trichotillomania or something else?

[Anonymous]

Hi everyone, My teenage son has ADHD and has been on a stimulant medication for many years, but over the summer had a medication change to another stimulant since his long time med no longer seemed to be working effectively.

Over the past few months I’ve noticed he’s been pulling at his hair, and hes always responded that his scalp was bother him which we attributed to a dry scalp, hat wearing or hoodie wearing. Yesterday, I saw the top of his head clearly for the first time in a few weeks and now he has a noticeable bald spot. The skin looks normal, not red or irritated and there’s some hair there of varying lengths.

I’m wondering if this could be anxiety, a medication side effect, or possibly trichotillomania, which I only recently learned about. His baseline has always been a little nervous about new situations, but never to the point where he would not engage, etc.

For background, he’s been evaluated for autism three times over the years, most recently in 5th grade, now in 9th, and has never met criteria for an ASD diagnosis, though he does have some sensory needs. He’s always been fully mainstreamed, plays sports, does other activities, has friends, and says he likes high school, his classes, and his teams and says he feels fine emotionally, which makes this harder to understand.

Has anyone else seen hair pulling start around medication changes or big transitions like high school even when things seem fine on the surface? What ended up helping? I would also really appreciate recommendations for types of therapists or therapies that were helpful.

I was able to get an appointment with his doctor later today and will be bringing this up. Part of me is ready to just stop the medication, but I worry about how that could affect the rest of his life and functioning, so I’m trying to be thoughtful.

Thank you so much.

[Anonymous]

I highly recommend you try NAC, a supplement that you can get on amazon and other places, and which seems to help with hair pulling and OCD type behaviors. Sometimes doctors don't know about it but it helps- takes a little while and I would also recommend NOT mentioning the hair pulling to your kid at all since its an OCD type behavior and you don't want to remind them.

[Anonymous]

My DS with ADHD has trich. It comes in waves and is seemingly unrelated to an external source. It’s a form of self soothing. If it gets bad, he’ll request to start NAC again.

[Anonymous]

The thing to understand is trich is a vicious cycle because the pulling makes the scalp irritated and the irritated scalp draws the attention and leads to more pulling.

So treating the scalp irritation is part of it but maybe trying hats, giving him other ways to do things with his hands (fidget toys, sometimes having ribbons or silky materials in someone's pockets helps fulfill the feedback needed). Hats are a good option for providing a barrier but for some people they can itchy.

So treat the scalp and try to address the pulling.

[Anonymous]

[i]r

Anonymous wrote:The thing to understand is trich is a vicious cycle because the pulling makes the scalp irritated and the irritated scalp draws the attention and leads to more pulling.

So treating the scalp irritation is part of it but maybe trying hats, giving him other ways to do things with his hands (fidget toys, sometimes having ribbons or silky materials in someone's pockets helps fulfill the feedback needed). Hats are a good option for providing a barrier but for some people they can itchy.

So treat the scalp and try to address the pulling.

Not saying that this stuff won’t work and OP should definitely try it. But we tried all these things. We even bought a wristband that vibrates when he lifted his hand to his head. The only thing that helped was NAC. The doctors we saw were totally useless and clueless but I bet you could find a good one if you find someone special in OCD.

[Anonymous]

I’m sorry you and he are going through this. I’m an adult with trich. It doesn’t necessarily have to start under extreme stress. I would recommend you seek out a therapist who works with teens with trich for CBT so he can begin to notice the pattern of when he pulls, where, how he’s feeling etc.

[Anonymous]

Check out this website and the support groups. They were hugely helpful! These people know so much about trich, they are full of ideas and experience and support. Good luck! Mine has gotten so much better. (In my case, NAC plus support group).

[Anonymous]

https://www.bfrb.org/tlc-support-groups

[Anonymous]

Additude magazine had a webinar about this that you can probably find archived.

[Anonymous]

Some adhd meds cause hair pulling. For my som that was true. Changed the stimulant medication and it stopped.