Brief functional analysis and supplemental feeding for postmeal rumination in children with developmental disabilities

Rumination is a serious problem demonstrated by some people with developmental disabilities, but previous research has not included a functional analysis and has rarely compared intervention methods during the assessment process. We conducted functional analyses with 2 children who displayed postmeal rumination and subsequently evaluated a supplemental feeding intervention following meals. Results showed that noncontingent food or liquid presentation effectively reduced rumination with both children.     

Empirically derived consequences to treat rumination

We evaluated a contingent oral hygiene procedure on rumination emitted by a 9‐year‐old boy with autism. Results of a functional analysis screening suggested rumination was maintained by automatic reinforcement. We conducted a stimulus avoidance assessment to identify a hierarchy of potential consequences to be used in treatment. During treatment, contingent toothbrushing resulted in a 97% decrease in rumination. Finally, we transitioned to a less intrusive intervention (i.e., contingent mouthwash spray) and rumination remained at near‐zero levels. Treatment effects generalized to different settings and caregivers and maintained over a 4‐year period.     

REDUCTION OF RUMINATION USING A SUPPLEMENTAL STARCH FEEDING PROCEDURE

A supplemental starch feeding (SSF) procedure was used to decrease rumination in a 27‐year‐old man. A multiple baseline across mealtimes design determined treatment efficacy, followed by 26 months of maintenance and fading implemented by direct‐care staff. Following intermittent meals, four slices of bread were offered in a paced manner, after which the frequency of rumination was measured. Subsequent to the SSF sessions, the participant's rumination reduced 47%, from 0.19 per minute (8.5 per session) after baseline sessions to 0.09 per minute (4.1 per session) after treatment sessions. Ongoing measures in the natural setting continued to show reductions through maintenance and fading of the supplemental feeding. No weight gain was noted during the time the procedure was in place. Copyright © 2011 John Wiley & Sons, Ltd.     

Brief report: effects of supplemental feedings of white bread on chronic rumination

A common intervention for rumination is satiation: allowing individuals to eat additional and unlimited portions at meals. The effectiveness of this intervention is often overshadowed by concerns of overeating and related long-term health issues. The current study evaluated a variation of food-satiation procedures by providing supplemental feedings of white bread to a 44-year-old man who had severe mental retardation, sensory impairment, and chronic rumination. Post-meal supplemental feedings were associated with decreases in rumination to near-zero levels. While the reasons for the effectiveness of this procedure are uncertain, it may be an alternative to traditional satiation procedures, particularly for individuals who have weight concerns or restrictive diets. © 1998 John Wiley & Sons, Ltd.     

Responses to positive affect,life satisfaction and self‐esteem: A cross‐lagged panel analysis during middle adolescence

During middle adolescence, elevated stress and a greater presence of psychological disorders have been documented. The research has paid little attention to the regulation of positive affective states. Fredrickson's broaden‐and‐build theory suggests that cultivating positive emotions helps to build resources that boost well‐being. The current research aimed to examine the longitudinal associations between responses to positive affect (emotion‐focused positive rumination, self‐focused positive rumination, and dampening) and psychological adjustment (self‐esteem and life satisfaction) during middle adolescence. A longitudinal study with two waves separated by one year was conducted, assessing 977 adolescents (M = 13.81, SD = 0.79; 51.5% boys) with self‐report measures. A cross‐lagged panel analysis was performed by including within the same model the relationships between all of the variables in the two assessment points. The results indicated cross‐lagged positive relationships of self‐focused positive rumination with both self‐esteem and life satisfaction, while dampening showed a negative cross‐lagged relationship with self‐esteem. Moreover, higher self‐esteem predicted more emotion‐focused positive rumination, and more dampening predicted lower life satisfaction. Thus, the use of adaptive responses to positive affect and a better psychological adjustment were found to be prospectively interrelated at the one‐year follow‐up during middle adolescence. The discussion argues for the need to implement programmes to promote more adaptive responses to positive affect to enhance psychological adjustment in the adolescent transition to adulthood.     

A multi‐component approach to the treatment of chronic rumination

A multi‐component intervention was used to treat chronic rumination exhibited by an adult female diagnosed with a developmental disability. The intervention consisted of: (a) interruption of precursor behavior, (b) the alternation of 10‐min periods of continued instruction that involved walking and working with (c) 10‐min periods in which instructions were not delivered but a variable time 5‐s schedule of noncontingent attention was programmed, and (d) a 1‐min differential reinforcement of other behavior (DRO) schedule. During the intervention, rumination decreased by 82% relative to baseline. Next, components of the multi‐component intervention were systematically removed to evaluate their individual contribution. Results suggested that each individual component contributed to the overall treatment effects. Copyright © 2010 John Wiley & Sons, Ltd.     

REARRANGING NATURALLY OCCURRING CONTINGENCIES TO INCREASE DESIRABLE BEHAVIOR IN A TODDLER CLASSROOM

Toddlers often display problem behavior during transitions. We rearranged naturally occurring events in a toddler classroom to promote more desirable classroom behavior during transitions to meals. In the intervention condition, teachers transitioned each child to meals only when that child was seated on a play mat (a requisite for engagement in teacher‐led play activities). In the reversal condition, teachers selected each child to transition when that child was by the barrier to the meal area (a practice commonly observed under natural conditions). The intervention increased the mean percentage of intervals when children were on the play mat and decreased the percentage of intervals when children were by the barrier. Individual child data show positive outcomes for five of six children. Results are discussed in terms of the positive effects of small manipulations to existing contingencies on classroom behavior as well as their potential influence on the adoptability of classroom interventions. Copyright © 2014 John Wiley & Sons, Ltd.     

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

The current study extends the literature on the assessment and treatment of rumination through the evaluation of a combined reinforcement‐ and punishment‐based intervention. The study included a single participant with a history of rumination maintained by automatic reinforcement, as identified via a functional analysis. Both noncontingent reinforcement (NCR) with preferred edible items and punishment, in the form of a facial screen, were implemented separately to evaluate their independent effects on the occurrence of rumination. The final treatment package included both NCR and punishment procedures. Implementation of the combined treatment resulted in a 96.5% reduction in rumination relative to baseline. Procedural modifications and integrity errors also were evaluated.     

Assessment and treatment of rumination in a young man with autism

After a pretreatment screening analysis suggested that rumination by a 19‐year‐old man with autism was maintained by automatic reinforcement, we evaluated his preference for three snack foods and the frequency of his rumination after consuming each. Rumination was more common after eating high‐preference foods. We then examined noncontingent access to a type of lollipop (i.e., a Ring Pop?) to decrease rumination. The Ring Pop? reduced rumination to moderately low levels. Next, to further decrease rumination, we added a reprimand, which reduced rumination to near zero levels. Finally, we evaluated the reprimand by itself, which resulted in a reduction in rumination roughly equivalent to that produced by the Ring Pop?. Results are discussed in terms of the source of reinforcement for rumination and the behavioral mechanisms responsible for intervention effects.     

THE USE OF A VERBAL REPRIMAND TO DECREASE RUMINATION IN A CHILD WITH AUTISM

After a pre‐treatment screening analysis suggested that rumination exhibited by a boy with autism occurred in the absence of social consequences, we evaluated the effect of a verbal reprimand contingent on the target behavior via a reversal design. The reprimand reduced rumination to near‐zero levels; we then thinned the reprimand schedule and rumination remained infrequent. Follow‐up data collected 6, 12, and 18 months after initial treatment suggested that intervention effects were maintained. Copyright © 2014 John Wiley & Sons, Ltd.     

Decreasing rumination using a starchy food satiation procedure

A starchy food satiation procedure was evaluated in an ABAB withdrawal design on the post‐meal rumination of a nine‐year‐old girl with autism. During treatment unlimited quantities of starchy foods were provided following each meal. High rates of rumination occurred during baseline conditions, followed by an immediate decrease in rumination during treatment. Rumination decreased to 82 and 97% of baseline during the first and second treatment conditions, respectively. In addition, follow‐up probes were conducted at irregular intervals for 4 years following treatment, during which zero or near‐zero rates of rumination were sustained. This study extends the literature on the functional relation between increased starchy food quantity and rumination in adults to rumination with a young child, and demonstrates maintenance of the treatment effect for 4 years. Copyright © 2002 John Wiley & Sons, Ltd.     

Attachment‐related differences in secrecy and rumination in romantic relationships

The study examined attachment‐related predispositions and patterns of cognition and emotion that contribute to different secret‐keeping experiences. Participants (n = 380) reported on their secret keeping, rumination, attachment anxiety, and attachment avoidance via online questionnaires. Results showed that both anxiety and avoidance were positively associated with keeping a secret from a romantic partner, while only avoidance was associated with a greater total number of secrets kept. The association between avoidance and rumination was partially mediated by perceptions of a partner's ownership rights to the secret and guilt for keeping the secret, such that those who were highly avoidant were less likely to perceive a partner's ownership rights. Finally, highly anxious participants reported higher levels of rumination, which were mediated by feelings of guilt for keeping a secret. The study extends research on the link between secrecy and rumination by offering a theoretical account based on attachment for why some people are more likely to ruminate about their secrecy than others.     

The effects of sleep disruption on the treatment of a feeding disorder

We evaluated the effects of sleep disruption on the mealtime behavior of a young boy with developmental disabilities. Results showed that bite acceptance was less likely to persist during meals following disrupted sleep, but only when escape extinction was not implemented. Findings are discussed in terms of establishing operations and the effects of sleep disruption on the assessment and treatment of feeding problems.     

FUNCTIONAL ANALYSIS AND TREATMENT OF RUMINATION USING FIXED‐TIME DELIVERY OF A FLAVOR SPRAY

A functional analysis suggested that rumination exhibited by an adult with autism was maintained by automatic reinforcement. Next, a preference assessment with three flavor sprays (i.e., flavored sprays used by dieters) showed that apple pie spray was most preferred. Finally, the effects of fixed‐time delivery of the apple pie spray on levels of rumination were evaluated. The spray reduced rumination, and the participant was taught to self‐administer the spray.     

En Route to Depression: Self‐Esteem Discrepancies and Habitual Rumination

Dual‐process models of cognitive vulnerability to depression suggest that some individuals possess discrepant implicit and explicit self‐views, such as high explicit and low implicit self‐esteem (fragile self‐esteem) or low explicit and high implicit self‐esteem (damaged self‐esteem). This study investigated whether individuals with discrepant self‐esteem may employ depressive rumination in an effort to reduce discrepancy‐related dissonance, and whether the relationship between self‐esteem discrepancy and future depressive symptoms varies as a function of rumination tendencies. Hierarchical regressions examined whether self‐esteem discrepancy was associated with rumination in an Australian undergraduate sample at Time 1 (N = 306; M_age = 29.9), and whether rumination tendencies moderated the relationship between self‐esteem discrepancy and depressive symptoms assessed 3 months later (n = 160). Damaged self‐esteem was associated with rumination at Time 1. As hypothesized, rumination moderated the relationship between self‐esteem discrepancy and depressive symptoms at Time 2, where fragile self‐esteem and high rumination tendencies at Time 1 predicted the highest levels of subsequent dysphoria. Results are consistent with dual‐process propositions that (a) explicit self‐regulation strategies may be triggered when explicit and implicit self‐beliefs are incongruent, and (b) rumination may increase the likelihood of depression by expending cognitive resources and/or amplifying negative implicit biases.     

Rejection sensitivity prospectively predicts increased rumination

Converging research findings indicate that rumination is correlated with a specific maladaptive interpersonal style encapsulating submissive (overly-accommodating, non-assertive and self-sacrificing) behaviours, and an attachment orientation characterised by rejection sensitivity. This study examined the prospective longitudinal relationship between rumination, the submissive interpersonal style, and rejection sensitivity by comparing two alternative hypotheses: (a) the submissive interpersonal style and rejection sensitivity prospectively predict increased rumination; (b) rumination prospectively predicts the submissive interpersonal style and rejection sensitivity. Currently depressed (n = 22), previously depressed (n = 42) and never depressed (n = 28) individuals completed self-report measures assessing depressive rumination and key psychosocial measures of interpersonal style and behaviours, at baseline and again six months later. Baseline rejection sensitivity prospectively predicted increased rumination six months later, after statistically controlling for baseline rumination, gender and depression. Baseline rumination did not predict the submissive interpersonal style or rejection sensitivity. The results provide a first step towards delineating a potential casual relationship between rejection sensitivity and rumination, and suggest the potential value of clinical assessment and intervention for both rejection sensitivity and rumination in individuals who present with either difficulty.     

CHEWING GUM AS A TREATMENT FOR RUMINATION IN A CHILD WITH AUTISM

Rumination involves regurgitation of previously ingested food, rechewing the food, and reswallowing it. In the current study, a child with autism displayed chronic rumination, resulting in the decay and subsequent removal of several teeth. After several treatments failed, including thickened liquids and starch satiation, the participant was taught to chew gum. His rumination decreased significantly when gum was made available. Results suggest that access to chewing gum may be an effective treatment for rumination in some individuals.     

Direct and distal effects of noncontingent juice on rumination exhibited by a child with autism

Previous research has demonstrated the efficacy of the noncontingent delivery of foods and liquids at suppressing rumination, the repeated regurgitation and rechewing of partially digested food. However, it is unclear how long this reduction is maintained after caregivers terminate this procedure. The current study examined the direct and distal effects of noncontingent juice on rumination by measuring the duration of rumination during juice delivery and immediately following the termination of juice delivery. Noncontingent juice suppressed rumination, but this suppression was not maintained after delivery termination.     

Competitive Memory Training for treating depression and rumination in depressed older adults: a randomized controlled trial

Although rumination is an important mediator of depressive symptoms, there is insufficient proof that an intervention that specifically targets rumination ameliorates the clinical condition of, depressed patients. This study investigates whether a time-limited cognitive behavioral intervention (Competitive Memory Training, or COMET for depressive rumination) is an effective treatment for depression and rumination. This intervention was tested in older adult depressed outpatients. A total of 93 patients (aged ≥65 years with major depression and suffering from rumination) were treated in small groups according to the COMET protocol in addition to their regular treatment. Patients were randomized to two treatment conditions: 7 weeks of COMET + treatment-as-usual (TAU) versus TAU only. COMET + TAU showed a significant improvement in depression and rumination compared with TAU alone. This study shows that the transdiagnostic COMET protocol for depressive rumination might also be successful in treating depression and rumination in older adults.     

Testing the benefits of expressive writing for workplace embitterment: a randomized control trial

Clinicians working in occupational health services often recognize features of embitterment in organizations; however, research on interventions for embitterment are scarce. The present study aimed to assess the effectiveness of an expressive writing intervention on working adults who experience workplace embitterment. Employing a randomized control trial we sought to test an expressive writing intervention for its effects on reducing embitterment, work-related rumination and sleep quality and assess whether the effect of the intervention was maintained over time by following up participants after one and three months. Findings partially supported our hypothesis as results showed that participants who completed the expressive writing intervention (N = 23) did not show significantly lower levels of embitterment, affective rumination, higher levels of detachment, either improved sleep quality, compared to participants who completed the factual writing (N = 21), when baseline values were controlled for. However, when looking at the mean scores embitterment and affective rumination levels diminished, detachment levels increased and sleep quality improved throughout the course of the intervention for both groups. Given the stability of embitterment and as findings from this study indicate embitterment diminished after a writing exercise irrespective of emotional disclosure taking place or not, further research and investigation are warranted.