Gastrointestinal Tract Symptomatology in Adults with Pica and Autism



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

General Information

Keywords: pica, autism spectrum disorder, GI diseases, microbiome, microbiota transfer therapy, comorbidity, prevalence, phenotype, sensory processing.

Journal rubric: Research & Diagnosis of ASD

Article type: scientific article


Acknowledgements. 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.

For citation: Alexander D.D., Lunde S.E., Berger D.E. Gastrointestinal Tract Symptomatology in Adults with Pica and Autism. Autizm i narusheniya razvitiya = Autism and Developmental Disorders, 2020. Vol. 18, no. 4, pp. 3–12. DOI: 10.17759/autdd.2020180401.


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Information About the Authors

Dean D. Alexander, PhD, Principal Investigator, Quality Assurance Study, Lanterman Developmental Center, ORCID:, e-mail:

Stanley E. Lunde, PhD, Director of Research, Lanterman Developmental Center, USA, ORCID:, e-mail:

Dale E. Berger, PhD, Professor of Psychology, Claremont Graduate University, USA, ORCID:, e-mail:



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