A systematic review of the effectiveness of behavioural treatments for pica in youths

Clin Psychol Psychother. 2021 Jan;28(1):39-55. doi: 10.1002/cpp.2491. Epub 2020 Jul 13.


Pica is the persistent consumption of non-nutritive, nonfood substances and is associated with adverse health complications. However, there is limited research on interventions for pica in youth. The objective of this study is to systematically review the empirical evidence for the effectiveness of behavioural interventions for pica in children and adolescents and to generate treatment recommendations. A systematic search yielded 823 articles extracted from five databases: CINALH, Family and Society Studies Worldwide, Medline, PsycINFO, and Web of Science. Two reviewers completed initial sorting based on article titles and abstracts. Five reviewers completed sorting based on full article review. Thirty articles were included and double coded for demographic information, co-morbid conditions, and intervention characteristics. These studies were case studies involving behavioural treatments for pica. Seventeen behavioural interventions were categorized into four treatment approaches: reinforcement-based, response interruption, "other" interventions, and punishment-based procedures. Interventions that resulted in near-zero rates of pica were deemed effective. Findings showed support for contingent reinforcement, discrimination training as part of a combination treatment, physical restraint, time out, and contingent aversive stimulus. No evidence supported the effectiveness of response interruption procedures, including response blocking and visual facial screen. Other coded procedures did not appear effective. We recommend that the least restrictive procedures are implemented first, including a combination treatment with contingent reinforcement and discrimination training. As needed, more restrictive procedures can be added to the treatment package. This review will facilitate future empirical work and assist clinicians with treatment options for pica in youth. High-quality trials are needed.

Keywords: behavioural intervention; empirically supported treatments; pica; psychological intervention; youth.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Behavior Therapy*
  • Child
  • Humans
  • Pica / therapy*
  • Reinforcement, Psychology
  • Treatment Outcome