School phobia may be secondary, due to concern about being behind in assignments. Family stress may be identifiable. Tell patient that cough has weakened chest muscles. Patient is told cough will stop in 24-48 hours, then may remove sheet. Child dresses, exits exam room.
Parent is informed of psychogenic nature of disorder and basis for therapy.
No deception or aversive stimulus. The remedy is to practice not coughing with parents' help. Parents monitor frequency of cough for 30 minutes daily, usually in the evening, on an announced basis, and also at an unannounced time during the day. Allowing the child to sip a beverage frequently or suck on lozenges helps. Praise, and if that doesn't suffice, tangible rewards are offered.