Luiselli health threatening eating disorders.pdf

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

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

Table of 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 ....................................................3
  2. Functional Behavioral Assessment and Functional Analysis of Self-Injury
    David E. Kuhn.................................................................................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 ..................................................................39

II Aggressive Behavior

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

III Sexual Offending Behavior

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

IV Health-Threatening Eating Disorders

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

V Criminal Behavior

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

VI Therapeutic (Physical) Restraint

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

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, and
  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).

Several severe health risks are associated with pica, including lead poisoning, intestinal perforation, and obstruction. The prevalence of pica in people with IDD (Intellectual and Developmental Disabilities) has been reported to be between 5.7% and 25.8%. In the largest study, pica occurred in 25.8% of a sample of 991 institutionalized individuals.

Functional Behavioral Assessment

To assess the operant contingencies maintaining pica, a functional behavioral assessment (FBA) is recommended. There are two categories of FBA procedures: indirect methods (interviews and questionnaires) and direct methods (observations). Experimental methods (i.e., functional analysis, FA) are the most rigorous and directly manipulate relevant antecedent and consequent variables.

Behavioral Treatment of Pica

Two broad classes of intervention have been shown to be successful: medical and behavioral interventions. Medical interventions, such as correcting identified nutritional deficits, have shown promise. Behavior analytic interventions typically involve multiple components, including antecedent interventions (e.g., noncontingent reinforcement) and consequent interventions (e.g., reinforcement, response blocking).

Noncontingent Reinforcement (NCR)

NCR involves delivering a reinforcer on a timed schedule independent of the individual's behavior. Access to reinforcement may reduce the motivation to perform the behavior.

Response Blocking

Response blocking involves preventing pica from occurring and has shown effectiveness in reducing problem behavior maintained by sensory reinforcement.

Differential Reinforcement

Differential reinforcement of other behavior (DRO) involves providing reinforcement for not engaging in pica. This has been less frequently evaluated but has shown some effectiveness in various studies.

Conclusions and Recommendations

The assessment and treatment of pica have evolved, with an increased focus on understanding behavioral determinants rather than relying solely on default interventions. The integration of reinforcement-based procedures relative to punitive measures is increasing, highlighting the importance of comprehensive, individualized treatment approaches.