PICA is a condition where individuals have a persistent craving and consumption of non-food items, such as dirt, paper, chalk, or even small objects. While it might sound unusual, PICA can pose serious health risks, especially for children and individuals with developmental disabilities. As a Specialist Behaviour Support Practitioner and Certified Behaviour Analyst, I’ve worked with several individuals diagnosed with PICA, helping to address the behaviour through targeted interventions.
In today’s blog, we’ll explore understanding PICA, causes, risks, and interventions. It's potential causes, the risks associated with it, and effective behavioural strategies to reduce or eliminate this behaviour.
What is PICA? PICA is a behaviour disorder characterized by the consumption of non-edible substances. It is most commonly observed in children, pregnant women, and individuals with intellectual or developmental disabilities. The behaviour must persist for at least one month to be considered PICA and occur at an age where eating such items is developmentally inappropriate.
Some of the non-food items individuals with PICA may consume include:
Dirt or soil
Chalk or plaster
Hair
Paper
Plastic or small objects
Paint chips
Clay
Soap
While the exact cause of PICA is still unclear, it is often linked to nutritional deficiencies, sensory needs, or psychological conditions such as obsessive-compulsive disorder (OCD) or developmental delays. It can also be a learned behaviour in some cases, reinforced by the sensory or oral stimulation that comes with eating non-food items.
Risks Associated with PICA: PICA can pose significant health risks, depending on the substances being ingested. Some of the common risks include:
Poisoning or Toxicity: Consuming materials like paint chips, which may contain lead, can lead to poisoning.
Choking or Intestinal Blockages: Swallowing non-food items like hair, small objects, or plastic can cause choking or blockages in the digestive system.
Infections: Eating dirt or other contaminated substances can lead to bacterial or parasitic infections.
Nutritional Deficiencies: In some cases, individuals with PICA may consume non-food items at the expense of regular food intake, leading to malnutrition.
Causes of PICA: The causes of PICA can vary widely, and there is no single factor that triggers the behaviour. Some potential causes include:
Nutritional Deficiencies: Some individuals with PICA have been found to have deficiencies in minerals like iron or zinc. The consumption of non-food items may be the body’s way of compensating for these deficiencies.
Developmental Delays: PICA is more common in individuals with developmental disabilities or autism spectrum disorder (ASD), possibly due to sensory-seeking behaviours or difficulties with impulse control.
Sensory Needs: Many individuals with PICA are drawn to the texture or sensory stimulation that comes from eating non-food items. For example, the crunch of dirt or the feel of plastic may provide a sensory experience that is reinforcing for the individual.
Psychological Factors: In some cases, PICA is linked to underlying mental health conditions like OCD, anxiety, or stress. The behaviour may serve as a coping mechanism or provide temporary relief from emotional distress.
Behavioural Interventions for PICA: As with other challenging behaviours, understanding the function of PICA is essential in developing an effective intervention plan. Behavioural interventions often focus on identifying the cause of the behaviour and teaching replacement behaviours that serve the same function but in a safer, more appropriate way.
Here are some evidence-based strategies used to address PICA:
Functional Behaviour Assessment (FBA): The first step is conducting a Functional Behaviour Assessment to determine the function of the behaviour. Is the individual engaging in PICA for sensory stimulation, attention, or escape? Understanding the motivation behind the behaviour helps guide the intervention plan.
Environmental Modifications: One of the key strategies in managing PICA is altering the environment to reduce access to non-food items. This might involve removing items like small objects, keeping unsafe materials out of reach, and supervising the individual closely in environments where PICA is likely to occur.
Reinforcement of Alternative Behaviours: A common approach is to reinforce appropriate behaviours, such as eating actual food or engaging with sensory toys instead of non-food items. This might involve using a system of positive reinforcement where the individual is rewarded for consuming only appropriate food items.
Oral Sensory Stimulation: For individuals with sensory needs, providing safe alternatives for oral stimulation can be an effective intervention. Chewable toys or oral-motor activities can meet the individual’s need for sensory input without the risk of ingesting harmful substances.
Task Modification and Structured Routine: Some individuals engage in PICA as a way to escape from difficult tasks or situations. Modifying tasks to make them more manageable or establishing a structured routine can reduce anxiety and help the individual stay focused on safe, positive activities.
Consistent Redirection and Extinction: Redirection involves guiding the individual away from the non-food item and toward a safer alternative, such as a toy or preferred activity. Extinction is a strategy where the behaviour is no longer reinforced (e.g., by consistently preventing access to non-food items), leading to a reduction in the behaviour over time.
Case Example: I worked with a young girl, let’s call her Maya, who had a persistent habit of eating paper and small plastic objects. Through an FBA, we discovered that her PICA behaviour was primarily sensory-seeking, as she enjoyed the texture and sensation of chewing these items.
We developed a plan that included:
Providing Safe Oral Alternatives: Maya was given chewable toys and textured foods that provided the oral stimulation she was seeking.
Environmental Modifications: We ensured that her environment was free of accessible paper and small objects.
Reinforcement: Each time Maya chose a safe alternative to chew on, she was rewarded with praise and a preferred activity.
Supervision and Redirection: Maya’s caregivers provided close supervision and gently redirected her to safer items whenever she attempted to engage in PICA.
Within a few months, Maya’s engagement with non-food items decreased significantly, and she began using her chew toys consistently.
Final Thoughts: PICA can be a challenging behaviour to manage, but with the right interventions, it is possible to reduce or eliminate the behaviour while keeping individuals safe. By understanding the causes and functions of PICA, we can create targeted, effective strategies that promote healthier behaviours.
If you or a loved one is dealing with PICA, I’m here to help. Contact me today for a consultation, and let’s work together to develop a plan that keeps your loved ones safe and supported.
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