Reply to How do you talk to your teen about picking at their skin?

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[quote=Anonymous][quote=Anonymous][b]Read about body focused repetitive behaviors. There is very little you can do until/unless she wants to stop.[/b] Drawing attention to it makes it worse. Being embarrassed by your teen's appearance is itself embarrassing.[/quote]

Eh. Yes and no. My youngest DS constantly bit his nails and picked at the skin around them. He always had gross, bloody, scabby, stubby little fingers. He sometimes had to get sent to the nurse for a pair of rubber gloves to wear because his hands were so scabby and bloody that kids didn't want him to touch anything. And I didn't blame them because we were the same way at home. He always had his own bowl of popcorn during movies. His siblings refused to allow him to pass things at dinner because they didn't want to risk there being blood on the object (happened more than once).

Did he want to stop biting his nails and picking his skin? No, of course not, but as his parents we had to overrule his wishes and push forth with treatment. We took him to a therapist who did CBT (cognitive behavioral therapy) and taught him HRT (habit reversal training). The therapist taught him the ARPS method (awareness, replacement/redirection, practice, support).

Awareness-He learned to spot his skin picking triggers (boredom & sensory issues)

Replacement-He replace the destructive body focused repetitive behavior with something repetitive but not harmful/destructive. For him this was tracing the lines on his palm, writing the ABCs on his palms, doing the alphabet in sing language, or drawing something the therapist called "soothing circles" (an endless circle doodle of sorts). The therapist allowed all these replacement behaviors at first and then slowly had him eliminate them as he became more comfortable (see below)

Practice-He learned how to become comfortable with his uncomfortable feelings (boredom & sensory issues) through the practice of the safe repetitive behaviors to the point where she weaned him from having so many options for safe behaviors.

Support-She had up set up a rewards system and also taught us lots of positive reinforcement for him when we noticed him doing the safe repetitive behaviors like tracing the ABCs or sign language. When we saw him try to fall back to a destructive repetitive behavior, we were taught how to bring it to his attention, help him verbalize what triggered it, and redirect towards a safer behavior.

It was not an instant fix at all and took lots of work on all our parts, but it was successful in the end. He hasn't bit his nails or picked his fingers in many years. He's now 20 and he still uses the ARPS mechanisms. We started him in piano lessons when he was 8, so now we'll catch him playing a piano piece with his fingers on his legs if he's bored. [/quote]

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