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Study shows promise for treating pica

Kristen B. Morales

March 23, 2015

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A College of Education graduate student recently had a major role in a study that finds behavioral therapy to be a successful treatment for children with pica.

Christina Simmons, a doctoral candidate in the Department of Educational Psychology's school psychology program, worked with lead author Nathan Call, director of severe behavior programs at Marcus Autism Center at Children's Healthcare of Atlanta and assistant professor of pediatrics at Emory University School of Medicine, along with Joanna Mevers, program manager of severe behavior and assistant professor of pediatrics at Emory and Jessica Alvarez, a postdoctoral fellow at Emory/Marcus. The study was published in the January issue of the Journal of Autism and Developmental Disorders.

Pica is the ingestion of a non-edible item, which can lead to life-threatening complications. Items consumed may be household items such as paperclips or batteries, or items found outdoors such as dirt or wood.

Simmons said until now, research on pica has mainly focused on case studies with only a few children at a time. "Typically, up to 25 percent of children with developmental disorders engage in pica, but there are no large studies," she added. "We wanted to look at clinical records of all children treated for pica at an intensive day treatment program. We wanted to eliminate the potential for publication bias with previously published studies."

This study analyzed the records of 11 children brought to the center over 12 years. All but one was diagnosed with autism spectrum disorder and all but one was referred to the outpatient program for pica (one was treated for pica after treatment for aggression). While specific behavioral interventions vary depending on the child and severity of the issue, treatment components included redirecting, blocking and/or rewards to turn a negative behavior into a positive one.

"With behavioral intervention, each treatment is based on the reason why an individual engages in the behavior," said Simmons. "You determine which treatment approach works, so it is individualized among the participants."

Overall, the behavior modification treatment was successful in nearly all cases, with an average reduction of 96 percent. To determine the effectiveness, the team trained parents or caregivers to continue the behavior modification treatment at home, then made follow-up assessments. Over the course of a child's treatment period, children were brought into rooms with items that would be tempting for them to consume.

The success of the behavior modification methods speaks well for programs such as the Applied Behavior Analysis program and clinic at the UGA College of Education. The program, which offers training to UGA students studying at the master's and doctoral levels, is one of two in Georgia and has shown promise in treating varying behaviors associated with autism spectrum disorder.

Simmons is a supervisor in the Applied Behavior Analysis Clinic and will soon begin her predoctoral internship at the Munroe-Meyer Institute at the University of Nebraska Medical Center, where she will continue her work in developmental disorders. The institute is one of three main treatment centers in the United States for people with severe behaviors, such as pica.