Results of two pica exchange programs Tennessee Association for Behavior Analysis 2008 Conference November 16, 2008 Nashville, TN Joseph A. Darling, Carolyn K. Buckner, and Jason T. Otto

Pica exchange Essentially amounts to discrimination training

Pica definition Compulsive, recurrent consumption of nonnutritive substances (Stiegler, 2005) Swallowing inedible items boogers, scabs

Pica terminology (Stiegler, 2005) Acuphagia – sharp objects Amylophagia – laundry starch Cautopyreiophagia – burnt matches Coprophagia – human feces, animal dung

Pica terminology (Stiegler, 2005) Foliophagia – leaves, grass, acorns, pinecones Geomelophagia – raw potatoes Geophagia – dirt, sand, clay Lignophagia – wood, bark, twigs Lithophagia – rocks, gravel, pebbles

Pica terminology (Stiegler, 2005) Pagophagia – ice, freezer frost Plumbophagia – paint chips (lead) Tobaccophagia – cigarette butts Trichophagia – hair wasps

Participant D 27 year old male PMR DSM IV: pica, bipolar D/O NOS, PDD NOS Came to GVDC in 1987 at the age of 7

Participant S 46 year old male PMR DSM IV: OCD, pica, autistic D/O Came to GVDC in 1968, 6 years old

Operational definitions Participant D - Pica – swallowing inedible objects Pica attempts - placing inedible objects in his mouth without swallowing them.

Operational definitions Participant S - Pica Attempts – Bringing inedible objects within three inches of his mouth or actually putting objects not intended for human consumption into his mouth. Pica – actual swallowing of inedible object. Pica items were primarily metal (screws, staples, zipper tabs, nails)

Pica exchange sessions One staff, one participant at the table 10 inedible items 10 trial sessions Trade for preferred edible (determined by preference assessment)

Pica exchange sessions fading & generalization Trade with person at the table Trade with someone 5 feet away Trade with someone 10 feet away Trade with someone standing at the door Independent, no trial, throughout the day

Session data participant D

Bureaucracy works because it doesn't work - Dale Brethower Lost data due to administrative fiat to use a different system

Session data participant D

Pica data participant D

Session data participant S

Therapist went on extended leave before the fading process started (6/03-9/03) Participant reported to independently pick up items to exchange

Participant S – independent pica exchange

Pica data participant S

Pica seeding Participant S

Pica seeding procedure During regular leisure time, metal objects were placed on the ground within 10 feet of the participant Observed for 10 minutes

Pica seeding procedure If participant picked up the seeded item, he was prompted to trade it for a preferred edible. If participant did not pick up the seeded item after 10 mins., he was prompted to pick up the items and trade for a preferred edible.

Pica seeding items PCP initially approved a dime or a nickel (easy to pass if eaten) After 60 sessions w/o pica attempts in two locations, PCP agreed to quarters, nuts, and bolts.

Pica seeding IOA 100% for all sessions (78) IOA data taken during 35% of sessions

X ray data Participant S Record review of x rays going back to the mid – 1980’s showed metal in most x rays Screws, bolts, zipper tabs, pop tops, staples

Confessions The pica exchange and pica seeding programs are part of an intervention package There are interventions for other target behaviors that may impact the rates of pica attempts

Questions?