Question:

I am working with an autistic teenager who has issues with skin picking. She is smart and talented. I have tried replacing the behavior with squeeze balls or giving her a visual prompt, but she keeps reverting back to skin picking. I personally think it is a combination of anxiety and decreased self-regulation. Do you have any ideas?

By the way, I have taken a few of your online courses and have found them extremely informative and helpful!

Answer:

I agree that skin picking is typically a way to cope with anxiety more than anything else. Here are some tips that might help:

  • Try motivating her to want to stop skin picking either through education about the risk of infection or becoming aware that it makes other people feel grossed out or uncomfortable or another reason that may work for her.
  • In addition to internal motivation, rewards would probably be helpful. Think about short- and long-term rewards. Talk to her parents and see how big they are willing to go with the rewards. For short-term rewards, it would be helpful to start with something small but frequent—maybe a skittle for every hour that she refrains from picking. Or you could use a token system. You could give her a token for every non-picking hour and at the end of the day, she could exchange the tokens for a treat. Long-term rewards could initially be set for 1 week (maybe going to a restaurant or movie with parents) and then move out to 1 month.
  • Help her discover the source(s) of her anxiety and address underlying issues. This may be within the scope of occupational therapy, or it may require the intervention of a mental health professional.
  • Create a choice board of calming sensory strategies for her to choose from throughout the day.
  • Allow her to experiment with a variety of sensory strategies to find out her preferences and what works best for her.

For a more in-depth discussion, check out Lori Adams’ course on Childhood Anxiety!

I hope that helps! Please keep posted if you find something that works for her. And thanks for participating in our courses!

Best Wishes,
Gwen