Clinical Characteristics, Sleep, and Temperament in Infants and Young Children with Problematic Hair Pulling and Skin Picking.

Abstract

This study examined clinical characteristics of problematic hair pulling (HP) and skin picking (SP) in infants and young children and their association with self-soothing, sleep, and temperament. An internet survey of parents/caregivers of 0-5-year-olds (n = 384 with data analyzed, of whom 26 experienced HP, 62 experienced SP, and 302 were controls free of HP and SP) assessed demographics and medical history, HP and SP characteristics, contextual factors, self-soothing, sleep patterns, and temperament. Participants were recruited through both HP and SP advocacy and support webpages and general webpages (e.g., parenting groups). Descriptive statistics, chi-square tests of independence, independent samples t-test clinically characterized HP, SP, and control groups. Logistic regression and one-way analysis of covariance controlled for sex and age in analyses. HP and SP rates were 6.1% (n = 26) and 14.5% (n = 62), respectively. SP presented in 23.1% of children with HP, and HP presented in 9.7% of children with SP. Mean HP and SP onset occurred at 12.2 (SD = 11.2) and 24.1 (SD = 15.8) months, respectively. Contextual factors, including boredom, upset, and awake-in-bed were common in HP and SP. Common caregiver responses included distracting the child, moving the hand away, and telling the child to stop. Few caregivers sought professional help for the child. Children with HP engaged in more hair twirling than controls, and children with SP engaged in more nail biting than controls. Children with HP, but not SP, had more sleep disturbance than controls. In terms of temperament, children with HP displayed sensitivity to stimuli, children with SP exhibited low persistence, and both HP and SP groups displayed serious, observant mood relative to controls. Findings expand clinical understanding of HP and SP in children aged 0-5 and provide targets (contextual factors, sleep, sensory sensitivity, persistence, and mood) for behavioral interventions. Low rates of treatment seeking highlight the need for expansion of clinical guidelines for HP and SP in this age range.