“Please, don’t touch your sores!”
That strategy never worked. Not even for a minute. We have been trying to figure out how to help Jess control her skin picking habit for 4 years. Jess is autistic, has cortical blindness, and is developmentally disabled. She has been encouraged to stop thousands of times in a thousand different ways. Reminding her has never really helped. Other strategies have included:
Long socks / long pants / long sleeves
Bandaids and wraps
Keeping fingernails short
Serious Lectures about infection
Bribery / Rewards
Finally! I Found A Solution and I Want to Share
Until this week nothing has had a significant impact. Then, last week an idea suddenly popped into my head. The plan to help Jess control her skin picking was formulated in a matter of minutes: I would give her Permission to touch her sores, then I would set a Schedule, when she touched a sore it would require Supervision, we would use lotion as a Medium, and we would incorporate frequent as well as long-term goal Rewards.
I let Jess know it was okay for her to touch the two sores on her face. I had suddenly realized that if I gave her permission, then maybe I could have more influence on WHEN and HOW she touched her wounds. By giving permission, I hoped it would make her feel like she did not have to sneak or hide her skin picking issues.
I set a schedule of touching time. With a schedule in place, Jess could have an ongoing countdown. She is very skilled at asking me questions like, “how much longer?” and, “what time is it now?” and, “when will it be 12:00?” She loosely keeps track of the time because she likes to watch dog videos on YouTube at 9:00 in the morning, she gets a phone call at 12:00 noon, and the dogs (videos) go to sleep for the day at 6:00 pm.
For Jess, an hourly schedule was a reasonable frequency to start with. That was something she could understand, and I could (maybe) remember. I didn’t make the hourly thing required. If she was busy with music and happy, I left her alone. On the other hand, I let her know that anytime she wanted to touch the wounds she could let me know and I would be available.
Supervision was required for each time she wanted to touch. This was not negotiable. Having supervision was a conditional requirement that was paired up with giving permission. In Jessica’s case, she did not mind the supervision aspect. By supervising each session, I was able to make sure she was only touching, and not skin picking again. It was almost like an hourly assessment.
We incorporated a medium into each touching session. Putting lotion on the wounds implies there is a legit reason for the touching, other than just plain ole stimulation. Jess had trouble stopping the skin picking because as scabs formed, she did not like the way her skin felt tight. Incorporating lotion served a dual purpose.
With our new routine in place, each hour when Jess touched her wound, she/we would massage a mild store brand facial lotion into her skin. At night, a small open container cup with a little lotion in it was left at her bedside. That way, if she was tempted to pick her skin during the night, she had a tool readily available to make it better without picking
An incremental reward system was established. First, Jess and I agreed upon the big reward she would receive when the two sores on her face were healed (chocolate cake with ice cream and hot fudge sauce, after dinner at one of her favorite restaurants). Then, I added in daily rewards. “If you don’t do any skin picking during the night, you can have ____ for breakfast.” “If you don’t pick all day and all night, we will make cookies tomorrow.” Yes, I use food rewards because Jess is basically always food oriented. She takes after her mama.
I had no idea that this plan would work so well. The two wounds on Jessica’s face were healed 5 days later. One of the two had been there February through mid-June.
IT’S IMPORTANT TO KNOW THE SIGNS THAT INTERVENTION NEEDS TO HAPPEN SOON
Figure out the signs that indicate the risk of skin picking is enhanced and intervention may be needed. To increase Jessica’s chances of success, I have fine-tuned my attention to signs that mean I need to check on her right away.
- Low-toned negative self-talk sessions
- Being suddenly upset/sad but reason is a complete mystery
- Quietness in her room means it might be about to happen, it is happening, or just happened.
- Staying in her room first thing in the morning often means she’s covering up bloody messes with bandaids.
BUILD YOUR OWN PLAN TO REDUCE SKIN PICKING
WITH THIS 5 STEP FOUNDATION
This is a system that worked for Jess, and I think it could also potentially help others. The key to our success was to work with Jessica’s current habits, her own personality and preferences. However, I do believe the basic 5 steps of Permission, Schedule, Supervision, Medium, and Rewards could simply be the foundation for building an individualized plan for others that struggle with skin picking issues. Change the plan, revise it, enhance it… do whatever works for you and your loved one.
FINALLY, AN ANSWER
Over the last few years I have had parents and loved ones reach out to me asking what I do to help Jess with her skin picking issues. I never felt like I had a good response until now. Please, let me know if this helps you in any way. I would absolutely love to hear that it made a difference for someone. Also, please let me know what individualized plan works for you.
Thanks for reading!