please give me advice for my autistic brother, (pica?)

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My brother is 15 years old and moderate-severe autistic. He can sometimes form sentences but has a hard time understanding ours. He has developed a problem similar to pica but we don't know for sure if it is pica. He is eating string and elastic from his clothes and furniture. He eats so much string everyday that when my mother changes his diaper, she literally has to pull strand after strand out of him. He screams and almost cries, she is very gentle, but it doesn't help. He has always had bowel problems, constipation for all of his life. He just started this about an year ago. He has always chewed on things but the eating string only began a year ago, and for the life of me I cannot think of any kind of trigger that would cause him to do this. I am with him almost 24 hours a day, 7 days a week, and I cannot think of what happened to make him start this or how to fix it.

He cannot keep clothes. He eats through his clothes and the strings that we end up throwing away underwear, shirts, shorts, and pants everyday. We cannot keep affording to buy clothes every week for him. He also tears up computer chairs that he sits in when he is on the computer all the way down to the flat bottom or base. So we have to buy chairs over and over also. Nylon clothes seem to be the only thing that last longer than the other materials. But after a few days, he still eats these too.

We've tried everything we can possibly imagine. We've tried telling him "No, Stop". We've tried directing his attention to something else and giving him other toys or things he can chew on. We've tried to word the best way to tell him that he will end up in the hospital and when he hollers from pulling string out of his bottom, we tell him that it's because he eats the string and if he would just stop, he wouldn't have that problem.

Please does anyone have any advice? I'm so scared that he will end up in the hospital because of all the string he eats. He will not take any toys to chew on, he wants the string. Please help.

It may sound strange at first thought, but have you thought of offering string cut to shorter pieces to your brother? If he insists on eating string, having him eat shorter bits of the stuff might at least facilitate its passage through his body. Also, if you offer him pre-cut string, you can control what kind of string he eats. I would guess that cotton would be less dangerous than synthetic fibres, as the body can at least soak that with digestive fluids and make it more likely to break apart when it gets caught somewhere in his intestines.

Apart from that, do you have any idea why string appeals so much to your brother? Might it be that he needs an extra-high degree of non-digestable substances in his diet? Sometimes things like bran that cannot be completely digested can help with digestive problems and more escpecially with constipation. With the latter, it could also be helpful if your brother increased his fluids intake. Not drinking enough can make constipation become worse.
Or is it more likely that the feeling of chewing the string appeals to your brother? In that case you could try foods that provide a similarly fibrous texture to chew upon, like pineapple.

That's all I can think of at the moment, but I reckon the closer you get to discovering your brother's reason for eating string, the easier it will be to offer him a less problematic alternative that he may accept.

Cook a whole bunch of spaghetti and portion it to his size portions. If he wants something stringy to eat, offer him spaghetti. He'll probably like the stringy texture.

This sounds like a great idea.

This is a good idea, only he won't eat spaghetti noodles. And the post about giving him certain cuts of string, I don't know. That seems to me as if we are telling him to stop, yet we're giving him string. He might get confused. The only thing is, he eats all day long, in his sleep sometimes. He likes to be alone to watch tv or play on the computer and he won't let us be in there without going into a fit. So it's very hard to sit and watch each and every time he eats the string, because it is an all day thing. So many things don't work with him, no matter how hard I try or the different things I try.

Have you tried talking to his doctor about this? What would the doctor suggest?

We haven't talked to a doctor yet. We were hoping to find a solution in other ways before talking to a doctor because there are not many doctors in this area that are familiar with all aspects of autism or autism at all. Most are not familiar with alternate solutions to some of the problems autistics face.

I remember one of my mother's friends had a daughter who sucked her thumb non stop so they put some nasty tasting stuff that came in a little bottle. Perhaps you can make the strings foul tasting.

We will try that tomorrow. Thank you for the idea. If it works, I'll post it.

I can see how my proposal may appear problematic or difficult to see through in a RL situation, but I tried to come up with something that could at least lessen the problem until you had worked out a permanent solution. I still think that trying to figure out the reason for your brother's behaviour is the key to making him stop eating string. I think that there is a reason even for an unusual behaviour like this, though it would be difficult to figure out if your brother's ability to communicate were poorly developed.

If it is indeed the feeling of chewing string or some similarly chewy texture that appeals to your brother, I have thought of some other items of food that might hold a similar appeal for him: dried fruit, more specifically dried pineapple, apricot or mango; dried fish or beef jerky. I don't reckon chewing gum would work in your brother's case because it is widely different from string in both texture and taste. If any of these foods appeal to him, you'll have to keep an eye on his overall calorie intake; many of them are rather high-energy, but the addtional fibres from dried fruit could help enhance his overall digestion.

Another reason I came up with is that eating triggers the mammal brain (and we humans are mammals after all) to release serotonin which in turn makes people feel better. This is one of the reasons why some depressive people overeat and gain weight - eating makes them feel better. Making your brother stop eating string would be more difficult if this were indeed the case. You'd have to find a substitute behaviour for him that also releases serotonin and that he enjoys enough to persue it regularly. Apart from having him spend time with his special interest(s), which makes most people on the spectrum feel better, repetitive motions came to mind. Ill-tended zoo animals often display repetitive patterns of movement and those release serotonin, thus lessening tje stress/unhappiness the animals are experiencing. I think many stimming behaviours also work because their repetitiveness releases serotonin. So if your brother is already stimming a lot, I don't think that serotonin release is the reason for him eating string, but if he doesn't stim much, it might be worthwhile to take a closer look at this aspect.

On a more practical note: have you tried leather trousers and jackets for your brother? Those are not only more difficult to pick apart, but leather often has a nasty taste due to the chemicals used for curing and tanning the leather. This might at least reduce the number of clothing items your brother attacks.

Have you tried ABA (Applied Behavioral Analysis)? My ex worked at a school for autistic adults, and the way they worked on altering behavior was by providing treats for good behaviors (like a cookie or a soda, or whatever was a meaningful incentive for that individual) and mild punishments for unwanted behaviors, like a time out, sitting in a corner (facing the room) for short periods.

You can read more about it on the internet or look for a specialist who knows about it and can help implement it.