Psychological approaches to the management of respiratory symptoms in children and adolescents.

Acute respiratory symptoms often demand immediate medical attention and can be a frightening experience for parents and children alike. Once immediate medical concerns have been dealt with, the physician may be left with a complex clinical picture of uncertain aetiology. Vocal cord dysfunction, hyperventilation, sighing dyspnoea and psychogenic cough are four well-described clinical syndromes where the aetiology may not be clear. Indeed for a busy clinician, it may also be unclear how to manage these patients and when to refer for more detailed psychological or psychiatric management. This paper will discuss the management of complex cases where a range of factors may influence outcome. A framework is presented that can be used to aid formulation and intervention. It is argued that the challenge to the medical practitioner is to combine a medical assessment with careful attention to the personal perceptions and experiences of patients' symptoms. In paediatric and adolescent medicine, particular attention needs to be paid to the wider context of the family, as well as to communication within the consulting room. A clinical example is presented that highlights common dilemmas and illustrates the use of solution-focused brief therapy and motivational interview techniques.