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Q&A: Picking Skin?


Do you have any suggestions for a student who has a problem with anxiety that when she feels anxious she will pick the skin off of her fingers?   The parents have tried giving her an incentive—getting her nails done—and this works for short time, but then she will continue.  Thank you for any help you can offer!


Unfortunately, since this behavior provides such intense sensory input, it is hard for us to find sensory activities that the child will use as substitutions.

The most successful approach will be to try to reduce the anxiety in the first place. Try to find out what increases the anxiety—certain environments? Task demand too high? Perceived pressure? Loud noises?
Certain times of day? If you can find a pattern or a predictable antecedent for the behavior, start there with modifications and adaptations.

The second thing you can do is to determine her sensory needs (most likely she will need primarily calming activities) and try to keep her in the “yellow zone” (just-right zone) throughout the day as a preemptive attempt to minimize her anxious reactions.

Certainly, you can try offering substitute forms of sensory input when she feels the need to pick—therapy putty, slime, spaghetti balls. Also, keep her hands well moisturized with lotion. It will be harder to pick skin if her hands are not dry. As a last resort, I would keep a pair of light-weight gloves handy for her to wear when needed as well to protect her skin integrity.

Anytime a child engages in self-injurious behaviors like this, I think it is worth talking to the doctor about antianxiety medications as well.

I hope that helps! Please keep me posted on what works best for this child.

Best Wishes,