Comparing methods for maintaining the safety of a child with pica.
Skipping restraints still kept a young learners with pica safe while cutting staff effort and protecting her quality of life.
01Research in Context
What this study did
A young learners girl with severe intellectual disability kept eating non-food items. Staff tried two ways to keep her safe: gentle physical restraint and no-restraint with close watching.
Each method ran for many days. The team counted pica attempts and how much work staff did.
What they found
Both plans stopped pica. The girl never swallowed dangerous items under either condition.
The no-restraint plan needed fewer staff minutes each day. The child also moved and played more freely.
How this fits with other research
Iwata et al. (1990) built the SIT Scale to measure tissue damage from self-injury. You can use that scale to track any mouth or throat injuries if pica returns.
Oliver et al. (2002) and English et al. (1995) tested Reiss Screen forms that flag pica as maladaptive behavior. These screens can help you decide when safety plans are still needed.
Together the papers show: measure harm, track behavior, then choose the least restrictive fix that stays safe.
Why it matters
You can drop restraints for some kids with pica and still keep them safe. Start with tight 1:1 supervision instead of holding the child. Collect data on pica tries and staff time. If safety stays high and effort drops, you have evidence to keep the lighter plan and give the child more freedom.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Try 5-minute momentary time samples of pica and staff contact; fade physical holds if counts stay at zero.
02At a glance
03Original abstract
Pica, a potentially life-threatening behavior problem exhibited among persons with mental retardation is sometimes addressed by methods such as application of restraints to reduce or eliminate associated risks (Rojahn, Schroeder, & Mulick, 1980). However, restraints may be associated with decreases in social interaction and negative impact on quality of life. We evaluated two methods (restraint vs. no restraint) for maintaining the safety of a client with pica on three dimensions: (a) level of pica, (b) therapist effort, and (c) impact on quality of life. Both methods prevented pica, however, the no restraint condition required less therapist effort and had less negative impact on quality of life. All three dimensions were included in a clinical decision-making model to determine the least restrictive, safe level of restraint for a 4-year-old girl while assessment and treatment procedures were conducted. The clinical utility of this multifactor decision-making model is discussed.
Research in developmental disabilities, 1997 · doi:10.1016/s0891-4222(97)00004-8