As many as 10 percent of people with intellectual disabilities, including autism and Down’s syndrome, display a behavioral habit called rumination – bringing back up their food after they have eaten and swallowed it.
Poorly understood, rumination begins in adolescence and, if it goes untreated, can lead to surgery later in life due to the stomach acid eating the lining of the esophagus.
A Florida Tech researcher is working to improve the understanding of this habit and determine ways to combat it.
David Wilder, a professor in the School of Behavior Analysis at the College of Psychology and Liberal Arts, through his extensive research with people with autism and intellectual disabilities, has started to develop behavior modifications that have shown some success in combating rumination.
His recent assessment and treatment of rumination in Hank, a 19-year-old with autism, was featured in, “Assessment and treatment of rumination in a young man with autism,” published earlier this year in the journal Behavioral Interventions. The article can be found here.
During baseline testing, Hank’s mean percentage of intervals with rumination was 68 percent. But when Wilder provided him a Ring Pop – one of his favorite treats – and coupled that with a reprimand, Hank’s percentage of intervals with rumination fell to 8 percent.
In this single-subject research effort, which Wilder believes may prompt others to do larger scale studies, Wilder and his staff first analyzed if the frequency of rumination was related to the taste of the food. In their study, Hank performed the action more after having preferred food, such as sweets.
With the intervention part of the study, the team provided Hank a competing behavior as they looked to decrease the frequency of rumination: gum. However, he didn’t have verbal or receptive skills, ultimately leading Hank to swallow the gum even after attempts to teach chewing it. The staff switched to a Ring Pop after meals, which decreased the rumination somewhat, but did not eliminate it.
The researchers then added a reprimand from an associate who had developed good instructional control with the subject. The reprimand brought the act down further, however, the staff wanted to ensure rumination would stop even if the staff member wasn’t available. The staff member started using a green piece of construction paper when reprimanding the subject. Soon the paper was synonymous with the reprimand.
“After repeatedly doing that, we gave the card to other staff members who also delivered the reprimand and in the presence of the card, that brought it down to very low levels,” Wilder said.
Wilder has done four previous studies on rumination, helping to provide critical information about a behavior that does not have reams of research behind it. In his previous research, Wilder and staff analyzed a correlation between ease of rumination and subjects having a liquid during meals. They also found that using dry items such as peanut butter and white bread, in addition to altering when liquid is served, may curtail subjects from ruminating.
In the future, Wilder will look at the motivations for rumination, such as avoidance. Due to the nature of the act, a person can smell bad, which can get them out of things they may not want to do, such as schooling or other instruction.
“I think in the future, on an individual basis, if you identify why, that will suggest specific intervention for that specific person,” Wilder said.