Why Kids with ADHD Pull Their Hair Out & Pick Their Skin

When parenting complex kids, there have definitely been times when tearing my hair out seemed like a perfectly reasonable – if not the healthiest – reaction to the latest home challenge!

But I never realized that many kids with ADHD pull their hair out because of boredom!

For kids with ADHD, chronic hair pulling and skin picking doesn’t necessarily mean they are stressed out or upset. Lots of complex kids (and neurotypical kids for that matter) are not even aware that they are pulling their hair out as a kind of fidgeting behavior. It’s not unusual for kids to be completely unaware of the severity of this habit until visible bald patches appear, or they’ve picked their face or fingers to the point of bleeding and scarring.

The first time our now 13-year old with ADHD & Autism showed us a bald spot on his head, he could not explain how it had happened. A sensory-sensitive guy, he’d mentioned feeling like his hair texture had suddenly changed in select spots (gone from straight to coarse and curly). Perhaps it had just fallen out?

Since we didn't know that many kids with ADHD pull their hair out, and this was our first experience with it, we were baffled by the mysterious hole in his hairstyle and promptly hauled him off to the pediatrician for an evaluation. Our biggest concern was that he was malnourished (despite our best efforts, he prefers a diet of carbs enhanced by multivitamins). Honestly, we worried that his hair loss was a tangible result of our failure to convince him to eat a nutritionally balanced diet.

The pediatrician seemed unconcerned, and assured us that our son was not showing signs of poor nutrition (thank goodness!). He encouraged us to wait and see if it happened again.

Sure enough, 2 weeks later, the second bald spot appeared. A week after that, half of our son’s right eyebrow went missing. A visit to the therapist confirmed what we were all coming to suspect. Our son was pulling out his hair -- literally.

But here's the surprise: for the most part, he was completely unaware that he was doing it!

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Body-Focused Repetitive Behaviors

As it turns out, Body Focused Repetitive Behaviors (BFRBs) are really common. Estimates vary, but roughly 3-6 million people nationwide have been diagnosed with Trichotillomania, or ‘Trich’ (hair pulling.)

According to Carla C. Allan, PhD, Director of Psychological Services at Children’s Mercy Hospital’s ADHD Specialty Clinic in Kansas City, kids with ‘Trich’ pull their hair out for all kinds of reasons. For example, they might be seeking sensory input during states of boredom, seeking symmetry, or feeling that some quality or property of the hair is not “quite right.” Many times, people that engage in hair pulling rituals will tell you that they feel some sense of relief after engaging in that behavior.

As you might expect, kids with ADHD pull their hair out because, by definition, they have a self-control deficit. Though in some cases, ‘Trich’ can also be an indicator of an additional underlying disorder, like OCD (obsessive compulsive disorder) or BMD (body dysmorphic disorder.) Rarely, there are also reported cases of 'Trich' developing as a side effect of starting amphetamine-based stimulant medication, though it's important to note that hair pulling symptoms resolved completely when the child was switched to methylphenidate-based or SSRI based therapies. If you notice your child is starting to pick or pull, check with your doctor to be sure.

Successful Treatment – Habit Reversal Training

The good news is that 'Trich' and similar disorders are highly treatable with Cognitive Behavioral Therapies like Habit Reversal Training or Comprehensive Behavioral Intervention for Tics. Dr. Allan says, "These treatments are extremely effective when the child and family are ready to make changes." Not surprisingly, she continues, "Parents play a critical role in helping their child or adolescent develop an awareness of hair pulling (many kids with ADHD lack insight into their own patterns & triggers), in addition to providing rewards for completing therapy homework and daily skills practice."

In Habit Reversal Training, the child finds a replacement behavior (like using a fidget toy, sitting on hands, or crossing arms) that makes it more challenging to default to hair pulling. For some kids, this is harder than it sounds.

Requirements for Change

The critical success factor in any type of behavioral therapy is that the child/family be ready to make changes. Although mystified by his ‘sudden’ hair loss, our 13-year old son doesn’t feel like the bald spots on his head are dramatically impacting his quality of life. Even though his teachers and friends at school have noticed and asked him about the bald spots, he doesn’t see why it’s such a big deal.

But once hair pulling becomes an ingrained behavior, it only gets worse over time. So, with the help of our therapist, we made a deal with our son. We clearly agreed upon the point at which his hair pulling would be severe enough to begin Habit Reversal Therapy. (In case you’re wondering, it’s when he has 4 or 5 dime-sized bald spots that ‘appear’ in less than a month’s time.) I’m cringing a bit as I share this – I really hope we don’t get there!

And now, because kids with ADHD also lack self-awareness, we’re photo-documenting his hair journey so he can see just what the spots look like and track the changes.

So, if you’re starting to wonder if your child has mange or is in danger of becoming completely bald, remember this: many kids with ADHD pull their hair out. Hair pulling and skin picking are incredibly common. Happily, they are also very treatable once you’ve identified the cause!