Assessment and treatment of pica within the home setting in Australia.

Abstract

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.

A brief assessment of pica

“…In addition to the study being conducted in an efficient format, the methodology described in Study 2 of this paper described a process for safely conducting FAs of pica in a home. This aspect of the study replicated previous studies focused on assessing pica in naturalistic settings (i.e., Ledford et al, 2019;Taylor, 2020). While pica can be dangerous and require safety precautions, hospital or clinical settings may not be available to all practitioners attempting to assess the behavior.…”

“…One reason is that there are few published assessments of pica that describe FA methodology used in settings other than hospitals or other contrived clinical settings. Two studies that do describe FAs of pica in applied settings are Ledford et al (2019) and Taylor (2020). Ledford et al, described procedures for conducting a FA of pica on a preschool playground, and Taylor described procedures for conducting a FA on pica within a home setting.…”

A review of response interruption and redirection: 2007–2021

“…The following diagnoses were represented in at least one participant across studies as displayed in Figure 1: ASD (97.61%, 41/42 studies); PDD‐NOS (Pervasive Developmental Disorder‐Not Otherwise Specified; 4.76%, 2/42: Ahearn et al., 2007; Dickman et al., 2012); communication delay (2.38%, 1/42: Miguel et al., 2009); Trisonomy 9 (2.38%, 1/42: Wunderlich & Vollmer, 2015); intellectual disability (7.14%, 3/42: Hagopian et al., 2011; Schmidt et al., 2017; Wunderlich & Vollmer, 2015); pica (7.14%, 3/42: Hagopian et al., 2011; Schmidt et al., 2017; Taylor, 2020); fetal hydantoin syndrome (2.38%, 1/42: Hagopian et al., 2011); seizure disorder (2.38%, 1/42: Hagopian et al., 2011); ADHD (4.76%, 2/42: Hagopian et al., 2011; Schmidt et al., 2017); feeding disorder (2.38%, 1/42: Schmidt et al., 2017); global developmental delay (2.38%, 1/42: Gould et al., 2019). These results indicate that RIRD research has largely been conducted with children and young adults and is almost exclusively centered around individuals with an autism diagnosis.…”

“…Many studies used a functional analysis (FA) or other form of functional assessment to determine the function of target behavior (78.57%, 33/42). A large percentage of studies (78.78%, 26/33 of studies which conducted an FA) conducted a traditional FA(Iwata et al, 1982(Iwata et al, /1994, while five studies (15.15%, 5/33:Cividini-Motta et al, 2019, 2020Gould et al, 2019;Shawler et al, 2020;Toper-Korkmaz et al, 2018) used an alone screen (as described byQuerim et al, 2013). Cividini-Motta et al (2020) conducted an attention screen in addition to an alone screen for one of their participant's public masturbations in order to determine whether the behavior was maintained by attention.…”

“…Figure2shows the percentage for each topography of collateral behavior evaluated in the studies reviewed. Topographies included appropriate vocalizations (62.96%, 17/27 studies which assessed collateral behavior), play (11.11%, 3/27:Boyd et al, 2011;Cividini-Motta et al, 2019;Saini et al, 2015), on-task behavior (7.40%, 2/27:Barszcz et al, 2021;Gibbs et al, 2018), holding objects (3.70%, 1/27:Boyd et al, 2011), heart rate (3.70%, 1/27:Frewing et al, 2015), vocal stereotypy (3.70%, 1/27:Pastrana et al, 2013), trashcan disposal of inedible items as an alternative to pica (11.11%, 3/27:Hagopian et al, 2011;Schmidt et al, 2017;Taylor, 2020),…”