Response‐Class Hierarchies in Self‐Induced Vomiting: Functional Assessment and Treatment
Treat vomiting as an attention habit—teach one card request, ignore the puke, and back it with a lean token system.
01Research in Context
What this study did
One teen with autism kept making himself throw up. The team watched to see what kept the vomiting going. Attention was the pay-off—staff looked, talked, or rubbed his back every time he vomited.
They also saw milder behaviors that got the same attention: loud sighs, hand waving, saying 'I'm sick.' They called this an attention response class and ranked the behaviors from most to least severe.
Next they taught the teen to hand over a card that said 'Attention, please.' When he did this, staff gave quick eye contact and a kind word. Vomiting and the other attention bids were then ignored (extinction). A token board was added; every few card touches earned a small prize.
What they found
Vomiting dropped from about 4 times a week to zero in six sessions. The milder sighs and hand waves also disappeared. The card touch became his new way to ask for attention.
Three-month follow-up showed no vomiting and only rare use of the card—he now used regular speech to start short chats.
How this fits with other research
Torres-Viso et al. (2018) got the same result with kids who screamed until adults moved furniture. Both studies used FCT plus extinction for attention-maintained behavior. The new piece here is adding a probabilistic token system while still withholding attention for vomiting.
Fisher et al. (2019) warned that richer baseline reinforcement can later trigger resurgence. Roth et al. (2025) guarded against this by thinning the token schedule slowly and keeping extinction in place for vomiting.
Jones et al. (1992) showed FCT alone lasts across new teachers. The token layer in Roth’s case gives clinicians another way to keep the response strong without extra attention that could feed the problem.
Why it matters
If you see vomiting or other severe self-care issues, test whether attention keeps it alive. Map the full response class—mild to wild—before you treat. Then teach one polite request, withhold attention for the old forms, and let a lean token system carry the new response. You may resolve a life-threatening behavior in under two weeks.
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02At a glance
03Original abstract
ABSTRACT Individuals with neurodevelopmental conditions sometimes engage in self‐induced vomiting, a behavior associated with serious medical complications and increased risk of exposure to communicable diseases. Despite its clinical significance, the functional dimensions of self‐induced vomiting remain understudied, particularly in cases where it occurs within a hierarchical response class of attention‐maintained behavior. This study describes the functional assessment and treatment of self‐induced vomiting in an adolescent male with multiple neurodevelopmental conditions. A response class hierarchy analysis was conducted to evaluate whether self‐induced vomiting, self‐gagging, pica, and other challenging behaviors were functionally related. Findings revealed systematic shifts in challenging behavior topographies with sequential exposure to extinction, supporting the presence of a hierarchically organized response class maintained by attention. Treatment involved functional communication training, extinction, and an individualized levels system involving token reinforcement and a probabilistic exchange schedule. This multicomponent intervention eliminated self‐induced vomiting, self‐gagging, pica, and other challenging behaviors within the attention‐maintained response class. These findings underscore the need for function‐based assessments in the treatment of self‐induced vomiting and related behaviors.
Behavioral Interventions, 2025 · doi:10.1002/bin.70048