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Pica in Autism: Causes, Signs, and Management

December 19, 2023

If you’re a parent, you’ve probably seen your child put something in their mouth that isn’t food. It’s normal behavior for toddlers, but if it happens past that stage of development, it’s usually a sign of an eating disorder known as pica. Unfortunately, pica in autism is a common issue for children on the spectrum, and it can be pretty challenging for parents to deal with.

Depending on what objects are ingested, young children may face nutritional deficiencies, choking, poisoning, parasites, blood infections, and more. We understand this is the last thing you want for your little one, and you’re not alone in your worries.

Learning about pica in autism and some management strategies can help you avoid any potential accidents in the future. We’re here to help you with that.

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What is Pica in Autism?

According to APA, pica is an eating disorder characterized by a constant craving for inedible substances like paint, hair, dirt, starch, and more. Although these items vary from person to person, most individuals with pica will still eat normal food items.

Thus, simply put, pica is a compulsive appetite for items that are not food, and it can be a dangerous, potentially life-threatening behavior for anyone.

Under the American Psychiatric Association’s diagnostic criteria, a person has pica when they:

  • eat non-food, non-nutritional substances for over a month,
  • do so at a stage of development that isn’t appropriate and,
  • do so outside of any culturally accepted practice.

Pica isn’t exclusive to autism spectrum disorder. It has also been seen in people with developmental disabilities, conditions such as schizophrenia or obsessive-compulsive disorder, and even in otherwise neurotypical pregnant women.

However, a recent study from the American Academy of Pediatrics reveals that pica is significantly more prevalent among children with autism. 

Approximately 28.1% of those with autism and intellectual disabilities also have pica, compared to 14% of children with autism but no intellectual disabilities. In contrast, the occurrence of pica in the general child population is just 3.5%.

Although the exact reasons for pica in autism remain unclear, researchers have several theories regarding this issue. Some suggest that sensory-seeking may drive this condition, where individuals on the ASD spectrum ingest objects to explore different textures and tastes.

On the other hand, some propose that pica could simply be a coping mechanism, helping children with autism regulate their overwhelming sensory experiences.

Pica in autism prevalence
https://www.autismparentingmagazine.com/pica-and-autism/

Symptoms of Pica

Identifying pica behavior is crucial for early intervention. However, it’s essential to differentiate between typical exploratory behavior and pica first. 

It’s common for children to explore the world through their mouths, but this is when it could be a sign of something more:

  • Eating non-food items, such as dirt, clay, paint, hair, rocks, and more
  • Tasting and chewing on non-food items
  • Obsessively craving non-food items

Very few epidemiological studies explore the pica occurrence in individuals on the spectrum. However, it is important to note that children often explore by putting foreign objects in their mouths, which is very normal.

Still, some things may help you distinguish between pica and normal development behavior:

  • Your child’s age: Although pica is more common in young children, it can occur at any age.
  • Your child’s developmental level: Pica is more common in children with developmental delays.
  • Your child’s medical history: Pica is more common in children with certain medical conditions, including nutritional deficiencies.
  • The type of object the child is eating: Pica involves ingesting non-food items, such as dirt, paint, hair, and more.
  • The cause of your child’s desire to ingest inedible objects: Children with pica often eat non-food items for sensory reasons, such as taste or texture.

What Causes Pica in Autistic Children?

There are many potential causes for pica. First, contact a doctor to rule out any dietary deficiencies since some patients engage in pica because they crave iron or other minerals. 

Other children with autism may be unable to distinguish between edible and inedible items and require more practice. Some children with developmental disabilities may still be in the mouthing stage, even above the age of two.

A dental issue could also be the culprit, causing the child with autism to chew on and incidentally ingest things to alleviate pain and pressure on their gums.

But perhaps the most common cause of pica in autism is sensory stimulation. For some kids, eating an object feels good in their mouth and fulfills a sensory craving. 

JJ Medicine, a medical resident presenting pica facts.

Managing and Treating Pica in Autism

The path you take for treating your autistic child’s pica will, of course, depend on the cause. 

If a nutritional deficiency is a problem, changing your child’s diet and/or introducing vitamins or supplements may be enough. 

Whatever the cause of your son or daughter’s pica, you should always inform their healthcare providers of it. They will need to be monitored for pica-related problems such as blockages and lead poisoning.

Make sure that every member of your child’s team is aware of their pica, from teachers to family members, therapists, and any other care providers. They should know to watch out for the behavior and keep any of your child’s preferred items out of the way as much as possible.

Therapy for Pica

Limited research on pica in individuals with autism, especially children, highlights effective behavioral interventions.

One study applied “differential reinforcement of functional communication” to redirect a six-year-old’s pica behavior. By encouraging verbal requests instead of direct picking, the child learned to wait for temptations, with consistent praise and clean food reinforcement.

Other studies explored methods like “differential reinforcement of an alternate behavior” (DRA) and “differential reinforcement of incompatible behavior” (DRI).

DRA encouraged chewing gum as an alternative to pica, while DRI reinforced behaviors incompatible with pica, such as using tools or exchanging cigarettes for food.

Results showed promise, but all children with autism spectrum disorder are different. Each will respond best to a different method. Experienced professionals can help you access the best treatments, services, support, and resources to help your child.


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Managing Pica at Home

Aside from your therapy program, there are things you can do to protect your child’s health until their pica is under control:

  • Find out what your autistic child’s preferred objects are, if any.
  • Consider getting child-proof cabinets, drawers, or boxes.
  • Clean the floor and surfaces regularly to avoid having small items sitting out and about.
  • Try to find activities that keep your son or daughter with ASD distracted from pica. 
  • Consider substitutes for pica, like healthy snacks, gum, or sensory chew toys.

Be sure to prioritize your own emotional support. Pica is a dangerous disorder, so it’s difficult for families to go through. Make room for your feelings, and don’t be afraid to access mental health resources for yourself and the rest of your family. 

You Are Not Alone

Pica is a serious concern for all parents because of the potential for medical complications. The prevalence of pica in children and adults with autism makes it particularly difficult for ASD families.

However, introducing behavioral intervention as early as possible can be an effective treatment for this condition. As an autism parent, you’re never alone in any of your struggles – and pica is no exception.

FAQs

Q: Is pica common in autism?

A: Pica, a common eating disorder in individuals with autism or developmental disabilities, involves consuming non-food items. Both children and adults with these conditions may tend to try eating a variety of non-edible objects.

Q: Is pica a sensory need?

A: Pica in children might stem from challenges distinguishing edible from non-edible items or continue from infant mouthing behavior. For those with autism, it could serve as a way to seek sensory input or alleviate pain and discomfort.

Q: What are the 2 most common causes of pica?

A: Iron deficiency anemia and malnutrition frequently lead to pica, a condition where the body signals an attempt to address a significant nutrient deficiency. Resolving these issues with medication or vitamins often alleviates the symptoms of pica.

Q: Does autism affect eating habits?

A: Eating challenges are common in autism, including limited food preferences, difficulty eating at work or school, prolonged periods without eating, and engaging in pica. Understanding and managing these issues can be complex.

Q: Are you born with pica?

A: Pica can occur at any age, commonly shown in young children under 6, during pregnancy, and those with specific mental health conditions such as autism, intellectual disabilities, or schizophrenia. People aren’t always born with pica.

References: 

Fields, V. L., Soke, G. N., Reynolds, A., Tian, L. H., Wiggins, L., Maenner, M., DiGuiseppi, C., Kral, T. V.E., Hightshoe, K., & Schieve, L. A. (2021). Pica, Autism, and Other Disabilities. Pediatrics, 147(2). https://pediatrics.aappublications.org/content/147/2/e20200462 

Goh, H.-L., Iwata, B. A., & Kahng, S. (1999). MULTICOMPONENT ASSESSMENT AND TREATMENT OF CIGARETTE PICA. Journal of Applied Behavior Analysis, 32(3). https://onlinelibrary.wiley.com/doi/pdf/10.1901/jaba.1999.32-297?casa_token=rbKtH1qeC8oAAAAA:GSeHyTJD3ihas06TZvRoIleRQFepx_VwwOtiwWez_HPcQ4ZHN-2OL4-PkWjfIse1wf7Lz0ISZaUDFDKL 

Matson, J. L., Belva, B., Hattier, M. A., & Matson, M. L. (2011). Pica in persons with developmental disabilities: Characteristics, diagnosis, and assessment. Research in Autism Spectrum Disorders, 5(4).

Napolitano, D. A., Blakkman, L. A., Kohl, L. B., Vallese, H. M., & McAdam, D. B. (2007). The use of Functional Communication Training to Reduce Pica. The Journal of Speech and Language Pathology – Applied Behavior Analysis, 2(1). https://psycnet.apa.org/fulltext/2014-51871-003.html

Theravive. (n.d.). Pica DSM-5 307.52 (F98.3) (F50.8). Theravive. https://www.theravive.com/therapedia/pica-dsm–5-307.52-(f98.3)-(f50.8)

Chalker, A. E. (2017). “The Psychopathology of Pica: Etiology, Assessment, and Treatment .” Inquiries Journal, 9(02).
http://www.inquiriesjournal.com/a?id=1540

Juberg DR, Alfano K, Coughlin RJ, Thompson KM. An observational study of object mouthing behavior by young children. Pediatrics. 2001 Jan;107(1):135-42.
https://pubmed.ncbi.nlm.nih.gov/11134447/

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