopathy (i.e. that mental retardation following encephalopathy is due to anoxia and not due to a direct destructive effect on the brain neurones). The arguments, which have been proposed for the conventional view, are rejected for the following reasons: (i) none of the prospective studies have found a relationship between cord blood lead levels and intelligence tested later, undermining the argument based on time precedence of lead exposure; and (ii) there is no convincing evidence that lead poisoning, short of encephalopathy, causes mental retardation.. We believe that the reverse causation hypothesis is a more plausible explanation of the facts.

Topics: Causality; Child; Environmental Exposure; Humans; Intellectual Disability; Intelligence; Lead; Lead Poisoning; Pica

Topics: Adult; Humans; Intellectual Disability; Mental Processes; Neuropsychological Tests; 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

Applied behavior analysis is based on an investigation of variability due to interrelationships among antecedents, behavior, and consequences. This permits testable hypotheses about the causes of behavior as well as for the course of treatment to be evaluated empirically. Such information provides corrective feedback for making data-based clinical decisions. This paper considers how a different approach to the analysis of variability based on the writings of Walter Shewart and W. Edwards Deming in the area of industrial quality control helps to achieve similar objectives. Statistical process control (SPC) was developed to implement a process of continual product improvement while achieving compliance with production standards and other requirements for promoting customer satisfaction. SPC involves the use of simple statistical tools, such as histograms and control charts, as well as problem-solving techniques, such as flow charts, cause-and-effect diagrams, and Pareto charts, to implement Deming's management philosophy. These data-analytic procedures can be incorporated into a human service organization to help to achieve its stated objectives in a manner that leads to continuous improvement in the functioning of the clients who are its customers. Examples are provided to illustrate how SPC procedures can be used to analyze behavioral data. Issues related to the application of these tools for making data-based clinical decisions and for creating an organizational climate that promotes their routine use in applied settings are also considered.

Topics: Adult; Behavior Therapy; Consumer Behavior; Data Interpretation, Statistical; Female; Humans; Intellectual Disability; Pica; Quality Assurance, Health Care; Restraint, Physical; Self-Injurious Behavior; Treatment Outcome

We report an unusual case of acute copper intoxication in a patient who died after swallowing more than 700 coins mainly of 1p and 2p denomination. At autopsy the liver showed fibrosis and extensive copper deposition was demonstrated in the histological sections. Electron probe microanalysis also confirmed the presence of copper in the hepatic tissue.

Topics: Copper; Electron Probe Microanalysis; Humans; Intellectual Disability; Laparotomy; Liver; Liver Cirrhosis; Male; Microscopy, Electron; Middle Aged; Pica; Radiography, Abdominal

Pica and scavenging are serious, sometimes life-threatening behavior problems among a significant percentage of individuals with mental retardation. This study describes procedures developed to reduce life-threatening pica and food scavenging in two adolescents with severe to profound mental retardation. Treatment was designed to teach the subjects to discriminate safe from unsafe items by training them to ingest only those items put on a specified placemat and to communicate with simple signs or gestures to obtain more food to be put on the mat. Discrimination was achieved by praising subjects when they selected and ingested items from their placemats and delivering a mild punisher when attempts to ingest nonplacemat items were made. A multiple baseline design across settings was used to evaluate the effects of the treatment package in three inpatient settings. All environments were "baited" with both edible and inedible items. Our treatment procedures appeared to be effective in reducing pica in each of the settings. Generalization of treatment effects to natural environments for one of the two subjects was documented.

Topics: Adolescent; Behavior Therapy; Discrimination Learning; Follow-Up Studies; Generalization, Response; Humans; Infant; Intellectual Disability; Lead Poisoning; Male; Pica; Punishment

The treatment of a 33-year-old female disabled by mental retardation and Prader-Willi syndrome who exhibited pica is described. Negative practice was administered following each occurrence of the target behavior, that is, biting off and chewing on inedible objects. Data were collected within a reversal design. The results indicated that pica was reduced to a near zero level. Follow-up data collected after 7 months while the procedure was continued revealed a sustained suppression of pica.

Topics: Adult; Behavior Therapy; Education of Intellectually Disabled; Female; Humans; Intellectual Disability; Pica; Practice, Psychological; Prader-Willi Syndrome; Reinforcement, Psychology

The case of a person with severe mental handicap whose pica became uncontrollable during episodes of depressive illness is described. Treatment of the depression with lofepramine markedly reduced the pica, and withdrawal of lofepramine led to recurrence. It is suggested that biological symptoms of depression should be monitored in people with severe mental handicap who show significant episodic worsening of long-standing repetitive behaviour.

Topics: Depressive Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Foreign Bodies; Humans; Intellectual Disability; Intestines; Lofepramine; Male; Middle Aged; Pica; Recurrence; Self-Injurious Behavior; Social Behavior

Blood lead levels of children admitted to Sion Hospital, Bombay (India), from the adjoining Dharavi slum areas have been determined by proton-induced X-ray emission (PIXE). Blood samples were collected from 36 children with suspected lead poisoning and from 20 control children. The analysis showed that the lead concentration of the patients varied from 0.1 to 6.0 micrograms ml-1. In addition to lead, K, Ca, Fe, Cu, Zn, Se, Br and Rb were also detected simultaneously, of which the concentrations of Fe, Cu, Zn, Se, Rb and Pb were determined. The high blood lead levels of the children from this area may be ascribed to environmental pollution due to heavy vehicular traffic and industrial sources.

Topics: Anemia, Hypochromic; Child; Humans; India; Intellectual Disability; Lead; Lead Poisoning; Pica; Reference Values; Spectrometry, X-Ray Emission; Trace Elements; Urban Population

Although pica is one of the most frequently observed eating dysfunctions among people with mental retardation, it is significantly underreported in the literature. Of 806 institutionalized adults with mental retardation in the present study, 15.5% exhibited pica. Prevalence estimates from previous studies have ranged from 25.8% to 3%. Fifty-four percent of the pica group had serum zinc levels below normal range, whereas 7% of the control group had serum zinc levels below the normal range. After supplementation with chelated zinc, residents had significant reductions in pica. Data indicated zinc as a possible adjunct to other treatment approaches.

Topics: Adult; Dose-Response Relationship, Drug; Female; Humans; Intellectual Disability; Male; Middle Aged; Pica; Zinc

In Prudhoe Hospital, a large mental-handicap hospital of 1000 residents, it was found that of the 94 deaths that occurred between 1982 and 1986, three were closely associated with the habit of pica. These deaths occurred in severely and profoundly handicapped males, whose average age was 32, compared with an average age of death of 58 for the combined groups of severely and profoundly mentally handicapped patients (22 cases), and an average age of death of 60 for all degrees of handicap (94 cases). It seems likely that the habit of pica constitutes a cause of considerable morbidity and mortality in certain institutionalised patients.

Topics: Adult; Death, Sudden; Esophagus; Foreign Bodies; Humans; Intellectual Disability; Male; Pica

Topics: Child; Growth Disorders; Humans; Institutionalization; Intellectual Disability; Male; Mother-Child Relations; Pica

Topics: Adult; Diagnosis, Differential; Humans; Intellectual Disability; Male; Paper; Pica; Porphyrias

The eggs of Trichuris, detected in the feces of 19 persons who had stayed in institutions for mentally retarded and/or multi-handicapped patients, were identified as those of T. vulpis (Froelich, 1789) on the basis of morphological features. This is the first record of human infection with the canine whipworm in Japan.

Topics: Feces; Humans; Intellectual Disability; Japan; Parasite Egg Count; Pica; Trichuriasis; Trichuris

Pica, an eating disorder, is commonly observed in infants, young children and in developmentally delayed persons. The behaviour is regarded as pathological if it persists beyond the age of about 18 months. The present study was designed to study the prevalence of pathological pica in a state residential institution for mentally retarded persons. Of the total sample of 607 residents, 56 or 9.2% were identified and observed to engage in pica. The occurrence of pica was related to the degree of retardation and age of the residents. Observational data showed that the occurrence of pica varied in frequency across four different settings, both within and between subjects. A wide variety of objects were used for pica including clothing, dirt, dust and fluff off the floor, toys, paper, and grass. Medical case notes showed that only a small number of the residents engaging in pica suffered from the commonly known problems associated with pica.

Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Female; Humans; Intellectual Disability; Male; Middle Aged; Pica; Residential Facilities

A two-phase functional analysis of a profoundly retarded 19-year-old male's pica facilitated the design of an effective intervention containing no aversive components. In the first analysis, frequent staff-client interaction resulted in 25% and 66% less pica than limited and no interaction, respectively. Paradoxical effects were obtained in the second analysis, where no protective helmet resulted in 38% and 26% less pica than the helmet with face shield and helmet without face shield, respectively. On the basis of these analyses, limited interaction and no helmet conditions were combined in an effective, staff-implemented treatment at a medium-sized institution.

Topics: Adult; Behavior Therapy; Head Protective Devices; Humans; Intellectual Disability; Male; Pica; Protective Devices

A treatment package was employed to manage the pica and self-stimulation of a 4-year-old profoundly mentally retarded girl. Each instance of pica was followed by a verbal reprimand, the removal of the particular objects/fingers from the subject's mouth, and physical restraint. Each instance of self-stimulation was followed by response interruption and positive practice overcorrection. In both cases, praise was contingent upon the absence of target behaviors. A multiple-baseline design across settings was employed. The treatment package resulted in rapid and dramatic decreases in the levels of pica and self-stimulation in each setting. These results significantly contributed to the reduction of the cost of treatment. Results suggest that efficacy and efficiency of treatment interventions should be emphasized when dealing with multiple problems of profoundly retarded children and special emphasis should be placed on the treatment package strategy to enhance the efficiency of a given therapeutic technique.

Topics: Aversive Therapy; Child, Preschool; Female; Humans; Intellectual Disability; Mothers; Pica; Practice, Psychological; Reinforcement, Social; Restraint, Physical; Stereotyped Behavior

Previous studies have shown that pica, the ingestion of inedible objects, can be effectively controlled in mentally retarded subjects using a two- or three-component overcorrection procedure or with one of these components in conjunction with another response-reduction procedure, differential reinforcement of other behavior. The present study showed that one of the components, oral hygiene, could eliminate pica by 2 retarded subjects when used alone. Although oral hygiene was the most effective component, each of the other components, tidying and personal hygiene, did decrease pica. In a later phase we found that a number of different therapists could easily and effectively implement the oral hygiene procedure.

Topics: Adult; Behavior Therapy; Female; Humans; Intellectual Disability; Oral Hygiene; Overlearning; Pica

Pica, the ingestion of inedible objects, and several collateral behaviors of a profoundly retarded woman were measured before, during and after the application of a screening contingency for pica. A variant of visual screening, blindfold, was used. Inedible objects were removed from the subject's mouth, but not her hand, during both baseline and treatment. During treatment each occurrence of pica resulted in the covering of the subject's eyes with a blindfold for 1 min. Pica was rapidly suppressed as the treatment was introduced sequentially in each of three settings in a multiple baseline design. It was further reduced to near-zero levels during later ward-wide maintenance and follow-up. Antecedents of pica, picking and handling inedible objects, also decreased to low levels without receiving special attention. Other untreated collateral behaviors, stereotypy, destructive and aggressive behaviors and social interactions with staff and other residents, which occurred at various levels initially, showed generally positive changes although these were sometimes small.

Topics: Adult; Aggression; Aversive Therapy; Behavior Therapy; Female; Humans; Institutionalization; Intellectual Disability; Interpersonal Relations; Pica; Sensory Deprivation; Stereotyped Behavior

Overcorrection and physical restraint procedures have been shown to be effective in controlling certain classes of maladaptive behavior in mentally retarded persons. In the present study, an alternating treatments design was used to measure the differential effects of overcorrection and physical restraint procedures in the treatment of pica. Changes in collateral behaviors were also monitored. Each occurrence of pica was followed by either an overcorrection procedure or a physical restraint procedure. Although both procedures reduced the occurrence of pica and had a similar effect on the occurrence of collateral behaviors, physical restraint was clinically more effective in terms of immediate response reduction.

Topics: Adult; Female; Humans; Intellectual Disability; Overlearning; Pica; Restraint, Physical; Stereotyped Behavior

The present study supported the finding of Bucher et al. (1976) that physical restraint can control pica. However, unlike the earlier study which additionally used a verbal reprimand, physical restraint alone was shown to be effective. Further, this study showed that while all three durations of physical restraint suppressed pica, the duration of 10 s was more effective than either 30 s used with one subject, or 3 s used with the other in alternating treatments designs. The procedure proved simple to use, took minimal staff training time, and required no equipment. During treatment some increase in pica was observed in settings where treatment had not yet been applied but later treatment in these settings quickly controlled the behaviour. Collateral behaviours were largely unaffected except for picking and handling, a precursor for pica, which showed variable changes, with reductions being the only large changes.

Topics: Adult; Aggression; Aversive Therapy; Child; Humans; Inpatients; Intellectual Disability; Male; Pica; Restraint, Physical; Stereotyped Behavior; Time Factors

Topics: Adolescent; Adult; Aged; Child; Diet; Female; Hair; Humans; Intellectual Disability; Male; Middle Aged; Pica; Zinc

A study population consisting of 66 mentally retarded individuals, 60 with and six without pica, was evaluated for iron status, and for plasma and hair zinc, copper, and magnesium levels within a month of known dietary intake. The parameters were all within the normal range for individuals without pica. In contrast, subjects practicing pica had low plasma zinc and elevated plasma copper values as compared to those without pica. Plasma magnesium was in the low normal range for all individuals in the study population. Among the indicators of iron status measured, Hb, hematocrit, plasma iron, total iron-binding capacity, iron saturation, and plasma ferritin, several values were low (p less than 0.001). Depression in plasma zinc level was related to the type and severity of the pica. In plasma, zinc was positively correlated with iron and negatively correlated with copper. No relationships were found between dietary intakes and plasma levels of these minerals. The data suggest that malabsorption of zinc and iron were associated with some types of pica although the individuals received adequate dietary intake of minerals. Zinc, copper, and magnesium concentrations in hair were within normal ranges. Hair was a less sensitive indicator than plasma of trace element status.

Topics: Adolescent; Adult; Aged; Copper; Diet; Female; Hair; Humans; Intellectual Disability; Iron; Magnesium; Male; Middle Aged; Pica; Trace Elements; Zinc

Pica was recognized in 25.8 percent of a population of 991 institutionalized mentally retarded adults. Food pica accounted for 5.4 percent, nonfood pica for 16.7 percent, and combination food and nonfood pica for 3.7 percent of the population. Pica became less frequent with increasing age, related to a reduction in the incidence of nonfood pica. Food pica was not age-related. Low IQ was associated with a high frequency of nonfood pica. The items consumed were classed into 29 nonfood and 7 food categories. Some medical complications such as intestinal obstruction and surgery secondary to foreign body ingestion occurred only in those with pica. Gastrointestinal parasites occurred more frequently in individuals with pica.

Topics: Adolescent; Adult; Aged; Child; Female; Foreign Bodies; Humans; Intellectual Disability; Intelligence; Male; Middle Aged; Pica; Seasons

A diagnosis of chronic lead poisoning in a mentally retarded adult with pica was initially proposed because of the presence of a "lead line" on the patient's gingiva. The patient had no other signs or symptoms suggestive of her toxic state. Lead poisoning is reviewed from the standpoint of epidemiology, pathophysiology, clinical and oral manifestations, and diagnostic procedures. Dentists working with children or mentally retarded patients should be aware of the increased incidence of lead poisoning in these patient populations and the importance of oral findings and lead-screening techniques in the detection of lead poisoning.

Topics: Chronic Disease; Female; Gingival Diseases; Humans; Intellectual Disability; Lead Poisoning; Middle Aged; Pica; Pigmentation Disorders

Research findings on the effects of raised lead levels on children's cognitive and behavioural functioning are reviewed. The results are considered separately with respect to clinic-type studies of children with high lead levels, studies of mentally retarded or behaviourally deviant children, chelation studies, smelter studies, and general population studies of dental lead. It is concluded that, although the findings are somewhat contradictory, the evidence suggests that persistently raised blood levels in the range above 40 microgram/100 ml may cause slight cognitive impairment (a reduction of one to five points on average) and less certainly may increase the risk of behavioural difficulties. There are pointers that there may also be psychological risks with lead levels below 40 microgram/100 ml, but the evidence on this point is inconclusive so far. Parallels are drawn with studies of other brain traumata and some suggestions are made with respect to both practical implications and the needs for further research.

Topics: Adolescent; Child; Child Behavior Disorders; Child Development; Child, Preschool; Cognition Disorders; Humans; Intellectual Disability; Lead; Lead Poisoning; Motor Skills; Pica

Topics: Adult; Behavior Therapy; Female; Generalization, Response; Generalization, Stimulus; Humans; Intellectual Disability; Male; Pica

Topics: Adult; Female; Humans; Intellectual Disability; Intestinal Perforation; Male; Pica

Topics: Child; Child Behavior Disorders; Dentin; Dose-Response Relationship, Drug; Environmental Exposure; Environmental Pollution; Female; Humans; Infant; Intellectual Disability; Intelligence; Lead; Lead Poisoning; Maternal-Fetal Exchange; Pica; Pregnancy

Visceral larva migrans, Entamoeba coli, evidence of latent toxoplasmosis and a history of plumbism were found in an emotionally disturbed, retarded child. Patients with pica should be screened for parasitism and other diseases transmitted orally.

Topics: Child; Diagnosis, Differential; Drug Hypersensitivity; Entamoebiasis; Eosinophilia; Humans; Intellectual Disability; Larva Migrans, Visceral; Lead Poisoning; Male; Pica; Psychotic Disorders

Topics: Hospitalization; Humans; Intellectual Disability; Intelligence; Lead; Pica

Topics: Behavior Therapy; Female; Humans; Intellectual Disability; Middle Aged; Pica; Practice, Psychological; Self Mutilation

Reported is a case representing an unusual form of geophagia, in which ingestion of pebbles by a 27-year-old mentally retarded woman resulted in impaction and complete filling of the colon with pebbles. Conservative therapy was successful in clearing the stones by the sixth day of treatment; however, a follow-up visit approximately six weeks later revealed that the patient was again ingesting pebbles.

Topics: Adult; Female; Humans; Intellectual Disability; Pica; Soil

Topics: Behavior Therapy; Child; Humans; Intellectual Disability; Pica; Research

Twenty-seven asymptomatic children with confirmed chronic increased lead absorption were compared with 27 matched control children for evidence of neuropsychological impairment. Evaluation of each child included a complete history, physical examination, quantitative neurological tests, and comprehensive psychological tests. There was significantly increased incidence of hyperactive behavior in the subjects with increased lead levels, but there was no significant difference in any of the quantitative test results. Uncontrolled variables, especially lead absorption in infancy and adverse environmental pressures other than lead, still leave questions about the relationship between chronic lead exposure and behavior of intelligence.

Topics: Chelating Agents; Child; Child, Preschool; Chronic Disease; Coproporphyrins; Feeding Behavior; Female; Humans; Hyperkinesis; Intellectual Disability; Lead; Lead Poisoning; Male; Medical History Taking; Neurologic Examination; Perceptual Disorders; Pica; Psychological Tests; Socioeconomic Factors; Urban Population; Wechsler Scales

Topics: Adult; Behavior Therapy; Female; Human Coprophagia; Humans; Hygiene; Intellectual Disability; Intestinal Diseases, Parasitic; Male; Oral Hygiene; Pica

Topics: Abnormalities, Drug-Induced; Age Factors; Air Pollutants; Air Pollution; Brain Diseases; Child; Child, Preschool; Electroencephalography; Female; Humans; Intellectual Disability; Lead; Lead Poisoning; Maternal-Fetal Exchange; Motor Skills; Paint; Pica; Pregnancy; Seizures

Topics: Adenoma; Adolescent; Electroencephalography; Epilepsy; Humans; Intellectual Disability; Language Disorders; Male; Motion Pictures; Pica; Pneumoencephalography; Sebaceous Gland Neoplasms; Sleep; Tuberous Sclerosis

Topics: Adolescent; Child; Child, Preschool; Edetic Acid; Feeding and Eating Disorders; Feeding Behavior; Humans; Intellectual Disability; Lead; Lead Poisoning; Pica

Topics: Child; Feeding and Eating Disorders; Humans; Intellectual Disability; Lead Poisoning; Pica; Toxicology