Assessment and Treatment of Pica Within the Home Setting in Australia
Tessa Taylor Paediatric Feeding International, Sydney, New South Wales, Australia, and
University of Canterbury
Pica is one of the most serious, life-threatening topographies of self-injurious behavior because a single instance can result in death. Despite this, there is a need for more research on teaching adaptive skills to replace pica, particularly outside of intensive specialized hospital admissions and with younger children. We present a case history of a 4-year-old male with autism spectrum disorder, pica, food selectivity, and food stealing in which assessment and treatment occurred in the family’s home. A functional analysis suggested pica was maintained by automatic reinforcement. A competing stimulus assessment showed pica was highest without competing stimuli, lowest with highly preferred edibles, and lower with highly preferred tangibles. Response interruption and redirection with differential reinforcement was effective with and without competing stimuli across contexts. The participant learned to independently throw away, put away, and use appropriately some materials and to refrain from touching other items he previously consumed inappropriately. Pica decreased by 97%, independent discards increased by 100%, and 100% of admission goals were met. His mother and therapist were trained to high procedural integrity on the treatment procedures, and they continued testing for generalization and maintenance. His mother reported high satisfaction with the program and outcomes and acceptability of the treatment procedures. Gains were maintained for over 2 years.
Keywords: pica, pediatric feeding disorders, food selectivity, autism spectrum disorder, avoidant/restrictive food intake disorder
Pica, the persistent eating of nonnutritive sub- stances, is a serious and life-threatening self-injurious behavior, as just one instance can result in death (American Psychiatric Association, 2013; Williams & McAdam, 2012). Examples of serious risks include choking, intestinal obstruction and per- foration, toxicity (e.g., lead paint), and the in- gestion of parasites (Matson, Belva, Hattier, & Matson, 2011; Stiegler, 2005). Physicians have published case examples of x-rays and surgical
pictures depicting large hair balls, strings, and disposable gloves spanning the colon, requiring surgery and loss of tissue; glass or screws tear- ing or getting stuck in the gastrointestinal sys- tem; and batteries that have been swallowed (Matson et al., 2011; Stiegler, 2005).
Functional analyses of pica most often identify automatic reinforcement (Call, Simmons, Mevers, & Alvarez, 2015; Hagopian, Rooker, & Rolider, 2011). That is, individuals who engage in pica
X Tessa Taylor, Paediatric Feeding International, Syd- ney, New South Wales, Australia, and Department of Psy- chology, Speech and Hearing, and School of Health Sci- ences, University of Canterbury.
This case history was presented as an invited presenta- tion at the Telethon Institute’s Autism Update Symposium: Research Into Practice in Perth, Australia, in 2018. It was also presented at the biannual conference of the Hellenic Community for Behavior Analysis in Athens, Greece, in 2017, and at the annual meetings of the Association for Behavior Analysis Australia in Sydney, Australia, in 2017. The author reports no conflicts of interest. This case history
was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments and the American Psychological Associa- tion’s ethical standards in the treatment of humans. Thank you to Hebert’s early intervention team including Susan Petrie and Kayleigh Smith of Beanstalk Child Psychology. Thank you to Nikolas Roglić for assistance with data analysis and video scoring.
Correspondence concerning this article should be ad- dressed to Tessa Taylor, Paediatric Feeding International, Double Bay, Sydney, New South Wales 2028, Australia. E-mail: DrTaylor@PaediatricFeedingIntl.com