A systematic review of the effectiveness of behavioural treatments for pica in youths

Abstract

Pica is the persistent consumption of non‐nutritive, nonfood substances and is associated with adverse health complications. However, there is limited research on interventions for pica in youth. The objective of this study is to systematically review the empirical evidence for the effectiveness of behavioural interventions for pica in children and adolescents and to generate treatment recommendations. A systematic search yielded 823 articles extracted from five databases: CINALH, Family and Society Studies Worldwide, Medline, PsycINFO, and Web of Science. Two reviewers completed initial sorting based on article titles and abstracts. Five reviewers completed sorting based on full article review. Thirty articles were included and double coded for demographic information, co‐morbid conditions, and intervention characteristics. These studies were case studies involving behavioural treatments for pica. Seventeen behavioural interventions were categorized into four treatment approaches: reinforcement‐based, response interruption, “other” interventions, and punishment‐based procedures. Interventions that resulted in near‐zero rates of pica were deemed effective. Findings showed support for contingent reinforcement, discrimination training as part of a combination treatment, physical restraint, time out, and contingent aversive stimulus. No evidence supported the effectiveness of response interruption procedures, including response blocking and visual facial screen. Other coded procedures did not appear effective. We recommend that the least restrictive procedures are implemented first, including a combination treatment with contingent reinforcement and discrimination training. As needed, more restrictive procedures can be added to the treatment package. This review will facilitate future empirical work and assist clinicians with treatment options for pica in youth. High‐quality trials are needed.

Pica in childhood: Prevalence and developmental comorbidity

“…Therefore, it is important for an interdisciplinary team to work with the patient, as it increases the likelihood that specialists will notice or pay attention to the signs or symptoms, and perform a more thorough examination and evaluation (6). As the etiology and pathogenesis of pica have not yet been elucidated, there is no current pharmacological treatment that can be applied; however, research shows that behavioral therapy is an effective way to treat pica (17,18).…”

Brief assessment and treatment of pica using differential reinforcement, response interruption and redirection, and competing stimuli

“…Results of functional behavioral assessments targeting pica have suggested that pica is largely maintained by automatic or sensory reinforcement (Hagopian, Rooker et al., 2011; Matson & Bamburg, 1999; McAdam et al., 2004; Schmidt et al., 2017). Therefore, response blocking, noncontingent reinforcement, and punishment procedures are common interventions for pica (Hagopian et al., 2012; Moline et al., 2020). However, these components do not provide an alternative behavior to replace the pica response.…”

A transdiagnostic, modular approach to treating pica in young girl.

“…This program was designed in response to several treatment barriers clinicians face in real-world mental health care, including comorbid symptom presentations, which could offer clinicians the much-needed flexibility in treating complex cases where pica is a presenting concern. Previous literature on the treatment of pica (see recent review by Moline et al, 2021), describes distinct behavioral components for treating pica typically conducted in inpatient or home settings. Rarely do these studies describe a comprehensive treatment program to treat the client and family, including the full range of presenting symptoms that may be comorbid with pica.…”

“…Behavioral treatments are typically recommended for pica and often include reinforcement, punishment, and response interruption procedures (see Moline et al, 2021; for a systematic review). These treatments vary in session number and duration but can be intensive; most interventions involve over 30, brief sessions (e.g., ranging from 5–147 sessions, lasting anywhere from 5 min to 6 hr in duration; Moline et al, 2021). Broadly speaking, there is a lack of evidence-based treatment manuals for clinicians facing youth pica and fewer resources available for complex presentations, including attachment-related dysfunction and trauma history.…”

“…Behavioral treatments are typically recommended for pica and often include reinforcement, punishment, and response interruption procedures (see Moline et al, 2021; for a systematic review). These treatments vary in session number and duration but can be intensive; most interventions involve over 30, brief sessions (e.g., ranging from 5-147 sessions, lasting anywhere from 5 min to 6 hr in duration; Moline et al, 2021).…”