Although free text data were collected in both phases of SEED, only data from the second phase of SEED had been processed and made available for this assessment nonetheless, we have no reason to believe responses differed between the 2 study phases. We considered a child to have pica if the mother responded, “somewhat or sometimes true” or “very true or often true.” We reviewed free text responses on item(s) the child had eaten to assess the accuracy of responses to the pica question.
Response options for each item were “not true,” “somewhat or sometimes true,” and “very true or often true.” Pica was ascertained via the item, “child eats or drinks things that are not food–not including sweets.” If this item was answered affirmatively, the respondent was asked to describe the consumed substance. The Child Behavior Checklist, 30 a standardized self-administered form, asked respondents to indicate whether their child had exhibited problem behaviors within the previous 2 months. Data collected included sociodemographic characteristics and child health conditions and behaviors. Mothers completed structured telephone interviews and self-administered forms. A small number of children recruited to the POP group screened positive on the SCQ and met study criteria for ASD they received a final ASD study classification. Children selected for the DD group who had an SCQ score <11 and no previous ASD educational classification or diagnosis were classified as DD without ASD characteristics. 29 Children who met the study criteria for ASD on the basis of their Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised assessments were classified as ASD cases 25 children who had been classified as potential ASD cases on the basis of symptoms or past diagnoses but did not meet the study ASD case criteria were classified as DD with ASD characteristics. 27 Children in the potential ASD group were additionally administered the Autism Diagnostic Observation Schedule, 28 and their caregivers were administered the Autism Diagnostic Interview-Revised. All children were administered an in-person general developmental assessment, the Mullen Scales of Early Learning. Additionally, children who had a previous ASD diagnosis or special education classification were considered potential ASD cases regardless of their SCQ scores.
Children with scores ≥11 were considered potential ASD cases regardless of their initial classification. 25 After enrollment, mothers of all children were administered the Social Communication Questionnaire (SCQ) 26 to screen for ASD symptoms in their child. Although children were initially identified as eligible for 1 of the 3 study groups, final study classification was determined by standardized research developmental assessment results. This analysis included children from all 3 study groups (ASD, DD, and POP) who were not missing data on pica. Because most studies in this review were limited to severe cases of pica resulting in intervention, the total prevalence of pica is likely higher than reported in these studies. In a literature review conducted by Matson et al, 1 pica prevalence estimates in children or adults with ASD and/or ID ranged from 4% to 26% the highest estimates were found in populations that were institutionalized because of their disabilities. Neumeyer et al 23 assessed children with ASD who were treated at 15 Autism Treatment Network sites they reported pica prevalence was 3.0% in children 6 years old.
In their prospective population-based cohort study, Emond et al 22 reported that children who were eventually diagnosed with ASD were more likely to have increased pica behavior at 38 and 54 months (12.3% and 12.5%, respectively) than controls (2.3% and 0.7%). 2, 3, 14– 21 In few studies has pica prevalence in individuals with ASD been systematically assessed. Available information is primarily from published case series and reports. However, studies of pica in individuals with ASD and other developmental disabilities (DDs) are limited.
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