Response‐Class Hierarchies in Self‐Induced Vomiting: Functional Assessment and Treatment

ABSTRACT Individuals with neurodevelopmental conditions sometimes engage in self‐induced vomiting, a behavior associated with serious medical complications and increased risk of exposure to communicable diseases. Despite its clinical significance, the functional dimensions of self‐induced vomiting remain understudied, particularly in cases where it occurs within a hierarchical response class of attention‐maintained behavior. This study describes the functional assessment and treatment of self‐induced vomiting in an adolescent male with multiple neurodevelopmental conditions. A response class hierarchy analysis was conducted to evaluate whether self‐induced vomiting, self‐gagging, pica, and other challenging behaviors were functionally related. Findings revealed systematic shifts in challenging behavior topographies with sequential exposure to extinction, supporting the presence of a hierarchically organized response class maintained by attention. Treatment involved functional communication training, extinction, and an individualized levels system involving token reinforcement and a probabilistic exchange schedule. This multicomponent intervention eliminated self‐induced vomiting, self‐gagging, pica, and other challenging behaviors within the attention‐maintained response class. These findings underscore the need for function‐based assessments in the treatment of self‐induced vomiting and related behaviors.