A new diagnosis identifying a nonorganic basis of dysphagia is proposed in relation to behavioral conditioning processes and thereby labeled "conditioned dysphagia" (CD). Literature review of both animal and human studies documents that rapidly acquired and persistent avoidance responses are learned when autonomic functions are contiguous with traumatic physical events. Three case studies with primary diagnoses of TE fistula, congenital heart disease and pseudobulbar palsy demonstrated an association between CD and early childhood incidence of trauma involving the esophagus. Successful treatment was achieved by operant deconditioning therapy. Results of a pilot epidemiological study of 28 postpharyngeal flap surgery children and 47 controls showed significantly higher incidence of mild to moderate CD in the surgery group.

A nonorganic pattern of maladaptive eating behavior was identified and diagnosed as conditioned dysphagia in a group of 28 children who had successfully completed pharyngeal flap surgery for correction of hypernasality. The physically intrusive diagnostic and surgical procedures are thought to contribute to the acquisition of a conditioned avoidance response to deglutition that is resistant to extinction but reversible after deconditioning therapy. Comparison with 22 matched normal siblings and 25 normal control children identified conditioned dysphagia as occurring in about 40% of the cleft palate children within 1 year after surgery. Characteristic eating problems included slowness, requiring assistance, eating only small pieces of solid foods, and not finishing meals. Early detection, treatment, and preventive measures are suggested at or about the time of surgery to avoid consequent nutritional deficits and, in some severe cases, a threat to survival if untreated.

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Children and youth with serious and persistent emotional disturbances are becoming increasingly more at risk for HIV transmission, particularly when considering the high incidence of child sexual abuse by infected adults among the impoverished, urban population. Brief psychiatric hospitalization affords an opportunity to empower the child victims and reduce risk behaviors in general. An inpatient program for youth is described with an emphasis on "taking care of yourself." High impact teaching methods such as role playing, competency training and raising self efficacy are discussed as critical elements of brief therapeutic interventions.