A food satiation and oral hygiene punishment program to suppress chronic rumination by retarded persons

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Abstract
Food satiation and oral hygiene punishment were used to treat the non-lifethreatening rumination of two institutionalized profoundly retarded persons. Satiation consisted of allowing the clients to eat until a satiation criterion of food refusal was achieved or until two full meal portions were consumed. The oral hygiene procedure consisted of cleansing the clients' teeth and gums with Listerine for 2 minutes following each instance of rumination. In the formal study, three conditions—baseline, satiation, and satiation plus oral hygiene—were used following the lunch meal in a multiple-baseline across-subjects design. One client's rumination decreased from an average of 89.5% during baseline to 48.8% during the satiation condition and to 3% during satiation plus oral hygiene. The second client's rumination decreased from a baseline average of 49.9% to 7.9% during satiation and to 1.4% during satiation plus oral hygiene. Generalization probes taken following the breakfast and dinner meals showed a systematic decline in rumination as the various conditions were implemented following the lunch meal. In the 16-week follow-up, rumination was treated following all meals with oral hygiene, and satiation was used at one of the daily meals for 1 week on a rotating basis. Rumination remained at a near-zero level following all meals throughout the follow-up. Thereafter, a maintenance program was conducted by the ward staff. The satiation plus oral hygiene punishment treatment program appears to be an immediate, effective, enduring, and humane method of treating the non-life-threatening rumination of retarded individuals.