The Handbook of High-Risk Challenging Behaviors in People with Intellectual and Neurodevelopmental Disabilities

Edited by
James K. Luiselli, Ed.D., ABPP, BCBA-D

Contents

I Self-Injurious Behavior

1. Biological Perspectives on Self-Injury Among People with Intellectual and Neurodevelopmental Disabilities
   Frank J. Symons and Craig H. Kennedy
   Page 3
2. Functional Behavioral Assessment and Functional Analysis of Self-Injury
   David E. Kuhn
   Page 21
3. Function-Based Behavioral Intervention for Self-Injury
   Johannes Rojahn, Iser G. DeLeon, Griffin W. Rooker, Michelle A. Frank-Crawford, Abbey B. Carreau-Webster, and Yanerys Leon-Enriquez
   Page 39

II Aggressive Behavior

4. Environmental Determinants of Aggressive Behavior
   Johnny L. Matson and Alison M. Kozlowski
   Page 63
5. Biopsychosocial Features Influencing Aggression: A Multimodal Assessment and Therapy Approach
   William I. Gardner, Dorothy M. Griffiths, and Jeffery P. Hamelin
   Page 83

III Sexual Offending Behavior

6. Risk Assessment for Sexual Offending
   Page x
7. Behavioral Assessment and Intervention for Sex Offenders with Intellectual and Developmental Disabilities
   Timothy R. Vollmer, Jorge R. Reyes, and Stephen F. Walker
   Page 121
8. Problem-Solving Treatment for Sexual Offending
   Christine Maguth Nezu, Travis A. Cos, and Arthur M. Nezu
   Page 145

IV Health-Threatening Eating Disorders

9. Behavioral Assessment and Treatment of Pica
   Louis P. Hagopian, Natalie U. Rolider, and Griffin W. Rooker
   Page 161
10. Ruminative Vomiting
    Jonathan Tarbox, Amy L. Kenzer, and Michele R. Bishop
    Page 177
11. Obesity and Weight Regulation
    Richard K. Fleming
    Page 195

V Criminal Behavior

12. People with Intellectual and Developmental Disabilities in the Criminal Justice System
    Susan Carol Hayes
    Page 211
13. The Death Penalty, the Courts, and Intellectual Disabilities
    J. Gregory Olley
    Page 229

VI Therapeutic (Physical) Restraint

14. Therapeutic Implementation of Physical Restraint
    James K. Luiselli
    Page 243
15. Regulatory Governance of Physical Restraint in Schools
    Joseph B. Ryan and Reece L. Peterson
    Page 257
16. Emergency Physical Restraint: Considerations for Staff Training and Supervision
    David Lennox, Mark A. Geren, and David Rourke
    Page 271

Behavioral Assessment and Treatment of Pica

Pica is defined diagnostically as:

1. Consumption of nonnutritive items for more than a month.
2. Consumption of nonnutritive items inappropriate to developmental age.
3. Eating that is not part of culturally sanctioned activity.
4. A behavior severe enough to require independent clinical attention when other clinical services are being provided for another mental disorder (American Psychological Association, 2000).

Prevalence of Pica

• The prevalence of pica in people with IDD has been reported between 5.7% and 25.8% (Ashworth, Hirdes, & Martin, 2009).
• The largest study evaluated 991 institutionalized individuals and found pica occurred in 25.8% of the sample (Danford & Huber, 1982).

Behavioral Assessment of Pica

Functional Behavioral Assessment

• A functional behavioral assessment (FBA) is recommended (Iwata et al., 1994).
• Indirect methods include:
  • Interviews and questionnaires aimed at identifying controlling variables based on the report of others.
• Direct methods involve observation and can be classified as correlational or experimental.

Experimental Methods

• Functional Analysis (FA) involves directly manipulating relevant antecedent and consequent variables and observing their effects on behavior.

Behavioral Treatment of Pica

Key Interventions

1. Noncontingent Reinforcement (NCR): Involves delivering a reinforcer on a timed schedule independent of the individual’s behavior.
2. Response Effort Manipulations: Involves increasing the effort required to engage in pica beyond the level supported by obtained reinforcement.
3. Differential Reinforcement of Other Behavior (DRO): Providing reinforcement for not engaging in pica.

Conclusions and Recommendations

• The goal of treatment should be to establish edible and inedible items as separate classes that occasion different responses.
• Effective interventions should be programmed for generalization across environments to ensure success.

References

• Ali, Z. (2001). Pica in people with intellectual disability: A literature review of aetiology, epidemiology and complications.
• American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., rev.).
• Ashworth, M., Hirdes, J.P., & Martin, L. (2009). The social and recreational characteristics of adults with intellectual disability and pica living in institutions.
• Bogart, L.C., Piersel, W.C., & Gross, E.J. (1995). The long-term treatment of life-threatening pica: A case study.