Journal of Autism and Developmental Disorders

, Volume 45, Issue 7, pp 2105–2114 | Cite as

Clinical Outcomes of Behavioral Treatments for Pica in Children with Developmental Disabilities

  • Nathan A. Call
  • Christina A. Simmons
  • Joanna E. Lomas Mevers
  • Jessica P. Alvarez
Original Paper


Pica is a potentially deadly form of self-injurious behavior most frequently exhibited by individuals with developmental and intellectual disabilities. Research indicates that pica can be decreased with behavioral interventions; however, the existing literature reflects treatment effects for small samples (n = 1–4) and the overall success of such treatments is not well-understood. This study quantified the overall effect size by examining treatment data from all patients seen for treatment of pica at an intensive day-treatment clinical setting (n = 11), irrespective of treatment success. Results demonstrate that behavioral interventions are highly effective treatments for pica, as determined by the large effect size for individual participants (i.e., NAP scores ≥ .70) and large overall treatment effect size (Cohen’s d = 1.80).


Pica Behavioral treatment Behavior analysis Clinical outcomes 


  1. Ali, Z. (2001). Pica in people with intellectual disability: A literature review of aetiology, epidemiology, and complications. Journal of Intellectual and Developmental Disability, 26, 205–215.CrossRefGoogle Scholar
  2. Ashworth, M., Hirdes, J. P., & Martin, L. (2009). The social and recreational characteristics of adults with intellectual disability and pica living in institutions. Research in Developmental Disabilities, 30, 512–520.PubMedCrossRefGoogle Scholar
  3. Campbell, J. M. (2003). Efficacy of behavioral interventions for reducing problem behavior in persons with autism: A quantitative synthesis of single subject research. Research in Developmental Disabilities, 24, 120–138.PubMedCrossRefGoogle Scholar
  4. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  5. Danford, D. E., & Huber, A. M. (1982). Pica among mentally retarded adults. American Journal of Mental Deficiency, 87, 141–146.PubMedGoogle Scholar
  6. Decker, C. J. (1993). Pica in the mentally handicapped: A 15-year surgical perspective. Canadian Journal of Surgery, 36, 551–554.Google Scholar
  7. Edwards, C. H., Johnson, A. A., Knight, E. M., Oyemade, U. J., Cole, O. J., Westney, O. E., & Westney, L. S. (1994). Pica in an urban environment. The Journal of Nutrition, 124, 954–962.Google Scholar
  8. Emerson, E. (2001). Challenging behaviour: Analysis and intervention in people with severe intellectual disabilities. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  9. Favell, J. E., McGimsey, J. F., & Schell, R. M. (1982). Treatment of self-injury by providing alternate sensory activities. Analysis and Intervention in Developmental Disabilities, 2, 83–104.CrossRefGoogle Scholar
  10. Hagopian, L. P., Rooker, G. W., & Rolider, N. U. (2011). Identifying empirically supported treatments for pica in individuals with intellectual disabilities. Research in Developmental Disabilities, 32, 2114–2120.PubMedCrossRefGoogle Scholar
  11. Hanley, G. P., Iwata, B. A., & McCord, B. E. (2003). Functional analysis of problem behavior: A review. Journal of Applied Behavior Analysis, 36, 147–185.PubMedCentralPubMedCrossRefGoogle Scholar
  12. Heyvaert, M., Saenen, L., Campbell, J. M., Maes, B., & Onghena, P. (2014). Efficacy of behavioral interventions for reducing problem behavior in persons with autism: An updated quantitative synthesis of single-subject research. Research in Developmental Disabilities, 35, 2463–2476.PubMedCrossRefGoogle Scholar
  13. Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197–209 (Reprinted from Analysis and Intervention in Developmental Disabilities, 2, 3–20, 1982).Google Scholar
  14. Kennedy, C. H. (2004). Single case designs for educational research. Boston, MA: Pearson.Google Scholar
  15. Mahoney, M. J. (1977). Publication prejudices: An experimental study of confirmatory bias in the peer review system. Cognitive Therapy and Research, 1, 161–175.CrossRefGoogle Scholar
  16. Matson, J. L., & Bamburg, J. W. (1999). A descriptive study of pica behavior in persons with mental retardation. Journal of Developmental and Physical Disabilities, 11, 353–361.CrossRefGoogle Scholar
  17. Matson, J. L., Hattier, M. A., Belva, B., & Matson, M. L. (2013). Pica in persons with developmental disabilities: Approaches to treatment. Research in Developmental Disabilities, 34, 2564–2571.PubMedCrossRefGoogle Scholar
  18. McAdam, D. B., Sherman, J. A., Sheldon, J. B., & Napolitano, D. A. (2004). Behavioral Interventions to reduce the pica of persons with developmental disabilities. Behavior Modification, 28, 45–72.PubMedCrossRefGoogle Scholar
  19. McLoughlin, I. J. (1988). Pica as a cause of death in three mentally handicapped men. British Journal of Psychiatry, 152, 842–845.PubMedCrossRefGoogle Scholar
  20. Parker, R. I., & Vannest, K. (2009). An improved effect size for single-case research: Nonoverlap of all pairs. Behavior Therapy, 40, 357–367.PubMedCrossRefGoogle Scholar
  21. Parker, R. I., Vannest, K. J., & Davis, J. L. (2011). Effect size in single-case research: A review of nine nonoverlap techniques. Behavior Modification, 35, 303–322.PubMedCrossRefGoogle Scholar
  22. Piazza, C. C., Fisher, W. W., Hanley, G. P., LeBlanc, L. A., Worsdell, A. S., Lindauer, S. E., & Keeney, K. M. (1998). Treatment of pica through multiple analyses of its reinforcing functions. Journal of Applied Behavior Analysis, 31, 165–189.PubMedCentralPubMedCrossRefGoogle Scholar
  23. Piazza, C. C., Hanley, G. P., & Fisher, W. W. (1996). Functional analysis and treatment of cigarette pica. Journal of Applied Behavior Analysis, 29, 437–450.PubMedCentralPubMedCrossRefGoogle Scholar
  24. Rose, E. A., Porcerelli, J. H., & Neale, A. V. (2000). Pica: Common but commonly missed. Journal of the American Board of Family Practice, 13, 353–358.PubMedGoogle Scholar
  25. Sham, E., & Smith, T. (2014). Publication bias in studies of an applied behavior analytic intervention: An initial analysis. Journal of Applied Behavior Analysis, 47, 1–16.CrossRefGoogle Scholar
  26. Sharp, W. G., Jaquess, D. L., Morton, J. F., & Herzinger, C. V. (2010). Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review, 13, 348–365.PubMedCrossRefGoogle Scholar
  27. Stiegler, L. N. (2005). Understanding pica behavior: A review for clinical and education professionals. Focus on Autism and other Developmental Disabilities, 20, 27–38.CrossRefGoogle Scholar
  28. Vollmer, T. R. (1994). The concept of automatic reinforcement: Implications for behavioral research in developmental disabilities. Research in Developmental Disabilities, 15, 187–207.PubMedCrossRefGoogle Scholar
  29. Williams, D. E., & McAdam, D. (2012). Assessment, behavioral treatment, and prevention of pica: Clinical guidelines and recommendations for practitioners. Research in Developmental Disabilities, 33, 2050–2057.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Nathan A. Call
    • 1
    • 2
  • Christina A. Simmons
    • 3
  • Joanna E. Lomas Mevers
    • 1
    • 2
  • Jessica P. Alvarez
    • 1
    • 2
  1. 1.Marcus Autism CenterAtlantaUSA
  2. 2.Emory University School of MedicineAtlantaUSA
  3. 3.University of GeorgiaAthensUSA

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