Question:
Female, 42 years old, Deletion
My daughter is a severe picker, wondering if you have any advice that would help?
Nurse Lynn’s Response:
Skin picking is a common and challenging behavior in individuals with PWS. Here are some strategies that might help a sample sensory plan is also included.
Environmental & Behavioral Strategies
- 1. Keep Skin Covered – Long sleeves, leggings, compression garments, or even bandages over frequently picked areas can help reduce access.
- 2. Fidget Alternatives – Provide sensory substitutes like fidget toys, textured fabrics, or stress balls to keep hands occupied.
- 3. Gloves or Barriers – Wearing light gloves (like cotton ones) at night or during high-risk times can discourage picking.
- 4. Increase Structure & Engagement – Picking often happens when idle, so keeping hands engaged with crafts, puzzles, or other activities can help.
Medical & Nutritional Approaches
- 5. Check for Underlying Skin Issues – Dry skin, eczema, or even minor blemishes can trigger picking. Regularly moisturizing with thick creams (like Aquaphor) can help.
- 6. Treat Any Wounds Promptly – Use liquid bandages, hydrocolloid dressings, or silicone scar sheets to cover picked areas and promote healing.
- 7. Consider Supplements – Some people find benefit from NAC (N-Acetylcysteine), an antioxidant that has been studied for compulsive behaviors, including skin picking. Check with her doctor before trying.
Psychological Support
- 8. Anxiety Management – Picking is often a response to stress. Techniques like deep breathing, mindfulness, or visual schedules might help.
- 9. Cognitive Behavioral Therapy (CBT) – If available, a specialist in PWS and compulsive behaviors can help with habit-reversal training.
Sample Daily Sensory Routine
Morning Routine:
1. Deep Pressure Activities:
- *Use a weighted blanket or compression vest for 10–20 minutes after waking to help calm the nervous system.
*Perform self-massage with a soft brush or massage ball on arms and legs (avoiding areas prone to picking).
*Engage in joint compressions or light yoga/stretching exercises.
2. Proprioceptive Input:
- *Do heavy work activities like pushing a chair, carrying a weighted backpack (light, under supervision), or household chores like sweeping.
3. Tactile Substitution:
- *Provide a sensory fidget, textured stress ball, or putty to keep hands busy during idle times.
Daytime Activities
1. Physical Activity:
- *Incorporate low-impact exercises, such as walking, swimming, or resistance bands, to release energy and promote body awareness.
*Schedule movement breaks every 1–2 hours (jumping jacks, wall pushes, or a brisk walk).
2. Visual and Tactile Stimulation:
- *Use calming visual aids, such as liquid motion timers or lava lamps, to focus attention during high-anxiety moments.
- *Offer access to a textured sensory mat to step or press on with hands or feet.
3. Fine Motor Engagement:
- *Provide activities like stringing beads, coloring, or using a sensory bin with rice or sand to engage hands in constructive tasks.
- *Include skin-safe fidgets like soft gloves to reduce the tendency to pick.
4. Behavioral Interventions:
- *Use visual schedules and timers to provide structure and predictability.
- *a token system or reward chart for avoiding picking behaviors and practicing replacement activities.
Evening Routine
1. Relaxation and Regulation:
- *Offer a warm bath with Epsom salts (if safe) for soothing tactile input.
- *Use aromatherapy (e.g., lavender) and dim lighting to reduce overstimulation.
2. Mindfulness and Sensory Calming:
- *Practice guided meditation or deep breathing exercises before bed.
- *Engage in a calming activity like listening to soft music, weighted lap pad use, or reading tactile storybooks.
Resources
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Jennifer Bolander has been serving as a Special Education Specialist for PWSA (USA) since October of 2015. She is a graduate of John Carroll University and lives in Ohio with her husband Brad and daughters Kate (17), and Sophia (13) who was born with PWS.
Perry A. Zirkel has written more than 1,500 publications on various aspects of school law, with an emphasis on legal issues in special education. He writes a regular column for NAESP’s Principal magazine and NASP’s Communiqué newsletter, and he did so previously for Phi Delta Kappan and Teaching Exceptional Children.
Evan has worked with the Prader-Willi Syndrome Association (USA) since 2007 primarily as a Crisis Intervention and Family Support Counselor. Evans works with parents and schools to foster strong collaborative relationships and appropriate educational environments for students with PWS.
Dr. Amy McTighe is the PWS Program Manager and Inpatient Teacher at the Center for Prader-Willi Syndrome at the Children’s Institute of Pittsburgh. She graduated from Duquesne University receiving her Bachelor’s and Master’s degree in Education with a focus on elementary education, special education, and language arts.
Staci Zimmerman works for Prader-Willi Syndrome Association of Colorado as an Individualized Education Program (IEP) consultant. Staci collaborates with the PWS multi-disciplinary clinic at the Children’s Hospital in Denver supporting families and school districts around the United States with their child’s Individual Educational Plan.
Founded in 2001, SDLC is a non-profit legal services organization dedicated to protecting and advancing the legal rights of people with disabilities throughout the South. It partners with the Southern Poverty Law Center, Protection and Advocacy (P&A) programs, Legal Services Corporations (LSC) and disability organizations on major, systemic disability rights issues involving the Individuals with Disabilities Education Act (IDEA), Americans with Disabilities Act (ADA), and the federal Medicaid Act. Recently in November 2014, Jim retired.