Gastrointestinal Tract Symptomatology in Adults with Pica and Autism 120
PhD, Principal Investigator, Quality Assurance Study, Lanterman Developmental Center, USA
PhD, Director of Research, Lanterman Developmental Center, USA
PhD, Professor of Psychology, Claremont Graduate University, USA
This study investigated pica behavior in those with and without autism in relation to gastrointestinal (GI) tract symptomatology and disease. A chart review of 64 residential adults with developmental disabilities indicated that individuals with pica had more GI tract diseases, and those with autism and pica had a higher rate of GI diseases compared to those with autism and no pica behavior. These data suggest that individuals with both autism and pica disorders may be a phenotypic subgroup in the autistic spectrum characterized by GI symptomatology, requiring a clinical algorithm for categorization and effective treatment. A behavior-analytic model is presented that conceptualizes pica as part of a chain of events that begins with exploratory behavior and culminates in GI symptomatology and disease. Issues of sensory processing are addressed within this model. Individuals exhibiting pica may benefit from gastrointestinal evaluation, including assessment of the microbiome, and, if indicated, microbiota transfer therapy to
These data are from a Medical Quality Assurance Study conducted at Lanterman Developmental Center which closed June 30, 2015. We gratefully acknowledge the support of the Medical Staff and the Health Service Specialists of Lanterman Developmental Center. Tony Rojas, Catherine Godkins, and Anthony D. Dinardo are acknowledged for help in gathering information for the Quality Assurance Study. William M. Sparks is acknowledged for help with the statistical analysis. We also thank Kathryn Grossman and Sandy Middleton for their technical help in preparation of this manuscript. The authors would like to thank Dr. Stephen M. Edelson for his valuable suggestions on an earlier version of this manuscript. The ideas expressed are those of the authors and are not to be construed as necessarily reflecting the policy of the Department of Developmental Services.
Ausman J., Ball T.S., Alexander D. Behavior therapy
of pica in a profoundly retarded adolescent. Mental Retardation, 1974,
vol. 12, no. 6, pp. 16—18.
Barhrick L.E., Todd J.T. Multisensory Processing in
Autism Spectrum Disorders: Intersensory Processing Disturbance as a Basis for
Atypical Development. In B. Stein (ed.) The New Handbook of Multisensory
Processing. Cambridge: The MIT Press, 2012. 840 p. ISBN 978-0-26201712-1.
Berding K., Donovan S.M. Microbiome and nutrition
in autism spectrum disorder: Current knowledge and research needs. Nutrition
Reviews, 2016, vol. 74, no. 12, pp. 723—736.
Bugle C., Rubin H.B. Effects of a nutritional
supplement on coprophagia: A study of three cases. Research in Developmental
Disabilities, 1993, vol. 14, no. 6, pp. 445—456.
Buie T., Campbell D.B., Fuchs G.J. et al.
Evaluation, diagnosis, and treatment of gastrointestinal disorders in
individuals with ASDs: A consensus report. Pediatrics, 2010, vol. 125,
no. Supplement 1, pp. S1—S18. DOI:10.1542/peds.2009-1878C
Buie T., Fuchs G.J., Furuta G.T. et al.
Recommendations for evaluation and treatment of common gastrointestinal
problems in children with ASDs. Pediatrics, 2010, vol. 125, no.
Supplement 1, pp. S19—S29. DOI:10.1542/peds.2009-1878D
Carbone P.S. Moving from research to practice in
the primary care of children with autism spectrum disorders. Academic
Pediatrics, 2013, vol. 13, no. 5, pp. 390—399.
Coury D.L., Ashwood P., Fasano A. et al.
Gastrointestinal conditions in children with autism spectrum disorder:
Developing a research agenda. Pediatrics, 2012, vol. 130, no. Supplement
2, pp. S160—S168. DOI:10.1542/peds.2012-0900N
Danford D.E., Huber A.M. Pica among mentally
retarded adults. American Journal of Mental Deficiency, 1982, vol. 87,
no. 2, pp. 141—146.
Danford D.E., Smith J.C., Huber A.M. Pica and
mineral status in the mentally retarded. The American Journal of Clinical
Nutrition, 1982, vol. 35, no. 5, pp. 958—967.
Diagnostic and statistical manual of mental disorders:
DSM-IV. 4th ed. Washington: American Psychiatric Association, 1994. 886 p. ISBN
DiCagno L., Castello D., Savio M.T. A case of
ulcerative colitis associated with pica: Psychological and clinical study.
Minerva Pediatrica, 1974, vol. 26, no. 35, pp. 1768—1777.
Edelson S.M. Research issues involving the biology
of autism. Autism and Developmental Disorders (Russia), 2019, vol. 17,
no. 1, pp. 4—14. DOI:10.17759/autdd.2019170102
Edelson S.M., Johnson J.B. (eds.) Understanding and
treating self-injurious behavior in autism. London: Publ. Jessica Kinsley
Publishers, 2016. 302 p. ISBN 978-1-78450189-1.
Fields V.L., Soke G., Reynolds A. et al. Pica
associated with autism and other disabilities, study to explore early
development. Pediatrics, in press.
Greenberg M., Jacobziner H., McLaughlin M.C. et al.
A study of pica in relation to lead poisoning. Pediatrics, 1958, vol.
22, no. 4, pp. 756—760.
Gutelius M.F., Millican F.K., Layman E.M. et al.
Nutritional studies of children with pica. Pediatrics, 1962, vol. 29,
no. 6, pp. 1012—1023.
Holingue C., Newill C., Lee L.C. et al.
Gastrointestinal symptoms in autism spectrum disorder: A review of the
literature on ascertainment and prevalence. Autism Research, 2018, vol.
11, no. 1, pp. 24—36. DOI:10.1002/aur.1854
Horvath K., Papadimitriou J.C., Rabsztyn A. et al.
Gastrointestinal abnormalities in children with autism. The Journal of
Pediatrics, 1999, vol. 135, no. 5, pp. 559—563.
Hull M. (ed.)
Pica // The Recovery Village Drug and
Alcohol Rehab [Web resource]. 2020. URL: https://www.
James S.J., Cutler P., Melnyk S. et al. Metabolic
biomarkers of increased oxidative stress and impaired methylation capacity in
children with autism. American Journal of Clinical Nutrition, 2004, vol.
80, no. 6, pp. 1611—1617. DOI:10.1093/ ajcn/80.6.1611
Kang D.W., Adams J.B., Coleman D.M. et al.
Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut
microbiota. Scientific Reports, 2019, vol. 9, article no. 5821.
Kang D.W., Adams J.B., Gregory A.C. et al.
Microbiota transfer therapy alters ecosystem and improves gastrointestinal and
autism symptoms: An open-label study. Microbiome, 2017, vol. 5, article
no. 10, pp. 1—16. DOI:10.1186/s40168-016- 0225-7
Kinnell H.G. Pica as a feature of autism.
British Journal of Psychiatry, 1985, vol. 147, no. 1, pp. 80—82.
Korman S.H. Pica as a presenting symptom in
childhood celiac disease. The American Journal of Clinical Nutrition,
1990, vol. 51, no. 2, pp. 139—141. DOI:10.1093/ajcn/51.2.139
Krajmalnik-Brown R., Lozupone C., Kang D. et al.
Gut bacteria in children with autism spectrum disorders: challenges and promise
of studying how a complex community influences a complex disease. Microbial
Ecology in Health and Disease, 2015, vol. 26, no. 1, article no. 26914.
Lourie R.S., Layman E.M., Milhican F.K. et al. A
study of the etiology of pica in young children, and early pattern of
addiction. In Hoch P.H., Zubin J. (eds.) Problems of addiction and
habituation. New York: Publ. Grune & Stratton, 1958. 262 p.
Matson J.L., Belva B., Hattier M.A. et al. Pica in
persons with developmental disabilities: Characteristics, diagnosis, and
assessment. Research in Autism Disorders, 2011, vol. 5, no. 4, pp.
McAdam D., Cole L., Howell L.
Provider’s Guide to
Managing Pica in Children with Autism / Autism Speaks Autism Treatment Network
[Web resource]. 2014. 7 p. URL:
sciencedocs/atn/pica_professionals_guide.pdf (Accessed 3.12.2020).
Miao D., Young S.L., Golden C.D. A meta-analysis of
pica and micronutrient status. American Journal of Human Biology, 2015,
vol. 27, no. 1, pp. 84—93. DOI:10.1002/ajhb.22598
Miller L.J., Misher K. Sensory processing disorder
and self-injurious behavior. In Edelson S.M., Johnson J.B. (eds.)
Understanding and treating self-injurious behavior in autism. London: Publ.
Jessica Kinsley Publishers, 2016. pp. 138- 150. ISBN 978-1-78450189-1.
Morozov S.A. On the issue of comorbidity in autism
spectrum disorders. Autism and Developmental Disorders (Russia), 2018,
vol. 16, no. 2, pp. 3—8. DOI:10.17759/autdd.2018160201
Ousley O., Cermak T. Autism spectrum disorder:
Defining dimensions and subgroups. Current Developmental Disorders
Reports, 2014, vol. 1, no. 1, pp. 20—28.
Pace G.M., Toyer E.A. The effects of a vitamin
supplement on the pica of a child with severe mental retardation. The
Journal of Applied Behavior Analysis, 2000, vol. 33, no. 4, pp. 619—622.
Pangborn J.B., Baker S.M. Autism: Effective
biomedical treatments: Have we done everything we can for this child?:
Individuality in an autism epidemic. Boston, 2005. 118 p. ISBN
Polyakova S.I. The pathophysiological rationale for
personalized metabolic therapy of ASD: Promising treatments. Autism and
Developmental Disorders (Russia), 2019, vol. 17, pp. 55—70.
Ratey J.J., Hagerman E. Spark: The revolutionary
new science of exercise and the brain. New York: Publ. Little, Brown & Co.,
2008. 303 p. ISBN 978-0-31611350-2.
Ristori M.V., Quagliariello A., Reddel S. et al.
Autism, gastrointestinal symptoms and modulation of gut microbiota by
nutritional interventions. Nutrients, 2019, vol. 11, no. 11, pp. 1—21.
Russo A.J., deVito R. Analysis of copper and zinc
plasma concentration and the efficacy of zinc therapy in individuals with
Asperger’s Syndrome, Pervasive Developmental Disorder-Not Otherwise Specified
(PDD/NOS) and autism. Biomarker Insights, 2011, vol. 6, pp. 127—133.
Sayar S.N., Sarlatti R., Naficy M. Studies on
clinical, haematological aspects and pathological changes of gastric mucosa in
geophagia [Web resource]. Acta Medica Iranica, 1975, vol. 18, no. 3-4,
pp. 137—147. URL: https://acta.tums.ac.ir/index. php/acta/article/view/4197
Spek A.A., van Riijnsoever W., van Laarhoven L. et
al. Eating problems in men and women with an autistic spectrum disorder.
Journal of Autism and Developmental Disorders, 2020, vol. 50, pp.
Srikantha P., Mohajeri M.H. The possible role of
the microbiota-gut-brain-axis in autism spectrum disorder. International
Journal of Molecular Science, 2019, vol. 20, no. 9, article no. 2115.
Toguleva V.K. Current Correction Techniques of Food
Selectivity in Children with Autism Spectrum Disorders (ASD). Autism and
Developmental Disorders (Russia), 2018, vol. 16, no. 4, pp. 21—27.
Valicenti-McDermott M., McVicar K., Rapin I. et al.
Frequency of gastrointestinal symptoms in children with autistic spectrum
disorders and association with family history of autoimmune disease. Journal
of Developmental and Behavioral Pediatrics, 2006, vol. 27, no. 2, pp.
Williams D.E., McAdam D. Assessment, behavioral
treatment, and prevention of pica: Clinical guidelines and recommendations for
practitioners. Research in Developmental Disabilities, 2012, vol. 33,
no. 6, pp. 2050—2057. DOI:10.1016/j.ridd.2012.04.001
Xu M., Xu X., Li J. et al. Association between gut
microbiota and autism spectrum disorder: A systematic review and meta-
analysis. Frontiers in Psychiatry, 2019, vol. 10, pp. 1—11.