I have two queries about a guy we work with who has autism, downs syndrome and learning disability

S&LTandMum

This discussion was created from comments split from: Hi, I'm Arlene. I'm a Specialist Learning Disability Occupational Therapist..

S&LTandMum

Hello. I have two queries about a guy that we work with who has autism, downs syndrome and severe learning disability. He has several 'behaviours' that we are looking into as a multidisciplinary team but we have no O.T (desperate but funding is an issue). One of the behaviours is continual regurgitation of his food - not reflux but more rumination we think - we have just had medical reasons ruled out. He has stopped doing it at the moment but we are sure the behaviour will return as it has in the past. We have looked at increasing intensive interaction, recording data on what he eats, pureeing his food (on recommendations of medics) and offering other things to stimulate his mouth etc. Anything else we could try?
The same guy is always putting his hands down the front of his trousers. It sometimes lessens if he is interacting/kept busy but it is a CONSTANT battle, asking him to take his hands out and no sooner are they out, then they are in again. We have talked initially about giving him other things such as a ‘water wiggler' (!) and about generally increasing his access to sensory activities such as goop and water play and bubbles (in relation to all of his difficulties) but again wondered if you had any ideas.

BusyOT

Hi - Sorry it has taken me so long to get back to you.
I've worked with a client who regurgitated his food regularly and also had pica. We used a behavioural model to reduce the pica type behaviours (substituting inappropriate foods for acceptable alternatives) but struggled with the regurgitation. We eventually identified the times of the bhvr, his level of activity, and then the times that were most unacceptable (i.e community settings, social meal times). We found that if he had physical exercise before the meal time his regurgitation was less (the theory would be increased proprioceptive and vestibular input into his system led to less need for feedback) but have never been able to eliminate it completely. It also appeared to offer him some comfort during stressful times and he had been ruminating for years. There are a couple of good journal articles about rumination and behavioural model interventions. I can give you the references if that would help?
I'm not sure that a water wiggler would help with the other issue (although I can see where you are coming from!!) since that would only provide tactile feedback to his hands and I assume he is achieving a range of other sensory feedback when he puts his hand down his trousers. Have you tried weight? A weighted blanket, cushion or wheat shoulder bag on his lap might give him additional p. & v. feedback and help meet his needs. There are lots of questions I would like to ask re this particular behaviour but it doesn't seem appropriate on a public forum. I am happy to discuss further via email if you would like. I can be found on twitter as BusyOT and you could DM me your email address or perhaps you could email netbuddy directly and they can forward your email to me. (I'll ask netbuddy their views on this first!). Good luck and keep fighting for your OT!!!

SLTandmum

Thanks for the reply on our guy with rumination and sensory behavoiurs - so sorry- I have only just seen your reply. I must have been checking in the wrong place and our email has been very up and down. That's been really helpful. I will contact you through your website about the further info.