5. Teaching the Child

- Tell the child that he/she will learn a new skill. Remind the child of other skills he/she is likely to have learned--skipping, dressing or eating independently.

- Separate the child from parents to learn pill-swallowing. Have the parent show confidence in the child's ability (e.g., "I can't wait to see you swallow pills"). If parents are overprotective or anxious, do not let child see it (i.e., coach parents beforehand to just show enthusiasm).

- Use short commands and be repetitive.

• "Sit up straight"
• "Keep your head straight"
• "Put the pill on your tongue"
• "Drink the water"

- The trainer models the behavior for the child with the smallest placebo.

- The trainer places the pill on his/her tongue and drinks water.

- The trainer shows the child that his/her mouth is empty and that the pill is swallowed.

- The child then practice the behavior.

- The child places the pill on his/her tongue and drinks water. If the pill does go down, the trainer should praise the child for successful trials (e.g., stickers, money, tokens). If the pill does not go down, the trainer should say, "That is okay, keep drinking." Other than saying "Keep drinking." The trainer should not give any reassurance or multiple commands. The trainer should be quiet to allow the child to calmly swallow water.

- After a success, the trainer should then move quickly to the next trial. The trainer tells the child "Next pill," never "Bigger pill." The child sees only one size placebo at a time.

- When the child successfully swallows the largest pill, have the child demonstrate a successful trial for parents. This models the behavior for parents and increases generalisability of the behavior to other settings.