A Parent Guide For Success Effective Parenting Strategies for Children With Trichotillomania and other BFRBs Presented by Suzanne Mouton-Odum, Ph.D. for the Austin Trich Support Group Austin, Texas February, 2014

Goal of This Talk Today: To help you develop compassion for your child and to teach you effective ways to be helpful in dealing with BFRB issues. Common mistakes parents often make.

Different Ages and Different Stages of Trich –Toddler –Elementary Age –Middle School Age –High School Age

Different Ages and Different Stages of Trich –Toddler Mommy and daddy are in control of changes. Toddlers tend to be more amenable to change. Toddlers are learning every day. Parents control the schedule. Have fun!

Different Ages and Different Stages of Trich –Elementary Age Mommy and daddy are still in control of changes, but less so. May not care about bald spots/scabs. Usually concerned about pleasing parents. Parents have less control over the schedule. Keenly aware of parent reactions.

Different Ages and Different Stages of Trich –Middle School Age Start of independence. Beginning to care about bald spots/scabs. Not as concerned about pleasing parents. Parents have much less control over the schedule. Keenly aware of parent reactions and how to manipulate situations to their advantage.

Different Ages and Different Stages of Trich –High School Age High need for independence. Can be very concerned about bald spots/scabs. Not as concerned about pleasing parents. Parents are much less involved in therapy. Power struggles abound! Need for social acceptance.

What are Key Elements of Good Treatment? Find a therapist who will: 1. Take a comprehensive approach:  Sensory triggers  Cognitive beliefs  Affective cues  Motor behaviors  Place (Situational cues) 2. Treat the child as a whole person. 3. Understand the developmental issues. 4. Address family dynamics. 5. Treat co-morbid conditions and co- occurring events.

How to Help, Not Hurt: Advice for Parents  Be patient, change is a process  Accept your child with a BFRB- she is more than just hair and clear skin!  “Release,” don’t “police” as much as you want to, you can’t control this!  Shift your focus to other aspects of your child  Love unconditionally  Get support for yourself

How to Help, Not Hurt: Advice for Parents Focus on loving you child:  Recognize their strengths and abilities  See them as a whole, not simply as “having hair/clear skin or not”  Acknowledge your reactions, feelings, frustrations and learn how to better cope with them  Realize that hair pulling is ADAPTIVE, your child is pulling or picking because it is helping them in some way  Don’t nag or shame your child

How to Help, Not Hurt: Advice for Parents  Assess Motivation: Who is more motivated…you or your child?  Assess Readiness: Is your child ready to make a change?  Reduce/eliminate conflict and power struggles around hair pulling/skin picking (there are plenty of others)  Ask yourself, “What do I want for my child?”

How to help, Not Hurt: Advice for Parents Strategies for change: Let go, don’t nag. Focus on the positive aspects of your child, e.g., her successes (sports, music, riding a bike, being funny, academics, theater). Reward the use of strategies, not hair growth/skin healing. Ask your child how you can help (let them drive the nature of the support) View recovery as a process, not a goal. Focus on your child, not their hair/skin.

Common Questions Do we tell family members? Did I cause this? Do BFRBs lead to “worse” things? Should we tell the school? Should we tell our friends? Should my child tell his/her friends? What do I say when someone we don’t know asks what is wrong with our child? Should we purchase a wig?

Common Questions What should my child say when another child asks them what is wrong with their hair? Are wigs and hair extensions a crutch? What if s/he is not using the strategies? What if my child is untruthful about pulling/picking? Will medication help? Will this ever go away?

Moving forward Consult with TLC to find a trained therapist in your area (ideal). Find a cognitive-behavioral therapist who is willing to learn about treatment for BFRBs. Educate your therapist about training opportunities (PTI) and books/articles. Work on yourself and any issues you may have regarding trich/behavior/control/shame. Get support for yourself (parent groups, list serves, therapy). Think about what is best for you and your family, is now the best time?

Resources TLC A Parent Guide to Hair Pulling Disorder The Hair Pulling Habit and You: How to Solve the Trichotillomania Puzzle PullFree (a mobile app)