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Ever Heard of Trichotillomania or Excoriation? What are Body-Focused Repetitive Behaviors (BFRBs)? By Kate Gibson, PsyD, ABPP

9/28/2020

You may have heard some of these terms before but been unsure what they are really about. Or maybe they are completely new to you and sound quite complicated. We have all seen someone bite their nails, twirl their hair, or maybe chew on their cheeks or lips... Although seeing this is common, for some people, it is harder for them to stop these behaviors and it may become more problematic.

Here is an explanation of Body-Focused Repetitive Behaviors (BFRBs) adapted from the TLC Foundation for Body-Focused Repetitive Behaviors (https://www.bfrb.org/). Some children and adults engage in repetitive behaviors that fall under the category of self-grooming and involve doing something to their bodies that causes damage. These behaviors become habits and can be exacerbated by stress. Many times people are not aware they are doing it, and need help noticing when it occurs. There are often triggers happening inside the person or in the setting around the person that may not have been identified as triggers yet. The symptoms cause emotional distress and have physical effects. This can be a persistent condition that worsens and improves at various times throughout a person’s life.

BFRBs occur in both boys and girls, but in adulthood are more common in women.

For kids the MOST COMMON types of BFRBs are:

Skin Picking (Excoriation) Disorder: Involves repetitively touching, rubbing, scratching, picking at, or digging into their skin, resulting in skin discoloration or scarring.

Hair-Pulling Disorder (Trichotillomania): Involves pulling out the hair from their scalp, eyelashes, eyebrows, and other parts of the body, and may behind leave patches without hair.

Nail-biting Disorder (Onychophagia): Involves biting their nails past the nail bed and chewing on cuticles until they hurt themselves, which may lead to soreness and infection.

Some other BFRBs are: cheek and lip biting, nail picking, scab eating.

How do you know when it’s a problem?

Body-focused behaviors are considered problematic for children when they are happening repeatedly over time and they result in negative physical, social, or emotional consequences.

Good news, there is help!!

Treatments such as cognitive behavioral therapy (CBT) or a form of behavioral therapy called Habit Reversal Training (HRT) have been shown to be very helpful for children with body-focused repetitive behaviors! HRT involves building motivation to change the behavior and building substitute behaviors to replace the unhelpful BFRB.

Often times kids need help bringing attention to when they are doing the behavior. This can be a gentle reminder from a parent at home or a teacher at school. Having something tactile to fidget with helps the child do something else with their hands, which allows them to work on changing the behavior.

You can find more information and resources at:
https://www.bfrb.org/
https://adaa.org/body-focused-repetitive-behaviors
https://www.stoppulling.com/
https://www.stoppulling.com/

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A Parent’s Guide to Understanding ADHD By Rachel Funnell, LMFT

9/17/2020

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What is ADHD?
ADHD stands for Attention Deficit Hyperactivity Disorder. It is one of the most common neurodevelopmental disorders of childhood. There are three different types of ADHD depending on the symptoms.

Predominantly Inattentive Presentation
Predominantly Hyperactive-Impulsive Presentation
Combined Presentation

Because symptoms can change overtime, the presentation may change over time as well.
ADHD is a chronic condition of the brain that makes it difficult to control behavior. Boys are more than twice as likely as girls to be diagnosed with ADHD. Children with ADHD often have trouble getting along with others and struggle with school work. If left untreated, ADHD in some children will continue to cause serious, lifelong problems such as poor grades in school, run-ins with the law, failed relationships and the inability to keep a job.

What are the symptoms?
According to the DSM 5, in order to be diagnosed with ADHD the symptoms have to be present for at least 6 months and they have to have six or more of the following symptoms for children up to 16 years or five or more for those 17 years and older and adults.

Predominantly Inattentive Presentation

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted
Is often forgetful in daily activities.

Predominantly Hyperactive-Impulsive Presentation
Often fidgets with or taps hands or feet, or squirms in the seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often “on the go” acting as if “driven by a motor”.
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting their turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)

Combined Presentation
This presentation is given if there are enough symptoms of both criteria for inattention and hyperactivity-impulsivity over the last 6 months.
In addition to the above, the symptoms must be present before the age of 12 years. The symptoms must be present in two or more settings. (home, school, with friends, or in other activities). And there is clear evidence that the symptoms interfere with, or reduce the quality of social, school or work functioning.

How do you get your child tested?
   The first step is to talk to your child’s health care provider about your concerns. They will go over the symptoms with you and see if your child fits the criteria. The diagnosis can sometimes be made by a mental health professional, like a licensed therapist, a psychiatrist or clinical psychologist, primary care provider or pediatrician. There is also comprehensive neuropsychological testing that can assess your child’s executive functioning (the brain functions that get impaired with ADHD).
   Once the diagnosis is confirmed, the outlook for most children who receive treatment is encouraging. While there is no specific cure for ADHD, there are many treatment options available.

What different treatments are available?
   There are a few treatments available for ADHD and depending on the child and how severe the symptoms are, you may need to use several of them at once.

Therapy:

Therapy can be beneficial to helping the child learn how to control impulses, work on paying attention and build social skills. Behavior therapy is the most common used for children with ADHD. Oftentimes, parents will be asked to participate to learn strategies that they can use with the child at home.

Medication:

For many people ADHD medication will reduce all of the symptoms and oftentimes is the best and fastest way to treat ADHD. There are several different types of medication that are available as well. Usually, doctors will start off with a stimulant. Although it seems unusual to treat ADHD with a stimulant it is very effective. Researchers believe that the stimulants are effective because they increase the brain chemical dopamine, which plays an essential role in thinking and attention.
Non-Stimulants are also an option but tend to take longer to start working than stimulants. They do help with improving focus, attention and impulsivity. The last type of medication used are antidepressants. However, they are not approved by the FDA to specifically treat ADHD. They are used mostly with adults and affect the brain chemicals norepinephrine and dopamine.

Occupational Therapy:

OT can help your child with improving certain skills, such as, organization, physical coordination, ability to do everyday tasks and control their “energy” levels.

Parenting Training:

Parenting training will revolve around the parent learning different ways to help their child’s behavior such as creating a routine, managing distractions, limiting choices, effective disciplining and using goals and praise or rewards.

Again, oftentimes a parent will need to use more than one of the above methods to help their child manage their ADHD symptoms. ADHD is completely manageable and doesn’t need to be something that stops your child from learning or being successful at life. While ADHD continues into adulthood, helping your child develop their strengths, structure their environment and using medication when needed, adults with ADHD can lead very productive lives.

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Ever Heard of Trichotillomania or Excoriation? What are Body-Focused Repetitive Behaviors (BFRBs)? By Kate Gibson, PsyD, ABPP

A Parent’s Guide to Understanding ADHD By Rachel Funnell, LMFT

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