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Exploring Pica in Autism: Causes, Symptoms, and Management

September 21, 2023

When Mary’s 4-year-old autistic son, Cameron, started putting pebbles and toys in his mouth, she didn’t initially worry. But soon, she was alarmed; he was eating paper, soil, and even chalk. “He has pica,” said her pediatrician. Is there even such a thing as pica in autism, she wondered. And what exactly is pica? 

Mary is certainly not alone in her worries. There are many parents out there who wonder the same. In this comprehensive guide, we delve into the intricacies of pica in autism and some practical methods of how you can help your child manage the challenges it brings.

Exploring Pica in Autism: Causes, Symptoms, and Management

What is Pica?

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. The name for the disorder comes from the Latin word for magpies, birds known for collecting inedible objects. 

Pica is thus a dangerous, potentially life-threatening behavior for anyone. Depending on what objects are ingested, young children may face nutritional deficiencies, choking, poisoning, parasites, blood infections, intestinal blockages or perforations, etc. These problems can require hospital visits surgery, and may even cause death.

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.

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The Prevalence of Pica

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%.

Unpacking Pica in Autism

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.

Signs and 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

Distinguishing Pica from Exploratory Behavior

According to a recent study, there’s no clear-cut distinction between pica and exploratory behavior. There are very few epidemiological studies that explore the pica occurrence in individuals on the spectrum. It is, however, important to note that children often explore but putting foreign objects in their mouths, and that is very normal.

Still, there are some things that may help you distinguish between pica and exploratory 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.

28% of children with autism and intellectual disabilities also have pica

American Academy of Pediatrics

Potential Causes of Pica in Autism

There are many potential causes for pica. However, before you jump to any conclusions, it’s best to contact a doctor first. That way, they’ll be able to rule out any dietary deficiencies, which are often a cause of this disorder. Let’s explore some of the most common ones.

Sensory Exploration and Stimulation

The most common theory sees sensory-seeking behavior as the main cause of pica in autism. The researchers claim that individuals on the ASD spectrum typically ingest objects as a way to explore different textures and tastes.

Nutritional Deficiencies

Pica could also be caused by nutritional deficiencies commonly seen in children with autism. According to recent research, the body’s attempt to make up for certain deficiencies may manifest as obsessive cravings for certain inedible substances.

Communication Challenges

For some autistic children, communication can be a significant challenge. In that case, when verbal communication falls short, pica may serve as their way of expressing their needs, desires, discomfort, and preferences.

JJ Medicine, a medical resident presenting pica facts.

Diagnosing Pica

Diagnosing pica should never be done without a comprehensive assessment by healthcare professionals, such as a psychologist, psychiatrist, and developmental pediatricians. For an accurate diagnosis, it’s important to understand the behavioral patterns, triggers, and potential causes.

Importance of Early Intervention

There are several reasons why early intervention is essential for pica in autism. This condition often leads to health problems, such as lead poisoning, intestinal blockage, and infection.

On top of that, it’s not uncommon for pica to be a sign of an underlying medical condition, such as iron and zinc deficiency, or even some mental health conditions, such as anxiety and OCD.

Early intervention enables you to prevent these health issues and identify any potential medical condition your little one may be dealing with. It will also help you teach your child about the dangers of pica and give you enough time to learn how to manage their behavior.

Impact of Pica on Autism Families

Yes, pica can significantly impact individuals with autism, but their families often face difficulties, as well. Because of the many dangers that pica brings, such as poisoning, it may also cause emotional distress for the individual and their caregivers.

Because of that, it’s important to remember that you should always seek professional help when things get hard. You and your family are not alone in this, and it’s crucial that you think about your health, too.

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Managing Pica in Autism

How you manage pica in your autistic child mainly depends on the cause of it. For example, if a nutritional deficiency is a problem, changing your child’s diet and/or introducing vitamins or supplements may be enough. Your doctor will help you make a plan to help you and your little one.

No matter what the cause of your child’s pica is, it’s essential to make their healthcare providers aware of it. Don’t forget to inform your child’s teachers, therapists, as well as your family members, too. That way, they’ll make sure to watch out and keep any of your child’s preferred items out of the way.

We understand how challenging it can be to manage pica in autism, but some things could help you. Let’s delve deeper.

Multidisciplinary Approach

Unfortunately, there hasn’t been as much clinical research into pica in autistic children as other self-injurious behaviors. However, several studies have shown successful behavioral intervention for pica patients with autism, an intellectual disability, or other disorders and conditions.

Managing pica in autism requires a collaborative effort. A multidisciplinary approach involves healthcare professionals, psychologists, behavior analysts, and occupational therapists for the most effective results.

All children with autism spectrum disorder are different, so 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.

Behavior Intervention Plans

Tailored behavior intervention plans can help greatly, as they replace pica behaviors with more appropriate alternatives. For these plans, positive reinforcement and teaching coping strategies are key components.

According to a study led by Dr. Lisa A. Napolitano, differential reinforcement of functional communication helped them lessen the pica of a six-year-old boy who has autism. This concept is also used in Applied Behavior Analysis therapy.

When it comes to this approach, specific behaviors are reinforced, while others are not. For example, if you’re trying to teach your child to consistently brush their teeth before bed, you might allow ten minutes of free time as a reinforcer. If they don’t complete the target behaviors, you withhold that reinforcement.

In the Napolitano study, the researchers wanted to encourage the six-year-old boy, Richard, to perform “functional communication” instead of pica behaviors. In other words, they wanted him to verbally request food instead of eating it off the floor.

They tested Richard by placing pretzels and rock candy on the floor near him. At first, he immediately reached for the items. The researchers taught him to wait and ask for the food after a timer went off, setting the timer for longer periods each session.

Every time he asked for the food after the timer went off, without reaching for the food on the floor, he was reinforced with praise and a clean food item. Eventually, Richard was able to wait almost five minutes without grabbing the “bait” around him.

Exploring Pica in Autism: Causes, Symptoms, and Management

Nutritional Support

Addressing nutritional deficiencies through a balanced diet and supplements proved to be an effective way to reduce pica tendencies. However, this method is the most effective for children whose pica is caused by nutritional deficiencies.

If your child is not getting enough of certain nutrients, they are more likely to eat inedible items in an attempt to get those nutrients they need. Providing them with a healthy, nutrient-rich diet can reduce their cravings for non-food items.

On top of that, it can improve your child’s overall health, as well. Providing a balanced diet, taking supplements, eating regular meats, and eating slowly are all effective ways you can help your child manage their pica behavior.

In order to develop a suitable nutritional plan, it’s important to consult a registered dietitian and provide them with the necessary information about your child’s condition.

Managing Pica at Home

You don’t have to sit and wait for a new therapy session that could help your child manage their pica behavior. Luckily, there are things you can do at home that will protect your child’s health until their pica is under control. Here are some ideas:

  • Find out what your autistic child’s preferred objects are: There may be a particular object, or a class of similar objects, that fulfills a sensory experience. As you observe your child, determine what those are and how to keep them out of their way.
  • Child-proof your home: Child-proof cabinets, drawers, or boxes will become your new best friends. Oh, and don’t forget to clean the floor and surfaces regularly! You definitely want to avoid having small items sitting out and about.
  • Find activities that keep your son or daughter with ASD distracted from pica: Behaviors that involve the use of hands could engage their sensory needs and keep him/her from picking up things to eat.
  • Don’t forget about your own emotional support: We know your child is your biggest priority. However, pica in autism can be difficult for families involved, too. Make room for your feelings and don’t be afraid to access mental health resources for yourself and the rest of your family.

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Pica in autism can pose many challenges for children on the spectrum, as well as their families. Luckily, with the right strategies and professional support, this behavior can be managed effectively.

By understanding the connection between autism and pica, recognizing different signs and causes, as well as implementing personalized management strategies, your child can lead a healthier and happier life.

FAQs About Pica in Autism

Q: Can Pica Behavior be Harmful?

A: Unfortunately, pica behavior can pose serious health risks. They often include gastrointestinal blockages or poisoning from ingested substances.

Q: Is Pica Exclusive to Autism?

A: No, pica is not exclusive to autism and it can occur in other individuals, as well. However, it’s more prevalent among those on the autism spectrum.

Q: How can I Differentiate Between Sensory Exploration and Pica?

A: Sensory exploration is a normal developmental phase in children. On the other hand, pica is characterized by constant craving and ingestion of non-food items over an extended period.

Q: Are There any Medications for Treating Pica?

A: Medications are typically not used as a way to manage pica. More effective approaches include behavioral interventions and addressing underlying causes.

Q: Where can I find Professional Help for Managing Pica?

Your child’s pediatrician, a developmental specialist, or a behavior analyst can help you manage pica effectively.

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