Symptoms included vomiting, diarrhea, loose stools, constipation, and/or pain on stooling. Child GI symptoms were ascertained from parent-administered health-history forms. We considered a child to have pica if the caregiver responded, “somewhat or sometimes true” or “very true or often true” to the item child eats or drinks things that are not food – not including sweets. Pica was ascertained from the Child Behavior Checklist (CBCL), 20 a standardized parent-administered form used to assess problem behaviors. 19 Caregivers also completed structured telephone interviews and self-administered forms assessing sociodemographic characteristics and child health conditions and behaviors.
18 Final ASD classification was determined by ADOS and ADI-R scores. Children with SCQ scores ≥11 and/or a previous ASD diagnosis or special education classification underwent in-depth developmental assessments including the Autism Diagnostic Observation Schedule (ADOS) 17 and their caregivers completed the Autism Diagnostic Interview–Revised (ADI-R). Upon enrollment, caregivers completed the Social Communication Questionnaire (SCQ) 16 to screen for child ASD symptoms.
POP controls were recruited from randomly-selected birth records at each site. Children with ASD and other DDS were recruited from multiple clinics and schools at each site. SEED included three study groups: children with ASD, children with (non-ASD) DDS, and children from the general population (POP). 15 Children eligible for SEED were aged 2–5 years at the time of study enrollment, lived in the respective site’s study area both at birth and at study enrollment, and lived with a caregiver since at least 6 months of age who could provide legal consent and communicate in English (all sites) or Spanish (two sites). Two phases of SEED data collection have been completed (2007–20–2016) in six study sites (California, Colorado, Georgia, Maryland, North Carolina, and Pennsylvania) following a common protocol. We examined an expanded sample from SEED, which has now completed two data collection phases, to assess associations between pica and common GI symptoms in preschoolers with and without ASD and other (non-ASD) DDS. The interplay between pica and GI symptoms among children with ASD or other DDS has not been assessed in large epidemiologic studies. 14 A previous study using data from the first phase of SEED, which ascertained GI symptoms, such as vomiting, diarrhea, and constipation, through parent-report, found that children with ASD were over 3 times more likely to have GI symptoms (34.6%) than children in the general population (POP) group, (12.0%) children with other DD types were nearly 2 times more likely to have GI symptoms (22.2%) than children in the POP group. 11, 12, 13 Prevalence estimates of GI symptoms in persons with ASD have varied widely across studies depending on sampling methods, population characteristics and measurement and definition of GI symptoms. Several studies have also found that GI symptoms and disorders occur more frequently in children with ASD and other DDS. 7 Associations between pica and ASD and ID remained significant after adjustment for sociodemographic factors with adjusted prevalence ratios (aPRs) ranging from 1.9 to 8.0 for various subsets of children with ASD diagnoses, ASD characteristics without a diagnosis, and/or ID. 2, 4, 7, 8, 9, 10 Most recently, we analyzed a large population-based sample of preschool-aged children from the Study to Explore Early Development (SEED) and reported that pica prevalence was 9.7%-28.1% in children with ASD, ASD characteristics, and/or ID, which were all significantly higher than the pica prevalence of 3.5% in preschool-aged children sampled from the general population (POP controls).
Pica prevalence has been found to be higher in children and adults with DDS, including autism spectrum disorder (ASD) and/or intellectual disability (ID) than in the general population. 1, 2, 3, 4 Case reports describe individuals with developmental disabilities (DDS) and pica having subsequent GI symptoms such as vomiting, weight loss, and abdominal pain requiring clinical intervention. Pica, the repeated ingestion of nonfood non-nutritious items, is a serious condition that can lead to adverse medical consequences, including gastrointestinal (GI) outcomes such as parasites, nutritional deficiencies, and obstructions.
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