Treatment of Life-Threatening Pica with 5-Year Follow-up

Pica is a dangerous behaviour that frequently results in exposure to restrictive behaviour management practices such as the arbitrary use of restraint and punishment. We implemented a multi-component function-based treatment analysis including noncontingent access to edible items, response effort manipulations, response blocking, and differential reinforcement with a 19-year-old man diagnosed with autism spectrum disorder, epilepsy, and severe intellectual disability who engaged in life-threatening pica. Following intervention, fading and generalization procedures were implemented with follow-up in the community setting. Pica was reduced to zero occurrences during treatment and generalization sessions, and remained at near zero levels during follow-up over a 5-year period. Social validity measures indicated that the intervention was deemed appropriate and rated favourably by caregivers. These results suggest that life-threatening behaviours such as pica can be effectively reduced with nonrestrictive interventions, and treatment results can be maintained in the absence of restrictive behaviour management practices in typical settings.