Treatment of Chronic Skin-Picking in an Adolescent With Asperger Syndrome and Borderline Intellectual Disability

Abstract

We present the case of a 17-year-old girl with Asperger syndrome and borderline intellectual disability with a 5-year history of chronic skin-picking. Our intervention approach included an initial functional assessment to identify variables maintaining skin-picking, followed by evaluation of a behavioral treatment package. Results of the functional assessment suggested that skin-picking was maintained by automatic reinforcement in the form of tactile and visual stimulation. The intervention, consisting of an antecedent control procedure (covering areas with bandages) and differential reinforcement, was evaluated in an ABAC single-case experimental design. The number of open sores decreased from an average of 37 in baseline to zero during intervention. No new sores were found 4 months following intervention. These results suggest that the treatment package was effective in reducing skin-picking and that the treatment effects were maintained, but it was not clear if both treatment components were necessary and/or sufficient for behavior change.