Picking & Biting lip

[nnej3]

Any recommendations or tips on how to help my 8 year old ADHD son stop picking scratches/scabs on his arms, hands and legs? Sometimes he’ll also bite his lip. I’m sure it’s a function of anxiety, nerves etc....once he starts he struggles to stop. If needed, I’ll use oral gel to stop him biting his lip; however, he’s pulled off bandaids and won’t easily stop picking his scratches and scabs. Thank you!

[Kd1970]

I don't have a solution for you, but maybe it will help to know that you're not alone. We are struggling with this with our 11 year old daughter who has ADHD. It is very concerning and upsetting. It has been going on for about two months. I'm hoping that when school ends for the year, the anxiety will decrease and the picking will stop. Good luck to you.

[nnej3 in reply to Kd1970]

Thank you for taking the time to reach out and reply. I'm sorry to hear that you are struggling with this as well with your 11 year old daughter. I realize how upsetting and concerning it is. We're also ready for school to end and to take a pause this summer after such a stressful year for everyone. Good luck to you too and I'll let you know if I come up with any good ideas on addressing this.

[Birdwatcher19]

Hi. Does he take any medication, and is he in therapy? Medication can sometimes help, so it’s worth discussing with your psychiatrist or pediatrician. CBT may be helpful in helping him to recognize his triggers so he can learn to redirect his impulses to pick/bite. In the meantime, you can offer him fidget/sensory-soothing items (Crazy Aaron’s putty, tangles, things like that) to keep his hands busy, and maybe gum or mints to suck on when you notice these behaviors. Also, you can try teaching him some breathing and progressive relaxation exercises to help him with his anxiety, and mindfulness skills to help him learn to recognize how anxiety/boredom feels in his body. Hope that helps. Be well.

[nnej3 in reply to Birdwatcher19]

Thank you so much for taking the time to respond - I greatly appreciate it and the useful suggestions. Yes, he's on medication but not in therapy... yet, we've been considering it! We notice the picking is worse on more stressful days or days where something 'new' is happening.

[Aspen797]

Decreasing the stimulant slightly and adding guanfacine worked for us.

[nnej3 in reply to Aspen797]

Thank you!

[Aspen797 in reply to nnej3]

We were fortunate that our son’s skin-picking went away when we changed medication. The recommendations made by Redpanda are excellent and are similar to the strategies we had been using before the switch. A great website with lots of information and sources of referral is here: bfrb.org/. The foundation for body focused repetitive behaviors (skin-picking, hair-pulling, etc).

[Redpanda5]

Hello, you are not alone. Yes, this is a thing. My daughter started doing this in second grade on her perfect little face! She had flawless skin and was destroying her face so I had to get help.

It’s called dermatillomania. We found a psychologist who is specifically trained in treating this disorder.

The doctor had us determine if there were certain times or certain locations where the skin picking seemed to occur most. From there she had us make fidget boxes (a small box of fidgets she liked (let her choose) and placed a box in each of those areas.

Then, to get her to use the fidgets instead of picking, a reward system was developed by the psychologist. We took a jar (the size of a small jar of spaghetti) and got some marbles. At the end of each day we would check in with her. If she didn’t pick during the day she would get two marbles for her jar. If she she admitted to picking then she would get one marble. When the jar was half full she got earned a predetermined reward. For a full jar she got a large predetermined reward.

It was a motivator and the doctor told us that the temptation for skin picking never goes away but that this is how it’s managed. She told me that as my daughter grew older to replace the rewards with money.

In addition, it seemed to also occur at night when she wasn’t even aware she was picking. So we put Vaseline on her face and even put band aids over her fingernails or gloves on her hands which did help.

Has it worked in the last eight years? Yes, for the most part. She has gotten older and begun to care more about her appearance. This has caused her to stop picking her face and it has moved to more covered places until it seemed to stop altogether. She then switched to running her fingers along the roots of her hair. This began during times of high stress in early high school to the point where it created a bald spot in a visible place. I think she became self conscious about the spot so she moved around to different spots on her head where it is less conspicuous.

Medication seems to have no effect. The best deterrent now is being around peers. Alone in the bedroom is the hardest place to fight it.

I hope this helps and good luck!

[nnej3 in reply to Redpanda5]

Thank you for sharing! Glad to hear things improved for your daughter. Very helpful for me but also will pass this on to a dear friend who is dealing with exactly the same thing for her ADHD daughter. Her face is totally ripped apart and my friend is devastated. This girl has really struggled being at home for school this year and so bored online for school that she’s picked her face. Her school is going back in class soon and, along with starting therapy, my friend is hoping they can deal with this.

[Redpanda5]

So glad to help! Psychologists are expensive so I am happy to share what we were taught! This therapy took about 8 sessions to discern, create and implement. I am also sorry to hear about your friend and her daughter. Hopefully this gives her a place to start. We found it to be a great framework. Hopefully this also spurs more ideas for you to help your son. Hang in there!

[nnej3 in reply to Redpanda5]

This is great info! Thank you again for the advice and support!