Assessment, behavioral treatment, and prevention of pica: clinical guidelines and recommendations for practitioners.
Stack multiple behavioral pieces and write the generalization plan up front to push pica to near-zero and keep it there.
01Research in Context
What this study did
Meier et al. (2012) pulled together every paper they could find on pica in people with developmental disabilities. They looked at how to assess it and how to treat it with behavior tools.
The team wrote a guide for clinicians. They listed gaps where research was thin, like keeping gains after therapy ends.
What they found
Behavioral plans can cut pica, but the drop is rarely perfect and often fades once staff change rooms or clients age out.
The review called for plans that mix several tactics and that spell out how to keep and spread the gains.
How this fits with other research
Frank-Crawford et al. (2025) later ran the largest case series. They used the same multi-piece recipe and hit ≥90% reduction in 30 of 33 clients. They also tracked generalization and showed it can work in new hands and places, plugging the exact gaps this review worried about.
Ruckle et al. (2023) trimmed the package to a quick trio: teach discard-to-trash, block and redirect, and give competing items. Their lean version still held pica low, proving you can stay light and still win.
Ledford et al. (2019) stretched the idea to a preschool playground. A simple attention-based plan cut pica and stayed in place weeks later, showing the guide works outside the usual clinic.
Why it matters
If you treat pica, treat it like a team sport. Start with a full assessment, stack at least two behavioral pieces, and write the generalization and maintenance steps into the plan from day one. The later studies prove this combo can drive pica to near-zero and keep it there even when staff or settings shift.
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02At a glance
03Original 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.
Research in developmental disabilities, 2012 · doi:10.1016/j.ridd.2012.04.001