Assessment and treatment of pica: A consecutive controlled case series study

Pica includes the persistent ingestion of nonnutritive, nonfood items at a level that is inappropriate given the individual's developmental level and cultural or religious practices. Behavioral treatments involve a variety of components to target the motivating operations that evoke pica, disrupt its occurrence, and reinforce adaptive alternatives; they have been characterized as well established and empirically supported. However, the literature consists of mostly small-n studies, limiting analysis of the general and comparative efficacy of different treatment components. The current study describes outcomes from two different sites for 33 consecutively encountered cases for whom a behavioral treatment for pica was evaluated. The final treatment reduced pica by at least 90% for 30 participants. Positive outcomes were maintained when treatment was extended to novel implementers, settings, and discard apparatuses for 26 of 29 participants. We examine the comparative efficacy of treatment components and discuss tactics used to safely assess and treat pica.