Assessment, behavioral treatment, and prevention of pica: Clinical guidelines and recommendations for practitioners
ABSTRACT Pica is a dangerous form of self-injurious behavior that occurs in people with developmental disabilities who are institutionalized. Studies also indicate that pica has led to the death of people with developmental disabilities. While a number of published studies have demonstrated that pica behavior can be decreased substantially with behavioral treatment, few of these studies incorporated strategies for generalization and maintenance outside of brief sessions. A second limitation of current research is that some studies reduced pica substantially, but pica responses still occurred at rates that are problematic in terms of prevention of adverse consequences, which leaves practitioners with the task of further decreasing pica to protect people exhibiting pica from harm. We make recommendations for assessment, treatment, and prevention of pica for practitioners. These recommendations are based on two extensive reviews of the literature and our extensive experience as practitioners in the treatment of pica. Our hope is that administrators, professionals and practitioners will consider our guidelines and recommendations as they attempt to protect people with pica and developmental disabilities from harm by developing standards for assessment, treatment and prevention for this difficult-to-treat population. Our hope is that children with pica will receive early intervention to prevent pica from developing into life-threatening behavior.
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- "Challenging behaviors such as SIB, aggression, and stereotypy have been associated with myriad of negative outcomes such as reduced integration into the community or educational settings, reduced opportunities for social interactions, placement in restrictive service settings, use of intrusive treatment procedures such as chemical or mechanical restraint, and impaired learning (Cunningham & Schreibman, 2008; Koegel & Covert, 1972; Matson & Boisjoli, 2009; Symons, 1995; Thompson, Egli, Symons, & Delaney, 1994; Waters & Healy, 2012). Severe challenging behaviors such as SIB or pica may also result in serious physical harm to the individual (Hyman, Fisher, Mercugliano, & Cataldo, 1990; Williams & McAdam, 2012) while aggressive behaviors may lead to the injury of others in their environment. While applied behavior analysis has had much success in treating challenging behavior (e.g., Brosnan & Healy, 2011; Lydon, Healy, O'Reilly, & McCoy, 2013; Kahng, Iwata, & Lewin, 2002; Scotti, Ujcich, Weigle, Holland, & Kirk, 1996), many scholars have remarked that the ability to treat challenging behavior far outweighs our understanding of these behaviors (e.g., Duerden et al., 2012; Janssen, Schuengel, & Stolk, 2002; Rapp & Vollmer, 2005; Schroeder and Tessel, 1994). "
ABSTRACT: A relationship between stress and challenging behavior in individuals with autism spectrum disorder (ASD) has been theorized but infrequently examined empirically. The current study sought to examine the relationship between a parent-reported measure of stress, a physiological measure of stress (diurnal salivary cortisol), and various topographies of challenging behavior among 61 children and adolescents diagnosed with ASD between the ages of three and 18 years. Significant differences in cortisol levels between those engaging in high and low rates of stereotyped behavior were observed such that higher levels of stereotypy appeared an overt manifestation of higher levels of stress. A comparison between a subset of participants with ASD and typically developing peers matched on age, gender, and pubertal status failed to yield any differences in diurnal cortisol levels or cortisol variability between the two groups. The results of the current study suggest that similar levels of stress may exist among children with autism and their typically developing peers, but that for a subset of individuals with ASD, stereotyped behavior may be an indicator of elevated cortisol levels.Research in Autism Spectrum Disorders 11/2014; 10. DOI:10.1016/j.rasd.2014.10.020 · 2.96 Impact Factor
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ABSTRACT: Hazardous chemicals can be released from artificial turf used in some school playgrounds. To distinguish between Health risk assessment (HRA) exposure scenarios for this study, the ratio of elementary, middle and high schools was considered before final selection. Considering exposure pathways (inhalational, oral and dermal), media and materials were examined, targeting hazardous chemicals released from artificial turf playground-related products. Upon evaluation, the quantity of infill chips was shown to exceed the domestic product content standard (90 mg/kg) at eight (16%) out of 50 schools. PAHs were shown to exceed standards (10 mg/kg) at two (4%) out of the 50 schools. The excess cancer risk (ECR) of carcinogens was shown to be in most users for the worst exposure scenario. In children with pica, who represented the most extreme exposure group, the ECR was expected to be as high as , showing the low risk level of carcinogens. The hazard index (HI) for individual chemicals was shown to be low, at around 0.1 or less, except for children with pica, according to the mean exposure scenario of artificial turf playground exposure. However, the HI was shown to exceed 1.0 in children with pica. Therefore, no direct health risk was found in using artificial turf playgrounds and urethane flooring tracks for the mean exposure scenario, except in children with pica.09/2012; 6(3). DOI:10.5572/ajae.2012.6.3.206
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ABSTRACT: We report a case of a 17-year-old institutionalised male with a medical history of fragile X syndrome, bilateral congenital glaucoma, cataracts and pica disorder. He was transferred to our paediatric intensive care unit owing to respiratory failure and hypotension. On transoesophageal echocardiogram, he presented left atrium compression. A CT of the thorax and mediastinum revealed an unknown heterogeneous material in the lumen of the stomach and oesophagus, with a lung parenchyma suggestive of alveolar foreign material. Endoscopic evaluation showed diaper fragments inside the oesophagus and stomach. Fragmentation and suction of diaper material was made. Medical treatment was performed with inotropic support, conventional mechanical ventilation and antibiotics.Case Reports 06/2013; 2013. DOI:10.1136/bcr-2013-008890