1. 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

2. Pica exchange
Essentially amounts to discrimination training

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

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

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

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

7. 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

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

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

10. 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)

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

12. 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

13. Session data participant D

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

15. Session data participant D

16. Pica data participant D

17. Session data participant S

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

19. Participant S – independent pica exchange

20. Pica data participant S

21. Pica seeding
Participant S

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

23. 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.

24. 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.

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

27. 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

29. 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

30. Questions?