Among 23 pediatric renal dialysis patients, we obtained self-reported assessments of psychological adjustment and biochemical and subjective ratings of adherence. Findings indicate elevated levels of depressive symptoms and substantial nonadherence. Depressive symptoms were associated with higher levels of hopelessness, more negative self-perceptions, and more depressogenic attributional style. The psychological adjustment measures did not significantly correlate with adherence. Nonsignificant associations among different measures of adherence underscore its multifaceted nature. Implications for monitoring the adjustment of children on dialysis, assessing adherence, and future research are discussed.

This case study reports the successful use of differential attention in the treatment of chronic operant coughing of 6 months' duration in a 13-year-old boy. The boy was hospitalized, where the symptom was ignored and his adaptive age-appropriate behaviors were reinforced with points and praise. Fines were levied for self-derogatory statements. Obtrusive and unobtrusive observations revealed the cough rate higher when the patient was aware of being observed than when he was unaware of being observed. After 4 days the cough rate dropped to zero, where it remained except for a slight recurrence on the day of discharge. His parents were trained in maintaining the differential attention contingencies in effect in the hospital and were able to transfer these conditions to the home. Thus, when the cough again returned once the patient was home, they were able to immediately terminate it. Follow-up of over 36 months revealed the boy to be symptom free.

This case study demonstrates the value of conceptualizing functional somatic disorders as opcrants. The subject, an adolescent girl, diagnosed as having a "hysterical neurosis," manifested the symptoms of incessant coughing at the rate of 40 to SO coughs per minute, over a 4-ycar period, and mutism for 2 of these last 4 years. After the failure of a course of electrical avcrsive conditioning, the cough and mutism were treated by extinction and shaping, respectively. Positive results were obtained, and the patient remained symptom free over a 20-month follow-up period. The etiology and maintenance of the disorder arc discussed from an opcrant point of view.

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