TREATMMENT OF CHRONIC RUMINATION THROUGH REVERSE OF REINFORCEMENT

행동치료를 통한 시설아동의 만성 구토행위 치료

The reverse of reinforcement technique was used in treating rumination of a 12-year old (estimated age) mentally retarded child in a residential setting. The subject's rumination pattern was first to vomit the food onto the floor and then to eat it back in several attempts. Consequently, the way to reverse the contingency of rumination in this child was to take away the discharge whenever rumination occurred. An ABAB single subject design was adopted to evaluate the treatment effect. In baseline 1 the frequency of his rumination for 2.5 hours after eating was an average of 46(range= 30-62), while decreased to 6.7 in treatment condition 1. However, when the discharge was not taken away in baseline 2, his rumination increased to 34 times and then decreased to zero to 1 time when the reverse of reinforcement was reinstituted in treatment condition 2. The results clearly indicate that the reverse of reinforcement which was implemented in the form of removing the discharge from the floor was successful. It was reported that the treatment effect has been maintained over 10 months post treatment.

12세로 추정된 시설아동의 2년간 지속된 구토행위를 행동치료 방법을 사용하여 치료하였다. 이 아동의 구토행위 형태는 바닥에 음식을 토해 낸 후 $2{\sim}3$ 차례에 걸쳐 토한 음식을 다시 먹는 것이었다. 치료 방법으로 일단 토해 낸 음식을 다시 먹지 못하도록 하기 위해 음식을 토할 때마다 즉시 토한 음식을 치웠다. 일단 위에 들어간 음식을 역류시켜 바닥에 토하지는 않았지만 입안에서 씹을때는 입을 강제로 벌려 입안의 음식물을 제거하였다. 치료는 약 3주간 지속되었는데 식사 후 2시간 30분동안 치료전에는 평균 46회($범위=30{\sim}62회$)토했고 치료 후에는 평균 1.12회($범위=0{\sim}10회$)로 감소하였다. 치료 종료 후 10개월이 지난 뒤에도 아동의 구토행위는 재발되지 않았다. 따라서 토하는 행위를 강화시키는 요인인 '토해낸 음식을 다시 먹는 기회'를 박탈한 본 연구의 치료방법은 구토행위의 치료에 매우 효과가 높은 것으로 나타났다.