Finger Picking or Skin Picking “Habits” That Are Difficult to Break by Bill Nason, MS, LLP

I just found a very informative page on Facebook, it is the “Autism Discussion Page – Helping Your Child Feel “Safe, Accepted, and Competent”.  This page was developed by Bill Nason, MS, LLP to discuss tools that help children on the autism spectrum feel safe, accepted and competent. Although each child is different, with their unique strengths and challenges, their are some common strategies that can strengthen the social, emotion, and cognitive security for most children on the spectrum.

“Come learn, share, and support”, writes Mr. Nason when he describes his page’s mission. “It is focused on parenting, teaching, and therapeutic strategies meant to improve the lives of children on the spectrum…This page has been a wonderful resource and support for many parents, children, teachers, professionals, and people on the spectrum.”

Mr. Nason gave us permission to post the following from his series on challenging behavior that can be found in his green book, “The Autism Discussion Page on Anxiety, Behavior, School, and Parenting Strategies – A toolbox for helping children with autism feel safe, accepted, and competent (Sept. 21 2014).”

Please note that we added the photos of SentioLife Solutions’ fidgets, the KidCompanions Clip-ons and SentioCHEWS.

Autism Discussion Page – Finger Picking

Carol, one of our members, presented concerns with her son’s finger picking and how to help him decrease this behavior. Picking at ones fingers can become injurious, leads to bleeding and occasionally result in infections. It can become a very habitual response that is hard for the child to control. Here is Carol’s post and my response.

Carol:

“My son is a flapper and a twirler. It has decreased over the past couple of years but instead of doing that, which is harmless, he is now picking at his nails and cuticles until they bleed and hates having to have the injuries cut off and band aide up (which he pulls off anyway). He does this when stressed or unsure. I would much rather him flap and twirl than hurt himself. Is there any way to re-direct him from this behavior? We prompt him each time he comes for first aid that it’s not a good idea to do this, as it hurts. He promises every time he won’t do it again but I think it is now an unconscious activity. Any ideas?”

Autism Discussion Page:

Carol, the picking of the fingers, like nail biting, is difficult to stop because it often occurs with minimal conscious awareness. It becomes an automatic, habitual response. The child himself often wants to stop the behavior (it injures him), but finds it very difficult. It becomes a “habit” that is difficult to break.

I probably would try and shape another “automatic”, habitual response to replace it. For example, in looking at the “function” that picking fingers provides, it seems to involve tactile stimulation to both hands and fingers (one set of fingers doing the picking, the other receiving the sensation of being picked).

How to Decrease Finger Picking?

To decrease this behavior by substituting a replacement behavior, we need to meet three primary qualities:

(1) the replacement behavior needs to provide tactile stimulation to the fingers of both hands,

(2) is portable so it is with the person at all times,

(3) can be performed as discretely as finger picking can be.

In this case we might consider working with the child to find some fidget items that he can keep in each of his pockets, which he can feel, rub, or fidget with to provide repetitive tactile stimulation to the fingers of both hands. This can be a piece of felt to rub between his fingers, piece of string, several paper clips hooked together, whatever feels good for him. You can buy little finger tip feelies that are placed on a finger and can be used for other fingers to rub against, or for the finger to rub across the other fingers. The child can provide ongoing tactile stimulation in “fidget fashion” to sooth or alert their nervous system.

How To Teach the Child to Use the Replacement Behavior in Place of the Finger Picking?

Often where people go wrong is they try to teach the new behavior (fidget item) by redirecting the child to do it when they see the negative behavior (picking) occur. However, this will not usually work. Simply redirecting to the replacement behavior when picking is observed will not be powerful enough to override the picking behavior. Since the picking is an automatic habit, we first need to teach the new behavior to also be an automatic habit. To do this we need to provide very frequent practice of the new behavior, and reinforce its use (not just wait until the negative behavior occurs).

Provide Frequent Practice with the NEW Behavior:

So, in your son’s case you want to do the following:

1) Have your son keep the items with him at all times, and prompt him frequently to fidget with them and then praise his use of them. We want him to establish a new “habit” with frequent use. If it feels good, it will become an automatic habit. While sampling a variety of fidget items, usually the child will land on a preferred one that can become “the” item. Make sure he is carrying the item on him at all times, and cue him to use it frequently throughout the day. This gives him frequent trials (exposure) to fidgeting with it. Judy, another member on this page, shared that she replaced her little one’s picking behavior with buttons. Her daughter fiddles and rubs them. Judy also sewed them on to her clothes, toys, pillowcase and other items dear to her daughter. This way her daughter always had the buttons available to fidget with. Again, this substitute has to be portable; meaning with the child at all times.

2) If the child is older or cognitively aware enough to understand, discuss with him the positive effects that using a fidget item will have on soothing him when anxious, and alerting him when under-aroused. Teach him how self stimming like this will help him stay calm and organized.

3) Prompt him to use the item frequently throughout the day and praise him heavily for calming himself by “fidgeting”. Another positive strategy is for the parent to model this by having their own fidget item that they frequently use throughout the day. The parent can also use it themselves during times of stress when the child would typically need to use theirs.

4) During times when you expect the behavior the most (situations that often bring on picking), prompt him to use the fidget before the picking has a chance to occur. Again praise him for doing so. For example, if this behavior occurs when he firsts goes to bed, before falling asleep, then you tuck him in each night give him the fidget item(s) and encourage/reinforce him to fidget until he falls asleep. He can carry them in his pockets at school, and everywhere he goes.

Help Your Child to Satisfy His Urge to Finger Pick with a Discrete Fidget

Do not scold him for picking his fingers, but encourage him that once he feels the urge to pick this is a cue for him to “fidget.” Over time you want to empower him to recognize when he feels the urge to pick to fidget instead. Of course, each time you do see finger picking, redirect to “fidget” and reinforce him.

Finger picking can occur at any age. It is important to teach these children as young as possible easy ways to pacify their nervous systems with safe sensory stimulation. Remember the tool needs to be portable (always on them) and discrete as possible. Many adults learn to use alternative “fidgets” and other self stimulation to keep their nervous system regulated and to avoid injurious behaviors like finger picking. It is empowering to learn simple tools for keeping your nervous system calm and organized.

What Else May Cause Finger or Skin Picking?

Finger (or skin) picking can also be stimulated by dry or rough skin, hang nails, scabs, or other abnormalities of the skin that the child hyper-focuses on. Sometimes treating the underlying cause of the dry skin can help. Keep the nails filed (not cut), cuticles cut, etc. can help. Many of the children are very hyper-sensitive to any little imperfection that constantly draws their attention. On the opposite side, some of the children are “hypo” sensitive (dull sensations) and may hyper-focus on picking scabs, nails, skins, etc. while seeking intense stimulation that they can feel.

Autism Discussion Page Books! by Bill Nason, MS, LLP