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.

perhaps I did the spell out the issue correctly. This person vomits intentionally because they enjoy it. This person gets stimulation from from it. They attempt to pull back up their food to taste and smell it, but it comes up too fast and ends up vomiting all over themselves and our home. We have tried redirecting his attention, feeding thick heavy meals, you name it. NOTHING works because he enjoys it too much. I know this is not easy for you and I to understand, but it is the truth. He consumes an average of 9000 calories per day, but only hold down about 1500-2200. Weight is maintained this way. Doctor simply said to feed him ice cream, patted me on the back and sent us home! They did a scope and found everything normal, so it's not medical, it's phsycological. I care for this person dearly, but cannot be expected to clean vomit 247, bath 5 times daily and fix 12 meals a day. No care provider can sustain such demands.

Answer 1

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.

Answer 2

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 3

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 feces 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 4

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 5

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 6

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 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

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 9

His mothers and fathers claims could also be partly precise, if he has no truly constitution or movements at dwelling then he might wrestle with dealing with one at preschool, the equal is going for the penalties. Not being competent to talk in his local language could also be seeing that he is suffering from finding out 2 languages while - you mentioned his local language is Japanese/Korean. This is traditionally getting annoyed by way of his having to be taught english at preschool aswell - this could comply with that he simply makes grunting noises as he has no language talents within the language the category is taught and could also be stressed as as to if you talk both of the languages he speaks (peculiarly if you do not seem Asian) This would even be the cause for his behaviour as he turns out to have constrained verbal exchange talents so has to hotel to behavior like taking toys. The throwing up is traditionally a coping mecahanism he has learnt as you traditionally name his mothers and fathers to return and get him whilst he does it for that reason getting him clear of the atmosphere he's burdened being in. The side approximately him now not being competent to bite or swallow is slightly extraordinary. The best different kids I have obvious with those disorders are kids who've had a bodily incapacity which has affected this capability or kids who've a few variety of meals phobia or crisis that's on the whole because of their growth in that discipline having hit a plateau or being not on time seeing that this is a response in opposition to the mothers and fathers. It turns out that he's not on time in really a couple of locations and traditionally is not fairly being helped by way of the further strain the preschool is placing on him. Not information different kid's feelings could also be a caution signal for Autism or Angleman's syndrome. Try giving those truth sheets to the mothers and fathers and notice if they may be able to see any of those factors of their son. Or you would move by way of them at preschool. You would additionally advocate to the mothers and fathers that if they're competent to get their little one assessed to peer if he has distinctive demands that you can be competent to get a individual who works totally with him which could make sure that his demands are met and that the opposite kid's demands are met because the common employees:little one ratio will then be restored.

Answer 10

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