A behavior therapy approach for obtaining cooperation during needle sticks was provided to 8 pediatric patients with intellectual and developmental disabilities. Therapy was provided during mock needle sticks. Hand lotion was applied to simulate topical anesthetic. Distracting activities established relaxation while needle stick materials were gradually introduced. Positive reinforcement was provided for cooperation. Behavioral distress was ignored, blocked, or redirected. After cooperating with mock needle sticks, needle sites were prepared with topical anesthetic (EMLA), then therapists and medical staff implemented the behavioral protocol while completing the actual needle stick(s). Observational measures of cooperation and interfering were obtained. Results were replicated across 8 children and evaluated using paired samples t tests. Initially, all children were uncooperative with needle sticks. With treatment, behavioral distress decreased, and patients cooperated with mock and actual needle sticks. Results support the effectiveness of behavior therapy for promoting cooperation in children with intellectual and developmental disabilities during needle sticks.

Pain in adolescents with CF is associated with lower HRQoL and more pulmonary exacerbations. Greater efforts are needed to manage pain in this population and to determine if treatment of pain improves other outcomes.

Chronic constipation is a common and challenging childhood problem. Effective treatment for chronic constipation and fecal incontinence includes a combination of medical and behavioral treatments. This study evaluates the outcomes associated with providing these treatments in a specialty outpatient clinic consisting of a nurse practitioner and behavioral psychologist. Fifty-seven patients were followed up for initial and follow-up appointments in this multidisciplinary chronic constipation clinic. In addition, 65% of the patients did not return after the initial visit; from this cohort, 21 patients (20%) were randomly selected and outcomes were derived by phone interview. Results showed a reduction in bowel accident frequency, abdominal pain, use of diapers, and perceptions of having constipation. In most cases, these outcomes were achieved after a single visit; however, a more extended treatment was required to achieve optimal benefits for patients who initially presented with frequent bowel accidents. These results suggest that a multidisciplinary clinic comprised of a nurse practitioner and behavioral psychologist provides an effective and efficient way to provide a combined treatment protocol for constipation in children. Future research should evaluate long-term effects of this intervention on constipation symptoms and overall health care utilization.