OCD nose picker, constant

Is he on medication, Michelle?

Janis

Yes, he’s medicated. While medicated he is doing fine until recently. Once is a great while he doesn’t get his meds. He is completely out of control and must be sent home, non comoliant.

He has had this picking the head thing going for two years. He has now switched it to his nose and arms, picking quite often.

He used to stop when prompted to stop picking his nose. He just won’t stop at all now. Sometimes he will try to hide it behing his other hand. Well, it’s gross an unsanitary. He will pick and then go to the supply box to use scissors, or pencils whatever. I should get him his own box but I’m trying not to draw too much attention to it.

I am goin to make him wash his hand after each nose picking but then will he wash his hands constantly like some OCD people do. This will become very distracting as I will have to stop my group and redirect him to make him follow through. My time is so precious. I can’t afford every two minutes stopping my group lesson.

I used to give him a tissue but now he refuses it.

I have talked to his mom, the nurse, and the pychologist. They are thinking about what to do, meanwhile I just don’t know what to do.

He picks at his skin until it bleeds. Everytime one thing is stopped he goes to another area.

Today he said as long as he’s busy he doesn’t do it but there are times when he must listen to a lesson.

We are going to do a lesson on HOW TO make a stress ball as soon as I can get all the supplies. Having these stress balls seemed to help but I was getting tired of replacing them. I called OT to see if they would help me with some, no.
Michelle

Michelle,

A couple of things based on personal experience.

My ds started skin picking when the medication he was on for OCD, Prozac, was increased. He said he felt itchy—this is a possible side effect of the SSRIs. (Doctor dismissed my this as a cause because “the side effect is rare.”) He scratched until his skin bled and would then pick at the scabs. (Doctor put it down as one of these things that happen with these types of kids.) He had scars all over his legs and arms—I sent him to summer camp and they called me to say he couldn’t go swimming because of his skin disease. This went on for a year until I could convince the doctor to take him off the prozac. But of course by then the behavior was ingrained.

The cycle has to be stopped by healing the wounds. I put that body sloughing stuff with salts in it from the Bath and Beauty shop on my ds’s arms and legs every night followed by Burt’s Bee Balm, a product I can’t say enough good about. When summer hit, I made him swim a lot and stay in the sun for healing. Chlorine is great for this, but a really salty body of water can be better. As the wounds healed the scratching stopped and since he was off the Prozac he wasn’t itching anymore to start new wounds.

Though my son had OCD, the picking wasn’t really so much OCD but a cycle of behaviors set up in reaction to the medication side effect. At about the same time, I put him into cognitive behavior therapy to address his truly OCD behaviors. This is not an easy route, but we got rid of the medication and actually got a cure. This wouldn’t be guaranteed for everyone, but it does have proven effectiveness. (In my son’s case, the OCD was induced by strep antibodies attacking the brain—this is called PANDAS—and according to the CBT therapist, these cases can be harder to treat than typical OCD.)

My recommendation would be an all out attack by the mother to get some healing on the wounds. She and the doctor should reassess his medication to see if side effects induced the problem. Perhaps a different medication could be used, given he’s out of control and no medication might not be an option. And she should run, not walk, to a competent cognitive behavior therapist.

You should talk to the school psychologist about how to implement simple CBT in the classroom. For example you could reward him in some way for refraining from nose picking (thank God I didn’t have to deal with this!)for a reasonably short period of time that would be stretch for him, but manageable, like five minutes. Then you lengthen the amount of time each day. (You would do this only once a day or perhaps once a class if you see him for more than one period.) The reward must be given immediately when he succeeds—no waiting for the end of class.You have to negotiate the reward with him—it has to be something he views as a reward, but one that you are comfortable with. I used books with my son. obviously, I didn’t want to give him a book for every five minutes or I would have gone broke and we would have quickly run out of books he wanted considering how many times I had to do this. I made a photocopy of the cover of the book he wanted and then cut it up into 25 puzzle pieces. Each time your student refrains from picking for the allotted time, you would give him a puzzle piece. When he has all the puzzle pieces, he would get the book or whatever you have deemed appropriate.

By the way, throwing away the tissue sounds very much like my son—he developed a strong aversion to them, although after a while he would use them but then immediately throw them out of his personal body space. As for hand washing, I used to have this fear too that it would induce obsession. Actually it didn’t, but he began being obsessive about how he dried his hands, which could take a large amount of time. I had to gently but firmly take the towel away from him after a very short period and shoo him out of the bathroom. With these children it is important to be ever vigilant for signs of an emerging obsession and nip it in the bud. You can’t do this, but his mother can. She may not know that this is called for (I certainly didn’t for some time). It is tough for a mother to do this to her child but the alternatives are a nightmare, one I am thankful every day that I no longer face.

I certainly wish both you and her a lot of luck.

Michelle, another thing. You said:

“I should get him his own box but I’m trying not to draw too much attention to it.”

I understand your concern about germs, but this is emphatically something you should not do. Once you have done this, you will have sent a signal to him that HE can control YOUR classroom through his obsessive behaviors. The more you accommodate his behaviors, the more reason he has to not stop, and even escalate, them. It will give him a sense of empowerment that is incredibly gratifying to a child who has lost control of himself so profoundly he cannot will his body to not engage in actions that he knows it shouldn’t be doing. (Could he be losing squishy balls because it gives a feeling of control over you? Defintely something to discuss with the psychologist.)

I am not passing judgment on this child in any way, just on his medical problem. I find it difficult now to admit the extent to which we allowed my very sweet ds’s behaviors to control our household until we were able to find competent advice on how to deal with this very difficult disorder.

Also, the germ presentation though fun, will not have done anything for him. OCD impulses come from a part of the brain that has nothing to do with rationality. More mature OCD sufferers actually know all too well their behaviors are not rational, but this knowledge does not in anyway help them to stop them.

When I wished you and the boy’s mother luck, I should have included him too. These children’s behavior can drive you so mad (even when they are your own sweet dc!) that it’s easy to forget that however bad it is for us, it’s infinitely worse for them.

MarieDC,

Hey, I want you to know I really appreciated your thouhtful post. I am going to read it again a few times to make sure I got it all has you are full of useful information. I had a rough day and I need to process it all. LOL.

Just so you know, the germ lesson wasn’t aimed just for him for for all my students. All of us could use a little lesson on handwashing now and then induding myself. I even plan to bring it home for my own 3 kids as I even find myself scrubbing my nails even better once I saw the germs I missed. It was a very powerful visual lesson.

Thanks again for your post, I appreciate a view of someone whose been there.

Michelle

Michelle,

I asked about meds exactly for the reason Marie told you about. The doctor of this child needs to know immediately about this side effect. I know of a child here who was on Straterra, I think, and she started picking her arms. They had to change the meds. It is not acceptable for a child to have medication-induced OCD behaviors, in my humble opinion.

Janis

Janis has made a good point here. I had assumed that the child was being medicated for OCD more generally and that perhaps a side effect of an OCD SSRI medication (like feeling itchy) had caused the skin picking. But what Janis is suggesting is that perhaps the child is being treated for ADHD. A known potential side effect of drugs for treating ADHD is OCD/Tourettes type behaviors. If the child is being medicated for ADHD, I agree with Janis that the doctor really needs to reasses now the child’s medication. Medication induced OCD/Tourettes is really not acceptable, as Janis has said, but sadly all too many doctors are dismissive that medication can cause them and feel that the real issue is the parents refusing to accept the true extent of their child’s problems.

My son has OCD and began picking his face and skin. He looked terrible and had many spots on the verge of infection. Meds helped, but what really helped break the cycle is using tape over spots he starts picking. Nexcare makes “gentle paper tape” in white and tan (skin color). It’s gentle and looks like a scotch tape dispenser.

You can’t use it on raw wounds and you have to insure there’s no infection, but I have had success covering imperfections and bumps or any spot my son picks once. The tape has turned things around 180 degrees. His skin has healed and the picking cycle is broken (at least on the spot he can no longer pick).

Hope the idea helps someone.

I would continue giving him things to play with.
Anything to keep his fingers busy. Once I covered a ping pong ball with tiny pieces of tape so the child could spend the day picking it off.
Yes, by all means cover the wounds. Sometimes just the feel of the bandage will redirect them.
I had one student who I taped/bandaid the tips of all his fingers. Another student wore surgical gloves. The worse case I had, I whip stitched gloves into a long sleeve T-shirt. That child also ‘picked’ other people. Worked wonders.

[quote=MIchelle AZ]I have a student who has obsessive behavior. He has a
quarter size hole in his head that has been raw for at
least 2 years. Also picks at sores on arms and picks his
nose. He used to pick it but with a gentle prompt would
stop. I now reach for a tissue and he refuses it and throws
it across his desk. Called mom and she can’t get him to
stop. He some kind of balm that helps and she said that
might help.

Talked to the nurse and she will try to think of what to
dao. Last year I posted and someone suggested a stress
ball. That did the trick for a long time until he lost it
and lost another. I am going to google for a recipi I can
make at home.

TOday we were passing around cards with the structure words
for a Viusalizing Verbalizing lesson. I got grossed out
when he had to take the cards. Next time I will have him
wash his hands.

I did have the nurse come in and do a lesson on germs with
the special soap and black light where students see the
germs. That was cool.

What else???????????????? He won’t stop picking his nose.
Do I send him to the restroom, (every 3 minutes). Do I
ignore it?[/quote]

Have you asked his parents to have a medical exam done on him? Sometimes that is a sign of worms.