Behavioral interventions for rumination and operant vomiting in individuals with intellectual disabilities: a systematic review.

Lang et al. (2011) looked at every paper they could find on stopping rumination and operant vomiting in people with intellectual or developmental disabilities.

They found 21 studies that together covered 32 participants.

The team tracked how treatments changed over the years and wrote practice guidelines for clinicians.

Old studies from the 1980s mostly used punishment like brief restraint or ammonia capsules.

Newer work shows a clear shift toward gentle, function-based reinforcement plans.

The review gives you a decision tree: assess why the behavior happens, then build a reinforcement plan that matches that function.

Wynne et al. (1988) warned that punishment studies back then were weak on design and ethics. Lang et al. (2011) shows the field listened—today’s studies favor reinforcement and functional analysis.

Taylor et al. (2017) found the same reinforcement-first trend for sleep problems in ID. Together, the two reviews say “function first” no matter the behavior.

St. Joseph et al. (2022) scoped in Russell’s evidence when they reviewed health routines like tooth-brushing. Their paper adds video modeling to the same reinforcement recipe, showing the approach keeps growing.

If a client brings up food or vomits to gain caregiver attention, stop any punishment you inherited from old care plans. Run a quick functional analysis, then deliver that same attention for swallowing or for keeping food down. You will be following the modern, evidence-based path the field has taken since the 1980s.