Functional Analysis and Treatment of Severe Pica

Abstract

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.

Clinical Evaluation of the Self‐injurious Behavior Inhibiting System (Sibis)

“…Recent advances in the experimental analysis of behavioral function for disorders such as aggression (Carr, Newsom, & Binkoff, 1980), pica (Mace & Knight, 1986), SIB (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982), and multiple behavior problems (Sturmey, Carlsen, Crisp, & Newton, 1988) suggest the possibility of matching the operational features of intervention with the motivational aspects of behavior, thereby increasing the likelihood of obtaining positive clinical outcome (e.g., Iwata, Pace, Kalsher, Cowdery, & Cataldo, 1990;Repp, Felce, & Barton, 1988;Steege, Wacker, Berg, Cigrand, & Cooper, 1989). Based on promising data reported by these and other researchers, some observers (e.g., LaVigna & Donnellan, 1986) SIB has been particularly resistant to treatment through solely nonaversive means.…”

Treatment of Life-Threatening Pica with 5-Year Follow-up

“…However, response blocking, contingent aversive consequences, and the use of seclusion, restraint, and protective devices, which are some of the most common approaches to managing severe pica (Sturmey and Williams 2016), can also be associated with a variety of negative outcomes. Restrictive behaviour management practices have been associated with a failure to effectively prevent the occurrence of pica (Mace and Knight 1986), a contribution to the onset of physical aggression and other collateral behaviours (Hagopian and Adelinis 2001;Lerman et al 2003), a reliance on or development of preference for restraints (Kahng et al 2008;Singh et al 1984), restraint-related physical injury (Singh et al 2009), social stigmatization (Sturmey and Williams 2016), and detriments to the individual's quality of life (Rojahn et al 1987).…”

“…These procedures have included the arbitrary use of restraint and punishment, overuse of protective equipment, and high doses of psychotropic medication (Brahm et al 2006;Ferreri et al 2006;Foxx and Martin 1975;Ginsberg 2006;Hagopian and Adelinis 2001;Mace and Knight 1986;Pace and Toyer 2000). However, Carter et al (2004) noted that over the last several decades, treatment has begun to rely less on intrusive procedures and trended towards function-based interventions informed by an individualized functional analysis.…”

Behavior disorders among the institutionalized mentally retarded: Challenging people, challenged practices, challenged placement

“…This includes: self-injury (Iwata et a]., 1982), stereotypy (Sturmey, Carlsen, Crisp, & Newton, 1988), aggression (Carr, Newsom, & Binkoff, 1980), property destruction (Slifer, Ivancic, Parrish, Page & Burgio, 1986), and pica (Mace & Knight, 1986). Methods for examining these types of contextual maintaining factors have involved some variant of either analog experimental analysis or naturalistic correlational analysis (Axelrod, 1987).…”