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User2718 , 17 Oct 2015

Need help for Special Needs client

Hello I have a client with special needs who picks at his skin a lot.
He has a few open sores but refuses band-aids and won't wear gloves. Because he is an adult it is his choice to pick and there isn't much we can do about that, however I'm trying to keep his hands busy, does anyone have any other alternatives to picking? Is there some type of fidget he might like, or something that would give him the same satisfaction from picking?
I know how hard it is because I have it too but not nearly as bad, I pick at my thumbs but can resist it now, it's much better since high-school. So I completely understand why he does, But it looks so bad when we go out and he has big sores on him.
We have tried Bandaids that really stick but he will pick those off too. If you guys have any suggestions at all I would appreciate it. His communication skills are not high but he is aware that we encourage him not to pick his skin.
We've gone through nurses and doctors, all they offer is to encourage not to do it, but I am hoping someone here might have a helpful suggestion.

6 Answers
October 17, 2015

Some specific to derma ideas are: weeding, this gives me a very similar satisfaction to picking. Self massage i.e. if I go to pick at my shoulders I'll try to rub sore muscles instead. Wearing thick nail polish (even clear, it's about how it actually feels not looks, it's uncomfortable to pick when your nails are heavy and thick). I've also heard of people who like putting a sticker on their phone case and picking it off. You could probably do similar with a bit of face paint or a safe type of glue to peel off your skin. As for fidgets in general there's a huge range of them and they can be quite personal. If you search for them online there's some good results, but sometimes you might find something perfect at the local dollar shop. It could be as simple as playing with a clicky pen or some ribbon. I have a scarf with little pompoms on strings at the end that always get tangled, I love wearing this to therapy sessions to play with! I'll also fold origami out of any scrap paper I find.

October 17, 2015

Yes! Weeding is amazingly therapeutic because to me it feels like essentially the same goal. As for the glue, I found a wound gel that's for going over cuts and grazes that peels off essentially like pva ( but a little more resistant) which I used as an interum measure to satiate the desire to pick without causing myself damage. Don't know where you're based and whether it's available where you are but there must be an equivalent - it was Savlon gel

October 29, 2015

I almost always wear some type of bracelet or ring to fidget with instead of picking so you could try something like that. I don't know how often you work with him, but you could try doing a reward system. Set a timer and if he can last 3 minutes without picking he gets a chocolate chip (or something small that he likes). If he picks before the 3 minutes are up then you restart the timer. Once he can do 3 minutes, make it longer and longer until you can do days and even weeks. I work with special needs kids too and this seems to be a technique that works for me.

December 13, 2015

So you're saying he's special needs- like how? Is he independent or is someone always there like a caregiver to look after him? That's really difficult because it isn't a choice. Especially considering the severity, he needs to see a dermatillomania specialist. Maybe a neurologist. I am not a professional but I know that misinformation is widespread with this and encouragement is a nice intention but really won't do anything. If he has any other disorders it would make sense that he has dermatillomania as well, and perhaps they are connected.
So if he isn't independent and can't control his behaviors, it would be up to the caregiver to watch him. However that isn't a long-term fix and he's not going to get better without treatment. Even in a distracted state picking happens. Changes in emotion, tiredness, and stress all trigger the behavior. My guess would be to find what really appeals to him, interests him and allows him to be fully absorbed. It can be a type of physical activity, art, video games.. It can be anything. This would really be the best therapy. I've noticed idleness and things that cause "spacing out" like tv will trigger picking. If you know his daily routine, monitor when he picks, you can adjust his activities to avoid triggers. Awareness is the first step. I hope this helps, and it's great you care so much to be researching this. Wish you both the best!

Tasneem Abrahams
December 16, 2015

Hi there, I am one of the therapists here at As an occupational therapist I have worked with adults with special needs so I do understand the challenge you are faced with. It is difficult to give specific advice about what tools or toys may be beneficial for your client as I do no know him and have not assessed him, but I do think you are on the right track with keeping his hands occupied. My first recommendation to you would be to document his picking to first gain a better understanding of his picking. This may require a team effort, but basically entails observing when he picks and recording the date and time, the environment, his mood, what he was doing or engaging in just before he started picking and while he was busy picking. Document this information in a table format for a week and then try to see if you can identify a pattern or specific triggers for his picking. This may help you be more proactive in managing and controlling his exposure to the stimulus to pick or better help you understand which tools or toys are most appropriate for him. Aside from helping him keep his hands occupied, you could also make picking more difficult or less satisfying by letting him rub cream onto his skin where he picks so that his skin is too slippery to pick effectively. Unfortunately there is no definitive answer, it will be a case of trial and error and lots of patience. Please do update us on anything you have tried that works or not. Best of luck!

January 07, 2016

You might try something like Bubble Wrap or Silly Putty( if you can trust him not to eat it)

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