Abstract
The present case is an 11-year-old, Caucasian boy (“Leo”) with irritable bowel syndrome (IBS) who demonstrated significant functional impairment with school and was referred to behavioral health for stress management by his gastroenterologist. We conceptualized Leo’s IBS from a biopsychosocial perspective, in which biological (e.g., abdominal pain), psychological (e.g., fear of bowel incontinence), and environmental (e.g., inadvertent reinforcement of school absenteeism) factors interacted and resulted in symptoms and impairment. In conjunction with medical interventions, we aimed to improve his coping with IBS symptoms and increase his school attendance through the implementation of a family based cognitive–behavioral intervention involving coping skills training, contingency management, and exposure. Over the course of the intervention, Leo continued to demonstrate difficulties with school attendance and participation, as well as poor engagement with behavioral and cognitive coping strategies. His mother attempted to reduce reinforcement of school absenteeism but continued to acquiesce to his requests to stay home from school. The challenges of this case highlight potential areas of need that may have been inadequately addressed by our original case conceptualization and intervention plan, including consideration of an underlying anxiety disorder, maternal barriers to contingency management, time restraints–low dose of treatment, and strengthening our partnership with medical and school stakeholders.
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