A quarterly publication of the Autism Research Institute
Summer, 2024 | Number 3, Volume 38
Pica—the eating of non-foods such as paper, dirt, paint chips, cigarette butts, and feces—is a behavior exhibited by nearly one-quarter of children with autism spectrum disorders (ASD) and is far more common in individuals with ASD than in those with other developmental disabilities. Although pica is generally treated with behavioral interventions, these interventions have limited success. In contrast, researchers in California say, “an internal (organic) rather than an external (behavior modification) approach is more likely to be successful (durable across settings) in long-term treatment.”
Dean Alexander and colleagues note that functional analyses of pica most often indicate that it is maintained by sensory variables. In addition, they point to evidence indicating that pica can actually be addictive due to its potential for enhancing dopamine transmission.
The researchers also cite studies showing that in children with ASD, the prevalence of gastrointestinal (GI) symptoms is significantly higher for those with pica than for those who do not exhibit the behavior. In fact, they speculate, “Pica may largely explain the link between autism and gastrointestinal problems.” Alexander and colleagues propose a seven-step model for the development of pica:
The first four steps of this model, they say, could lead to systemic problems resulting in dopamine depletion, and thus to an “addiction” to pica.
The researchers emphasize that behavioral interventions can play an important role in addressing pica. However, they say that treatment should also emphasize bionutritional approaches focusing on the potential root causes of pica behavior. These approaches, they say, include the correction of nutritional deficiencies; the removal of pathogens; and the use of interventions to enhance the health of the microbiome. They add, “[T]here is also opportunity for tiered or combined approaches to protect and ensure both the immediate and future health of persons with pica disorder.”
The researchers add, “Pica research remains ‘a poor cousin’ compared to a wealth of research on autism, even while ingestion of non-foods affects approximately a quarter of the individuals on the ASD spectrum. Research methodologies for persons with autism can and should be extended to include
pica as a factor of almost certain clinical significance.”
“Pica and autism/pica in developmental disability—ports of entry,” Dean D. Alexander, Stephen M. Edelson, Stanley E. Lunde, and Dale E. Berger, American Journal of Medical and Clinical Research & Reviews, June 25, 2024 (free online). Address: Dean D. Alexander, Lorenz Counseling Services, 9377 Haven Ave, Suite 100, Rancho Cucamonga, CA 91730.
