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Patients with psychogenic cough tic syndrome have been described as having a frequent cough - as often as every five minutes - which persists long after a minor cold and which subsides during sleep. Previous reports have described an aversive technique for treating psychogenic cough which provides negative social and physical reinforcement to encourage discontinuation of the cough. In this technique, a bedsheet is wrapped around the chest muscles and the patient is given a command of 'no more cough.' In previous evaluations of this technique, deception was involved, as affected children were told that the sheet provided support to weakened chest muscles, while parents were told that the coughing was psychosomatic but the child needed the sheet as a face-saving device and the alternative explanation of muscular involvement. The authors of this article provide an alternative treatment, which relies chiefly on positive rather than negative reinforcement to halt coughing, involves little deception, and encourages children to gain mastery over their condition. In this technique, parents and children are told that the cough may have originated from a particular likely disease process but has continued although the disease had resolved. The cough is compared to a habit like thumb-sucking, which could be broken if the child practiced gradual reduction of the symptom. After this explanation, parents record the frequency of coughing for rationed time periods, and children are informed of this. Declining cough frequency is then followed by setting goals of lower frequencies. In this study, stable or increased frequency of coughing was treated with a reward system, using tangible or social rewards. A return to normal school and other activities was strongly encouraged, to serve as distraction and to minimize possible avoidance of unpleasant tasks. Four cases are described in which this therapy was successful. Only one case required rewards to decrease cough frequency; the child was able to decrease coughing from 131 per half hour to 6 per half hour, with coughing finally ceasing. (Consumer Summary produced by Reliance Medical Information, Inc.)