Assessment and treatment of rumination in a young man with autism

Abstract

After a pretreatment screening analysis suggested that rumination by a 19-year-old man with autism was maintained by automatic reinforcement, we evaluated his preference for three snack foods and the frequency of his rumination after consuming each. Rumination was more common after eating high-preference foods. We then examined noncontingent access to a type of lollipop (i.e., a Ring Pop™) to decrease rumination. The Ring Pop™ reduced rumination to moderately low levels. Next, to further decrease rumination, we added a reprimand, which reduced rumination to near zero levels. Finally, we evaluated the reprimand by itself, which resulted in a reduction in rumination roughly equivalent to that produced by the Ring Pop™.Results are discussed in terms of the source of reinforcement for rumination and the behavioral mechanisms responsible for intervention effects.

Empirically derived consequences to treat rumination

“…For instance, in the case of rumination, researchers could investigate factors that predict whether an individual's rumination would be sensitive to an antecedent‐based approach like competing oral stimulation. Using Wilder and Neve () as an example, incorporating a pre‐treatment preference assessment to determine the extent to which food preference influences rumination may be an important treatment consideration in determining whether or not noncontingent food is likely to be an effective intervention. Identification of factors that differentially influence treatment effectiveness for this challenging and persistent behavior may lead to a more synthesized approach to applied research and contribute to more streamlined practice guidelines.…”

“…Finally, some individuals may ruminate more during meals and periods of access to food (Wrigley, Kahn, Winder, Vollmer, & Sy, ) or following access to highly preferred food. For example, in a recent study on the effects of food preference on rumination, Wilder and Neve () conducted a preference assessment of food items and provided the participant noncontingent access to high‐, moderate‐, and low‐preference food. The participant in their study ruminated more following periods of access to high‐preference food.…”

“…Thus, the use of dietary manipulation and competing oral stimulation may not be suitable or effective for all individuals and continued investigation of treatment for rumination that does not rely these methods is warranted. As demonstrated by DeRosa et al () and Wilder and Neve (), interventions that involve punishment may sometimes be necessary to decrease rumination to clinically significant levels. These findings are perhaps not surprising given that rumination is often maintained by automatic reinforcement (Luiselli, ), and previous research has shown that treatments involving differential reinforcement and noncontingent reinforcement are less effective when behavior is maintained by automatic reinforcement relative to socially mediated reinforcement (Iwata et al, ).…”

A Multicomponent Evaluation of Food Properties Affecting Rumination in an Adult with Intellectual Disabilities

“…Researchers have conducted extended observations when evaluating dietary manipulation procedures Johnston et al, 1991;& Masalsky & Luiselli, 1998). However, some analyses have relied on briefer windows of observation following (e.g., Carroll et al, 2011;Woods et al, 2013;Wilder & Neve, 2018;& Migan-Gandonou & Leon, 2020). Although the duration of rumination may vary across participants, this analysis demonstrates the utility of extended observations in better capturing occurrences of rumination.…”