Differential attention in the treatment of operant cough

Abstract

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.

Psychogenic Cough: A Profile of 32 Cases

“…In most cases, diagnosis is delayed several 356 / BHATIA, CHANDRA AND VAID weeks to several months because physicians do not know about this psychogenic entity [9]. In the present study, the majority of patients (65.6 percent) had a duration of psychogenic cough of one month or more.…”

Psychogenic Cough in Children: A Literature Review

“…Coughing is traditionally conceptualized as a physiological response to the presence of secretions, debris, and inhaled foreign material in the lungs (Mellis, 1979). It is less often thought of as a learned behavior that is maintained by environmental consequences (Munford & Liberman, 1978). Kravitz et al (1969) reported that in most of the cases they reviewed, diagnosis was delayed several weeks to several months because physicians were not aware of the psychogenic cough syndrome.…”

“…Irritation to the throat area may then, in turn, stimulate the cough reflex, which is reinforced, and so on. Munford et al (1976) and Munford and Liberman (1978) offered evidence of the operant nature of the syndrome in their observations of increased rates of coughing when the patient is aware of being observed. Their findings suggest that psychogenic coughing is a behavior that is positively reinforced by social attention.…”

“…Their findings suggest that psychogenic coughing is a behavior that is positively reinforced by social attention. Further support for the operant nature of psychogenic cough stems from the effectiveness of behavior modification techniques such as self-management (Munford et al, 1976), contingency management (Lavigne, Davis, & Fauber, 1991), extinction (Weinberg, 1980), differential reinforcement of other behaviors (Munford & Liberman, 1978), and differential reinforcement of low rates and zero responding (Watson & Heindl, 1996) as the primary form of treatment.…”

“…DRO involves completely removing reinforcement for coughing and reinforcing any other behavior besides coughing. Munford and Liberman (1978) used DRO to treat a 13-year-old boy by instructing staff at the psychiatric facility where the he was hospitalized to completely ignore coughing. The patient received no cough medications, social attention, or exemptions from hospital activities or expectations contingent on coughing.…”