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Call NA, Bernstein AM, O’Brien MJ, Schieltz KM, Tsami L, Lerman DC, Berg WK, Lindgren SD, Connelly MA, Wacker DP. A comparative effectiveness trial of functional behavioral assessment methods. J Appl Behav Anal 2024; 57:166-183. [PMID: 38049887 PMCID: PMC10843530 DOI: 10.1002/jaba.1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023]
Abstract
Clinicians report primarily using functional behavioral assessment (FBA) methods that do not include functional analyses. However, studies examining the correspondence between functional analyses and other types of FBAs have produced inconsistent results. In addition, although functional analyses are considered the gold standard, their contribution toward successful treatment compared with other FBA methods remains unclear. This comparative effectiveness study, conducted with 57 young children with autism spectrum disorder, evaluated the results of FBAs that did (n = 26) and did not (n = 31) include a functional analysis. Results of FBAs with and without functional analyses showed modest correspondence. All participants who completed functional communication training achieved successful outcomes regardless of the type of FBA conducted.
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Affiliation(s)
- Nathan A. Call
- Marcus Autism Center, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alec M. Bernstein
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Matthew J. O’Brien
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Kelly M. Schieltz
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Loukia Tsami
- Center for Autism and Developmental Disabilities, University of Houston-Clear Lake, Houston, Texas, USA
| | - Dorothea C. Lerman
- Center for Autism and Developmental Disabilities, University of Houston-Clear Lake, Houston, Texas, USA
| | - Wendy K. Berg
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Scott D. Lindgren
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Mark A. Connelly
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - David P. Wacker
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
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Fisher WW, Greer BD, Mitteer DR. Additional Comments on the Use of Contingent Electric Skin Shock. Perspect Behav Sci 2023; 46:339-348. [PMID: 37425986 PMCID: PMC10323055 DOI: 10.1007/s40614-023-00382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 07/11/2023] Open
Abstract
Prior to the ABAI member vote to decide between two alternative position statements on contingent electric skin shock (CESS), the current authors helped draft a consensus statement supporting the abolition of CESS. In this commentary, we provide additional, supporting information for that consensus statement by (1) showing that the extant literature does not support the supposition that CESS is more efficacious than less-intrusive interventions; (2) providing data showing that implementing interventions that are less intrusive than CESS does not lead to overreliance on the use of physical or mechanical restraint to control destructive behavior; and (3) discussing the ethical and public relations issues that arise when behavior analysts use painful skin shock to reduce destructive behavior in persons with autism or intellectual disability.
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Affiliation(s)
- Wayne W. Fisher
- Children’s Specialized Hospital, Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES), 888 Easton Avenue, Somerset, NJ 08873 USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
- Rutgers Brain Health Institute, Piscataway, NJ USA
| | - Brian D. Greer
- Children’s Specialized Hospital, Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES), 888 Easton Avenue, Somerset, NJ 08873 USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
- Rutgers Brain Health Institute, Piscataway, NJ USA
| | - Daniel R. Mitteer
- Children’s Specialized Hospital, Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES), 888 Easton Avenue, Somerset, NJ 08873 USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
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3
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Bravo-Garrido N, Morán-Cortés JF, Coronado-Vázquez V, Ramírez-Durán MDV. Impact of creative workshops in an institutionalized patient with moderate/severe cognitive impairment with behavioral disorders: A case report. Front Psychiatry 2023; 14:1132659. [PMID: 36970293 PMCID: PMC10033970 DOI: 10.3389/fpsyt.2023.1132659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/24/2023] [Indexed: 03/29/2023] Open
Abstract
The Hospital Care Unit for individuals with intellectual disabilities and behavioral disorders provides comprehensive care in a controlled and video-surveyed facility that minimizes access to potentially manipulative materials during aggression or pica episodes. The patient was admitted to the unit due to issues including ingestion of non-edible fluids, aggression toward staff and other patients, and self-injury. All patients participated in occupational activities led by an occupational therapist from Monday to Friday from 10 a.m. to 11:30 a.m. In addition, creative workshops such as cinema forums and cooking workshops were held on some afternoons. During the analyzed period from January to June 2022, the patient experienced three episodes of pica, 14 assaults toward staff, and eight toward peers. All of these incidents occurred after dinner and were triggered either by the inability to eat dessert or by refusal to brush teeth afterward. In our case study, the implementation of creative workshops such as cooking had a positive effect on decreasing instances of pica and aggression. These workshops slightly improved participation in other occupational therapy activities and stabilized the patient's behavior, increasing the likelihood of her being able to return to her habitual residence.
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Affiliation(s)
| | | | - Valle Coronado-Vázquez
- Department of Semiology and Clinical Communication, Universidad Francisco de Vitoria, Madrid, Spain
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4
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Williams F, Gibbs S, Addo AS. The assessment and management of pica in people with intellectual disability. BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Pica is a condition associated with a number of physical and mental health diagnoses. The potentially fatal consequences of pica and the links with significant physical health problems are not always recognised. Pica is like other forms of behaviour that can challenge: clinicians must seek the underlying cause and treat this first, before primarily pursuing a behavioural form of treatment. In this article, we discuss the associations, consequences, assessment and management options available for pica to guide professionals. Pica often presents in a way individual to the particular patient, so tailoring of assessment and treatment is important.
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Du MC, Chen HY, Zhang YX, Zhang LB. Pica with superior mesenteric artery syndrome and nutcracker syndrome as imaging manifestation: A case report. Asian J Surg 2022; 45:2038-2039. [PMID: 35568610 DOI: 10.1016/j.asjsur.2022.04.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ming-Cheng Du
- Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Hong-Yu Chen
- Chengdu Wenjiang District People's Hospital, Pediatric Department, Chengdu, 611731, China
| | - Yi-Xian Zhang
- Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Li-Bing Zhang
- Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China, Chengdu, 611731, China.
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Stimulus Control Procedure for Reducing Vocal Stereotypies in an Autistic Child. CHILDREN 2021; 8:children8121107. [PMID: 34943302 PMCID: PMC8700641 DOI: 10.3390/children8121107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/04/2022]
Abstract
Stereotyped vocal behavior exhibited by a seven-year-old child diagnosed with autism spectrum disorder and maintained by automatic reinforcement was placed under stimulus control through discrimination training. The training consisted of matching a green card (SD) with free access to vocal stereotypy and a red card (SD-absent) with interruption of stereotypy and vocal redirection. At the same time, appropriate behaviors were reinforced. After discrimination training, the child rarely engaged in vocal stereotypy in the red card condition and, to a greater extent, in the green card condition, demonstrating the ability to discriminate between the two different situations. After the training, the intervention began. Once they reached the latency criterion in the red stimulus condition, the child could have free access to vocal stereotypy (green card condition). The latency criterion for engaging in stereotypy was gradually increased during the red card condition and progressively decreased during the green card condition. The intervention follows a changing criterion design. This study indicates that stimulus discrimination training is a useful intervention to reduce vocal stereotypy in an autistic child.
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Abstract
Pica is the developmentally inappropriate consumption of non-nutritive items for at least one month. Pica can lead to many adverse outcomes, but the exact pathophysiology of pica is unknown or variable across populations. Several studies have evidenced that there is a high prevalence of pica among youth with sickle cell disease (SCD). However, the lack of knowledge regarding the correlates of pica contributes to overlooking the condition, inaccurate diagnoses, and a lack of evidence-based treatments once pica is identified. This review examines the literature to develop a biopsychosocial model of pica in SCD. Elucidating the potential relationships among the proposed biological, psychological, and social factors, and pica will inform our understanding of this phenomenon in pediatric SCD and may guide future research and clinical recommendations.
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Affiliation(s)
- Nikita Rodrigues
- Department of Psychology, Georgia State University, Atlanta, GA, USA.
- , Washington, DC, USA.
| | - Sharon Shih
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Lindsey L Cohen
- Department of Psychology, Georgia State University, Atlanta, GA, USA
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Morris C, Stapleton K, Conway A, Peterson SM. A brief assessment of pica. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Cody Morris
- Western Michigan University Kalamazoo MI USA
- Now at Salve Regina University Warwick RI USA
| | | | - Alissa Conway
- Western Michigan University Kalamazoo MI USA
- Now at NeurAbilities King of Prussia PA USA
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Abstract
Gastrointestinal disorders are one of the most common medical conditions that are comorbid with autism spectrum disorders. These comorbidities can cause greater severity in autism spectrum disorder symptoms, other associated clinical manifestations, and lower quality of life if left untreated. Clinicians need to understand how these gastrointestinal issues present and apply effective therapies. Effective treatment of gastrointestinal problems in autism spectrum disorder may result in marked improvements in autism spectrum disorder behavioral outcomes. This article discusses the gastrointestinal disorders commonly associated with autism spectrum disorders, how they present, and studied risk factors.
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Affiliation(s)
- Moneek Madra
- Department of Pediatrics, Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10025, USA,Institute of Human Nutrition, Columbia University Irving Medical Center, 630 West 168th Street, PH1512E, New York, NY 10032, USA
| | - Roey Ringel
- Department of Pediatrics, Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10025, USA,Columbia College, Columbia University, New York, NY, USA
| | - Kara Gross Margolis
- Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10025, USA; Institute of Human Nutrition, Columbia University Irving Medical Center, 630 West 168th Street, PH1512E, New York, NY 10032, USA.
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10
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Fields VL, Soke GN, Reynolds A, Tian LH, Wiggins L, Maenner M, DiGuiseppi C, Kral TV, Hightshoe K, Schieve LA. Pica, Autism, and Other Disabilities. Pediatrics 2021; 147:peds.2020-0462. [PMID: 33408069 PMCID: PMC9188765 DOI: 10.1542/peds.2020-0462] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pica, the repeated ingestion of nonfood items, can be life-threatening. Although case reports describe pica in children with autism spectrum disorder (ASD) or intellectual disability (ID), there has been little systematic study of pica prevalence. We assessed pica in children 30 to 68 months of age (median = 55.4 months) with and without ASD. METHODS Our sample from the Study to Explore Early Development, a multisite case-control study, included children with ASD (n = 1426), children with other developmental disabilities (DDs) (n = 1735), and general population-based controls (POPs) (n = 1578). We subdivided the ASD group according to whether children had ID and the DD group according to whether they had ID and/or some ASD characteristics. Standardized developmental assessments and/or questionnaires were used to define final study groups, subgroups, and pica. We examined pica prevalence in each group and compared ASD and DD groups and subgroups to the POP group using prevalence ratios adjusted for sociodemographic factors. RESULTS Compared with the prevalence of pica among POPs (3.5%), pica was higher in children with ASD (23.2%) and DD (8.4%), and in the following subgroups: ASD with ID (28.1%), ASD without ID (14.0%), DD with ID (9.7%), DD with ASD characteristics (12.0%), and DD with both ID and ASD characteristics (26.3%); however, pica prevalence was not elevated in children with DD with neither ID nor ASD characteristics (3.2%). Between-group differences remained after adjustment (adjusted prevalence ratio range 1.9-8.0, all P <.05). CONCLUSIONS Pica may be common in young children with ASD, ASD characteristics, and ID. These findings inform the specialized health care needs of these children.
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Affiliation(s)
- Victoria L. Fields
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gnakub N. Soke
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ann Reynolds
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lin H. Tian
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Tanja V.E. Kral
- Department of Psychiatry University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristina Hightshoe
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura A. Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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11
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Kaligis F, Massarapa MH, Marsubrin RII, Wiguna T. A case of pica in childhood with intellectual disability: focus on non-psychopharmacology management. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.cr.204010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Non-psychopharmacology management is crucial in pica in childhood with intellectual disability. This case report shows the effectiveness of pica management centered on behavioral therapy over the use of pharmacotherapy in improving the patient’s symptoms. A-7-year-old girl had been eating plastic bags since she was 3. In the last 6 months, this behavior worsened and coupled with emotional and behavioral problems. Her intellectual function showed that she had a moderate intellectual disability, which was confirmed by her intelligence quotient test result. She also had iron deficiency anemia and constipation. Non-psychopharmacological management was delivered to the patient and family. The patient was treated with a reinforcement strategy of behavioral therapy, involving parental education during the process to stimulate desirable behavior, discourage unwanted behavior, and improve parent-child interaction. After six sessions of behavioral therapy and parental psychoeducation, the patient showed improvement as the frequency of eating nonfood substances was decreasing.
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12
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Buono S, Zagaria T, Recupero M, Elia M, Kerr M, Di Nuovo S, Ferri R. The evolution of self-injurious behaviors in people with intellectual disability and epilepsy: A follow-up study. Seizure 2020; 82:99-104. [PMID: 33045542 DOI: 10.1016/j.seizure.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Longitudinal studies of the evolution of Self-Injurious Behaviors (SIBs) in people with Intellectual Disability (ID) and epilepsy are not common. This study aimed to analyze the evolution (in terms of remission and persistence) and changes in the type, localization, frequency, and intensity of SIBs. METHODS SIBs were assessed in a sample of 52 people with ID and epilepsy, and re-evaluated after a seven-year interval, using the "Scale for the Assessment of Self-Injurious Behaviors". The scale was administered to caregivers (parents or health professionals) through a semi-structured interview conducted by a specifically trained psychologist. RESULTS The most frequent types of SIBs identified were: self-biting, self-hitting with objects, self-hitting with hand, object-finger in cavities. The main localizations of SIBs were: hands, mouth, head and cheeks. SIBs were found to be maintained after seven years, for type, localization, frequency, and intensity, in 90.4% of the sample. SIB types were stable over time, as were the affected areas. Global SIB frequency and intensity scores were found to be unchanged. Finally, a positive correlation was found between the frequency of SIBs and levels of intellectual disability. SIBs (frequency and intensity) and seizure frequency showed no correlation. CONCLUSION Given the negative impact of SIBs on the adaptation and quality of life of people with ID and epilepsy, we believe that further studies on biological, psychological and environmental aspects are needed in order to identify any potential factors that might explain the persistence of SIBs and to find effective interventions to reduce them.
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Affiliation(s)
- Serafino Buono
- Unit of Psychology, Oasi Research Institute-IRCCS, Troina, Italy.
| | - Tommasa Zagaria
- Unit of Psychology, Oasi Research Institute-IRCCS, Troina, Italy
| | | | - Maurizio Elia
- Unit of Neurology, Oasi Research Institute-IRCCS, Troina, Italy
| | - Mike Kerr
- Institute of psychological medicine and clinical neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Santo Di Nuovo
- Department of Education, University of Catania, Catania, Italy
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Clark OM, Williams R. Pica behaviors in pediatric patients with sickle cell disease: a scoping review protocol. JBI Evid Synth 2020; 18:2018-2024. [PMID: 32813438 DOI: 10.11124/jbisrir-d-19-00241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to explore existing literature regarding pica in pediatric patients with sickle cell disease and to identify associated interventions and outcomes. INTRODUCTION Pica is a psychological eating disorder that is characterized by the consumption of items that contain no nutritional value. The ingestion of non-food items causes complications that can be harmful or even fatal. Approximately one-third of patients with sickle cell disease will also develop pica behaviors. INCLUSION CRITERIA This review will consider studies that include pediatric patients from 18 months to 18 years of age who have been diagnosed with any type of sickle cell disease and have a history of pica. The study will examine interventions used in any setting to treat pediatric patients with sickle cell disease and pica and associated outcomes. Any study type will be considered for inclusion. METHODS Databases to be searched will include CINAHL (EBSCO), Embase (Elsevier), Europe PubMed Central (PubMed), Psychology and Behavioral Sciences Collection (EBSCO), and Scopus (Elsevier). Data will be extracted from included papers by two independent reviewers. The data extracted will include details about the populations, concept, context, and study methods of significance to the review questions and objective. The extracted data will be presented in diagrammatic or tabular form in a manner that aligns to the objectives and scope of this review.
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Affiliation(s)
- Olivia M Clark
- School of Nursing, The University of Mississippi Medical Center, Jackson, United States.,Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence
| | - Renee Williams
- School of Nursing, The University of Mississippi Medical Center, Jackson, United States.,Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence
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Moline R, Hou S, Chevrier J, Thomassin K. A systematic review of the effectiveness of behavioural treatments for pica in youths. Clin Psychol Psychother 2020; 28:39-55. [PMID: 32628326 DOI: 10.1002/cpp.2491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 05/19/2020] [Accepted: 06/25/2020] [Indexed: 11/09/2022]
Abstract
Pica is the persistent consumption of non-nutritive, nonfood substances and is associated with adverse health complications. However, there is limited research on interventions for pica in youth. The objective of this study is to systematically review the empirical evidence for the effectiveness of behavioural interventions for pica in children and adolescents and to generate treatment recommendations. A systematic search yielded 823 articles extracted from five databases: CINALH, Family and Society Studies Worldwide, Medline, PsycINFO, and Web of Science. Two reviewers completed initial sorting based on article titles and abstracts. Five reviewers completed sorting based on full article review. Thirty articles were included and double coded for demographic information, co-morbid conditions, and intervention characteristics. These studies were case studies involving behavioural treatments for pica. Seventeen behavioural interventions were categorized into four treatment approaches: reinforcement-based, response interruption, "other" interventions, and punishment-based procedures. Interventions that resulted in near-zero rates of pica were deemed effective. Findings showed support for contingent reinforcement, discrimination training as part of a combination treatment, physical restraint, time out, and contingent aversive stimulus. No evidence supported the effectiveness of response interruption procedures, including response blocking and visual facial screen. Other coded procedures did not appear effective. We recommend that the least restrictive procedures are implemented first, including a combination treatment with contingent reinforcement and discrimination training. As needed, more restrictive procedures can be added to the treatment package. This review will facilitate future empirical work and assist clinicians with treatment options for pica in youth. High-quality trials are needed.
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Affiliation(s)
- Rachel Moline
- Department of Psychology, University of Guelph, Guelph, Canada
| | - Sharon Hou
- Department of Psychology, University of Guelph, Guelph, Canada
| | - Julia Chevrier
- Department of Psychology, University of Guelph, Guelph, Canada
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Abstract
Gastrointestinal disorders are one of the most common medical conditions that are comorbid with autism spectrum disorders. These comorbidities can cause greater severity in autism spectrum disorder symptoms, other associated clinical manifestations, and lower quality of life if left untreated. Clinicians need to understand how these gastrointestinal issues present and apply effective therapies. Effective treatment of gastrointestinal problems in autism spectrum disorder may result in marked improvements in autism spectrum disorder behavioral outcomes. This article discusses the gastrointestinal disorders commonly associated with autism spectrum disorders, how they present, and studied risk factors.
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Affiliation(s)
- Moneek Madra
- Morgan Stanley Children’s Hospital, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York
| | - Roey Ringel
- Morgan Stanley Children’s Hospital, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Columbia College, Columbia University, New York, New York
| | - Kara G. Margolis
- Morgan Stanley Children’s Hospital, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York
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Goodspeed K, Bliss G, Linnehan D. Bringing everyone to the table - findings from the 2018 Phelan-McDermid Syndrome Foundation International Conference. Orphanet J Rare Dis 2020; 15:152. [PMID: 32546186 PMCID: PMC7298935 DOI: 10.1186/s13023-020-01389-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/22/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Phelan-McDermid Syndrome (PMS) is a rare neurodevelopmental disorder characterized by global developmental delay, autism spectrum disorder, and numerous systemic complications including seizures, gastrointestinal dysfunction, and renal anomalies. The Phelan-McDermid Syndrome Foundation (PMSF) was created to improve the quality of life of people affected by PMS worldwide by supporting families, accelerating research, and raising awareness. To further this mission, the PMSF initiated the Phelan-McPosium in 2016 to bring families affected by PMS, clinicians, and researchers together to design patient-centered rigorous clinical and translational research. Here, we present findings from the 2018 Phelan-McPosium. RESULTS The 2018 Phelan-McPosium was attended by 183 families and 35 researchers and clinicians. Overall, the Early Childhood parents raised the fewest number of concerns, families of Late-Childhood patients raised more concerns around epilepsy and behavioral problems, and Teen and Adult families were primarily concerned about implications of genetic testing, gastrointestinal dysfunction, and regression. All families were concerned with feasibility, safety and importance of clinical trials for PMS. CONCLUSIONS The concerns raised by families across the sessions varied by age in a manner which may overlap with the emergence of various signs and symptoms through the natural history of PMS. The design of the Phelan-McPosium session has successfully generated thoughtful research questions that led to innovative investigations and clinical trials that are shaping the standard of care for PMS. This is an approach which could be employed by any rare disease group to align translational research efforts with a patient-centered focus.
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Affiliation(s)
- Kimberly Goodspeed
- Department of Pediatrics, Neurology & Neurotherapeutics, and Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Geraldine Bliss
- Phelan-McDermid Syndrome Foundation, P.O. Box 1153, 8 Sorrento Drive, Osprey, FL, 34229, USA
| | - Diane Linnehan
- Phelan-McDermid Syndrome Foundation, P.O. Box 1153, 8 Sorrento Drive, Osprey, FL, 34229, USA
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Jackson MS, Adedoyin AC, Winnick SN. Pica Disorder among African American Women: A Call for Action and Further Research. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:261-270. [PMID: 32660362 DOI: 10.1080/19371918.2020.1791778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pica is simply defined as the consumption of none food products such as laundry starch, clay dirt, ice, soap, and chalk. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies Pica as the habitual consumption of nonfood and non-nutritive substances for at least one year. Pica disorder is usually unnoticed, under-reported, causes serious harm to clients especially African American women, and seldom discussed in social work scholarship. It is, therefore, important to begin to sensitize social workers to the harmful effects of Pica, especially because it is often unrecognized and misdiagnoses can cause harm. This article provides a panoramic overview of Pica, the signs and symptoms of the disorder specifically among African American women and also address some of the adverse effects, and highlights some of the evidence-based effective treatment strategies. Finally, an urgent clarion call to social workers to conduct more research on Pica disorders among African American women is articulated.
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Affiliation(s)
- Mary S Jackson
- School of Social Work, College of Health and Human Performance, East Carolina University , West Greenville, North Carolina, USA
| | - A Christson Adedoyin
- Department of Social Work, School of Public Health, Samford University , Birmingham, Alabama, USA
| | - Sarah N Winnick
- School of Social Work, College of Health and Human Performance, East Carolina University , West Greenville, North Carolina, USA
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18
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Hagopian LP. The consecutive controlled case series: Design, data-analytics, and reporting methods supporting the study of generality. J Appl Behav Anal 2020; 53:596-619. [PMID: 32125716 PMCID: PMC8805508 DOI: 10.1002/jaba.691] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 07/20/2023]
Abstract
Single-case experimental designs (SCEDs) have proven invaluable in research and practice because they are optimal for asking many experimental questions relevant to the analysis of behavior. The consecutive controlled case series (CCCS) is a type of study in which a SCED is employed in a series of consecutively encountered cases that undergo a common procedure or share a common characteristic. Additional design elements, data-analytic, and reporting methods enable researchers to ask experimental questions relevant to the study of generality of procedures and processes. The current paper discusses the CCCS methodologies, including the retrospective, prospective, and randomized CCCS. These methodologies can be applied to examine the generality of clinical procedures (including their general efficacy, the limits of their generality, and variables that may mediate generality); study the epidemiology and phenomenology of clinical problems; and compare the efficacy of 2 clinical procedures within a randomized controlled trial combining SCEDs with randomized group designs.
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Affiliation(s)
- Louis P Hagopian
- Kennedy Krieger Institute
- Johns Hopkins University School of Medicine
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19
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Hyman SL, Levy SE, Myers SM. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics 2020; 145:peds.2019-3447. [PMID: 31843864 DOI: 10.1542/peds.2019-3447] [Citation(s) in RCA: 496] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
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Affiliation(s)
- Susan L Hyman
- Golisano Children's Hospital, University of Rochester, Rochester, New York;
| | - Susan E Levy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Scott M Myers
- Geisinger Autism & Developmental Medicine Institute, Danville, Pennsylvania
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20
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Eating as an autistic adult: An exploratory qualitative study. PLoS One 2019; 14:e0221937. [PMID: 31465510 PMCID: PMC6715205 DOI: 10.1371/journal.pone.0221937] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/19/2019] [Indexed: 12/28/2022] Open
Abstract
Background Although eating difficulties are known to be common in children on the autism spectrum, there is a lack of research on whether these behaviours persist or change into adulthood. Emerging evidence suggests that autistic adults may experience higher levels of disordered eating than the general population, indicating the impact of autism on eating in this adult population warrants further exploration. Method This study interviewed 12 autistic adults about their eating habits, with a focus on the continuing or changing presence of behaviours often seen in autistic children such as sensory sensitivity or a preference for routines. Interviews were transcribed and analysed using thematic analysis. Results Overall, participants suggested that autism did continue to impact their eating into adulthood, particularly in the areas of sensory sensitivity, medical difficulties, executive functioning difficulties, and rigidity, but that they had learned to adapt so that these issues no longer represented a problem. However, a minority of participants did feel that their autism had a negative effect on their eating, particularly those diagnosed with eating disorders. Additionally, eating behaviours associated with autism were identified as potentially contributing to having an unhealthy body weight. Conclusions Certain traits associated with autism, such as cognitive rigidity and sensory sensitivity, could potentially continue to influence the eating behaviours of autistic adults. These traits are typically experienced as differences which can be adapted around and managed, rather than specific problems. However, these traits can potentially contribute to difficulties such as disordered eating and weight gain, and the implications of these should be explored by future research.
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Lomas Mevers J, Muething C, Call NA, Scheithauer M, Hewett S. A consecutive case series analysis of a behavioral intervention for enuresis in children with developmental disabilities. Dev Neurorehabil 2018; 21:336-344. [PMID: 29652207 DOI: 10.1080/17518423.2018.1462269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Children with developmental disabilities (DD) are more likely than typically developing peers to have issues with enuresis. Past research has shown the success of behavioral treatments consisting of scheduled sits and reinforcement for continent voids. However, this research has included small sample sizes, while studies with larger numbers have lacked key information (i.e., baseline rates and follow-up data to evaluate maintenance and generalization). The current study conducted a consecutive case series analysis of 44 individuals with developmental disabilities who completed a 2-week program for enuresis. Results showed significant improvement in continent voids and follow-up data suggested positive results maintained when treatment was implemented by caregivers in a home environment.
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Affiliation(s)
- Joanna Lomas Mevers
- a Severe Behavior Department , Marcus Autism Center , Atlanta , GA , USA.,b Department of Pediatrics , Emory School of Medicine , Atlanta , GA , USA
| | - Colin Muething
- a Severe Behavior Department , Marcus Autism Center , Atlanta , GA , USA.,b Department of Pediatrics , Emory School of Medicine , Atlanta , GA , USA
| | - Nathan A Call
- a Severe Behavior Department , Marcus Autism Center , Atlanta , GA , USA.,b Department of Pediatrics , Emory School of Medicine , Atlanta , GA , USA
| | - Mindy Scheithauer
- a Severe Behavior Department , Marcus Autism Center , Atlanta , GA , USA.,b Department of Pediatrics , Emory School of Medicine , Atlanta , GA , USA
| | - Shannon Hewett
- a Severe Behavior Department , Marcus Autism Center , Atlanta , GA , USA
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22
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Using response ratios for meta-analyzing single-case designs with behavioral outcomes. J Sch Psychol 2018; 68:99-112. [DOI: 10.1016/j.jsp.2018.02.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/29/2017] [Accepted: 02/24/2018] [Indexed: 10/17/2022]
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Erturk B, Machalicek W, Drew C. Self-Injurious Behavior in Children With Developmental Disabilities: A Systematic Review of Behavioral Intervention Literature. Behav Modif 2017; 42:498-542. [PMID: 29179569 DOI: 10.1177/0145445517741474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We reviewed single-case research studies examining the effects of behavioral interventions for self-injurious behavior (SIB) in young children with autism and developmental disabilities. Systematic searches of electronic databases, journals, and reference lists identified 46 studies (66 participants younger than the age of 12) meeting inclusion criteria. Studies were examined based on (a) participant demographics, (b) topography and function of SIB, (c) type of functional behavior assessment (FBA), (d) intervention procedures and outcomes, and (e) experimental design and measurement. Intervention strategies were categorized as antecedent manipulations, teaching behavior, consequence-based procedures, and/or extinction procedures. Positive outcomes were reported for 78% of participants in the reviewed studies and 88% of the participants were diagnosed with autism. Results suggest the effectiveness of behavioral interventions to decrease SIB for young children with disabilities; however, the frequent use of packaged interventions without component analysis limits the conclusiveness of any treatment recommendation. Suggestions for future research are discussed.
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McNaughten B, Bourke T, Thompson A. Fifteen-minute consultation: the child with pica. Arch Dis Child Educ Pract Ed 2017; 102:226-229. [PMID: 28487433 DOI: 10.1136/archdischild-2016-312121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/15/2017] [Accepted: 02/28/2017] [Indexed: 11/03/2022]
Abstract
Pica is defined as the persistent ingestion of non-nutritive substances for more than 1 month at an age at which this behaviour is deemed inappropriate. It occurs most commonly in children, in patients with learning disabilities and in pregnancy. The aetiology of pica is poorly understood and is probably multifactorial. Clinical assessment can be difficult. History and examination should be tailored to address potential complications of the substance being ingested. Complications can be life threatening. Pica often self-remits in younger children. In those with learning disabilities, however, pica may persist into adulthood. Management strategies should involve a multidisciplinary approach, and interventions are primarily behavioural in nature. There is limited evidence to support pharmacological interventions in the management of children with pica.
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Affiliation(s)
| | - Thomas Bourke
- Royal Belfast Hospital for Sick Children, Belfast, UK
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A Different Kind of Craving: Incidence and Treatment of Pica After Laparoscopic Roux-en-Y Gastric Bypass. World J Surg 2017; 41:2324-2328. [PMID: 28477159 DOI: 10.1007/s00268-017-4048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Iron deficiency can occur in patients after Roux-en-y gastric bypass due to altered absorption. Pica, the compulsive craving and intake of non-nutritive substances, is a rare and poorly understood presentation of iron deficiency. To our knowledge, the rate of pica after RYGB has never been reported. METHODS The medical records of patients who underwent laparoscopic RYGB from 2001 to 2011 were reviewed. Patients with pica or other abnormal cravings were identified. RESULTS Pica was identified in 16/959 (1.7%) patients who underwent RYGB during the study period. The most common presenting sign was pagophagia. All patients with pica were female and had multiple risk factors for iron deficiency with 13/16 being premenopausal and 7/16 non-compliant with oral iron supplementation. Pica symptoms presented at a mean of 3.9 ± 1.9 years after RYGB. Iron deficiency was identified in all 16 patients, with a median ferritin level of 5.0 ng/mL (range 2-27). All 16 patients received intravenous iron and pica symptoms resolved. CONCLUSIONS Pica is a rare phenomenon associated with iron deficiency and can occur despite oral iron supplementation. In our experience, intravenous iron can relieve symptoms. Patients considering bariatric surgery should be counseled on pica. Patients with unusual cravings should be evaluated for iron deficiency.
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Call NA, Alvarez JP, Simmons CA, Lomas Mevers JE, Scheithauer MC. Clinical outcomes of behavioral treatments for elopement in individuals with autism spectrum disorder and other developmental disabilities. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:375-379. [PMID: 27178995 DOI: 10.1177/1362361316644732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The external validity of behavioral treatments for elopement (i.e. leaving supervision without permission) remains unclear because studies to date include only small samples ( n = 1–3). This study quantified the overall effectiveness of behavioral treatments for elopement by retrospectively examining treatment data from all patients seen for the treatment of elopement at an intensive day treatment clinic ( n = 11), irrespective of treatment success. Reductions in elopement from baseline to the final treatment for each participant demonstrate that behavioral intervention is a highly effective treatment for elopement, as determined by the large effect size (Cohen’s d = 1.18).
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