Psycho-therapeutic approaches for school-aged children with hair-pulling behavior

Abstract

Hair-pulling disorder (HPD: trichotillomania) is a psychological condition that generally starts in childhood, and results in hair loss or thinning. Some behavioral approaches, including habit reversal training, are known to be effective for pediatric HPD, as they result in decreased hair-pulling behavior. However, very little is known about the treatment for those with chronic pediatric HPD who do not respond to behavioral approaches. In order to investigate better treatment approaches for pediatric HPD, we assessed the characteristics and the treatment of 9 school-aged outpatients, 6 months after their initial visit to the department of child psychiatry. Supportive and behavioral approaches including psychoeducation were shown to be effective for 4 patients without ASD (autism spectrum disorder). For one patient with ASD, a multi-dimensional approach was needed, which included collaborative care at school as well as for family support, and play therapy. The remaining 4 chronic HPD patients (two patients with and two without ASD) also needed a multi-dimensional approach. Our study suggested that essential treatment strategy for pediatric HPD should be supportive and behavioral at the beginning of treatment. For those with chronic HPD, the comorbid ASD should be assessed along with providing a multi-dimensional approach, including collaborative care with educational or welfare staff.