ABSTRACT
Mr Esperanza was a 29-year-old non-ambulatory Caucasian man diagnosed with profound intellectual disability. Immediately following meals, staff noticed that he would regurgitate and chew his food before re-swallowing. Given the serious health-risks associated with this behaviour, this problem was brought to the attention of the staff psychologist. A subsequent assessment battery of the Screening Tool of Feeding Problems (STEP), the Questions About Behavioural Function (QABF), and Maladaptive Behaviour Record (MBR) cards (i.e. cards that document antecedents, behaviours and consequences associated with a problem behaviour) were administered in conjunction with a barium swallow study. The results of the STEP indicated the problem was frequent in occurrence and severe in nature. Results of the QABF indicated that the behaviour served a non-social function. The MBR cards revealed that the behaviour was occurring at almost every meal. It did not appear to be socially maintained, because the behaviour took place whether or not other staff or clients were present. Staff observation also revealed that there was a greater tendency for Mr Esperanza to engage in rumination when there were sweet foods in his meal. The images obtained from the barium swallow study revealed that much of the food was not making it down into his stomach before it was brought back up to his oral cavity through constriction of his oesophagus. Medical staff did not find any structural anomalies that may better account for regurgitation, and the higher frequency of this behaviour with meals accompanied by specific types of food indicated that a diagnosis of rumination was appropriate.
