Special needs person, with very special, difficult problem?

Question

I've been a care provider for many years and seena wide range of needs. However. the latest person sent into my care has a behavior I don't know if I can deal with. I'm hoping someone else in this field has encoutered such issues and can advise me in the right direction for some help. Ill warn you in advance, the issue pertaining to this individual are not pleasent, but they are real.

To make a long story short, this person will intentionally vomit their meals after they eat. This indivdual has a functioning level of a 2-3 year old child, but is an adult. So behavior modification, intervention has had no success. Basically anything that goes down, comes back. This person has to eat constantly to meet nutritional requirements. Are there any medical procedures, or other intervention methods that can be done to help the situation. I am ready to give up care for this person, as it is just too much. Any advise is appreciated.

Answer 1

I've never heard of a problem like this but there's some behavior training that could help.  

I'm sure you've tried ignoring the behavior instead of overreacting.  But if you haven't it could be worth a try.  The person may not be vomitting solely for the purpose of vomitting.  THey could enjoy the physically stimulation from the touch and bathing.  There are documented cases of institutionalized persons smearing f***s on themselves to gain personal attention.  

Is the person high enough functioning to have to clean up after themselves.  It is punishment in a sense and I don't really believe in that with persons with special needs but it's an option.  

Have you tried rewarding this individual for not vomiting.

There is also the option of GI tube or IV feeding.  It doesn't seem healthy for an individual to be vomitting that many times a day even if they are getting their nutritional requirements.   It seems to be like this individual will experience all the problems that persons with bulimia would experience with acid destruction of the teeth and throat passage ways.

Is there another type of stimulation the individual enjoys.  Could you provide this stimulation during meals.  Maybe tactile or visual depending on the type of disability.

Psychiatrists might be the last effort you can take.  

I wish you and your client well.

Answer 2

Perhaps the reason behind this individual's vomiting is simply an act of attention seeking? Negative and Positive alike, all is attention. The best way would be to completely ignore him/her when s/he does to offer rewards for not vomiting, Something that you can do together. If they don't vomit for a period of time (start off small and build up), I'd also try the popcorn thing, a really good idea.

Answer 3

You need to contact an eating disorders specialist for help. Our site is devoted to helping people manage troubled children but this is too serious for you to handle alone. Since it is a safety issue, seek help immediately. I am a clinician, here is my web site, so you can see we have expertise with extremely troubled populations: http://www.youthchg.com

Answer 4

it is possible that the person likes the scratchy feeling in the throat as the vomit comes up. offer some pop corn or other crunchy (not necessarily sweet) snacks and maybe that will give enough 'scratchy' sensation in the mouth and throat that there wont be a need to feel the vomit.

Answer 5

I used to have a girl in my class who did something similar, but with her, it was more to get attention or because she was angry or upset. What we did was work towards a goal- her big reinforcer was a video. If she made it through so much of a meal without vomiting, she immediately got to watch the video. We also had a behavior specialist come in to analyze her behavior but that was pretty much worthless for us. I would recommend seeing a doctor again. Try to find someone who specializes in treating people with special needs and see if you can get more help or if they can find some kind of medical reason. A last resort may be to have the person get a GI tube (a tube surgically inserted into the stomach to allow them to be fed) just for nutritional reasons. I can totally empathize with how frustrating it can be. Good Luck!

Answer 6

This may get a few thumbs down--but don't feed him. A lactose feed from 0.01 solution may help.

Answer 7

Sometimes, what seems to be deliberate really isn't.

You may be dealing with a gastroesophageal medical problem here. Many times, food is regurgitated because of a hiatal hernia, pockets in the lining of the esophagus or esophageal webbing, or even a malfunctioning lower esophageal sphincter. It could also be due to undetected GERD.

It is possibe a feeding tube may be necessary, but without a medical consultation, one can't be certain.

It's time for a visit to a gastroenterologist.

Answer 8

I know the person is under medical care, but I would be worried that the consequence for vomiting is getting what I would consider a highly preferred food. The person vomits they get ice cream in order up their calorie intake. I would be interested to know what "behavior modification" has been tried. Like someone else mentioned I would have them clean up all the vomit change their clothes everything. I know given their functioning they will still likely need help but if there is an over correction procedure or other mildly aversive consequences for vomiting this may help. I would also not follow up vomiting behavior with some highly preferred food items. I would look into providing a tasteless protein shake or something else that is not so rewarding for vomiting. I would also look at the schedule of vomiting. How long after eating does it usually happen. Can your provide increased monitoring during that time and if vomiting does not occur provide a highly preferred reward or activity. If vomiting does occur follow it up with the clean up/ correction procedure. i understand this person is in a care home and it really is a lot to ask. I would call this person's case worker and ask for professional help. Tell them you will not keep this up without a plan and help.. and thanks for trying.

Answer 9

It could be a very simple problem such as acid reflux. Or it could be something much more complicated and psychological. Without knowing what the persons diagnosis is it is very difficult to say whether it is physical or psych logical. Could it be a sensory problem? I have a family member who is diagnosed with autism and cannot eat and if they try to eat they vomit straight away. This person is now fed via a gastrostomy button in their stomach. This is a very drastic procedure and only used as a last resort. There are things that can be done such as the administration of certain medications. Surely this persons doctor knows of the situation and should be doing all he can to make life as comfortable as possible for this person?

Answer 10

I did the same thing when I was a child. The way I was stopped was to have me clean it up. I only had to clean up my own vomit once and I never did it.

Answer 11

Oh my, I am so sorry.  Can this person vomit up liquids?  Could you do milkshakes and smoothies and ensure and only let him have maybe a tablespoon to a quarter cup at a time?    I wonder if the operational word here isn't "meal."  

Is there ANYTHING that is a reward for not trying to vomit?  (would have to be non food).  Have you tried major distractions just after eating - like forcing him to move around or clap or jump or dance?  Or even stopping for that tablespoon in the middle of fun, preferred activities and starting it very smoothly again.  Bounce the ball two times, take a sip of ensure, bounce the ball again right away with LOTS of noise and distraction.  If he tries to vomit stop the activity immediately, make him sit down and turn your back.  Do NOT rush to clean up.  Part of the stimulation is the attention and the grosser he gets, the more attention.  Seems to me like the behavior is going to have to be unlearned - even if have to do it by the tablespoon.  

This person could also have a form of OCD.  Medication might help.  

I am not a behavioral expert, but I do have a handicapped kid with lots of behavior issues.