Parent treatment of complex pica in a teen with autism
Adding a small response cost to competing stimulus and RIRD let parents stay hands-off and still wipe out teen pica for a year.
01Research in Context
What this study did
One family and their teenage son with autism tried a three-step plan for pica at home.
First, parents gave a favorite toy to keep hands busy. Next, they blocked and redirected every grab for non-food items. Last, they removed one minute of screen time after each pica attempt.
The parents ran all steps alone while researchers coached on Zoom.
What they found
Pica dropped sharply and stayed down for a full year.
Mom and Dad could step back and still keep the teen safe without hovering.
How this fits with other research
Slocum et al. (2017) also cut pica in an autistic teen, but they taught the girl to throw items away instead of using response cost. Both studies show parents can win with very different tactics.
Morris et al. (2021) first showed a quick home FA plus reinforcement works; Thomas et al. (2023) adds response cost and proves the effect lasts twelve months, not weeks.
Matson et al. (1999) saw mixed results when they thinned NCR for cigarette pica. The new case avoids that fade-out problem by adding response cost and parent control.
Why it matters
You now have a parent-friendly package that keeps working after you thin supervision. Try the three-step plan if in-home FA plus DR has stalled or if caregivers need a leash-free option. Start with a competing item, add a brief loss of preferred activity for each pica attempt, and track for maintenance.
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02At a glance
03Original abstract
AbstractPica is a severe behavior disorder involving the persistent consumption of nonnutritive substances. Due to health complications and risks for fatality, designing effective behavioral treatments that are feasible for implementation by family members at home is imperative. This case report presents a parent‐conducted functional analysis and treatment evaluation of automatically maintained pica in a teenager with autism spectrum disorder. Initial treatment with a competing stimulus was effective when paired with response interruption and redirection. Although effective, this combination of treatment components required very close parental proximity and led to increases in untargeted body‐oriented pica (e.g., ingestion of skin, hair, and nails). Upon extending treatment to include the second topography of pica, both the originally targeted (object‐oriented) pica and body‐oriented pica decreased. Nonetheless, treatment effects were not sustained while fading parent proximity. The treatment was then augmented a third time with response cost. This final treatment package produced clinically significant reductions in all pica, facilitated parent proximity fading until the participant was alone, extended to their home, and maintained over a year of follow up.
Behavioral Interventions, 2023 · doi:10.1002/bin.1956