Treatment of pica in an adult disabled by autism by differential reinforcement of incompatible behavior

doi:10.1016/0005-7916(87)90012-7

Journal of Behavior Therapy and Experimental Psychiatry

Volume 18, Issue 3, September 1987, Pages 285-288

https://doi.org/10.1016/0005-7916(87)90012-7 Get rights and content

Abstract

The usefulness of diffential reinforcement of incompatible behavior was examined in the treatment of pica in a young man severely disabled by autism in a nonsheltered place of employment. The results indicated that a reduction in pica could be achieved by differential reinforcement of other behavior (DRO). Behaviors which were reinforced included remaining in his assigned location, keeping his hands on his work, working quickly and keeping his mouth clear. Reinforcements included favorite drinks, snacks, activities and praise. Treatment procedures were implemented by direct care paraprofessional staff. Withdrawal of treatment resulted in an increase inpica, with renewed reduction on reinstatement of the reinforcement schedule.

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Cited by (24)

The relationship between derived mutually entailed relations and the function of challenging behavior in children with autism: Comparing the PEAK-E-PA and the QABF
2017, Journal of Contextual Behavioral Science
Citation Excerpt :
Approaches to problem behavior reduction typically involve (a) identifying or teaching an appropriate alterative behavior (e.g., a communicative behavior) that serves the same function as the challenging behavior, and (b) differentially providing access to the maintaining consequence contingent upon the appropriate alternative behavior rather than the challenging behavior. Some common treatment procedures include functional communication training (FCT; e.g., Carr & Durand, 1985; Durand & Carr, 1991; Tiger, Hanley, & Bruzek, 2008), differential reinforcement of alternative or incompatible behaviors (DRA/DRI; e.g., Chowdhury & Benson, 2011; Smith, 1987; Vollmer & Iwata, 1992), and non-contingent reinforcement strategies (NCR; e.g., Carr et al., 2000; Carr, Severtson, & Lepper, 2009; Wilder, Normand, & Atwell, 2005). Such an approach to understanding and treating challenging behaviors exhibited by individuals with autism, however, may be limited in application once individuals begin to acquire meaningful language.
The study evaluated the relationship between participants’ abilities to derive mutually entailed relations across arbitrary stimuli and the function of their challenging behavior as indicated in the Questions About Behavior Function (QABF) indirect assessment. Entailed relational abilities were assessed using the Promoting the Emergence of Advanced Knowledge Equivalence Pre-Assessment (Dixon, 2015), and assessments were conducted across 47 individuals with autism or a related developmental disability. The results indicated that overall scores generated by the QABF were significantly lower for participants who could derive mutually entailed and/or combinatorially entailed relations (t (44) = 2.468, p < .05), and that in a greater proportion of cases, the QABF failed to isolate a single behavior function for individuals who could derive either mutually entailed or combinatorially entailed relations (χ ² (1, N = 47) = 3.166, p < .05). The ability to derive entailed relations was not predictive of any specific challenging behavior topography (χ ² (3, N = 47) = 6.251, p > .05) and was only related to scores on the Physical subscale of the QABF (t (24) = 3.37, p < .05). The results have implications for the assessment and treatment of individuals with autism, as well add to the development of a conceptual understanding of relational abilities and challenging behavior in this population.
Pica in persons with developmental disabilities: Approaches to treatment
2013, Research in Developmental Disabilities
Citation Excerpt :
DRI was also used by Donnelly and Olczak (1990) for cigarette pica of two adults with ID. They also reported positive effects similar to Smith (1987). Noncontingent reinforcement (NCR) has also been used for cigarette pica.
Pica is a very serious problem in which an individual ingests substances without nutrition value, such as paper and paint. As this behavior is often life-threatening resulting in surgery, pica has received attention from researchers for several decades. During that time, a number of interventions have been devised, such as behavioral methods (e.g., aversive stimuli, overcorrection, time-out, reinforcement) and biological interventions (e.g., pharmacotherapy, nutritional supplements). This paper is a broad review of the research on treatment studies for this problem, with a focus on persons with autism and/or intellectual disability (ID), which constitutes almost all of the published treatment papers. In addition, strengths and weaknesses of different pica treatments are discussed. Upon review, applied behavior analysis (ABA) was found to have the most robust empirical support to treat this behavior. Most clinicians are drifting away from aversive techniques and relying on more positive procedures to guide their treatment plans. The implications of current status and future directions for research are also addressed.
Assessment, behavioral treatment, and prevention of pica: Clinical guidelines and recommendations for practitioners
2012, Research in Developmental Disabilities
Citation Excerpt :
In the treatment of pica, however, no studies show that DRA alone produces reductions near zero rate and over a 24-h period for 7 days a week. Smith (1987), for example, described the reduction of pica displayed by a 23-year-old male with autism and a profound intellectual disability following differential reinforcement of incompatible behaviors (DRI). The rate of pica at the end of treatment was 3.7 per day, still a high rate of pica in a clinical setting.
Pica is a dangerous form of self-injurious behavior that occurs in people with developmental disabilities who are institutionalized. Studies also indicate that pica has led to the death of people with developmental disabilities. While a number of published studies have demonstrated that pica behavior can be decreased substantially with behavioral treatment, few of these studies incorporated strategies for generalization and maintenance outside of brief sessions. A second limitation of current research is that some studies reduced pica substantially, but pica responses still occurred at rates that are problematic in terms of prevention of adverse consequences, which leaves practitioners with the task of further decreasing pica to protect people exhibiting pica from harm.
We make recommendations for assessment, treatment, and prevention of pica for practitioners. These recommendations are based on two extensive reviews of the literature and our extensive experience as practitioners in the treatment of pica.
Our hope is that administrators, professionals and practitioners will consider our guidelines and recommendations as they attempt to protect people with pica and developmental disabilities from harm by developing standards for assessment, treatment and prevention for this difficult-to-treat population. Our hope is that children with pica will receive early intervention to prevent pica from developing into life-threatening behavior.
Functional assessment of pica behaviours in a child with pallister killian syndrome and autism
2011, Neuropsychiatrie de l'Enfance et de l'Adolescence
Cette recherche aborde au travers d’une étude de cas, la question du traitement des comportements de pica (ingestion de substances non comestibles et/ou consommation inappropriée de produites comestibles) résistants, observables chez un enfant porteur d’un syndrome de Pallister Killian associé à un autisme et à un retard mental profond. Les comportements de pica pouvant être envisagés comme remplissant des fonctions, nous avons procédé à une évaluation fonctionnelle, basée sur un recueil d’observations directes et indirectes. Suite à ces observations, nous avons pu élaborer quatre hypothèses fonctionnelles expliquant l’apparition ou le maintien de ces comportements : soulagement de douleurs dentaires ; compensation de carences en oligoéléments ; gestion de situations vécues comme stressantes ; autostimulations sensorielles. Sur cette base, nous avons ensuite développé une approche thérapeutique multimodale, qui a donné lieu à la disparition des troubles du comportement.
Through a case study, the paper deals with persistent pica behaviour in a child of 12 with Pallister Killian syndrome associated with autism and profound mental retardation.
Pica behaviour may have a functional role. We thus carried out a functional assessment in order to make functional assumptions before targeting our interventions. Our methodology was divided into three parts: observations for 6 days – six sessions of 5 hours during which different activities were carried out; interviews with parents and members of the multidisciplinary team; making functional hypotheses; interventions: adapted to these hypotheses. In order to assess their efficiency, the frequency of targeted behaviour was measured out after the intervention.
Step 1: functional analysis: data gathered from indirect observation displayed an early occurrence and an evolution of pica behaviour. Moreover, significant change in the child's environment resulted in an increase of these types of behaviour. In the medical histories, numerous dental diseases were noted (aching tooth eruption, dental decay, recurrent abscess and moth ulcer); blood tests showed iron deficiency. Step 2: functional hypotheses: after the observations, we could make four functional assumptions explaining the apparition or the continuation of the behaviour: relieving the toothache; compensation for nutritional deficiency of trace elements; management of stressful situations; sensory stimulations. Step 3: intervention: according to the assumptions, several types of intervention were suggested in order to reduce or even to stop pica behaviour: the child's environment was asked to improve or intensify the dental care; after an operation which took place a few days later, four decayed teeth were pulled out – teeth that could have ached if they had not been pulled out; a treatment in trace elements was prescribed during that period in order to readjust the iron deficiency; the child's environment was told to anticipate important daily changes; a behavioural intervention was scheduled in order to counter-balance the reinforcement caused by self-stimulation.
The observations carried out during three days three weeks after the behavioural intervention depicted no pica behaviour.
Will these results continue in the medium term and in the long run? May this evolution be generalized to the child's other environments – at home for instance?
Identifying empirically supported treatments for pica in individuals with intellectual disabilities
2011, Research in Developmental Disabilities
The purpose of the current study was to critically examine the existing literature on the treatment of pica displayed by individuals with intellectual disabilities. Criteria for empirically supported treatments as described by Divisions 12 and 16 of APA, and adapted for studies employing single-case designs were used to review this body of literature. A total of 34 treatment studies were identified, 25 of which were well designed and reported at least an 80% reduction in pica (21 studies reported 90% or greater reduction in pica). Results indicated that behavioral treatments in general, and treatments involving the combination of reinforcement and response reduction procedures in particular, can be designated as well-established treatments for pica exhibited by individuals with intellectual disabilities.
Use of differential reinforcement to reduce behavior problems in adults with intellectual disabilities: A methodological review
2011, Research in Developmental Disabilities
The least-restrictive-alternative guideline for providing treatment emphasizes the use of non-aversive procedures to reduce maladaptive behaviors in individuals with intellectual disability (ID). Differential reinforcement (DR) is an excellent example of such a non-aversive, reinforcement based behavioral intervention. The purpose of this literature review was to summarize and provide a methodological analysis of studies, conducted between 1980 and 2009, using a DR contingency to reduce problem behaviors in adults with ID. A total of 31 studies were located that met the inclusion criteria. Of these, 15 reported DR to be an effective intervention when used independently. Of the remaining, 10 studies found DR to be useful as part of a treatment package, and six found a DR contingency used independently to be ineffective, and only observed treatment effects when an aversive component was added. Very few studies assessed the use of DR in older adults and in individuals with mild ID; these reflect areas of future research. A methodological analysis found that several studies did not report information on key methodological variables; for example, conducting a functional analysis and a stimulus preference assessment to guide choice of treatment and reinforcers, thinning very dense DR schedules, assessing collateral behaviors, generalization of behavior change across settings and implementers, and following up treatment outcomes over time. The overall positive findings about the effectiveness of DR are encouraging; however, more methodologically robust studies would serve to make such findings more conclusive and practically relevant for implementation in natural settings for adults with ID.

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Treatment of pica in an adult disabled by autism by differential reinforcement of incompatible behavior

Abstract

J. Behav. Ther. Exp. Psychiat.

Behav. Res. Ther.

J. Behav. Ther. Exp. Psychiat.

Behavior therapy of pica in a profoundly retarded adolescent

Mental Retardation

food pica and iron deficiency

Arch. Int. Med.