Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


45th Annual Convention; Chicago, IL; 2019

Event Details

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Symposium #234
Translational Intervention Research in Rumination Disorder: Novel Populations and Analytic Methodology
Sunday, May 26, 2019
10:00 AM–11:50 AM
Swissôtel, Event Center Second Floor, Vevey 3/4
Area: CBM/DDA; Domain: Translational
Chair: Robert D Rieske (Idaho State University)
Discussant: Nicole M. DeRosa (SUNY Upstate Medical University)
Abstract: The efficacious treatment of rumination disorder and the process by which we meta-analytically assess efficacy in single-case designs are both areas of research that have been lacking. Although treatment of rumination disorder has been researched for decades, the global effectiveness of these interventions have been limited. The current translational symposium will present four papers across various domains focused on the treatment of rumination disorder and the evaluation of treatment efficacy utilizing a novel methodology with the evaluation of rumination interventions as an example. First, a single-case study evaluating three common interventions in the treatment of rumination disorder in a non-verbal young adult with autism spectrum disorder will be presented. The second presentation will focus on the treatment of rumination disorder in neurotypical adolescents in a specialized treatment program for adolescent rumination syndrome (ARS). The third presentation will describe a novel application of simulation modeling analysis (SMA; Borckardt et al., 2008) to conduct meta-analyses of single-subject time-series studies. Lastly, a meta-analysis of rumination interventions for individuals with intellectual and developmental disabilities utilizing the SMA procedure will be presented with comparison to other traditional and contemporary methods of effect size estimation.
Instruction Level: Basic
Keyword(s): adolescent rumination, meta-analysis, rumination disorder, simulaiton-modeling analysis
Rumination Disorder: A Case Study
(Applied Research)
KAROLINA STETINOVA (Idaho State University), Diane Keister (Idaho State University), Gabriela Sepulveda (Idaho State University), Michelle Lemay (Idaho State University), Robert D Rieske (Idaho State University)
Abstract: Rumination disorder is classified as a feeding disorder in which an individual regurgitates and re-swallows food soon after its initial consumption. Various interventions have been used in the treatment of rumination disorder, three of which were assessed within this single-case study. The participant in this study was a non-verbal young adult male with a diagnosis of autism spectrum disorder, severe intellectual disability, and long-term, treatment-resistant rumination disorder. Interventions utilized included a satiation procedure, a replacement behavior, and contingent reinforcement via attention and sensory stimulation. These interventions were chosen based on the participant’s needs, his personal preferences, and results of a meta-analysis completed on the topic of rumination disorder presented within this symposium. The study utilized a multiple-treatment reversal design (ABACADA) with reversals to baseline after each treatment. Treatments were assessed for effectiveness through visual inspection and simulation modeling analysis (SMA), and the most effective treatment was then implemented by residential staff to assess for maintenance and feasibility of a staff-implemented procedure. The results and procedures of this study will serve as a template in treatment planning and evaluation for other individuals suffering from rumination disorder, as the effectiveness of multiple interventions was assessed by this study.

Adolescent Rumination Syndrome: Three Case Studies

(Service Delivery)
ANTHONY ALIOTO (Nemours; A.I. duPont Hospital for Children)

The treatment of rumination disorder in neurotypical adolescents has received an increase in attention over the past 10 years. Behavioral interventions have been shown to be the mainstay of treatment, with approaches studied such as the use of diaphragmatic breathing, biofeedback, habit reversal therapy (HRT), distraction, gradual refeeding, and habituation. Most demonstrations of efficacy, however, have utilized case studies or a group of patients undergoing non-standardized treatment protocols. As such, the utility and generalizability of results has remained difficult to ascertain. The current paper demonstrates the challenges in outcome variable selection, data collection, and presentation of results by presenting three case studies. Each adolescent took part in an inpatient intensive treatment program specifically designed to treat adolescent rumination syndrome. While the general approach to treatment was similar across patients, each patient’s rumination presentation, individual needs, and treatment goals were distinct enough to make similar data collection across patients a significant challenge. Treatment and data from each admission will be presented to highlight these challenges and the need for a methodology to compare results across patients and studies.


Simulation Modeling Analysis: Innovative Applications for Meta-Analyses With Single Case Experimental Designs

SAMUEL PEER (Idaho State University), Robert D Rieske (Idaho State University), Michelle Lemay (Idaho State University)

Meta-analysis of single case experimental designs (SCEDs) can uniquely advance the scientific literature and guide evidence-based service delivery–particularly for comparatively rare populations and/or syndromes (e.g., rumination disorder). Notwithstanding these potential benefits (e.g., cross-field interoperability, identification of moderators and mechanisms of change, increased external validity of ideographic results), meta-analysis of SCEDs has been stymied by a lack of feasible, valid, and translational methods. For instance, visual analysis of time-series data, especially data with autocorrelation, can be unreliable and prone to overestimating the presence and/or level of an effect. Additionally, the ubiquitous autocorrelation in SCEDs’ time-series data contraindicate conventional statistics, including common meta-analytic computations of statistical significance and effect size. Although some extant methods do address autocorrelation, they typically require an oft-prohibitive number of data points per phase. One notable exception is simulation modeling analysis (SMA), a free, user-friendly bootstrapping technique designed to perform both univariate effect-of-phase and multivariate process-change analyses with autoregressive data streams while maximizing power and minimizing Type I error rates. Prior studies have demonstrated SMA’s utility with individual SCEDs, but the current presentation will propose and illustrate a novel application of SMA for meta-analyses with SCEDs and discuss potential implications for behavior analytic scholarship, practice, and policy.


A Meta-Analytic Review of the Treatment of Rumination Disorder: A Pilot Utilizing Simulation Modeling Analysis

(Applied Research)
MICHELLE LEMAY (Idaho State University), Robert D Rieske (Idaho State University), Samuel Peer (Idaho State University), Diane Keister (Idaho State University), Karolina Stetinova (Idaho State University), Megan Olsen (Idaho State University)

The purpose of the current meta-analysis was to assess the efficacy of common treatments for rumination disorder in an intellectual/developmentally disabled population with limited verbal abilities. No publication to our knowledge has yet to statistically evaluate and compare these treatments in one comprehensive study. Our literature search resulted in a total of 45 articles and 72 individual cases receiving treatment. The mean age for participants was 22 years and 30% were female. We used simulation modeling analysis (SMA) to determine the effect size of the change in rumination between baseline and treatment phases. The cases were categorized into establishing operations (EO), punishment (PU), and reinforcement (RE). The effect sizes were then combined within each group and an ANOVA was used to determine statistical significance between groups. Results of this study can inform the field by identifying effective treatments to be implemented for rumination disorder as well as what treatments have been shown to be ineffective. The study also serves as a pilot of utilizing a novel methodology in the estimation of comparison of effect sizes in single case designs.




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