Rumination and vomiting in the developmentally disabled: a critical review of the behavioral, medical, and psychiatric treatment research.

Barrett et al. (1987) read every paper they could find on rumination and vomiting in people with developmental disabilities. They looked at three kinds of treatments: medical, psychiatric, and behavioral. The team wanted to know which approach had the best proof when doctors ruled out stomach or gut problems.

They pulled studies from hospitals, clinics, and research journals. The review covered kids and adults living in both institutions and family homes.

When no physical illness was found, behavioral methods won by a mile. DRI (doing something else with the mouth) and filling the stomach with small, frequent meals cut rumination fastest. Medical drugs helped only when real gut disease was present. Psychiatric talk or drugs showed almost no effect.

The authors warned that medicine often gets tried first, yet behavior plans give the quickest relief for the largest group.

Loukus (2015) updated the same question 28 years later and agreed: start with a functional analysis. That review adds newer tricks like continuous access to a preferred sippy cup or extra feedings right before problem times. The core message stayed the same—behavior first, medicine only for clear biology.

Lancioni et al. (2009) looked at hand stereotypies instead of rumination but found the same pattern. Simple behavioral tactics worked, yet no single fix fits every client. Both reviews remind you to test, then pick the least intrusive option that works.

Demello et al. (1992) showed one DRA plan can knock down several problem behaviors at once. Their single-case success lines up with P et al.’s claim that behavioral packages can be both powerful and efficient.

Before you order labs or meds for a client who brings up food, run a quick functional analysis. Try DRI with a chewy tube or schedule extra snacks first. Track for three days—if rumination drops, you just saved weeks of pointless medication trials. If it doesn’t budge, then pursue medical work-up with clear data in hand.