Treating Operant Vomiting With Visual Screening

Abstract

The authors present a case study of an 8-year-old boy with autism who engaged in operant vomiting. Functional assessment indicated that vomiting persisted in the absence of social reinforcement. After interventions involving noncontingent access to preferred items, differential reinforcement of other behavior (DRO), and DRO plus time out failed to produce clinically significant decreases in vomiting, we implemented a contingent mouthwash procedure and a contingent visual screen (VS) procedure. The results show that the contingent mouthwash produced only temporary decreases in vomiting whereas the VS procedure gradually decreased the boy's vomiting to zero levels over the course of 23 weeks. In addition, a 4-month followup assessment showed that ongoing implementation of the VS procedure produced zero levels of vomiting. The gradual reduction in the boy's vomiting following the introduction of the VS procedure suggests that the intervention extinguished one or more of the sensory consequences that were formerly produced by vomiting.

The combined effects of noncontingent reinforcement and punishment on the reduction of rumination

“…Lang et al () noted that the advent of functional analysis methods produced an increase in the use of reinforcement‐based treatments for rumination, including the use of noncontingent reinforcement (NCR; e.g., Lyons, Rue, Luiselli, & DiGennaro, ) and differential reinforcement (e.g., Rhine & Tarbox, ; Sanders‐Dewey & Larson, ). However, consistent with other forms of problem behavior, punishment procedures may sometimes be a necessary complement to reinforcement‐based treatments for rumination (e.g., Baker, Rapp, & Carroll, ). The current study examined the effects of NCR and punishment, both alone and in combination, on the occurrence of rumination.…”

“…The current study, combined with previous research (e.g., Baker et al, ), extends the literature on the need for combinations of punishment‐ and reinforcement‐based procedures to treat rumination. Although punishment is subject to ethical considerations, it should be noted that Darnell had been exposed to 22 different reinforcement‐based procedures before the current study, none of which was effective.…”

An evaluation of a punisher assessment for decreasing automatically reinforced problem behavior

“…More specifically, we evaluated the effects of various procedures, when delivered contingent on problem behavior, using a multielement design. This contrasts with previous research in which punishers were selected for treatment arbitrarily (e.g., Watkins & Rapp, ), or selecting procedures that seem to match the topography of problem behavior (e.g., mouthwash for rumination; Baker et al ). An empirically based assessment, the stimulus‐avoidance assessment, has also been used to inform punishers for treatment of automatically reinforced problem behavior (DeRosa et al, ; Mitteer et al, ).…”

“…Differential reinforcement using an arbitrary reinforcer (e.g., an edible or leisure item) has also been found effective for treating automatically reinforced problem behavior (Ringdahl et al, ; Taylor, Hoch, & Weissman, ; Toussaint & Tiger, ); however, researchers have demonstrated the need for additional punishment components before clinically significant outcomes are observed (Anderson & Le, ; Baker et al, ; Mitteer, Romani, Greer, & Fisher, ). Anderson and Le () found that DRO alone (i.e., delivery of preferred edible and video contingent on the absence of stereotypy for a specified duration) was ineffective in decreasing stereotypy.…”

“…Negative punishment occurs when a stimulus is removed contingent on a response and the future likelihood of that responses decreases. Various punishment procedures (e.g., hands down, overcorrection, response cost) have been used successfully for decades to decrease challenging behavior in clinical settings (Baker, Rapp, & Carroll, 2010;Fisher, Piazza, Bowman, Hagopian, & Langdon, 1994;Fisher, Piazza, Bowman, Kurtz et al, 1994;Foxx & Azrin, 1973;Lerman & Toole, 2011;Singh, Watson, & Winton, 1986;Thompson, Iwata, Conners, & Roscoe, 1999).…”