Early childhood trichotillomania (TTM) has often been considered to be benign. However, untreated early childhood TTM can have significant negative physical and psychological consequences. This report describes the behavioral treatment of a 29-month-old girl with TTM. Treatment consisted of 14 daily sessions of behavioral intervention, followed by 3 consecutive days of follow-up treatment conducted 7 weeks after the end of initial treatment. The hair pulling was addressed by using reinforcers for not pulling, provided at intervals of increasing length. At the end of initial treatment, the hair pulling improved significantly. At follow-up, although some of the initial treatment gains were reduced, the patient maintained significant improvement compared with baseline.
"The research has shown that this early-onset version of TTM is equally prevalent in both genders (Tay et al., 2004; Whiting, 1999). Early-onset TTM can be more benign (Reeve, 1999; Walsh & McDougle, 2001) and time limited (Swedo & Leonard, 1992; Walsh & McDougle, 2001), and may respond well to behaviorally oriented psychotherapy (Byrd, Richards, Hove, & Friman, 2002; Rahman, Toufexis, Murphy, & Storch, 2009; Watson et al., 2000). Treatment is often recommended to prevent negative psychosocial or physical outcomes (Watson et al., 2000). "
[Show abstract][Hide abstract] ABSTRACT: Trichotillomania (TTM), or compulsive hair pulling, is a disorder that typically onsets in childhood. It is mistaken to believe that children will "age out" of this behavior, as pediatric TTM often has a chronic, debilitating course that does not remit without treatment, resulting in considerable psychological and physical impairment. Because most children with TTM will be seen initially by nursing professionals in the practices of dermatologists, pediatricians, gastroenterologists, and other disciplines, raising nurses' awareness of this disorder is of the utmost importance for accurate nursing diagnosis and assessment. As the health care providers who spend the greatest amount of time with patients, nurses' detection and diagnosis of TTM can make a critical difference in the initiation of early intervention. Therefore, the purpose of this article is to provide an overview of pediatric TTM, including its epidemiology, clinical presentation, and treatment options, from the perspective of nurses who may interact with such patients in their workplace.
[Show abstract][Hide abstract] ABSTRACT: Trichotillomania (TTM) is characterized as an impulse control disorder in which individuals fail to resist urges to pull out their own hair, and is associated with significant functional impairment and psychiatric comorbidity across the developmental spectrum. Onset in childhood or adolescence appears to be the norm, yet the research literature involving pediatric samples is particularly sparse. Efficacious treatments have been developed, in particular cognitive-behavioral interventions involving procedures collectively known as habit reversal training, yet relapse in adults appears to be common. Recent developments in pharmacotherapies for TTM and in combining cognitive-behavioral therapy approaches with medication hold promise, and efforts to examine their relative and combined efficacy are needed. Dissemination of information about TTM and its treatment is a critical next step in the field, since many affected individuals and families cannot find local treatment providers with sufficient knowledge to deliver interventions known to reduce hair pulling behavior.
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