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Pica

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I am looking to connect with other professionals who work with children and adolescents in particular who display pica behaviour.  I am working with a colleague to collect more information about the basis for this behaviour and in particular how this behaviour fits with other eating behaviours (such as very avoidant and restrictive diets) in young people with ASC.  I am currently working with a number of young people who display very potentially risky pica because of the objects they are ingesting and any additional case information or ideas for interventions would be welcome.    

Edited on February 23, 2017 - 9:07am

Nathalie Dick

October 01, 2014 - 3:36pm

Hi Elizabeth

Autism Data has some articles on pica:

Title: Magnetised intragastric foreign body collection and autism
Authors: Rashid F.; Davies L.; Iftikhar S.Y.
Source: Autism, 2010, 14(2), pp. 139-145
Abstract: The pica phenomenon, where non-edible substances are repeatedly consumed, has been linked with
developmental and behavioural disorders, particularly autism. The clinical presentation of foreign body ingestion in patients with autism is discussed, and recommendations for caregivers are provided based on the available literature. An 18-year-old man with severe autism and behavioural difficulties presented with a vague history of decreased appetite and melaena of eight months duration. Foreign body ingestion commonly occurs in individuals with autism spectrum disorders and should be suspected in patients who present with vague gastrointestinal symptoms. The adverse medical and surgical consequences of foreign body ingestion emphasize the need for early recognition.
 
Title: An all-consuming problem
Authors: Waltz M.
Source: Autism Eye, 2013, Autumn, pp. 32 - 37
Abstract: This article discusses pica - why does it happen, and what can be done about it? Possible causes, looking at
diets and food intake, sensory components in relation to behaviour and techniques that may tackle the problem are
investigated.
Publication Date: 2013
Availability: Available from the NAS Information Centre
 
 
Title: Pica in persons with developmental disabilities: Approaches to treatment
Authors: Matson J. L. et al
Source: Research in Developmental Disabilities, 2013, Vol. 34(9), pp. 2564-2571
Abstract: Pica is a very serious problem in which an individual ingests substances without nutrition value, such as paper and paint. As this behaviour is often life-threatening resulting in surgery, pica has received attention from researchers for several decades. During that time, a number of interventions have been devised, such as behavioural methods (e.g., aversive stimuli, overcorrection, time-out, reinforcement) and biological interventions (e.g., pharmacotherapy, nutritional supplements). This paper is a broad review of the research on treatment studies for this problem, with a focus on persons with autism and/or intellectual disability (ID), which constitutes almost all of the published treatment papers. In addition, strengths and weaknesses of different pica treatments are discussed. Upon review, applied behaviour analysis (ABA) was found to have the most robust empirical support to treat this behaviour. Most clinicians are drifting away from aversive techniques and relying on more positive procedures to guide their treatment plans. The implications of current status and future directions for research are also addressed.
Publication Date: 2013
Address: J. L. Matson, Louisiana State University, United States; email: johnmatson@aol.com
 
 
Title: Pica in persons with developmental disabilities: Characteristics, diagnosis, and assessment
Authors: Matson J. L. et al
Source: Research in Autism Spectrum Disorders, 2011, Vol. 5(4), pp. 1459-1464
Abstract: Pica is a very serious and often life threatening problem which occurs largely in persons with developmental disabilities. The topic has received sporadic attention from researchers for several decades. This paper reviews definitions, diagnostic implications, causes, prevalence, and assessment methods that have been described in the research literature. A review of available studies is presented and the current state of our knowledge with respect to these areas is covered. The implication of these findings and future areas of research are discussed.
Publication Date: 2011
Address: Johnny L. Matson, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana 70803, USA; email: johnmatson@aol.com
 
Availability: Available from the NAS Information Centre
 
 
Title: Magnetised intragastric foreign body collection and autism
Authors: Rashid F.; Davies L.; Iftikhar S.Y.
Source: Autism, 2010, 14(2), pp. 139-145
Abstract: The pica phenomenon, where non-edible substances are repeatedly consumed, has been linked with
developmental and behavioural disorders, particularly autism. The clinical presentation of foreign body ingestion in patients with autism is discussed, and recommendations for caregivers are provided based on the available literature. An 18-year-old man with severe autism and behavioural difficulties presented with a vague history of decreased appetite and melaena of eight months duration. Foreign body ingestion commonly occurs in individuals with autism spectrum disorders and should be suspected in patients who present with vague gastrointestinal symptoms. The adverse medical and surgical consequences of foreign body ingestion emphasize the need for early recognition.
 
Availability: Available from the NAS Information Centre
 
There is also some information on the NAS website.
 
I hope this helps.
 
Best wishes
 
Nathalie 
Network Autism Team

 

October 01, 2014 - 3:51pm

Many thanks Nathalie, I appreciate the references.  I have some of these already as I am putting together a review of the literature for a conference on Childhood Feeding Disorders in November where I am hosting a workshop and networking opportunity for professionals who are working with children and adolescents with pica.  I am particularly interested in gathering more case information from parents and from other professionals as together with colleagues who work in the field of eating feeding behaviour we are trying to understand the overall eating pattern of these young people.  My background is in eating issues in ASD (I spoke at the NAS conference this year and am writing a piece for Network Autism for publication in November) and I am currently doing some work with children and adolescents with ASD & severe LD and have a number of cases myself I am trying to better understand. I am particularly interested in understanding more about the eating behaviour of those children who have very avoidant and restrictive diets (which is typical of ASD) but who also display pica from a developmental point of view. Thanks again for the very useful references.

 

 

October 02, 2014 - 12:51pm

Hi Elizabeth,

I work in a residential school for children with ASD and ID. I would beinterested in working on links between eating behaviours, dietary preferences and pica. We have a number of children who regularly eat leaves in our grounds, and a group of children with restricted diets. The childrens' diets remain a source of concern for the parents. Perhaps you could contact me on timothy.williams@reading.ac.uk to chat about how to take this forwards?

Anne Adams

October 02, 2014 - 2:12pm

Hi Elizabeth

I am Headteacher at a residential school for children with ASC and additional needs -pica & dietary preferences is an issue for some of our students - we would be interested in being involved in discussions in this area.

Fel free to get in touch

anne.adams@higfordschool.co.uk

Anne

October 02, 2014 - 4:01pm

Thanks Tim and Anne.  I am particularly interested in what young people are ingesting (as opposed to mouthing), what ages it starts and how this might fit with their developmental (as opposed to their chronological age).  We are also looking to see which young people also restrict their food intake as these behaviours ought to oppose each other (in that children with avoidant and restrictive eating usually have high disgust responses and refuse to put anything in their mouth they are not sure about). Gathering more case study information will help us all have a better understanding.  As a clinician also I have several children with this behaviour on my caseload, including one who is potentially very risky because of what he is ingesting, so I am keen to find strategies that I can use in my practice too.  

Thanks, any information we can share about what has worked will be helpful. I've emailed you both separately also so we can continue to communicate.

Liz 

October 14, 2014 - 1:57pm

I'd be really interested in hearing more about this too. I've worked with adults in the past who have ingested non-food items, cigarette ends, paper and plastic were particularly noticable. I'm now a trainer and it comes up as a frequent topic during training, particulalry during the sensory course.

I can try and start asking more specific questions about what they are ingesting and how their other food intake.

My email is lorraine.macalister@nas.org.uk

Lorraine

October 14, 2014 - 3:18pm

Hi Lorraine 

Those are precisely the types of information that myself and colleagues are interested in.  We have begun to develop a preliminary model that looking at how pica  may sit within a developmental feeding framework   Examples of cases or anything that you have been able to ascertain is driving the behaviour in individuals will help also, particularly in children where there is very little literature.  As a clinician I see cases myself and frequently run out of bright ideas for interventions so any additional ideas you may have would be very welcome.  I am currently putting together some information for a conference in a few weeks.  My email is elizabeth.shea@foodrefusal.co.uk if you want to get in touch directly.

BW 

Liz 

http://www.ucl.ac.uk/ich/education-ich/events/International_Feeding_Diso...

Nathalie Dick

February 17, 2015 - 11:48am

Medical News Today reports on research that suggests behavioural therapy is effective in treating pica in children with autism: see our News today.