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

ABSTRACT

Medical and psychiatric research regarding the treatment of vomiting and rumination among developmentally disabled individuals was selectively reviewed. Because of serious methodological flaws which pervade the psychiatric literature, claims for the effectiveness of psychiatric interventions for vomiting and rumination cannot be justified. Medical interventions (e.g., pharmacological and surgical interventions) were found to be effective when rumination was attributable to a specific organic pathology. In the absence of identified organic pathology for rumination, medical interventions are of questionable efficacy and because of the risks and side effects associated with these procedures, are seldom the intervention of first choice for functional rumination. Behavioral procedures for the treatment of vomiting and rumination are described and critically reviewed for their efficacy, side effects, and the generalization and maintenance of their effects. Although methodological weaknesses limit conclusions regarding the efficacy of some behavioral interventions, several procedures have sound experimental support including oral hygiene, differential reinforcement of incompatible behaviors, and food satiation procedures. These behavioral interventions are the treatments of choice when organic causes of rumination cannot be identified. Suggestions for future research and applications are discussed.