Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: a systematic review.
Skin-picking in DD responds to mixed behavioral packages, but only 16 small studies exist, so keep testing and sharing data.
01Research in Context
What this study did
Lang et al. (2010) hunted for every paper that tried behavioral tricks to stop skin-picking in people with developmental disabilities.
They found 16 tiny studies. Each one mixed tools like toys, gloves, praise, or brief restraint. No drug trials were counted.
What they found
All 16 studies said the behavior dropped, but the proof was weak. Samples were small and most lacked follow-up.
The team could not name one best package. They simply noted that combos of reinforcement plus blocking looked helpful.
How this fits with other research
Luiselli (1989) is inside Russell’s pile. One teen wore gloves right after picking. The behavior stayed low for three months, giving the review a rare long win.
Porter et al. (2008) also sits in the review. Five adults got acceptance-enhanced habit reversal. Picking fell no matter if ACT or HRT came first, showing order may not matter.
Diz et al. (2011) looked at pica instead of skin-picking but used the same rule book. They stamped behavioral packages as “well-established,” a stronger label than Russell could give skin-picking. The gap hints that pica simply has more studies, not better tricks.
Why it matters
You now know the skin-picking playbook is thin. Borrow tactics that work for neighbors: gloves after the response, brief RIRD, rich sensory substitutes, and sturdy data sheets. Run quick probes, watch for auto-reinforcement, and publish your numbers so the next review can finally say “well-established.”
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02At a glance
03Original abstract
Skin-picking is a type of self-injurious behavior involving the pulling, scratching, lancing, digging, or gouging of one's own body. It is associated with social impairment, and increased medical and mental health concerns. While there are several reports showing that skin-picking is common in individuals with developmental disabilities, knowledge about effective treatment approaches is sparse. We therefore reviewed studies involving the treatment of chronic skin-picking in individuals with developmental disabilities. Systematic searches of electronic databases, journals, and reference lists identified 16 studies meeting the inclusion criteria. These studies were evaluated in terms of: (a) participants, (b) functional assessment procedures and results, (c) intervention procedures, (d) results of the intervention, and (e) certainty of evidence. Across the 16 studies, intervention was provided to a total of 19 participants aged 6-42 years. Functional assessment procedures included direct observations, analog functional analyses, and functional assessment interviews. The most commonly identified function was automatic reinforcement. Treatment approaches included combinations of differential reinforcement, providing preferred items and activities stimuli (e.g., toys), wearing protective clothing (e.g., helmets or gloves), response interruption and redirection, punishment, and extinction. Improvements in behavior were reported in all of the reviewed studies. Suggestions for future intervention research are offered.
Research in developmental disabilities, 2010 · doi:10.1016/j.ridd.2009.10.017