Presentation Handout available HERE

Amanda Tami, LPC, BCBA, talks about Eye Movement Desensitization and Reprocessing (EMDR) therapy and its use for autistic individuals. She discusses how traumatic memories can get “stuck” in the body and relived when we are exposed to similar stimuli. Tami explains how EMDR works as a form of adaptive information processing that allows the brain and body to let go of these traumatic memories and make room for feelings of safety and calm. The speaker emphasizes the need for more research around trauma and autism, underscoring that living in a world that wasn’t built for you is innately traumatic. She outlines barriers to EMDR therapy and details modifications for autism. Tami gives a clinical example of using modified-EMDR treatment for an autistic patient before the Q&A.

More information on EMDR and providers near you – EMDR International Association

Holidays can be challenging for autistic individuals. Amanda Tami, LPC, BCBA, will share tips, tricks, and suggestions to help you plan for a merry holiday season.

Handouts available HERE

More information:

Planning for the holiday season – Resource Page

Choosing toys for a child with autism – Article

Originally published on December 10, 2025

Dean Alexander, Ph.D., discusses pica, the ingestion of non-food substances, which has received insufficient attention as a common, sometimes lethal, form of self-injurious behavior. He discusses the prevalence of pica in autistic individuals and the long-term health implications associated with pica behavior. The speaker details numerous case studies and highlights the need for multidisciplinary collaborative treatment strategies based on functional behavior assessments. Alexander describes available treatment strategies and presents the SMART acronym for treatment recommendations. e.

Handouts are available for download (PDF) HERE
Take the knowledge quiz for this presentation HERE

This is a joint presentation by ARI and the World Autism Organisation.

In this webinar: 

2:12 – What is pica
5:22 – Study: Soda can and rubber ball
8:00 – Challenges with behavioral treatments
13:00 – Sensory stimulation and pica
14:20 – Pica prevalence and impact
16:08 – Study: GI symptoms and pica
17:30 – Study: Autism, GI symptoms, and pica
19:00 – Study: Pica prevalence in autistic adults
25:25 – Pica as a phenotypic subgroup
26:30 – Studies: polyvisol, vivinex, iron supplements, zinc and antioxidant therapy
29:46 – Metabolic profiles and phenotypic subgroups
31:57 – Why nutritional interventions
34:04 – Comprehensive vitamin-mineral interventions
36:10 – Dietary changes
38:21 – Study: Homeopathic treatment
44:28 – SMART interventions

Pica and behavioral treatments

Pica is the ingestion of inedible substances and is the most dangerous form of self-injurious behavior associated with autism (2:12). Items frequently ingested include generally harmless things like dirt, leaves, and grass, as well as dangerous and potentially lethal items like rubber gloves, clothing tags, and screws (3:30). Alexander details a case study involving a 50-year-old autistic man who ingested cigarette butts. The presenter explains how treatment strategies capitalized on the individual’s preferences by incorporating soda cans and a red rubber ball into his walk to work. Over six months, the client’s nicotine and cotinine levels decreased from those of a chain smoker to zero (5:22). Alexander highlights the simplicity of this case, noting the trial and error implicit in creating holistic treatment strategies (6:43). 

Establishing effective behavioral treatments for pica can be challenging due to costs, availability, environmental restrictions, and the generality of treatments across time (8:00). The presenter notes the importance of functional behavioral assessments, which help identify the factors that drive and maintain pica behavior, like attention-seeking, sensory issues, pain attenuation, or escape/avoidance (11:00). Sensory stimulation, he continues, is often a significant factor in maintaining pica behavior and can be challenging to address. Solutions to sensory drivers can include finding substitute foods with similar sensory properties (i.e., grape nuts in place of dirt) or engaging individuals with play during unstructured hours (13:00). The presenter notes that pain attenuation is often related to dental issues (14:01). 

Pica Prevalence and Impact

Around 23.2% of autistic children and up to 60% of autistic adults experience pica (14:20). The speaker outlines two studies on the intersection of autism, pica, and GI issues in children (16:08). Researchers found that autistic children and children with developmental disorders who also have pica have a higher prevalence of GI signs, symptoms, and diseases compared to those without pica (15:24). Prevalence of food cravings and specific GI conditions like irritable bowel syndrome (IBS) and gastroesophageal reflux (GERD) are also higher in autistic children with pica than those without (17:30). To assess the prevalence and co-occurring conditions in adults, researchers examined ten years of medical records compared to a comprehensive list of symptoms and diseases (19:00). Four groups were assessed: autism only, autism and pica, pica without autism, and a control group of developmentally disabled individuals without pica. Findings revealed that the prevalence rates across the ten most frequently occurring diseases were two to three times higher for individuals with pica, where the autism and pica group had the highest rate (22:33). Alexander emphasizes that pica takes a severe toll on the body over time which can lead to shorter life expectancy and higher mortality rates. He asserts that autistic individuals with pica may represent a phenotypic subgroup characterized by GI symptoms and requiring specialized treatments (25:25). 

Intervention Options

Alexander outlines research showing that autistic children have relatively less diversity in gut bacteria and generally have fewer healthy bacteria than unhealthy (30:55). These findings emphasize the importance of including nutritional interventions in treating pica. The speaker underscores that dietary interventions do not necessarily rely upon practitioner availability and so may be more accessible (27:36). He details promising research using iron supplements, liquid multivitamins (poly-vi-sol), specialized formulations (vivinex) (26:30), and zinc supplements and antioxidant therapy (28:42) to reduce pica behaviors like coprophagy (ingestion of feces) in autistic individuals. The presenter discusses a study that revealed significant differences in metabolic profiles between autistic children and their non-autistic peers (29:46). Targeted nutritional therapies, including folinic acid, betaine, and methyl B12, succeeded in correcting metabolic imbalances. Alexander asserts these findings suggest the presence of a metabolic phenotype and that aspects of autism are treatable. 

Maintaining a healthy gut is critical for the body’s ability to fight infection, digest food and produce vitamins (31:57). The presenter outlines other nutritional treatment approaches, including gluten-free, casein-free, and Mediterranean diets (37:17), as well as comprehensive vitamin-mineral interventions (34:04). Alexander details a case study where a seven-year-olds pica behaviors stopped just one week after implementing a gluten/casein free diet (36:10). The speaker summarizes the behavioral, dietary, and vitamin/mineral based interventions and highlights the need to try and assess each strategy. He outlines a homeopathic treatment study that showed remarkable improvements in a 15-year-old boy with severe autism. Supplemental behavioral interventions alongside homeopathic recommendations significantly improved the child’s functions, behavior, communication, and quality of life (38:21). 

S.M.A.R.T. Interventions

Alexander highlights the need for collaborative treatment strategies and introduces the SMART acronym for treatment recommendations (44:28): 

Safety: Safety precautions are critical. Potential dangers and treatment environments must be appropriately assessed based on individual needs.

Medical issues related to eating habits, food cravings, stomach pain, antibiotic use, and mouth sensitivities must be addressed. It is best to be assessed by a team of professionals including, but not limited to, a dentist, GI specialists, and nutritionist (45:33). 

Analysis/assessments of behavior function and consequences are best practices. Such assessments are critical for accurately identifying drivers and potential treatments for pica behavior (47:40). 

Reinforcement inventory or a “menu” of activities or objects that help minimize Pica behavior (e.g., soda cans and rubber balls). These can aid in implementing differential reinforcement strategies and finding alternatives. 

Treatment packages or a combination of various approaches to create a collaborative treatment strategy. Treatment packages include psychotherapy, pharmacological treatments, behavioral techniques, and nutritional support. Such holistic therapies are generally the most effective (49:44). 

Dean Alexander, Ph.D., discusses pica, the ingestion of non-food substances, which has received insufficient attention as a common, sometimes lethal, form of self-injurious behavior. Behavioral approaches to treatment, more often than not, fall short. Biological intervention, if supported, may hold out new promise.

Handouts are available for download (PDF) HERE

This is a joint presentation by ARI and the World Autism Organisation.

Part One: Challenges when your son or daughter is experiencing a difficult time

Paul Shattock provides a parent’s perspective on handling his son Jamie’s challenging behaviors and describes the experiences of other families who have navigated similar situations. This webinar was produced in partnership with the World Autism Organization.

In this webinar

0:00 – History of World Autism Organization|
1:25 – 5:00 – Jamie’s life from birth to age 8
4:40 – First signs of aggression
6:08 – Difficulties with hair cuts
8:40 – Sunderland parents and school
9:45 – Experiences with aggressive outbursts
12:15 – Age patterns for aggression and SIB
13:48 – Experience with pharmacological remedies
16:30 – Jamie’s life today 

Shattock details his son’s behaviors across his lifetime and describes the experiences of his family and community in creating supportive environments for Jamie and his peers. He recounts Jamie’s diagnosis, the disparity between autism science today compared to the 1970s, and their journey through various schools, medication, and community support. Shattock closes by noting that Jamie is now able to work and live away from his parents and that his aggressive behaviors dissipated over time. 

To explore the perspectives of another parent, a pediatrician, and a behavior analyst on aggression and SIB, take a look at Aide Canada’s interview series on Understanding and Supporting Children with Self-Injurious Behaviour. 

Part Two: Teaching Children with Autism How to Communicate Their Wants and Needs 

Lauren Moskowitz, Ph.D., discusses teaching children with autism how to communicate their wants and needs. She reviews communication difficulties in the autistic population and highlights understanding challenging behaviors as communication functions. Moskowitz defines function-based behavior intervention plans and details functional communication training. She provides various examples and advises how to select and teach replacement skills and ensure they are used correctly. Moskowitz describes successful treatment plans and emphasizes the importance of learning to tolerate delays in reinforcements before closing with a Q&A session.

Handouts for Dr. Moskowitz’s talk are online HERE

In this webinar: 

1:00 – Communication in children with autism
3:55 – Communication impairment and challenging behaviors
5:25 – Challenging behaviors as functions of communication
9:40 – Functions of communication
11:18 – How to teach children with autism to communicate wants and needs
12:55 – Principle of functional equivalence
13:50 – How to identify the function
15:50 – ABC flowchart and examples
21:00 – Creating function-based behavior interventions
23:10 – Building replacement skills
24:10 – Functional communication training
25:36 – Replacement skills for gaining attention
27:54 – Replacement skills for escaping disliked activities
29:27 – Replacement skills for obtaining tangible item/activity
30:12 – Replacement skills for obtaining sensory stimulation
32:03 – What communication skills to teach?
32:40 – How will communication skills be taught?
34:17 – How to ensure communication skills will be used?
37:03 – When to teach communication skills?
38:30 – FCT Case Example – Eli
48:37 – Competing with challenging behaviors
50:23 – Learning to tolerate delays
53:12 – Notes from Dr. Stephen Edelson, Executive Director at ARI
56:20 – Q & A

Language and communication difficulties are core symptoms of autism, and around one-third of children with autism are nonverbal or minimally verbal. Moskowitz explains that verbal children often struggle with communication in moments of distress (1:00; 10:45). She emphasizes that communication impairments do not cause challenging behaviors (CB). However, the likelihood of an individual using CB can increase if they have difficulty communicating their wants or needs (3:55). Individuals engage in CB because those behaviors serve a specific function, and behaviors persist because they meet an immediate need (5:25). Throughout the presentation, Moskowitz emphasizes the difference between behaviors and their functions (8:35). She suggests viewing CB as functions of communication and focusing on why an individual exhibits CB instead of the behavior itself (9:40). 

Moskowitz describes functional communication training (FCT) as teaching appropriate functional communicative behaviors to replace CB (11:18). She outlines the principle of functional equivalence (12:55), functional behavior assessments (FBA) (13:50), and the ABC (antecedent, behavior, consequence) flowchart (15:50). She underscores looking for patterns of behavior via direct observations. The speaker presents three examples of observed behaviors and circumstances in the ABC format (16:46) and suggests video recording to help track patterns of behavior and caregiver reactions (19:19). Once antecedents and consequences (outcomes) are understood, treatment teams can create a function-based behavior intervention plan (BIP) that will (21:00):

1. Prevent CB by changing the circumstances that trigger behaviors
2. Teach appropriate replacement skills that allow individuals to get what they need
3. Respond to CB by changing consequences to no longer reinforce those behaviors

The presenter refers viewers to her previous webinars for information on prevention strategies and notes a variety of skills that can serve as alternative behaviors (23:10). Moskowitz stresses teaching skill sets that match the function and outcome of the CB specific to each individual (24:10). She provides examples of replacement skills that can be taught when the function of a behavior is to gain attention (25:36), to escape/avoid disliked or strenuous activities (27:54), to obtain a tangible item/activity (29:27), and to obtain sensory stimulation (30:12). Selected replacement skills should be something the individual is capable of learning and executing on their own. They must serve the same function and work as well or better than the CB (32:03). 

Moskowitz asserts that replacement strategies must be taught with prevention interventions and learned in situations that provoke the CB. It is best to practice new skills in contrived conditions before prompting them in naturally occurring situations (32:40). To ensure continued use of communication skills, the presenter explains that the new behaviors must be easier to perform than the CB and the consequence of the replacement skill should be more reinforcing than that of the CB. Replacement behaviors should also be responded to immediately and consistently, or an individual may revert to the CB (34:17). Moskowitz discusses when to teach replacement communication techniques and emphasizes that new skills can only be learned during teachable moments before escalation or after recovery (37:03). The presenter stresses that after the communication skill is well-established, individuals must learn to tolerate delay in responses/reinforcement so they can eventually use the technique independently (50:23). Moskowitz provides an in-depth case example of FCT broken down into seven steps: 

1. Assess the function of CB (38:34)
2. Select mode of communication (40:55))
3. Arrange the environment to create teaching opportunities (42:40)
4. Prompt communication (43:44)
5. Fade prompts (46:00)
6. Teach new forms of communication and expand settings where requests are made (47:33)
7. Modify the environment (48:25)

Before the question and answer session (56:20), Dr. Stephen Edelson, Executive Director at ARI, notes ARI’s free online screening tool (ATEC) as well as the development of an online program to help provide insight into various behaviors via a decision tree about causes and functions of CB (53:12). 

View Dr. Moskowitz’s past talks on:

• Assessing and Treating Challenging Behaviors
• Anxiety and ASD
• Self-injury and ASD

Also Featured: Resources

Read Dr. Edelson’s editorial HERE