Pica in the learning disability population: a review of behavioural management.

Background: Pica is frequently observed in people with autism and learning disabilities. It can result in many life threatening health complications, such as intestinal obstruction and gastrointestinal bleeding. People in this population have complex needs and are particularly vulnerable to experiencing health care and social inequalities. Pica reduces the quality of life in this population, and is a distressing disorder for patients and their families, especially if little is known about the disorder. Methodology: A search of databases that included OVID, EMBASE and MEDLINE was conducted looking specifically at behavioural management of pica in the learning disabled population. All age groups and severity of learning disability were included. A total of 316 results were obtained from this search. After screening, a total of 8 papers were reviewed. Results: This review summarises 8 published studies that examined the assessment and use of behavioural interventions in the management of pica in people with learning disabilities and autism. The interventions discussed include differential reinforcement of pica, exposing participants to mild forms of punishment contingent upon pica, and discrimination training. The review explores the acceptability of such interventions, especially of punishment procedures, and highlights some areas for future research. Conclusion: Future research is required to explore the efficacy of managing pica via behavioural interventions in the adult population with learning disabilities, as this review found papers only on the child and adolescent population. The interventions studied in this review were primarily based in inpatient settings; therefore we need to establish whether they are applicable in the community, and how they can be generalized to a modern day society. With this knowledge, it may be possible to further develop successful behavioural interventions appropriate to the needs of the population. [ABSTRACT FROM AUTHOR]