Chronic ruminative vomiting: a comparison of four treatment procedures.
Reinforce toy play after meals, not DRO, to stop post-meal vomiting faster.
01Research in Context
What this study did
One teen with Down syndrome kept throwing up after every meal. The team tried four ways to stop it.
Each day they picked a different method: DRO, DRI, plain extinction, or extinction plus toy play. They counted how often vomiting happened after lunch.
What they found
Toy play plus extinction slashed vomiting fastest. DRO and extinction alone helped a little, but not as much.
The teen kept most meals down when adults praised and gave toys for playing instead of vomiting.
How this fits with other research
Kohlenberg (1970) once used small shocks to stop the same problem. Bacon-Prue et al. (1980) shows you can get the same gain without pain by reinforcing play.
Silverman et al. (1994) later copied the toy-play idea in a boy with autism and added medical tweaks. The child gained weight and stayed well for months.
Staddon et al. (2002) and Alaimo et al. (2018) ran the same kind of contest: DRA plus extinction beat other packages for feeding issues. The pattern holds across kids and decades.
Why it matters
If a client vomits after meals, skip DRO. Give a toy the child loves and praise every second of play. Pair this with brief ignoring of any retching. You should see fewer wet bibs and more smiles within days.
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Join Free →Pick a toy the child can mouth safely. After lunch, give the toy and praise for two minutes of play. Ignore any gagging sounds.
02At a glance
03Original abstract
An experimental analysis of a case of chronic ruminative vomiting in a 15-year-old, profoundly retarded, Down's syndrome boy addressed the consequences of vomiting in the postmealtime environment. The experiment compared four treatments in each hour-long session using a multiple reinforcement schedule with order of the following procedures counterbalanced over days in a Latin square design: differential reinforcement of any behaviors other than vomiting (DRO) in which periods of no vomiting were followed by reinforcement and vomiting postponed reinforcement; differential reinforcement of specific behaviors alternative to vomiting (DRI) in which conjoint periods of no vomiting and sustained toy play were followed by reinforcement and the lack of either postponed reinforcement; extinction plus reinforcement of alternative behavior in which vomiting was ignored but toy play was reinforced; extinction in which vomiting was ignored. Data revealed an orderly dual cyclical pattern of vomiting throughout the day, with increased vomiting in the morning and immediately following food ingestion. Postluncheon treatments emphasizing reinforcement of alternative behavior were more successful in decreasing vomiting than DRO or extinction alone.
Journal of autism and developmental disorders, 1980 · doi:10.1007/BF02408471