Suggestions for Pica Treatment

Welcome to the December edition of Ask Dr. Emily! We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights in a question and answer format. We welcome you to send us your questions and Dr. Rastall will do her best to answer them each month.

My child engages in Pica and I had him tested for iron & other deficiencies which came back clear. He does it when he is stressed, over excited and has even done it whilst he appears relaxed. Unsure where to go from here as have tried chewing gum, sensory chew items and scented play doh? Unsure where to go from here.  Any suggestions?

“Pica” (pronounced “pie-cuh”) is described as an individual “eating non-food items,” such as dirt, hair, paint/glue, rocks, lint, or paperclips. Pica is not uncommon in children with developmental disabilities, such as autism, but the precise prevalence is not known. The function of pica varies from individual to individual; the literature tells us that the most common explanation for pica is that it serves a sensory purpose—simply put, it feels and/or tastes good. Pica can also be a self-soothing strategy (like when stressed) or can be driven by social reinforcers (like attention from parents/teachers/peers). 

Regarding treatment, the literature tells us that interventions using applied behavioral analysis (ABA) techniques are most effective for treating pica. However, before you start behavioral treatment, it’s important to consult with your pediatrician to rule out any nutritional deficiencies as the root cause. The next step (and the first step in creating an effective behavioral treatment plan) will be to determine the reason the pica behavior is occurring; the behavioral treatment will vary based on the purpose of the behavior for your child. Thus, a functional analysis (FA) needs to be conducted by a trained behavioral expert (such as a BCBA). 

Subsequent treatment plans may include things like behavioral replacement (like chewing gum or “chewies”) which it sounds like you’ve tried, environmental enrichment (offering the child other items or activities and reducing the availability of non-food items in the environment), and/or reinforcement (rewarding the child when they engage in OTHER, more appropriate behaviors). Something to note: If a child or individual has received medical attention (e.g., trip the emergency room) or has health issues potentially due to pica, more immediate assessment and treatment will be called for.

If you’re waiting to see an ABA provider, there are some preventative strategies you can use to minimize harm. For example, you can remove preferred non-food items from the home. Educate all of the people your child interacts with (teachers, child care providers, extended family members) so that they can help supervise and prevent items from being ingested that might cause harm. Finally, minimize your emotional reaction (but do attend to it) to your child’s pica to decrease the chance that pica is reinforced by your attention. The Pica Toolkit for Parents and Professionals by Autism Speaks is also a nice resource.