Brief assessment and treatment of pica using differential reinforcement, response interruption and redirection, and competing stimuli

Abstract

Pica is a life threating form of challenging behavior displayed by individuals with intellectual and developmental disabilities. In most cases, pica is maintained by automatic reinforcement. Common interventions for pica use some combination of response blocking, response interruption and redirection (RIRD), differential reinforcement of alternative behavior (DRA), and noncontingent reinforcement with competing stimuli. However, there is need for additional research regarding DRA procedures that emphasize skills acquisition by teaching alternative behaviors that modify the established behavioral chain of pica responses that occur in the presence of non-edible stimuli. There is also a need to examine the generality of recent advances in competing stimulus assessment (CSA) methodologies-namely, the augmented-CSA (A-CSA)-to pica. Thus, the purpose of the present investigation was to systematically replicate and extend previous research for the assessment and treatment of pica in an individual with IDD. First, we conducted a functional analysis to identify environmental variables associated with pica. Next, taught Patrick a differential response (i.e., discard pica items in trash receptacle) to earn reinforcers in conjunction with a RIRD procedure. Finally, we conducted an A-CSA for pica. Overall, low rates of pica were maintained over time with a combination of these procedures, and treatment was generalized across settings and people.

Parent treatment of complex pica in a teen with autism

“…A second solution may be to evaluate an entirely different treatment(s) depending on the severity of the behavior (see Moline et al for a review). For example, CS approaches have been combined with DRA of discarding pica-related substances with some success (e.g., Hagopian, Rooker et al, 2011;Hagopian, González et al, 2011;Ruckle et al, 2022;Taylor, 2020). The DRA discard approach was not appropriate for Maude for two reasons.…”

“…To promote increased item engagement, the augmented CSA (A‐CSA) involves additional components, such as response blocking and/or interruption (e.g., Ahearn et al., 2007), prompting engagement with the items to promote more sustained engagement and potential competition with the function of pica (Hagopian et al., 2020; Jennett et al., 2011) and differential reinforcement of item engagement (Leif et al., 2020). Within the pica treatment literature, CS‐based studies have most commonly included prompted engagement along with blocking or interruption (e.g., Hagopian, Rooker et al., 2011; Hagopian, González et al., 2011; Ruckle et al., 2022). Thus, while identification of items that sustain engagement without social mediation may not require as much effort, or continuous supervision, additional treatment components may be necessary to produce clinically significant results.…”

Pica in a girl with non-suicidal self-injury: a case report

“…In contrast, behavioral treatments show more promise as a potent means of preventing pica ( 17 ). Typical interventions for pica often involve response blocking, differential reinforcement of alternative behavior (DRA), response interruption and redirection (RIRD), and noncontingent reinforcement using competing stimuli ( 18 ). In line with earlier findings, her impulsive self-injury behaviors are directed towards either alleviating dysphoria or seeking pleasure ( 19 ).…”