16 Still, the Agency of Healthcare Research and Quality reported that between 19 there was a 93% increase in cases of pica, the largest rise for any category of eating disorder. 6 Further, as pica is generally perceived as a socially undesirable behavior, self-reports are likely to skew the clinical understanding. Overall rates of pica among the general population are not well understood, nor is there sufficient depth to studies of prevalence as they typically lack detail related to persistence, duration, and relationship with socio-cultural traditions. 14 Pica is also considered medicinal in certain regions, including Peru and Bolivia. 12-14 Culturally organized pica has been assessed in diverse contexts including rural life in India, 12fertility rituals among women in East Africa, 13and famine-induced pica in Europe. In a variety of cultures and geographical regions, presentation of pica is acknowledged as a sanctioned behavior though it often coincides with pregnancy-induced pica. 9,10 Pica is also documented among individuals with dementia. 8 Likewise, sickle cell anemia has been known to promote the ingestion of sponge or foam rubber in children and adolescents. Patients undergoing dialysis in the treatment of kidney disease have sometimes presented with pagophagia, amylophagia, and geophagia. Pica has also been associated with specific medical conditions, often as a response to treatment protocols. Children under the age of two are believed to have the highest prevalence. 6Childhood prevalence for pica has been estimated between 10%-32% for children under age 6 though this figure refers to occasional episodes, rather than ongoing behavior. For this cohort, pica behavior is typically extinguished naturally during the progressive aging process. Pica is also demonstrated in typically developing children, possibly as a form of tactile input or as a means of exploration.
3,4See Table 1 for a listing of the most common categories of pica behavior. 5 Among pregnant women geophagia - the consumption of soil or clay - is the most prevalent form of presentation. 3,4 Pica during pregnancy is idiopathic though hypothesized as a response to nausea and/or vomiting as well as a physiological response to varied nutritional deficiencies. Autism also has a large overlap, or comorbidity, with intellectual disability (ID). Because ASD and intellectual/developmental disability (IDD) are diagnostically related, research addressing one of these cohorts is often applicable to at least portions of the other.įor nutrition professionals, pica is most commonly associated with pregnant women as a sporadic behaviorduring the gestation period or post-natal during breastfeeding. Autism falls under the larger umbrella of developmental disability (DD), which is defined by severe impairments in cognitive and/or physical functioning with onset before the age of 22. 2There is a pronounced diversity of presentation and a tremendous range of abilities and impairment. 1ĪSD, a neurobiological condition with no clear biologic marker, is diagnosed through assessment of deficits in communication and social development as well as behavior rigidity. Pica behavior is manifested in both genders and across the lifespan. Traditionally, pica was inclusive of various non-nutritive items that no longer fit within the diagnostic understanding of the condition, including consumption of ice and scavenging for food. Pica is formally defined as the consumption of abnormal or unusual nonfood substances. It is important that healthcare professionals working within the realm of disordered eating have a measured understanding of the clinical presentation of this behavior for those with ASD and IDD and appreciate how it differs from pica in the general population. Pica is relatively well defined as an eating disorder, but for those with ASD and IDD this condition is manifested in distinctive patterns. In so doing, it will contrast this behavior with what is understood regarding pica presentation among the general population. This analysis is intended to introduce healthcare professionals to the patterns of pica behavior, diagnosis and treatment for those with autism spectrum disorder (ASD) and other intellectual and developmental disabilities (IDD). And Part III appears in the February 2019 E-Newsletter and can be read by clicking here.) Part II continues in the January 2019 E-Newsletter and can be found by clicking here.
#PICASAFE REVIEW SERIES#
(This is Part I of a 3 part series on the named topic.
Contrasting Pica Behavior for Individuals with ASD and IDD Against Presentation in the General Population – Part I
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