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

RésuméCette recherche aborde au travers d’une étude de cas, la question du traitement des comportements de pica (ingestion de substances non comestibles et/ou consommation inappropriée de produites comestibles) résistants, observables chez un enfant porteur d’un syndrome de Pallister Killian associé à un autisme et à un retard mental profond. Les comportements de pica pouvant être envisagés comme remplissant des fonctions, nous avons procédé à une évaluation fonctionnelle, basée sur un recueil d’observations directes et indirectes. Suite à ces observations, nous avons pu élaborer quatre hypothèses fonctionnelles expliquant l’apparition ou le maintien de ces comportements : soulagement de douleurs dentaires ; compensation de carences en oligoéléments ; gestion de situations vécues comme stressantes ; autostimulations sensorielles. Sur cette base, nous avons ensuite développé une approche thérapeutique multimodale, qui a donné lieu à la disparition des troubles du comportement.

SummaryObjectiveThrough 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.MethodPica 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 5 hours 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.ResultsStep 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.ConclusionThe observations carried out during three days three weeks after the behavioural intervention depicted no pica behaviour.Questions remainWill these results continue in the medium term and in the long run? May this evolution be generalized to the child's other environments – at home for instance?