After trying a few different stimulants for my 14 yo daughter’s inattentive adhd, we decided to take a break. She was reporting feeling less happy with the meds and even on the smallest dose we noticed an “edginess” that isn’t there without the meds. Anyway, we decided we’d rather she be happy than slightly less flighty. (The meds also didn’t seem to help much with forgetting which is her main issue).
But I wanted to ask about finger picking. She picks at the skin around her nails with her fingers (not nail biting) to the point of bleeding. She did this on meds but continues to do it off meds (and it’s been months now). The pediatrician says apply hand cream so the skin isn’t dry and “asking” to be peeled, but that hasn’t made much difference and I’m wondering if anyone has successfully dealt with this? She does it in church, in class during the school year, riding in the car, waiting anywhere, watching tv. It’s fidgeting- anytime she isn’t busy with her hands in some other way, she’s picking.
Would love any ideas on this! If your kid with inattentive type is on a med that has helped with this, I’m open!
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Yellow-cello
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Sorry to say, I've been picking at my fingers since I was little, and I still do it now. ADHD makes it harder for us to ignore those little irritations. If a neurotypical person doesn't scratch an itch, eventually it goes away. If an ADHDer doesn't scratch an itch, it can be constantly in the foreground, get worse and worse, and make it so it's all we can think about.
That being said, things that help:
Something to fiddle with
something to cover up the offending spot so it can't be seen/felt (cloth gloves?)
A task I can hyperfocus on
practicing relaxation techniques as part of my daily routine
As for medication, we can often get laser focussed on performance (attention, memory, etc) but it's also important to consider other impacts (psychosocial, flexible thinking, emotion regulation, self-monitoring, etc) If the stimulant med is causing problems, consider looking for other treatments.
As for the IDEA of being on medication, ask if you and she would feel the same way about insulin, or anti-seizure meds, or needing glasses, or even a wheelchair if your daughter couldn't walk. Taking medication is morally neutral. It's a tool, not a crutch, and it's being used to manage a neurodevelopmental disorder. I'm not saying she needs to be on medication, but rather that you take a look at it with your eyes open and do your best to make sure you're balancing risks and benefits of meds/no meds, and that your decision is not based on an inherent bias.
Def don’t have any moral objection to meds! As you can see in my post I asked for recommendations and said “I’m open” to meds! I guess I didn’t explain very well they were affecting her mood negatively and not helping enough with forgetfulness to make it worth it. I feel like we can tolerate some side effects but I’m not willing to mess around with depression.
does she pick with her hands or teeth? If she’s biting them, there’s a bad tasting nail polish that works.
When my daughter started a stimulant, she started tics. It’s been more than a year, and though it is sometimes gone, it does come back when she’s anxious. Maybe look into anxiety meds. Also, there’s a gene sight test that can help someone find out which mental health medications will have adverse effects.
Yes, years of picking. I think aquaphor is more effective than hand creams, but it needs to be applied after bathing. Silk gloves can be worn overnight afterwards also. Magnesium and a b complex are given if the behavior increases. A non-stimulant was very effective also, and bleeding has been rare since.
I probably don't use a magnesium in the correct form or high enough dose to be effective for anxiety. I give 200mg of pedia-lax magnesium hydroxide, a chewable.
It is. I'm not sure if it helps picking, I just give it with b complex to check a box mentally. I think magnesium threonate would be better for this if mine were old enough to swallow a larger pill, and I will change mag types as soon as she's able. I take this one (for other reasons, but it works):
He had lab work as part of an annual physical. He’s an athlete and doesn’t drink and the ped said his liver looked like he had an alcohol issue which would take years to develop. When he stopped strattera, numbers returned to normal.
My 6yr old child has some body focused repetitive behaviors like this. Skin picking is one of them. I know it’s hard. I have adhd combination type myself.
With my child I have found that talking about it in a solution based accepting way helps. We’ve tried fabric finger bandages. They like those because I can fold them in such a way where they can still pick at that but not harm his skin underneath.
I’ve also crocheted them covers for their thumb and index finger on the side that picks the other hands fingers. They enjoy that and has even said they like the texture. I’ve even thought about crocheting beads into it.
Anyway, I think with excoriation it’s not so much about eliminating the behavior as it is find a way to let them engage in it in a way that is not harmful. Even at 6 I talk to my child about that and they seems to understand. I remember as a kid my mom would get embarrassed if I stimmed with my hair (I would love to find the coarsest hair I could and pull it) her negative reaction just made me hide it and engage it the behavior more often.
Thanks for your reply! I do find that asking her what she thinks would help (when it comes to focus/attn issues as well) works best. I’m often telling her she knows herself best and I might have ideas but she knows what will actually work if she wants to stop. She’s tried bandaids, painting nails etc. Things get better briefly and then flare up again.
I am an adult with inattentive ADHD, and I had similar finger picking habits starting around age 12. I also bit my nails regularly.Whenever my dad noticed me biting my nails, he pulled a pair of fingernail clippers out of his pocket to lend to me.
He gave no judgment or criticism. He didn't preach at me. He just acted out of concern and it was pretty matter of fact about it. I have noticed that he sometimes bites his nails, too, until he catches himself and pulls out his trusty nail clippers. (My dad also has ADHD traits, but he has not been diagnosed with it.)
I think that's his non-judgmental approach was half the reason that I adopted this strategy so easily, without feeling shame over my behavior.
I was about 13 or 14 when I started carrying my own nail clippers. (I bought them myself with my allowance at the time.) I'm sure that this is greatly reduced my nail picking and nail biting. (I also often used the nail clippers as a fidget toy, but I'd recommend that your daughter carry a fidget with her that doesn't have a sharp edge on it.)
I also use the clippers to carefully nip cuticle tears (which I used to get regularly), so I didn't bite or pick at them.
I'm 49 now, and I have consistently carried a pair of fingernail clippers since my teens, which has helped me to keep from having a regular problem with skin picking and nail biting. However, the days that I don't have my clippers with me, I often find that I am unconsciously biting my nails or picking at a rough edge on a nail. So, sometimes these behaviors don't go away.
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I think that the cause of this behavior can vary.
It could simply be an ADHD fidgeting issue, it might be anxiety related, or even related to an ADHD comorbidity (such as OCD or Autism).
For me, I think it is rooted in ADHD, but when I am experiencing heightened anxiety, I do it a lot more (unconsciously). So, I do my best to keep my anxiety down for this and other more significant reasons.
I think I read a while back that stimulant medications might eliminate or exacerbate this type of behavior. I cannot remember where I think I read that, so I am not sure if it is true.
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As for medication, since I also have inattentive ADHD, with a great deal of forgetfulness when I am not taking medication, what worked for me was Strattera.
A low adult dosage (40mg) worked very well for me. I saw your concerns about your son having elevated liver enzymes on Strattera. I know that there's a risk, and I know that my doctors had me tested at least twice (when I was taking Strattera and an SSRI at the same time).
Strattera is an SNRI (selective norepinephrine reuptake inhibitor). There is a newer SNRI which has been approved to treat ADHD called Qelbree. According to what I've read about it, it seems to be generally more effective for kids with ADHD and carries less risk of side effects. So, consider discussing Qelbree with your daughter's doctor.
When I first started taking the medication, one of the first improvements that I noticed was a significant improvement in my working memory capacity and short-term memory recall.
• There's a psychology concept known as "the magic number 7, plus or minus 2". Supposedly, studies have found that the average person can keep 5 to 9 unrelated items in working memory at any one time. For me, before starting on ADHD medication, I could only hold a list of 1 to 3 items in my working memory at one time (for about 3-5 minutes...and then it would vanish). So, I used to have to write things down right away, or I would forget them.
• Shortly after I started on Strattera, I conducted the test of my memory by going to the grocery store without a written list. I memorized a list of eight items (just general grocery items that my family needed at the time, but not related items for a particular meal... because association is a memory trick to remember more things). Not only was able to get every item on that list, but while I was at the store (not even in the dairy aisle), I was able to also recall that the milk was low... So I got 9 out of 8 items on my grocery list (and no impulsive purchases, like a chocolate bar, which I have a weakness for when I'm not on ADHD medication).
• Also, instead of a "goldfish memory" of only being able to tell something in my memory 3 to 5 minutes, I can now keep most things in my mind for 20 minutes, give or take a few.
• My short-term memory recollection has also improved many times over. I used to I did extremely difficult to recall recent things. Now, my short-term memory recall has improved at least 10 times over what it used to be. I would guess that I am much closer to neurotypical levels, but I have not actually tested my short-term memory, like I did my working memory.
• My long-term memory recall is much better for memories formed since starting on ADHD meds then it is for memories formed before my diagnosis. [Because of my lifelong issues with short-term memory, what I can recall from long-term memory is limited in number of events, but I can recall emotionally significant events and I can recall narratives... memories that follow a consistent story within my life.]
These can be an indication of another attention disorder which has been studied and found to have a somewhat high comorbidity rate with ADHD, especially Inattentive ADHD (but is not in the diagnostic guide yet). This disorder is known as Cognitive Disengagement Syndrome (CDS), but until 2022 it was known as Sluggish Cognitive Tempo (SCT).
• Dr Russell Barkley has done a few video presentations on CDS (SCT). He is the first ADHD expert that I learned about it from. Within the last year, I started noticing other professionals talking about it in articles (on CHADD.org and ADDitudemag.com, at least ) and I think a couple of other videos.
According to Dr Barkley, atomoxetine (the medication known by the brand name Strattera) has been found to be an effective treatment for CDS in at least one research study. Meanwhile methylphenidate (the medication found in Ritalin and Concerta) was found in another study not to be very effective for CDS.
But I can tell you is that I have every symptom of inattentive adhd, and I also have every symptom associated with CDS, and Strattera helped treat all of them.
• When I started on it, the first thing that I noticed was that the brain fog was gone. The only times in my life that the brain fog left before was when I was in Fight-or-Flight mode (which causes a rush of adrenaline, also known as epinephrine, which is closely related to norepinephrine... and atomoxetine treats norepinephrine deficiency)
• The second improvement that I noticed was the increase in my working memory capacity. This was not as immediate as the brain fog clearing up, but nearly so.
• The rest of the symptoms improved for me within 5 days of starting on the medication. (This was very a typical, much faster transition time than most people experience. It takes most patients on Strattera weeks or months to reach full effect.)
I bring this up because this one medication seemed to treat both sets of symptoms very well for me.
Qelbree would probably be effective for the same, but I haven't tried it.
(I recently started on bupropion/Wellbutrin, a norepinephrine and dopamine reuptake inhibitor commonly used to treat depression, but increasingly prescribed off-label to treat ADHD. It seems to be helping with the same sets of symptoms. I switched to see if it helps with motivation, as well, because Strattera didn't help my with that at all. ...Still don't know how effective it is, but it's easier to get out of bed in the morning.)
Thanks for your replies! So glad you found something to help you. She doesn’t check the boxes for CDS but our next move will be to a non-stimulant if need be.
Stimulants made my grandson angry. Straterra really helped and guanfacine for the anxiety. He used to scratch himself until he bled before he got stable.
I have some anxiety and used to bite my fingernails. I have acrylic nails and can't bite them anymore.
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