Long-term maintenance of a behavioral alternative to surgery for severe vomiting and weight loss

A 34-year-old woman with severe mental retardation suffered from gastroesophageal reflux, projectile vomiting, weight loss, and a prepyloric ulcer. Despite the implementation of non-intrusive behavior treatment procedures involving simple correction and differential reinforcement (Treatment A), fundoplication surgery with implantation of a gastrostomy feeding tube had been recommended. A descriptive functional analysis suggested that the woman's vomiting was maintained by escape. Revised treatment was implemented throughout her waking hours. Treatment B consisted of the addition of escape extinction and antecedent control procedures. Treatment C added to these procedures food choice and additional differential reinforcement procedures. Results showed the respective mean frequency of vomiting and mean weight were: Treatment A--1.4 episodes/day and 118 lbs; Treatment B--1.1 episodes/day and 105 lbs; Treatment C--0.2 incidents/day and 133 lbs. The woman's progress has been maintained for nearly 2 years.