Categories: ASD and DD, Child-focused
Pica (pronounced “pike-ah”) is a very dangerous disorder characterized by craving or ingesting inedible items. The word pica originates from the Latin word for magpie, a bird with a ravenous appetite known to eat just about anything.
Pica is not as rare as one might think. The disorder is commonly seen in women who are pregnant and in small children. Pica behavior is also exhibited by a number of individuals with autism and other developmental challenges. For these individuals, the behavior can be especially difficult to prevent and address, and may require special safety measures to minimize the level of risk in the home and community.
The exact cause of pica is not known, but research suggests gastric parasites, obsessive-compulsive disorder, Prader-Willi syndrome, sickle cell disease, mental illness, and/or traumatic brain injury as potential causes. There are also many studies that point to iron deficiency as the source. The theory is that due to low levels of iron in the body, some people ingest inedible items in an attempt to supplement the deficiency.
A person with pica may eat dirt, rocks, screws, nails, hair, feces, crayons, glue, cleaning supplies, plastic, erasers, buttons, paint chips, chalk, wood, glass, needles, rubber bands, cigarette butts, and/or wire. While some of these items may not lead to significant medical complications, others can cause poisoning, bowel obstructions or perforations, malnutrition, and even death.
Unfortunately, pica is often discovered after an individual has already ingested the inedible item. In many cases, it is diagnosed in a hospital emergency room after a person has been transported there because of a physiological reaction such as vomiting, constipation, fever, or rectal bleeding caused by the ingestion of the inedible item.
Pica is a difficult disorder to treat, but there are a number of ways to make the environment safer and minimize an individual’s risk of ingesting inedible items. Increased supervision and monitoring are crucial, but may not be enough for someone who is constantly seeking inedible items to consume. It may be necessary to modify the environment. This might include installing locks on cabinets or drawers used to store items such as pushpins, batteries, and other potentially ingestible items. It might also include putting safety latches on refrigerators or locking trashcans to prevent the individual from accessing uncooked or spoiled food items.
Conducting thorough and frequent “sweeps” or inspections of the environment, and removing potentially ingestible items from the area must become a standard practice within the individual’s home, vehicle, and community.
One of the most important ways to prevent pica is to provide safe, healthy, and appropriate alternative food items that an affected person can access whenever he or she has cravings. Teaching him or her to discriminate between edible and inedible foods can be difficult, but it can be accomplished through effective behavior programming and skill training.
It is also possible to teach the individual to dispose of the inedible item. His or her Behavior Support Plan, Individual Service Plan, and/or Individualized Education Program should outline all training procedures, safety measures, and restrictions that must be approved by the members of the treatment team. These plans must also be reviewed and approved by a formal Human Rights Committee.
As family, friends, and caretakers of individuals with intellectual disabilities, our job is to provide safe and healthy living environments. By implementing effective safety measures, providing access to healthy alternative food items, increasing supervision, and teaching appropriate behavior, we can protect the individuals we support, and help them live long and productive lives.
By Teka J. Harris, M.A., BCBA