Pathological Pica

Pathological Pica Running head: PATHOLOGICAL PICA

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Pathological Pica Delilah Hodge Western New Mexico University

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Pathological Pica The term pica comes from the Latin word for magpie, a bird known for its large and indiscriminate appetite, as it feeds on whatever it finds or comes across. In humans, pica is used to describe an eating disorder where non-food items such as clay, laundry starch, and match heads are regularly ingested over a period of time. In many societies around the world, forms of pica are culturally accepted and ritually performed. Although pica is observed most frequently in children, it is the most common eating disorder seen in individuals with developmental disabilities, epilepsy, and emotional disturbances. The purpose of my paper is to address why students with mental retardation are more likely to be labeled as having pica and whether or not their pica should be considered pathological. What is Pica? Definition According to the DSM-IV-TR (2000) in order for children to be clinically labeled as having Pica they must meet the following criteria: (a) eat one or more nonnutritive substances on a persistent basis for a period of at least 1 month, (b) this behavior must be developmentally inappropriate, (c) not part of a culturally sanctioned practice, and (d) sufficiently severe to warrant individual clinical attention. So if a child is between 18 months and 2 years, the ingestion and mouthing of nonnutritive substances is common, age appropriate, and should not be considered pathologic. Only students whose ingestion of non-food items is severe enough to warrant medical attention should be labeled as having pica. In these students pica is typically considered to be a secondary diagnosis with mental retardation or other health impairment usually being the primary issue. Younger children with pica often eat paint chips, plaster, string, hair, or cloth, whereas

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older children will eat animal droppings, sand, insects, leaves, or pebbles. Prevalence The prevalence of pica is unknown because the disorder is often unrecognized and underreported. Pica is seen more in children than adults. It is observed more commonly during the second and third years of life and is considered developmentally inappropriate in children older than 18-24 months. Children with mental retardation and autism are affected more frequently than children without these conditions. In this population, the risk for and severity of pica increases with increasing severity of mental retardation. Research suggests that pica occurs in 25-33% of children under age 2 and 20% of children seen in mental health clinics. Pica typically occurs in equal numbers of boys and girls; however, it is rare in adolescent and adult males of average intelligence who live in developed countries. Why does Pica Occur? The specific causes of pica are unknown, but there are many conjectures. The most common assumptions are nutritional, sensory, physiologic, and psychosocial needs, cultural explanations, and poverty. The nutritional theory suggests that appetite-regulating brain enzymes, altered by an iron or zinc deficiency, trigger specific cravings. One physiological theory to explain pica is that eating clay or dirt helps relieve nausea, control diarrhea, increase salivation, remove toxins, and alter odor or taste perception, as it contains alkaloids which may help neutralize the pH of an acidic stomach. Some psychological theories explain pica as a behavioral response to stress, a habit disorder, or a manifestation of an oral fixation. People may consume clay or dirt as part of a daily routine such as smoking. Another explanation is that pica is a cultural feature of certain

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religious rituals, folk medicine, and magical beliefs. Several cultures believe that eating dirt will help them incorporate magical spirits into their bodies. Malnutrition and hunger in impoverished families can also result in pica, as there may be nothing else to eat. Why are Students with Mental Retardation are Overrepresented Mental retardation is one type developmental disability that refers to a person having limitations in present levels of functioning. In the developmental perspective of cognitive development in students who have mental retardation, theorists assume that “cognitive development… is similar to that of a younger child who is not retarded.” (Beirne-Smith, 2002, P. 249) If this is the case, a seven-year-old child who has mental retardation may be entering the oral phase normally associated with that of a toddler. Teachers observing this child mouthing and eating non-food items would refer the student as having pica because it’s not appropriate for the child’s chronological age, even though it is appropriate for the child’s developmental age. Some children with Pica have been said to be imitating a family pet, cat or dog that they have watched eat a particular item. This would make sense because students with developmental delays often mimic the world around them without knowing what is socially accepted and what is not. Also individuals with mental retardation may not always be able to discriminate between food and nonfood items; “however, this theory is not supported by findings of selection of pica items and the often aggressive search for nonfood items of choice.” (Ellis, 2002, ¶ 40) On the other hand, pica is rarely observed in people who are not mentally disabled because they know it’s socially inappropriate and unacceptable. These peopled are reluctant to reveal their unusual cravings and may not realize that their symptoms

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indicate an underlying problem. Pica Outcomes If a child continues to consume non-food items, he/she may be at risk for potential health problems. Complications of pica can include, malnutrition, intestinal obstruction, intestinal infections or parasites from soil, anemia, mercury poisoning, liver and kidney damage, constipation and abdominal problems. The eating of non-food substances may interfere with the body's consumption of normal nutritional food. More so, since substances such as paint chips are toxic, ingesting these things can cause poisoning. If an individual has pica and experiences abdominal pain, problems with their bowels or any other discomfort, they should seek prompt medical attention. Consequences of pica range in severity from benign to life threatening, and the ingestion of contaminated material could lead to cognitive impairment and/or death. Classroom Implications If a child is engaging in pica during class he/she is being distracted from the lesson and not receiving the information. The student may also be disturbing his/her peers. By providing snacks, gum, or squishy balls, the teacher may help the student receive an alternative sensory stimulation, remain attentive/alert, and not disrupt the rest of the class. Because each child is unique, there are no set characteristics for students who engage in pica. They will all benefit from Gardner’s 8 multiple intelligences (verbal/linguistic, logical/mathematical, visual/spatial, body/kinesthetic, musical/rhythmic, interpersonal, intrapersonal, and naturalist) being incorporated with multisensory instruction and differentiated instruction, because each student will have a

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different learning style or modality that works best for him/her. What To Do? If a child has pica, a multidisciplinary approach involving parents, teachers, psychologists, social workers, and physicians is recommended for the most effective treatment. Careful analysis of the function of pica behavior is critical in order to find out why the child is engaging in the behavior. The treatment plan must take into account the symptoms of pica and its contributory factors, as well as the management of possible complications of the disorder. Although there is no medication to eliminate pica, Kaopectate or Maalox will help with an acidic stomach. Counseling from psychologists help with students who engage in pica due to stress. Other strategies that have been effective are antecedent manipulation; discrimination training between edible and nonedible items; self-protection devices that prohibit placement of objects in the mouth; sensory reinforcement; differential reinforcement of other or incompatible behaviors, such as screening (covering eyes briefly), contingent aversive oral taste (lemon), contingent aversive smell sensation (ammonia), contingent aversive physical sensation (water mist), and brief physical restraint; and overcorrection (correct the environment, or practice appropriate alternative responses). Is It Truly Pica? Although students with developmental delays may be ingesting non-food items because they are at the developmental stage where it is common and appropriate, it becomes pathological as it develops into a habit. When students regularly engage in pica for environmental and/or sensory stimulation or because it is a learned behavior, they are doing serious harm to their bodies, which warrants individual clinical attention.

Pathological Pica References American Psychiatric Association. (2002). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author Beirne-Smith, M., Ittenbach, R.F., & Patton, J.R. (2002). Mental retardation (6th ed.). Upper Saddle River, New Jersey: Merrill Prentice Hall. Ellis, C.R., & Schnoes, C.J. (2002, September 10). Eating disorder: Pica. Emedicine. Retrieved from http://www.emedicine.com/ped/topic1798.htm Kerr, M.M., & Nelson, C.M. (2002). Strategies for addressing behavior problems in the classroom (4th ed.). Upper Saddle River, New Jersey: Merrill Prentice Hall. The Nemours Foundation, Kids Health for Parents. (n.d.). Pica. Retrieved July 14, 2003, from http://kidshealth.org/parent/nutrition_fit/nutrition/pica.html Turnbull, R., Turnbull, A., Shank, M., Smith, S., & Leal, D. (2002). Exceptional lives: Special education in today’s schools (3rd ed.). Upper Saddle River, New Jersey: Merrill Prentice Hall.

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