Functional Analysis and Intervention for Chronic Rumination

Abstract

We conducted a functional analysis and treatment evaluation of chronic rumination in a 19-year-old man with intellectual disabilities. Outcomes of the functional analysis suggested that rumination was maintained by automatic reinforcement. Results of the intervention evaluation suggested that (a) noncontingent access to food after meals reduced rumination more effectively than did noncontingent access to inedible stimuli, (b) a particular type of food was associated with lower levels of rumination than other types of food, and (c) both presession and continuous access to food reduced levels of rumination more effectively than did fixed-time access to food.

Behavioral treatment of rumination: Research and clinical applications

“…All of the studies described in this review included continuous or FT access to sensory stimuli (in most cases, foods and liquids). For some individuals, certain foods and liquids are more effective than other items (Lyons et al, 2007;Woods et al, 2013), suggesting that the differential effectiveness of gustatory stimuli in treating rumination should be researched more extensively (Kliebert & Tiger, 2011). Indeed, there is evidence that rumination frequency can be influenced by the nutrient composition of some foods (Dudley, Johnson, & Barnes, 2002) and that increased liquid consumption may actually facilitate rather than inhibit rumination during and after meals (Heering, Wilder, & Ladd, 2003).…”

“…Indeed, there is evidence that rumination frequency can be influenced by the nutrient composition of some foods (Dudley, Johnson, & Barnes, 2002) and that increased liquid consumption may actually facilitate rather than inhibit rumination during and after meals (Heering, Wilder, & Ladd, 2003). Another key research finding is that the most positive effects of food and liquid on rumination may be dependent on delivering them rapidly (Woods et al, 2013) and for a prolonged period of time after meals (Kliebert & Tiger, 2011;Lyons et al, 2007). Also, with few exceptions (e.g., Rhine & Tarbox, 2009), the long-term outcome from rumination treatment is unknown.…”

The Use of a Verbal Reprimand to Decrease Rumination in a Child With Autism

“…Recently, some studies have employed a functional analysis to examine the environmental variables responsible for rumination (Lyons, Rue, Luiselli, & DiGennaro, ; Wilder, Register, Register, Bajagic, & Neidert, ; Woods, Luiselli, & Tomassone, ). The results of these studies suggest that rumination is often presumably maintained by automatic reinforcement.…”

“…Specifically, rumination may produce oral stimulation, esophageal stimulation, or both. Correspondingly, treatments for rumination have largely focused on antecedent‐based interventions that may either compete with the reinforcer produced by rumination (e.g., Lyons et al, ; Wilder et al, ; Woods et al, ) or prevent the occurrence of rumination (e.g., Heering, Wilder, & Ladd, ). For example, providing noncontingent access to food or other stimuli may compete with stimulation produced by rumination and rescheduling liquid intake may prevent rumination.…”

“…For example, providing noncontingent access to food or other stimuli may compete with stimulation produced by rumination and rescheduling liquid intake may prevent rumination. Although these interventions are effective for some individuals, they require special preparation and planning (Heering et al, ) and/or extra resources (Lyons et al, ; Wilder et al, ; Woods et al, ). Furthermore, such treatments may not be effective for all persons who ruminate, and research on additional interventions is warranted.…”