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Autism and Pica: Study Shows Behavioral Intervention Can Reduce Danger

A review of autism treatment records identifies behavioral strategies that reduce tendency to eat dangerous nonfood items
February 11, 2015

A new report finds that behavioral therapy can effectively curb pica – the dangerous tendency to eat things that aren’t food. Pica is common among those with autism and can require constant vigilance from caregivers trying to prevent it. 

The report appears this week in the Journal of Autism and Development Disorders. In it, the researchers identify several intervention strategies that appear particularly helpful.

Behavioral therapists have long tried to curb pica in children with autism. Previous reports, based largely on individual cases, have supported different approaches. But none of these reviews have demonstrated which strategies, if any, are most effective.

“Because even one instance of pica can be life threatening, the goal of treatment should be the behavior’s complete elimination,” comments behavior analyst Kara Reagon, Autism Speaks associate director of dissemination science. Dr. Reagon was not directly involved in the new study.

The researchers, with Atlanta’s Marcus Autism Center, reviewed treatment records for 11 children with autism, ages 3 to 19, who received behavioral intervention specifically for pica. Most of the children also had intellectual disability. All were first screened for nutritional deficiencies, which sometimes trigger pica.

By way of example, one 19-year-old had been hospitalized several times for eating dangerous objects including a swimming-pool chlorine tablet and an open safety pin. As a group, the children had swallowed a wide range of dangerous objects including glass, nails, small toys, ornaments, paint chips, sticks, rocks and paper.

The behavioral intervention program consisted of 10-minute sessions in which the therapist worked with a child in the presence of tempting inedible objects. The goal was for a child to complete three consecutive 10-minute sessions without attempting to place an inedible object in his or her mouth.  

In all but one child, the intervention program reduced the number of pica attempts by more than 90 percent (compared to the first session). Three of the children stopped eating inedible objects entirely, and another five achieved a 97 percent or better reduction.

The most-effective strategies
The children varied widely in how many sessions it took to curb their pica – from three to 87. And the therapists tailored their interventions to each child using a combination of approaches. Yet within this variation, the researchers identified a combination of three strategies that appeared particularly helpful:

1. Rewarding the child with a small treat for discarding or putting away an inedible object in an appropriate way – for example, in the trash.

2. Redirecting the child’s attention from the inedible object to a favorite activity.

3. Shadowing a child to block attempts at eating inappropriate objects. This could be verbally or through a gentle but firm physical restraint. While effective in the short term, blocking didn’t have a lasting effect on curbing pica.

The therapists also involved parents or other caregivers in the sessions, so that they could learn the techniques and continue them at home.

“With its varying results, this report reinforces what we know about the need to individualize treatment programs for each individual with autism and pica,” Dr. Reagon comments. “More research is needed on how well and how long these strategies continue to curb pica after the therapy sessions are over.”

To learn more about pica and its treatment, see Pica: A Guide for Parents and Pica: A Guide for Professionals. Follow the title link to download these Autism Speaks ATN/AIR-P tool kits, free of charge, from the Autism Speaks website.