Experimental functional analysis of severe skin-picking behavior in Prader-Willi syndrome.
Skin-picking in Prader-Willi syndrome is usually driven by its own sensory feedback, so swap in matched sensory items instead of social praise.
01Research in Context
What this study did
Levin et al. (2014) ran functional analyses on skin-picking in people with Prader-Willi syndrome. They wanted to know if the picking is driven by social attention, escape, or automatic sensory input.
Twelve participants took part. The team compared alone, social attention, demand, and play conditions. They counted how often each person picked their skin in every condition.
What they found
Eight out of twelve showed clear automatic reinforcement. Their picking stayed high even when no one was in the room.
Four people had low, flat rates across all conditions. The behavior did not jump when staff gave attention or tasks.
How this fits with other research
Jeglum et al. (2022) extends these results. They treated an adult with ASD whose skin-picking was also automatic. Non-contingent competing stimuli cut the behavior to near zero for five months.
Adams et al. (2021) also extends the picture. Parents in their study said they mainly use distraction to stop picking. The 2014 data now tell us why distraction helps: the behavior is sensory, not social.
Carr et al. (2002) used the same analysis method on self-injury in Lesch-Nyhan syndrome. Both papers show functional analysis works even when the topography and syndrome are rare.
Why it matters
If you work with Prader-Willi syndrome, plan sensory-based plans, not social rewards. Offer fidget bands, textured toys, or hand lotion before the urge starts. Track which items compete best and keep them easy to grab across rooms.
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02At a glance
03Original abstract
Skin picking is an extremely distressing and treatment resistant behavior commonly shown by individuals with Prader-Willi syndrome (PWS). However, with the exception of a limited number of published single-case and survey studies, little is known about the environmental determinants of skin picking in this population. In this study, functional analyses were conducted with thirteen individuals with PWS, aged 6-23 years, who engaged in severe skin-picking behavior. In addition to the conditions typically employed in a functional analysis (i.e., alone, attention, play, demand), we included an ignore condition to examine potential effects of stimulus control by the presence of an adult. Twelve participants engaged in skin picking during the functional analysis, with the highest levels occurring in the alone and ignore conditions for eight participants, suggesting that skin picking in these participants was maintained by automatic reinforcement. For the remaining four participants, an undifferentiated pattern of low-rate skin picking was observed across conditions. These data confirm previous studies indicating that skin picking in PWS may be maintained most often by automatically produced sensory consequences. There were no associations between demographic characteristics of the participants (e.g., sex, age, IQ or BMI) and levels of skin picking observed in the functional analysis. Additional investigations are needed to identify the nature of the sensory consequences produced during episodes of skin picking in PWS. Behavioral interventions designed to extinguish or compete with the potential sensory consequences arising from skin picking in PWS are also warranted.
Research in developmental disabilities, 2014 · doi:10.1016/j.ridd.2014.05.025