Teaching Adaptive Skills in Multiple Contexts to Decrease Pica and Increase Beach and Sun Protection Safety in Australia

Abstract

Pica is one of the most lethal self-injurious topographies. Despite this, more research is needed on teaching comprehensive adaptive skills to replace pica in varying contexts, particularly outside of specialised hospital admissions in the United States. Pica may include items such as sand, lotion, non-potable water, and clothing. Culturally, most Australians live near the coast. Australia has the highest skin cancer rates in the world, and for children enforces substantial mandatory sun protection and water safety measures (e.g., rash guard “rashie” tops, sun hats with school uniforms, sunblock, Surf Life Saving training). We present a case history of an 8.5-year-old male with pica and food stealing. He engaged in pica with his rashie, sun hats, and sunblock, and consumed substantial volumes of sand, sea water, seaweed, and chlorine swimming pool water. Behaviour-analytic assessment and treatment using single-case experimental designs occurred in the family home. Pica was high in the absence of social environmental consequences, and no stimuli competed. Response interruption and redirection with differential reinforcement was effective in increasing independence in multiple contexts with 7 skills such as discarding, putting away, and engaging with some materials appropriately (apply sunblock, put and keep sun hats on, play with beach toys and a sand and water play table), and refraining from touching other items (e.g., mud puddle, other’s food). Toy engagement increased and pica decreased. He met 100% of goals and learned to drink potable water and eat appropriately from crockery on a table. Parents were trained and reported high social validity, and gains maintained.