Pica in individuals with developmental disabilities

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Pica in individuals with developmental disabilities

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Autism and Child Psychopathology Series Series Editor: Johnny L Matson Peter Sturmey Don E. Williams Pica in Individuals with Developmental Disabilities Autism and Child Psychopathology Series Series editor Johnny L Matson, Baton Rouge, LA, USA More information about this series at http://www.springer.com/series/8665 Peter Sturmey Don E Williams • Pica in Individuals with Developmental Disabilities 123 Peter Sturmey Queens College City University of New York Flushing, NY USA Don E Williams Williams Behavioral Consulting Greenville, TX USA ISSN 2192-922X ISSN 2192-9238 (electronic) Autism and Child Psychopathology Series ISBN 978-3-319-30796-1 ISBN 978-3-319-30798-5 (eBook) DOI 10.1007/978-3-319-30798-5 Library of Congress Control Number: 2016932858 © Springer International Publishing Switzerland 2016 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland To individuals with pica and their families When we first observed people with pica, we could find little research to guide us in assessing and treating you It took us a long time to provide what you needed Some died prematurely perhaps, and we know you have suffered We apologize for our shortcomings This book represents our latest attempt to improve your clinical treatment and your movement to a safe, humane life Chapter recounts a program for people with pica established over 25 years ago at one facility Although an article was published in 2009 describing the program for people with pica, this article has been ignored by some, and criticized by some, but we launched the program for you and your families and we think you benefited We did not plan the program for research, but now we think parents and staff have the right to know what we have done We are sure more criticism will come, but that should not cause you to suffer We hope you and your parents will know the difference between those who acted and those who did not After all, it was B.F Skinner who said “caring is…a matter of action.” Foreword One of the most severely challenging aspects of raising an individual with autism is discovering the limited number of people who know how to effectively help your child The professionals, including pediatricians and doctors, that a parent typically turns to for support in a crisis are often ill-equipped to address the deficits of autism and chart a clear path for the parent who is asking: “What we next?” Due to an increased national focus on autism, however, there has been a corresponding expansion of dedicated research toward treatment and etiology There is now a strong body of scientific research supporting improved outcomes through evidence-based treatment utilizing applied behavior analysis (ABA) Nevertheless, for individuals with autism who experience severe behavior problems, including aggression and self-injury, parents may find themselves overwhelmed by the risk of injury to themselves, siblings, or the child with problem behaviors Ingesting items of little or no-obvious nutritional value is among the most serious self-injurious behaviors with consequences including infections, choking, intestinal blockage, and possibly death In the presence of low-incidence behaviors that pose a high risk to the client or staff, parents frequently find the door to help closed with the prospect of placement outside the home looming large The possibility of finding an effective treatment for autism and other developmental disabilities is more real today than ever—thanks to practitioners of behavior analysis who continue to undertake the work of isolating and documenting techniques that are effective when applied consistently by trained educators and parents Much of the field’s work in the past 20 years has focused on documenting and disseminating basic treatment information to ameliorate the key symptoms of autism seen across a broad swath of the spectrum, including deficits in language, social interaction, self-care, and academics Major cities typically have at least a half-dozen or more site-based treatment programs as well as practitioners consulting with families and school districts to provide treatment that is increasingly subsidized by insurance or public funding As a result, many families today have access to professionals who are familiar with the basic methods of treating the most common deficits Nevertheless, the number of behavior analysts with a depth of vii viii Foreword experience treating pica is small, and with the closure of institutional settings, the responsibility for addressing severe problem behaviors today falls ever more squarely on families This work by Sturmey and Williams is among those that represent the next step in the behavior analytic treatment literature for autism: works that shed light on how the field can better address problem behaviors, like pica, that lie at the extremes of the spectrum The authors gather what is known about past successes and failures in the treatment of pica and provide direction for researchers and practitioners who must start on the same page in order to collaborate to effectively treat behavior that poses severe, often life-threatening danger to clients’ physical and emotional safety An effective treatment of all problem behaviors, including pica, requires consistency across environments with participation by family members and professionals Because of the limited number of pica cases in most treatment locations, it is essential that behavior analysts in geographically dispersed locales have a common base of knowledge so that they may jointly move the treatment forward and collaborate with families for consistency The authors have laid the groundwork for that collaboration They begin with descriptive information on pica and follow up with a comprehensive review of the existing literature on studies of pica in autism, many of them single-subject design They also review several meta-analyses of the literature This informs the assessment of the function of most pica as automatic positive reinforcement as well as a hierarchy of the efficacy of treatment protocols As parents of individuals with autism, we have identified ABA as the field offering the greatest promise for treating our children with autism We have also spent inordinate amounts of time learning the concepts and language of ABA to more effectively implement recommended procedures Nevertheless, ours are like most families that remain heavily reliant on public schools, therapists, and day programs to carry out treatment protocols We are acutely aware of the issues that most programs face, including lack of training resources, high client-to-staff ratios, and inadequate supervision by board-certified behavior analysts, all of which combine to slow or eliminate our children’s progress—whether as students or adults In addition to recommendations for designing and conducting a treatment program, the authors acknowledge and provide guidance on some of the practical issues surrounding staffing, staff training, and creating pica-safe environments in a section of the book that describes a 12-year-long pica program with 41 clients in an institutional setting The information is highly useful for professionals as well as families evaluating and executing programs for a child or an adult with pica Over the past 20 years, much scientific research has emphasized the importance of early intervention for ASD As with all facets of behavioral treatment of autism, early identification and intervention in the treatment of pica behaviors should enhance long-term outcomes Unfortunately, the existence of pica behaviors is not always acknowledged or addressed before it becomes a life-threatening or an endemic issue that isolates the child from environments that support integrated learning experiences, according to the authors Amidst a range of deficits, parents and professionals are not attuned to pica as a problem until health suffers or a child Foreword ix is hospitalized for swallowing a dangerous object Laying a foundation for treating pica behaviors and teaching safe adaptive behaviors early and in the context of community and family settings is a significant need highlighted by this volume The more rapidly research is advanced and disseminated, the quicker targeted treatment protocols will be widely available to families and service providers We believe, as the authors of this book, that a solid foundation exists for researching and disseminating the best treatment protocols for pica This volume will be an outstanding resource in moving those efforts forward Lisa Hill Sostack, MBA, Co-founder Amy M Wood, Pharm.D., President Families for Effective Autism Treatment (FEAT)—Houston 168 References Decker, C J (1993) Pica in the mentally handicapped: A 15-year surgical perspective 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J C., & Kohn, C S (2009) Brief report: A comparison of indirect versus experimental strategies for the assessment of pica Journal of Autism and Developmental Disorders, 39, 1582–1586 Williams, D E (2010) Reducing and eliminating restraint of people with developmental disabilities and severe behavior disorders: An overview of recent research Research in Developmental Disabilities, 31, 1142–1148 Williams, D E., & Grossett, D L (2011) Reducing restraint of people with intellectual disabilities: An organizational behavior management (OBM) approach Research in Developmental Disabilities, 32, 2236–2239 Williams, D E., Kirkpatrick-Sanchez, S., Enzinna, C., Dunn, J., & Borden-Karasack, D (2009) The clinical management and prevention of Pica: A retrospective follow-up of 41 individuals with intellectual disabilities and pica Journal of Applied Research in Intellectual Disabilities, 22, 210–215 Williams, D E., Lee, G T., & Grossett, D L Prevention of severe problem behavior (in press) In N N Singh (Ed.), Clinical handbook of evidence-based practices in intellectual and developmental disabilities Berlin: Springer (in press) Williams, D E., & McAdam, D (2012) Assessment, behavioral treatment, and prevention of pica: Clinical guidelines and recommendations for practitioners Research in Developmental Disabilities, 33, 2050–2057 Williams, D E., & McAdam, D B Pica In N N Singh (Ed.), Clinical handbook of evidence-based practices in intellectual and developmental disabilities Berlin: Springer (in press) Williams, D E., & Sturmey, P (2016) Severity Index for Pica Unpublished document Winton, A S W., & Singh, N N (1983) Suppression of pica using brief-duration physical restraint Journal of Intellectual Disability Research, 27, 93–103 Woods, D W., Miltenberger, R G., & Lumley, V A (1996) A simplified habit reversal treatment for pica-related chewing Journal of Behavior Therapy and Experimental Psychiatry, 27, 257–262 Woods, D W., & Miltenberger, R G (1995) Habit reversal: A review of applications and variations Journal of Behavior Therapy and Experimental Psychiatry, 26, 123–131 178 References Young, S L (2010) Pica in pregnancy: New ideas about an old condition Annual Review of Nutrition, 30, 403–422 Young, S L (2011) Craving earth Understanding pica The use to eat clay, starch, ice and chalk New York: Columbia University Press Young, S L., Wilson, M J., Miller, D., & Hillier, S (2008) Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials PLoS One, 3(9), e3147 Zaja, R H., Moore, L., Van Ingen, D J., & Rojahn, J (2011) Psychometric comparison of the functional assessment instruments QABF, FACT and FASTfor self-injurious, stereotypic and aggressive/destructive behaviour Journal of Applied Research in Intellectual Disabilities, 24, 18–28 Zeitlin, S B., & Polivy, J (1995) Coprophagia as a manifestation of obsessive-compulsive disorder: A case report Journal of Behavior Therapy and Experimental Psychiatry, 26, 57–63 Index A Abbreviated habit reversal, 94 Administrative priority requiring leadership, 126 Adult disability services, 154 Advice for families, 161 Aggression, 52 aggressive behavior, 60 Alternate behavior, 48 Antecedent-based procedures, 83 Applied behavior analysis (ABA), 146, 158 Autism, 4, 19, 24, 28 Autism spectrum disorders (ASP), 24 Automatic reinforcement, 50 Aversive stimuli, 61, 87 unpleasant odors and tastes, 87 water mist, 87 B Baited environments, 66, 71, 75 Behavioral assessment, 42, 45, 47, 145, 149 Behavioral equivalent, 36 Behavioral interventions, 49 Behavioral outcome, 49 Behavioral problems, 160 Behavioral research, 43 Behavioral skills, 152 Behavioral treatment, 51 case series, 103 environmental structuring, 104 staff training and monitoring, 104 Behavior analysis, 162 Behavior analyst, 153 Behavior analyst certification board (BACB), 46 Behaviorism, 41 Behavior management, 47 Behavior treatment, 149 Biomedical conditions, 143 Biomedical treatments nutritional interventions, 133 Brief contingent personal restraint, 57, 62 C Challenging behavior, 146 Change in behavior making, 147 Children with lead poisoning pica in, 27 Cigarette pica, 91 Client safety, 45 Clinical populations pica in, 11, 20 Code of professional conduct, 43 Cognitive behavior therapy (CBT), 112, 139 Community-based research, 144 Conceptual framework and technology, 43 Contemporary community services, 144 Continuous restraint, 117 plus one-to-one staffing, 118 Cooper’s history of pica, Coprophagia, 55, 62, 91 Counseling, 139 Crisis intervention, 115 Crit du chat syndrome, 19, 25 D Dangerous ingestions, 161 Delectavite, 136 Department of Justice (DOJ), 145 Depression hypothesis, 36 Developmental disabilities (DD), 20, 143 Diagnosis of pica, 6, Diagnostic criteria, 146 Differential reinforcement, 53 Differential reinforcement of other behaviors (DRO), 122 Differential reinforcement of alternate behavior (DRA), 53 © Springer International Publishing Switzerland 2016 P Sturmey and D.E Williams, Pica in Individuals with Developmental Disabilities, Autism and Child Psychopathology Series, DOI 10.1007/978-3-319-30798-5 179 180 Index Differential reinforcement of alternative responses (DRA), 50 Differential reinforcement of higher rates of behavior (DRH), 53 Differential reinforcement of incompatible behavior (DRI), 53 Differential reinforcement of low rates of behavior (DRL), 53 Differential reinforcement of other behavior (DRO), 53, 121, 122 Discrimination training, 56 Dopaminergic model, 32 Down syndrome (DS), 19, 24, 25 Function-based treatment, 78 Function-based treatment, pica of, 73 E Early development, 145 Early diagnosis, 146 Early intervention, 154 Effective behavior plan, 144 Effective treatment, 44 Empirically derived consequences (EDC), 61, 96 Empirically supported treatments (ESTs), 109 Environmental enrichment (EE), 52, 77 Environmental modifications, 125 Environmental systems management prevention by, 123 Epidemiological research, 145 Epidemiology, 19 Epidemiology of pica, 19 Ethical issue, 44 Ethical principles, 44 Ethics of pica, Ethics of treatment, 43 Etiology of pica, 29 Evidence-based practice, 162 Experimental analysis of behavior (EAB), 41 Exposure therapy, 138 Extended restrictive management practices, 45 H Habit reversal, 59 Hand mouthing, 60, 146 Health outcomes, 147 Health-threatening events, 147 Hierarchical pica treatment program, 121 History of pica, Hunger hypothesis, 35 Hypothesis of depression, 36 F Families, advice for, 161 Food aversion, 99 Forms of pica, Functional analysis, pica of, 69, 76 Functional assessment, pica of, 65 Functional assessment/analysis, 47 Functional behavioral assessments (FBAs), 121, 149, 150 G Gastrointestinal distress, 148 Gastrointestinal obstructions, 160 Gastrointestinal protection hypothesis, 34 Generalization environment, 152 General population pica in, 19 Genetic models, 35 Genetics of pica, 35 I Idiosyncratic aversive stimuli, 96 Implications for contemporary services, 153 Individuals with ID/ASD, 143 Ineffective treatment, 44 Institutional environment, 144 Institutional settings pica in, 20 Integrating biomedical and behavioral research, 148 Integrating research across populations, 147 Intellectual disabilities (ID), 4, 51, 90 Iron level and pica, 135 L Lead poisoning, 19 Lead poisoning and pica, 27 Learning models of pica, 30 Life-threatening pica, 42 M Measurement of pica, 48, 123 pica severity, 49 Medical assessment, 154 Medical procedures, 50 Index Meta-analyses, 107 Meta-analysis of pica treatment, 84 Mineral deficiencies, 148 Motivation assessment scale, 93 N Negative practice, 59, 93 Neuroanatomical models, 32 Non-contingent food (NCF), 98 Non-contingent reinforcement (NCR), 50, 55, 121, 123 Non-function-based reinforcement-based procedures, 81 Non-humans, pica in, 15 Non-social reinforcement, 145 Non-specific gastrointestinal problems, 154 Non-training materials, 62, 124 Nutrient deficiency models, 33 Nutritional deficiencies, 143 Nutritional interventions, 133 Nutritional supplementation, 143 O Observational functional assessments, pica of, 66 Obsessive compulsive disorder, One-to-one staffing to temporarily prevent pica, 116 Oral hygiene procedures, 62 Organizational issues, 156 Other clinical populations of pica, 26 Overcorrection, 62, 90 Overcorrection procedures, 92 P Phenylketonuria, 25 Pica-safe observational checklist, 104 Plan of action, 155 Policies and procedures on pica safety, 126 Positive punishment, 67, 78, 85 Pregnancy, pica in, 10 Pregnant women, 148 Pretreatment functional analysis, 52 Prevention by environmental systems management, 123 Prevention by staff training, 125 Prevention of pica using crisis intervention, 115 Program methodology, 119 181 Proportion of non-overlapping data points (PND), 111 Psychiatric disorders, pica in, 14 Psychoanalytic theory, 37 Psychometric measures of function, 68 Psychopharmacological treatment, 153 Psychotropic medication, 136, 143 Punishment contingencies, 123 R Radical behaviorism, 41 Regional planning, 158 Regional technical support, 160 Reliability and validity, 146 Reprimands, 62, 95 Response blocking, 60 Response blocking parameters, 77 Response blocking procedure, 89 Response chain, 67, 76, 77 Response effort, 66, 69, 75, 76 Response interruption procedure, 89 Restitutional overcorrection, 90 Restraint to suppress pica, 88 Restrictive behavior management, 105 Right to effective treatment, 45 Risk determining, 130 Risk assessment of pica, 51 Risk of pica, 16, 23 S Safe training materials, 62, 124 Screening with modified alone conditions, 74 Seizure, 144 Self-injurious behavior (SIB), 97, 115 Sensory integration therapy (SIT), 112, 139 Severity of pica, 12 culturally normative forms of pica, definition, pica, developmental disabilities, 4, 11, 13, 14, 16 terms of pica, Sickle cell anemia, 26 Sickle cell disease, 19, 26, 27 Skills training, 52, 161 Social reinforcement, 52 Special education, 154 Staff assignment, 126 scheduling of, 126 182 Statewide planning, 158 Stimulus control, 77 Structured supervisory monitoring and feedback, 126 Survey and participants, 119 Survey form behavior plans, 121 client rights and protections, 121 T Thioridazine, 138 Total population samples, 22 Training materials, 62, 124 Treatment analysis, 56 Treatment efficacy, 44 Treatment goals, 50 Treatment hierarchy, 124 Treatment implications, 149 Index Treatment plan, 46 ideographic treatment plan, 152 Tuberous sclerosis, 19, 24 V Verbal reprimands, 57 Verbal warning, 57 Visual screening, 58, 94 brief contingent visual screening, 58 Vitamin deficiencies, 148 Vitamin deficiency models, 33 Y Young’s biocultural approach, 36 Z Zinc level and pica, 134 ... own clinical experience in treating pica Since the publication of Bicknell’s volume on pica in individuals with autism and intellectual disabilities, behavioral research has increased apace In the... stereotypical movement disorder Matson and Bamburg compared individuals with pica with individuals without pica on the MESSIER, a measure of social skills They found that individuals with pica had... all to see Such examples of pica are interesting © Springer International Publishing Switzerland 2016 P Sturmey and D.E Williams, Pica in Individuals with Developmental Disabilities, Autism and

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  • Foreword

  • Preface

  • Contents

  • About the Authors

  • Part IFoundational Issues

  • 1 Definition and Diagnosis

    • 1.1 A Brief History of Pica

      • 1.1.1 Some Common Factors

      • 1.2 Diagnosis

        • 1.2.1 Pica Terms

        • 1.2.2 Differential Diagnosis

        • 1.3 Culturally Normative Pica

          • 1.3.1 Culturally Normative Forms of Pica

          • 1.3.2 Pica During Pregnancy

          • 1.4 Pica in Clinical Populations

            • 1.4.1 Developmental Disabilities

              • 1.4.1.1 Problem Severity

              • 1.4.1.2 Summary

              • 1.4.2 Psychiatric Disorders

              • 1.5 Pica in Non-humans

              • 1.6 Risks

              • 1.7 Summary

              • 2 Epidemiology

                • 2.1 General Populations

                  • 2.1.1 Clinical Populations

                  • 2.1.2 Summary

                  • 2.2 Developmental Disabilities

                    • 2.2.1 Institutional Settings

                    • 2.2.2 Total Population Samples

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