[Dysphagia] Conditioned dysphagia

[DGregore at Christianacare.org (Gregore, Dale)]

Need suggestions for this case I just evaluated  yesterday:
13 months ago, a 17 year old patient observed his sister choking on a soft
pretzel:  she required the Heimlich from Mom, scary situation but no damage
done, sister is fine.
One week after this choking incident, he was reclining, had "about 8" gummy
shacks in his mouth> choked:  spit everything out.  Scary situation for him
Since then, he initially refused to eat for fear of choking:  then liquids
only; existed on tomato soup, cream of wheat and milk/ ice cream pretty much
until recently.  (+) eats ice cream at school for lunch.  Limits his eating
in public. Expresses fear of choking, states it is beyond his control.  Very
anxious.
Anxiety meds and ADD meds have been stopped due to the fact that they
affected his appetite, per mom
He eats crispy crunchy snacks no problem.  Avoids any meats and puddings
(interesting texture disparity there) 
Sitting and eating a meal with family is difficult.  Parents are very
supportive.  He initially lost 20# then gained it back w/ liquid
supplements.
did have a Upper GI:  normal; clinical swallow function normal 
Patient is seeing a behavioral therapist.  He was receptive when I spoke
about the factors one can 'control' during eating:  rate, quantity and
position (referring to his reclining position intake while wolfing gummy
snacks)  he chose cheez its, soda and ice cream and exhibited no overt
dysphagia symptoms on direct examination and/ or when attention was diverted
(talking, putting puzzle together)  nice kid seeking absolutes, "you mean I
cant choke when I'm sitting up?" to which I just couldn't say 'yes'. 

Anyone have a similar case before?  I would appreciate suggestions for
treatment planning/ approach, etc....thanks. 

Dale R. Gregore, M.S. CCC SLP
Christiana Care Health System
Delaware, USA