Controlling Childhood Rumination through Differential Reinforcement of other Behavior

Abstract

Rumination is a rare behavior disorder of childhood involving regurgitation of food which is then ejected or reswallowed. The present study investigated the control of rumination through use of a positive reinforcer (a mixture of honey and water) delivered on a differential reinforcement of other behavior (DRO) schedule. The subject was a 26-month-old girl who had lost 50% of body weight through rumination. DRO was used as part of a multifaceted treatment program which also included, at different phases, punishment and time out from positive reinforcement. Evaluation of treatment components via a single-subject experimental design with withdrawals indicated the DRO procedure exerted powerful controlling effects over rumination. Transfer of control to social consequences was attempted through use of time out with punishment. The subject's weight increased over her 69-day hospitalization from 7.1 kg. to 11 kg. A 10-month followup revealed continued weight gain and suppression of rumination. Possible limitations to generalizability of findings, particularly previous experience with punishment, are discussed as are advantages of DRO in the management of this behavior problem.

Tic Disorders, Trichotillomania, and Other Repetitive Behavior Disorders

“…Studies of differential reinforcement procedures (e.g., delivering a reinforcer whenever ruminative behavior has not occurred for approximately 30 seconds with the interval being gradually lengthened as the rate of rumination decreases) have also found mixed results, have been conducted on a total of three subjects (Mulick et al, 1980;O'Neil, White, King, & Carek, 1979;Barmann, 1980) and have been criticized for significant methodological flaws (Starin & Fuqua, 1987). Finally, a procedure involving the delivery of noncontingent reinforcement found that social attention delivered before, during, and after mealtimes significantly reduced rumination (Whitehead, Drescher, Morrill, Corbin & Cataldo, 1985).…”

Chronic rumination reduction in a severely developmentally disabled adult following combined use of positive and negative contingencies

“…Further, while Mulick et al (1980) found that DRO in and of itself was not particularly effective in the reduction of rumination, O'Neil et al (1979) suggest that use of DRO or DRI in conjunction with ''aversive'' procedures may produce more substantial results than any one treatment alone. To date, however, the majority of the research incorporating both types of treatment procedures (i.e., ''aversive'' and DRO or DRI) utilize them in either a sequential manner (e.g., lemon juice therapy phase followed by a phase of DRO;O'Neil et al, 1979) or by implementing a variety of techniques concurrently (e.g., pepper water, extinction, DRO, DRI, stimulus control, etc; Murray, Keele, & McCarver, 1976).…”

“…In general, while use of these strategies have resulted in some decreased rumination, specific drawbacks that may preclude their usage include weight gain (Dudley, Johnson, & Barnes, 2002), decreased efficacy (Wilder, Draper, Williams, & Higbee, 1997), and temporary and/or situation specific responses (Mulick, Schroeder, & Rojahn, 1980;O'Neil, White, King, & Carek, 1979). Further, while Mulick et al (1980) found that DRO in and of itself was not particularly effective in the reduction of rumination, O'Neil et al (1979) suggest that use of DRO or DRI in conjunction with ''aversive'' procedures may produce more substantial results than any one treatment alone.…”

“…In general, while use of these strategies have resulted in some decreased rumination, specific drawbacks that may preclude their usage include weight gain (Dudley, Johnson, & Barnes, 2002), decreased efficacy (Wilder, Draper, Williams, & Higbee, 1997), and temporary and/or situation specific responses (Mulick, Schroeder, & Rojahn, 1980;O'Neil, White, King, & Carek, 1979). Further, while Mulick et al (1980) found that DRO in and of itself was not particularly effective in the reduction of rumination, O'Neil et al (1979) suggest that use of DRO or DRI in conjunction with ''aversive'' procedures may produce more substantial results than any one treatment alone. To date, however, the majority of the research incorporating both types of treatment procedures (i.e., ''aversive'' and DRO or DRI) utilize them in either a sequential manner (e.g., lemon juice therapy phase followed by a phase of DRO;O'Neil et al, 1979) or by implementing a variety of techniques concurrently (e.g., pepper water, extinction, DRO, DRI, stimulus control, etc; Murray, Keele, & McCarver, 1976).…”

Decreasing rumination using a starchy food satiation procedure

“…For example, behavioral studies of rumination have examined the effects of differential reinforcement of other behavior (DRO) (Conrin, Pennypacker, Johnston, & Rast, 1982;McKeegan, Estill, & Campbell, 1987;O'Neil, White, King, & Carek, 1979), and differential reinforcement of incompatible behavior (DRI) (Mulick, Schroeder, & Rojahn, 1980). Mulick et al (1980) used a counterbalanced design to compare a DRO procedure with a DRI procedure.…”