Strategies to Treat Rumination in Individuals With Autism

Autism is a mental disorder characterized by severely abnormal development of social interaction and verbal and nonverbal communication skills. Rumination syndrome is mostly seen in individuals with autism and other developmental disorders. Here, we will see some of the ways of rumination syndrome treatment.

Rumination is the involuntary regurgitation of previously ingested food, re-chewing the food and re-swallowing or expelling it. The regurgitation is mostly effortless and does not involve retching or nausea. The regurgitation may be preceded by belching.

A diagnosis of rumination syndrome requires that the regurgitation behavior must persist for at least 1 month. Rumination mostly occurs immediately after meals and may last for 1 to 2 hours. Rumination may occur daily and may persist even for years.

There is always hope and given the advances in medicine, there will surely be a solution for rumination disorder. A positive mindset is very essential for patients as well as caregivers to manage and treat rumination disorder symptoms associated with autism.

Rumination syndrome may cause halitosis (foul odor from the mouth), malnutrition, growth failure, weight loss, dehydration, electrolyte imbalance, upper respiratory tract distress, gastric disorders, dental problems such as dental caries, choking, aspiration, and pneumonia.

Indigestion, halitosis, weight loss, and chronic chapped lips are some of the symptoms of rumination. Rumination may be a self-stimulating behavior in autistic patients and hence behavior modification may take time but with patience and a positive mindset, behavior modification can be possible.

Center for Autism and Related Disorders’ (CARD) Research Study has found chewing gum as an effective treatment for children with autism. The study reveals that rumination syndrome treatment can be effective by using chewing gum as a replacement behavior. This study is published in the Journal of Applied Behavior Analysis.

Behavioral intervention for the treatment of rumination is a useful study published in the Journal of Pediatric Gastroenterology and Nutrition. Some treatment alternatives for rumination in individuals with autism and developmental disorders are biofeedback with abdominal relaxation, diaphragmatic breathing, relaxing while eating, contingent exercises, reinforcement of incompatible behaviors, guided imagery, complete chewing, stress management, decreasing caffeine and alcohol, sipping water in between, and throat clearing.

Starch satiation is also used to treat rumination where the individual is given unlimited access to starchy foods immediately after meals. This is found to be an effective treatment in several studies. Brief functional analysis and supplemental feeding for post-meal rumination in children with developmental disabilities is also a useful study published in the Journal of Applied Behavior Analysis.

A functional assessment is to be made to check whether rumination is self-stimulatory or is socially motivated. Electroshock therapy and contingent pinching are also some of the strategies used for rumination syndrome treatment depending upon the health status of individuals.

Aversive behavioral strategies may be recommended depending upon the health condition of the patient. Psychodynamic strategies include providing noncontingent holding for young and institutionalized individuals and addressing psychological distress, anxiety, and depression. The Effects of Noncontingent Reinforcement is also another useful study.

Psychopharmacological research is very limited and caution is recommended for the use of medication in rumination syndrome treatment. Habit reversal behavioral therapy has been found to be effective in treating most patients with normal intelligence. In patients with acid injury to esophagus, proton pump inhibitors and H2 receptor antagonists may be prescribed to protect the lining of esophagus.