An analysis of the topography, severity, potential sources of reinforcement, and treatments utilized for skin picking in Prader-Willi syndrome.
Skin picking in PWS is usually severe, injurious, and likely sensory-maintained—plan functional assessment before treatment.
01Research in Context
What this study did
The team sent a survey to 55 families who have a child or adult with Prader-Willi syndrome. They asked where, how often, and how badly the person picks their skin. They also asked what parents thought was keeping the behavior alive.
What they found
Almost every person had visible skin damage. Fingers, arms, and legs were picked the most. Parents said the picking felt good or sounded like it gave sensory feedback, not attention or escape.
How this fits with other research
Van Houten et al. (1980) warned that self-injury labels carry extra meaning. Capio et al. (2013) listened: they listed each body site and kept the term neutral.
Storch et al. (2012) watched the adults with ID and found self-injury timed other behaviors into neat chains. The PWS survey lines up: parents saw picking happen in regular spots, hinting at the same chain pattern.
Kirby et al. (2016) saw kids with autism seek sensory input most during free play. The PWS families guessed sensory payoff drives picking, so both papers point you to automatic reinforcement first.
Why it matters
Before you write a behavior plan, run a quick sensory test. Place soft fabric or a fidget in the usual picking spot and watch if the fingers go there instead. If they do, you likely found the reinforcer and can build a matched sensory replacement.
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02At a glance
03Original abstract
We examined the topography, severity, potential sources of reinforcement, and treatments utilized for skin-picking behavior shown by individuals with Prader-Willi syndrome (PWS). The parents of 55 individuals with PWS, aged 6-25 years, were interviewed about their child's skin-picking behavior using the Self-Injury Trauma Scale (SIT; Iwata, Pace, Kissel, Nau, & Farber, 1990) and the Functional Analysis Screening Tool (FAST; Iwata, DeLeon, & Roscoe, 2013). Results showed that skin picking in PWS occurred on the extremities (i.e., arms, legs, hands, and feet) for 75% of cases and resulted in bodily injury for 83.7% cases. Skin picking posed a high risk to the individual concerned in 41.8% of cases. Automatic sensory stimulation was identified as a potential source of reinforcement in the majority of cases (52.7%) followed by access to social attention or preferred items (36.4%). Treatments utilized by parents were primarily behavioral strategies (56.3%) followed by basic first aid (54.5%). There were no differences in the topography, severity or potential source of reinforcement between those with the deletion (DEL) subtype and those with the uniparental disomy (UPD) subtype. Taken together, these data indicate that skin picking shown by individuals with PWS is a particularly severe and intractable behavioral issue that may be maintained by (as yet unknown) sensory consequences. Further studies to identify the determinants of skin picking in PWS are therefore needed. The implications for interventions are discussed.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.06.014