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

We present the case of a 17-year-old girl with Asperger syndrome and borderline intellectual dis-ability 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 interven-tion, 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 effec-tive 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