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How Behavioral Interventions for Pica Work

written by: Carma Haley Shoemaker • edited by: Elizabeth Wistrom • updated: 5/19/2011

Pica is a medical disorder characterized by the consumption of non-food substances and objects. The main goal of behavioral interventions for pica is to reduce and/or eliminate the habit of eating these non-food items.

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    Pica is a medical disorder characterized by an appetite for non-food substances (such as metal, dirt, soap, or chalk), or food substances that are in basic form, such as flour, butter, baking soda, salt, etc. For the disorder to be truly considered pica, the eating patterns or behaviors must be present and persist for longer than a one month time period, and occur at an age where eating these types of substance or objects is considered developmentally inappropriate.

    Regardless of the severity, there are many behavioral interventions for pica available to help reduce or eliminate the manifestation of the disorder.

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    Providing Alternative Forms of Oral Stimulation

    Offering alternate options for oral stimulation (such as chewing gum, "theratubing" (a cylindrical rubber tube which can be used to bite on), sugarless candy, and/or popcorn) is often used as one of the behavioral interventions for pica. Depending on the individual and the cause of the pica behaviors, various tastes and textures may need to be attempted before finding one that is suitable.

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    Pica Box

    Similar to alternate forms of oral stimulation, assembling a collection of items which are safe for the individual to chew, bite, mouth, and/or ingest in a “pica box" ensures that there is always a supply of safe items on hand as an alternative to preferred pica, or non-edible items. It’s important when collecting items for the pica box to choose those that closest resemble the appearance, texture, shape, and/or taste of the individual’s preferred non-edible or pica items. When this behavioral intervention begins, the box should be available to the individual at all times. Eventually, the amount of time the pica box is available can be reduce. This will aid in reducing or minimizing the pica behaviors, as well.

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    Discrimination Training

    Discrimination training involves teaching the individual the difference between food and non-food items, using the best method of learning for their age, education, and skill level. For example, games can be played to sort food from non-food items with a reward – such as stickers – for correct answers. Visual charts can be used with pictures of edible and non-edible foods. In addition, levels of nutrition education can be included, as well as education as to why pica behaviors need to be changed (will make him sick, can hurt his stomach or throat, etc.). Another method of discrimination training that is used as one of the behavioral interventions for pica is modeling healthy eating habits. Caretakers and parents can eat nutritious meals with the individual to help demonstration good eating habits. It’s very important, especially when dealing with a child with pica, to be sure to offer praise and rewards when food items are eaten instead of non-food items.

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    Aversive Techniques

    More severe behavioral interventions for pica are referred to as aversive techniques. Traditionally, these types of interventions are unpleasant, may be punishing in nature, may inflict physical or mental discomfort, or may cause embarrassment to the individual. While the use of these techniques is still found in private practices, the National Institutes of Health reports that aversive techniques are no longer recognized as acceptable, and taking every effort to use non-aversive behavioral interventions for pica is instead recommended. On the next page, several of these aversive techniques are mentioned, and are offered here for information only, as to what has been used for pica treatments in the past.

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    Aversive Presentation

    This has implemented the use of oral taste, smell sensation, and/or physical sensation as a deterrent when pica behaviors are being attempted. For example, when the individual attempts to put chalk or dirt in their mouth, they may be misted in the face with water, had ammonia placed under their nose, or lemon inserted into their mouth. The belief is that by introducing these negative sensations with, or directly after the pica behavior, the individual would associate one with the other, and avoid placing dirt or chalk in their mouth for fear of what’s to follow.

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    Teaching Self Restraint

    When pica behaviors were attempted, the non-edible object or item would be held against the individual’s mouth without allowing them to take it into their mouth or ingest it. The belief behind this intervention was that the individual would eventually learn self restraint and would tire of the object – similar to exposure therapy.

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    Physical Restraint

    To avoid the ability to place non-food items in their mouth, individuals were placed in helmets, had protection devices placed over their mouth, or had devices placed over their hands so they couldn’t pick anything up. Some felt the periods of brief restraint from the pica behaviors would result in their eventual disappearance.

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    How Interventions are Chosen

    According to the National Institutes of Health, the majority of doctors, clinicians, psychologists, and parents will opt to choose behavioral interventions for pica based on the cause. By addressing the cause of the disorder, it is believed that the chosen behavioral intervention will offer a more effective outcome. The most common causes used in choosing behavioral interventions for pica include: child; developmentally disabled –with several subcategories; pregnancy induced; and psychopathic. The various methods and interventions may emphasize environmental, psychosocial, and/or family guidance approaches within the treatment plan.

    The types of behavioral interventions for pica range from mild interventions to extreme. Before implementing an intervention method for use, it is best to consult the patient’s physician, counselor, or psychologist.

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    Resources:

    OMNI Medical Search. Conditions & Diseases – Eating & Weight Disorders. (2010). Accessed from http://www.omnimedicalsearch.com/conditions-diseases/pica-disorder-treatment-options.html. January 9, 2011.

    National Institute of Health. (2011). http://www.nlm.nih.gov/medlineplus/eatingdisorders.html

    U.S. National Library of Medicine. National Institutes of Health. (1990). http://www.ncbi.nlm.nih.gov/books/NBK255/ January 9, 2011.