Handbook of Evidence-based Practice in Clinical Psychology. Behavioral interventions to reduce the pica of persons with developmental disabilities. Perspectives on The Use of Non-Aversive and Aversive Interventions for Persons with Developmental Disabilities. Least restrictive use of reductive procedures: guidelines and competences. Education and Training in Developmental Disabilities, 39, 346–358. Pica: A review of recent assessment and treatment procedures. Journal of Intellectual & Developmental Disability, 26, 205–215.Ĭarter, S. Pica in people with intellectual disability: A literature review of aetiology, epidemiology and complications. Structured activities and increased engagement to prevent boredomĪli, Z. Oral sensory stimulation - safely chew objects Unlimited access to nutritive substances (limit one hour before meals)įoods of diverse texture, density, and strong flavorĪlternative sensory stimulation - tactile, temperature, visual, sound, taste Further treatment options should be discussed with the individuals’ health care providers. Treatment focuses on distracting and providing alternative stimulation that satisfies the individuals’ sensory needs. Prevention is the most effective treatment for pica in individuals with developmental or intellectual disabilities. Respiratory distress (wheezing, pain, difficulty breathing)īehavior changes (irritability, routine change, restlessness, new repetitive behavior) In some instances, hospitalization and invasive surgery may be required. Ingestion of non-food items can cause airway obstruction, dental injury, poisoning, infectious disease, gastrointestinal obstruction, and other internal injuries.
Referral for medical evaluation may be based on observation of ingestion, discovery of a missing item, self-report by the individual, or physical symptoms. Limit observance of behaviors by others (chewing on hair, pens, etc.)Īppropriate and timely medical evaluation is important when it is discovered or suspected that an individual has ingested a non-food substance. Remove easily ingestible items such as pens, erasers, paper clips, etc.Įnsure decorative items on clothing and toys are well-secured (buttons, snaps, patches, strings).Įvaluate materials that may be worn or easily disassembled (worn clothing, bedding, toys). Secure devices with small batteries (remotes, toys, clocks). Pay special attention to pleasantly scented items (wet-wipes, hand sanitizer, lotions). Store all medical and cleaning supplies out of reach or in locked cabinets (latex gloves, medication cups, thermometers, Band-Aids, bottles/aerosol with removal caps). Restrict access to garbage and compost (including cigarette butts, food waste, paper products). Routinely monitor areas utilized by the individual with pica tendencies. Additionally, visitors and caregivers should be educated on the disease and trained in prevention and treatment. Individuals with a history of pica should be clearly identified and their “favorite” non-edible items should be identified. Clear “House Rules” and regular sweeps aim to prevent access to pica hazards. Negative Reinforcement: Swallowing relieves some bad feeling.Ĭannot discriminate between food/non-food due to intellectual disability or developmental level.Ī safe living environment requires constant vigilance on the part of caregivers and visitors. Positive Reinforcement: Swallowing or chewing feels good and provides sensory stimulation. While there is some support for cultural practices or nutritional deficiencies leading to increased rates of pica, in individuals with intellectual disabilities, literature suggests stronger relation to behavioral, developmental, and other cues driving behavior. Prior to the age of 18 months, pica is considered developmentally appropriate. Pica behaviors can be seen in all cultures however prevalence is greatly increased in cultures that accept the practices and in individuals with intellectual disabilities. Risks of pica are discussed below but may include infection, respiratory obstruction, or gastrointestinal obstruction. Practically the illness is characterized by a pattern (more than once in 1 month) of ingesting (eating vss mouthing) inedible materials (rocks, rubber gloves, hair, etc.). Pica is one of the most common eating disorders among individuals with autistic spectrum disorder and intellectual disabilities.
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