My daughter, who is eight years old, began picking a little at her face several years ago. It began with an itchy midge bite. I told her not to scratch or pick at it in case it got infected.
She did scratch at it and has continued to do it more or less ever since. She almost always has one or maybe two small red spots on her face due to picking. She also picks a little at other areas of her body, her back, shoulders or tummy.
I have tried everything I can think of to get her to stop. I ignored it completely for a year hoping that she would get out of the habit, but she didn't.
I tried rewards, threats, being firm, talking to her but she seems to be unaware that she is doing it. Recently, she is beginning to get a bit distressed when she sees that she has picked during her sleep.
She is, generally, a bright, happy child and is getting on very well at school.
I am sure she will stop eventually (do you think so?) but I worry in case she will have permanent scars on her face. Any advice about what would be the best way to help her?
David says: There are several things that you can do to try to change her behaviour. I usually like to try to firstly understand why a child might be behaving in a given way, as this usually points to the best solutions for long-term change.
Skin-picking is more properly known as Dermatillomania. Just like with your daughter, it often starts with a mole, a scab or some imperfection in the skin. In your daughter's case, it was the itchy fly bite that began the process.
Most commonly, children (and adults) will continue to pick at their skin as a form of stress-relief or release. It is almost like a coping mechanism for dealing with tension or stress.
Ultimately, the behaviour becomes habitual and, as you describe for your daughter, subconscious. Your daughter, for example, picks at her skin in her sleep.
Your aim is to work with her to solve this problem. The fact that she gets distressed herself about her habit and her apparent lack of control over it means she will probably be motivated to work with you.
The first step in dealing with it is to bring her awareness to it. You don't have to do this in a critical or punitive way. Staying matter-of-fact, you simply let her know that you notice her picking at her skin.
This might help both you and her to notice at what times of the day, or what kinds of situations, she picks more. For example, does she pick more when trying to do her homework? Does she pick when she is relaxed on the sofa? Does she pick more when she is tired, or cross, or upset, or bored?
I would imagine that you will find that there is a pattern to her picking. You have already noticed that she has picked more often or less often during particular periods. What was happening during the periods when she picked more?
Perhaps these were times of transition, or turmoil in her life or the family's life?
Naturally, if you discover that there are indeed certain activities or places or times when she picks more, you may have to alter her routine to avoid those situations so that she isn't triggered to pick by habit or by stress.
You might also want to return to the idea of reinforcing her avoidance of picking. So perhaps you may be able to identify a reward that will be attractive to her if she can allow scabs to heal or avoid picking for a day, or a week.
Again this will have most success when she is alert to her own behaviour and more conscious of when she is picking. That will allow her to have more chance of being able to stop. So increasing her awareness will also help with this approach.
A further option is to give her gloves to wear, since the picking action will have less effect. Once the behaviour no longer fulfils its initial function (because it feels different or doesn't work as well) the behaviour should reduce.
Yet another approach is to give her an alternative behaviour to do, in place of the skin-picking. As ever, she needs first to notice when she picks.
Assuming she is more conscious of the skin-picking, you might then give her a piece of modelling clay (or plasticine) that she can manipulate with her fingers, keeping them busy.
Indeed, you may find that a combination of distracting her, diverting her with plasticine and breaking the link between the skin-picking and particular trigger times or situations may all contribute to helping her stop.
Anxiety is consuming my child
I live with my husband and three daughters and I am lucky enough to be at home with my children. My 12-year-old daughter is the middle child of my three girls. As she has grown up she has gotten more and more anxious.
It started with her watching films like 'Jurassic Park' and 'Gremlins'.
She used to have nightmares and was never able to fall asleep, so we let her sleep beside one of her sisters. The light in her room or the landing light has to be on until she is fast asleep.
Our downstairs loo was broken for a few months last winter and she would ask me to go upstairs with her to the toilet in the evenings rather than go up on her own. I can't count the amount of times I have had to collect her from sleepovers – once in the middle of the night. My mother suffers from incredible anxiety and going out the door is a big deal for her.
She was diagnosed with bipolar disorder just over a year ago, after my father died. As a child she had all the same habits my daughter does – she was afraid to sleep on her own, had to have the light on etc. I'm afraid if we don't do anything about my daughter it will only get worse as she gets older. What should we do?
David says: When we get anxious we get a very strong physical reaction. Adrenalin is released into our systems and this will raise our heart rates, speed up our breathing and often lead to tension in various muscles.
Ironically, the stronger our physical reaction the more anxious we will feel.
So anxiety can quickly spiral up and up as our minds and bodies take on board the signals that each other gives off.
It is this pattern that can lead to anxiety becoming more and more problematic as we get older if we never have an opportunity to learn to regulate it.
When children watch scary movies (or at least scary-for-them movies) then they will have this physiological reaction of an increased heart rate, flushing, bodily tension etc. It is really important, then, that they have some time and a strategy to calm themselves down afterwards.
Typically, they will cling to any strategy that works to reduce their anxiety for any future occasions they experience it.
So, in your daughter's case, sleeping with her sister gave her the feeling of safety and security that allowed her anxiety to drop and the adrenalin to dissipate.
At the same time, she probably also associated the landing light being on with that reduction in anxiety and greater feeling of security.
Consequently, she has come to rely on these things, particularly to reduce any anxiety that she now feels.
Her difficulty is not that she gets anxious (we all can get anxious at times) but that she hasn't learnt any effective strategies for soothing and regulating that anxiety, apart from relying on other people (to be present with her).
Often the most important thing we can give children who are anxious is a confidence that there is something they can do about their own worries. Having some effective relaxation techniques is a great way to do that.
The relaxation techniques that I prefer to teach children are abdominal breathing and guided visualisation (like a meditation). I find that they are both easy for them to do alone and very effective.
If your daughter learns relaxation techniques like these, she can also learn to use them when going to sleep if she wakes up in the night, or when doing something on her own, like going upstairs at night.
The guided visualisation technique encourages children to use their imaginations to create a warm, safe and inviting place. In my work, when I guide children in such a visualisation, I often take them on an imaginary walk in the woods to a beautiful sunny glade with water running through it where they can "rest" on a warm rock, or on the grass.
It is in this imaginary place that they can let their cares slip away and relax. This is a particularly good technique for children to use before sleeping.
I recorded this visualisation for Ryan Tubridy's radio show and it is still available as a downloadable podcast. If you type the following into your browser it will take you to the podcast: http://bit.ly/lLO2Rh
Similarly, I also recorded all of the steps for abdominal breathing on a separate podcast for the show and that can be accessed at: http://bit.ly/iodh5F
If your daughter has a phone, iPod or MP3 player then she can listen to both of these podcasts, follow the instructions, and learn to relax.
I do believe that both, or either, of these techniques will help her to combat her anxiety. Both of these techniques will significantly reduce the amount of adrenalin in her system and give her a greater feeling of relaxation.