The effectiveness of four antecedent treatments for rumination was compared for two individuals with autism, severe intellectual disabilities and long histories (at least 20 years) of rumination. Comparisons of increased meal size, supplemental feedings, fixed-time provision of peanut butter, and liquid rescheduling found liquid rescheduling to be the most effective intervention for both clients. However, within-session analyses, both during intervention and for 30 min after the meal, showed individualized schedules of fluid provision were needed to increase the effectiveness of the treatment.
Rumination is the repetitive regurgitation, chewing or sucking, and re-swallowing of food that has been previously ingested (Rast, Johnston, Drum, & Conrin, 1981). Up to 10% of individuals with developmental disabilities engage in rumination, a behavior that can cause physical harms, e.g., malnutrition, dehydration, esophageal damage, and severe tooth decay (Rast et al., 1981). In addition to health effects, rumination may lead to reduced social attention, restrict community outings, and alter the manner in which people interact with the individual (Dudley et al., 2002 and Vollmer and Roane, 1998).
Over the last 20 years there has been an increase in research on treatments that involve antecedent manipulations. Liquid rescheduling involves restricting access to liquids during and after a meal. Heering, Wilder, and Ladd (2003) found liquid rescheduling to reduce rumination both in the hour after a meal and in the hour following the provision of liquid (given 90 min after meal completion). Supplemental feeding, in which the individual is given additional food on a fixed-time schedule for a specified period following the meal, has been found to be effective at reducing rumination during a 20-min treatment period (Lyons, Rue, Luiselli, & DiGennaro, 2007). However, Lyons et al. did not evaluate rumination after each 20-min treatment period, nor did they evaluate rumination during meals other than lunch. Greene et al. (1991) found the supplemental feeding of peanut butter on a fixed-time schedule after meals to be effective for five adults with intellectual disabilities. Kenzer and Wallace (2007) compared larger portion sizes with supplemental feeding, finding that the provision of a larger portion size decreased rumination after a meal, but not as effectively as supplemental feeding.
The current study compared the effectiveness of liquid rescheduling, supplemental post-meal food, supplemental post-meal peanut butter, and increased meal size on the levels of rumination of two adults with intellectual disabilities and autism. The aim was to assess the effectiveness of each intervention both during the treatment period and in the 30 min after treatment, using both session total data and within-session analysis.
