The Education Act 1981.

and expiration if a foreign body is suspected), but at times additional, more invasive tests may be indicated. The long term outcome is almost always excellent for the child with a psychogenic cough, but as the symptoms may persist for months-or even years-an early remission will benefit both the child's education and the family's sanity. Usually the cough will resolve after the parents are reassured that there is no underlying disease and that it is simply a habit or tic. If reassurance fails or if there are other obvious behavioural problems psychiatric referral may be helpful.3 A recent publication from New York has suggested a more dramatic and apparently highly effective approach which the authors describe as a reinforced suggestion technique.4 Once the diagnosis has been made the patient is informed that his cough has weakened his chest and that as a result he needs a chest support. This is provided by tying a folded bed sheet around the child's chest, leaving a large knot over his sternum. Any attempt to cough after tightening the knot leads to sharp commands to "stop coughing." In 31 out of 33 patients this proved effective within 24 to 48 hours with no subsequent relapse. This rather colourful approach may not appeal to all. There is little doubt, however, that this condition is grossly underdiagnosed and that a happy outcome may almost always be achieved once the parents understand the nature of the condition. 1 Korach A. Psychogenic cough tic in children and adolescents: nine case histories illustrate the need for re-evaluation of this common but frequently underdiagnosed problem. The Education Act 1981, which became law on 1 April 1983, has tried to provide adequate safeguards, rights, and duties for all those concerned with the education of children with special educational needs and to ensure these children's right to be integrated into the life and work of the community.' It also gives effect to the recommendations of the Warnock report, which emphasised the importance of early identification of children with special educational needs and, where possible, provision for their education in normal schools.2 Although many doctors may be unaware of the statutory obligations of the Act, there can be few for whom it will not at some stage have implications. Among other things the Act requires that if a child is identified by a doctor employed by a health authority as having, or being …