Behavioral Treatment of Pica in a Child With Sickle Cell Disease

Objective: Children with sickle cell disease (SCD) have the highest population risk for pica, a dangerous feeding disorder that involves consuming nonnutritive and nonfood items. There are currently no evidence-based treatments for pica in children with SCD. This study describes an applied behavior analysis (ABA) treatment of pica in a child with SCD and autism spectrum disorder. Method: A pretreatment functional analysis revealed the child's pica was maintained by automatic reinforcement (i.e., nonsocial consequences). The final behavioral treatment involved differential reinforcement of discarding pica items, communication, response interruption and redirection, and response cost. Results: Treatment resulted in near zero pica that was maintained across months of follow-up, new contexts, and with minimal supervision. Additionally, parents continued implementing the treatment with high integrity and reported satisfaction with the process. Conclusions: Results indicate the potential effectiveness of evidenced-based ABA methods in treating pica in SCD, and suggest treatment referrals to licensed professionals with Board Certified Behavior Analyst (BCBA or BCBA-D) credential or similar ABA experience. Implications for Impact StatementPica is a dangerous behavior frequently occuring in children with sickle cell disease (SCD). There is minimal published literature to guide treatments for this population. The prevalence of SCD is higher in children of color. Adding to the existing literature to guide treatment could help with greater healthcare equity among racially minoritized children. This case report describes the successful use of applied behavior analysis procedures to support parents in treating pica in a young child with SCD and autism spectrum disorder.