Analyse fonctionnelle des comportements de pica d’un enfant présentant un syndrome de pallister killian associe à un autisme

Abstract

Objective : Through a case study, the paper deals with persistent pica behaviour in a child of 12 with Pallister Killian syndrome associated with autism and profound mental retardation. Method : Pica behaviour may have a functional role. We thus carried out a functional assessment in order to make functional assumptions before targeting our interventions. Our methodology was divided into three parts: observations for 6 days – six sessions of 5hours during which different activities were carried out; interviews with parents and members of the multidisciplinary team; making functional hypotheses; interventions: adapted to these hypotheses. In order to assess their efficiency, the frequency of targeted behaviour was measured out after the intervention. Results : Step 1: functional analysis: data gathered from indirect observation displayed an early occurrence and an evolution of pica behaviour. Moreover, significant change in the child’s environment resulted in an increase of these types of behaviour. In the medical histories, numerous dental diseases were noted (aching tooth eruption, dental decay, recurrent abscess and moth ulcer); blood tests showed iron deficiency. Step 2: functional hypotheses: after the observations, we could make four functional assumptions explaining the apparition or the continuation of the behaviour: relieving the toothache; compensation for nutritional deficiency of trace elements; management of stressful situations; sensory stimulations. Step 3: intervention: according to the assumptions, several types of intervention were suggested in order to reduce or even to stop pica behaviour: the child’s environment was asked to improve or intensify the dental care; after an operation which took place a few days later, four decayed teeth were pulled out – teeth that could have ached if they had not been pulled out; a treatment in trace elements was prescribed during that period in order to readjust the iron deficiency; the child’s environment was told to anticipate important daily changes; a behavioural intervention was scheduled in order to counter-balance the reinforcement caused by self-stimulation. Conclusion : The observations carried out during three days three weeks after the behavioural intervention depicted no pica behaviour.