Q&A: Child Pulling His Hair Out?

Question:

I have a student with autism and cognitive delays who has no behavior issues. He is gentle and always smiling and happy. But he is pulling his hair out so badly now that he looks like he has had chemo treatments. He wears hats every day, which helps, but does not prevent this behavior. We gave him a pipe cleaner that he likes to bend and fidget with, but there has been no real improvement. Do you have any suggestions you could offer?

Answer:

I wish I had something magic to offer you, but this is a difficult behavior to address! It sounds like this might be trichotillomania rather than a sensory issue. Here’s a link to info on this diagnosis:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002485/

I have not had much (if any) success treating this from a sensory perspective. To be sure you have covered all your bases though, here are my suggestions:

• Analyze the behavior:

A—antecedent: What precedes the behavior? Are there any consistent triggers? Certain environments?

B—behavior: The behavior itself, hair pulling, certainly gives intense sensory feedback. Therefore, you need to attempt to match the intensity with the sensory strategies you offer. Let him try standing on his head against a wall, zoob tubes, bubble wrap, or vibrating hairbrush.

C—consequence: What he getting from this? Attention? Task avoidance? Endorphin release? If you think he’s going for endorphins, try intense activities such as jumping and crashing, playing tag, etc.

• Social stories: Try making a social story about what to do with his hands.
• Honesty: Talk to him about the downsides of hair pulling, if this discussion would make sense to him.
• Rewards and consequences: Ask him to recommend reward ideas then set up a reward system. Appropriate consequences could include sweeping the floor.

Please keep me posted if you find something that works.

Best Wishes,
Gwen