Controlling Childhood Rumination through Differential Reinforcement of other Behavior

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Abstract
Rumination is a rare behavior disorder of childhood involving regurgitation of food which is then ejected or reswallowed. The present study investigated the control of rumination through use of a positive reinforcer (a mixture of honey and water) delivered on a differential reinforcement of other behavior (DRO) schedule. The subject was a 26-month-old girl who had lost 50% of body weight through rumination. DRO was used as part of a multifaceted treatment program which also included, at different phases, punishment and time out from positive reinforcement. Evaluation of treatment components via a single-subject experimental design with withdrawals indicated the DRO procedure exerted powerful controlling effects over rumination. Transfer of control to social consequences was attempted through use of time out with punishment. The subject's weight increased over her 69-day hospitalization from 7.1 kg. to 11 kg. A 10-month followup revealed continued weight gain and suppression of rumination. Possible limitations to generalizability of findings, particularly previous experience with punishment, are discussed as are advantages of DRO in the management of this behavior problem.