In today’s video, I want to talk about ADHD and skin picking — something that comes up far more often than most parents realize.
A parent recently asked me about this. They shared that their child does it, then talked to a friend whose child also has ADHD and does the same thing. Suddenly it turned into a whole group of kids with ADHD who pick their skin. That moment of realization — oh, this is actually common — is something I see again and again.
This Is Not an Imaginary Connection
If your child picks their skin, their lips, or their scabs, this is not an imaginary connection. This is something we see on a regular basis.
And it’s not just a bad habit. It’s not something that if they “just tried harder,” they could stop doing.
My hope is that instead of trying to stop the behavior, we shift toward understanding what the nervous system is asking for — and then focus there. When we do that, we often see improvement in the picking without shame, secrecy, or power struggles.
Along the way, we can also give kids new tools for emotional regulation and body awareness.
What Skin Picking Really Is
Skin picking is a body-focused repetitive behavior. That can include:
Picking scabs
Picking the skin on the lips
Scratching bug bites
Tugging or pulling hair
For many children, this happens automatically. It’s not intentional. They’re not sitting on the couch thinking, “I’m going to pick my skin now to annoy my parents.”
Even though it can feel that way.
This is a behavior, not a character flaw. I always come back to Ross Greene’s idea that kids do well when they can. Kids don’t pick their skin when they can avoid picking their skin.
Why Kids With ADHD Are More Prone to Picking
The biggest driver I see in kids with ADHD is sensory and emotional regulation.
We often focus ADHD evaluations on hyperactivity, impulsivity, and inattention — but a huge and often overlooked piece is emotional regulation. It’s not always visible across the classroom, so it gets missed, even though it affects nearly every area of a child’s life.
When emotional regulation improves, we often see improvements everywhere.
Skin picking can show up when kids are:
Understimulated and seeking sensory input
Overstimulated and trying to self-soothe
Tired, anxious, bored, overwhelmed, or transitioning
The behavior provides feedback to the brain: this calms me down. That relief reinforces the habit — not consciously, but neurologically.
Impulse control also plays a role. Without good “brakes,” kids may not notice the picking until it’s already happening, especially when watching TV or doing something mindless.
In those moments, skin picking becomes a pressure-release valve — a way to regain control and regulation.
Remove Shame First
My first step is always to remove shame.
Comments like:
“Why do you keep doing this?”
“Stop picking.”
“Look how bad your arm looks.”
…don’t help. They increase shame, which increases anxiety — and anxiety makes picking worse.
Instead, I frame it this way: your body is trying to help you feel regulated. Now let’s figure out a safer way to do that.
Replace the Behavior, Don’t Just Stop It
Rather than trying to eliminate picking, we work on replacement strategies:
Keeping hands busy with fidgets, putty, Play-Doh, or textured items
Offering chewable alternatives if chewing is part of the pattern
Identifying high-risk moments (tired, stressed, watching TV)
The goal is to protect the skin while still meeting the nervous system’s needs.
We also reduce triggers:
Improve sleep (this alone makes a huge difference)
Create healthier screen boundaries (not screen-free — just intentional)
Lower overall stress and emotional load
As kids get older, we gently build awareness:
“I notice your hands are busy right now.”
Using a neutral code word instead of calling it out
Later, we can reflect together: What was your body feeling? What helped you stop?
Medications and Supplements
There’s no medication that directly stops skin picking, but some things can help the underlying drivers.
N-acetylcysteine (NAC) is the supplement with the best evidence. It helps modulate the brain’s reward and compulsive loops and has been shown to reduce the intensity and frequency of picking in both kids and adults. We usually start low and go slow due to possible GI side effects.
ADHD medications can either help or worsen picking depending on what’s driving it:
If anxiety or hyperfocus is the driver, stimulants may worsen picking
If impulsivity and emotional regulation are the issue, stimulants may help
Sometimes non-stimulants like guanfacine or clonidine can help by improving emotional regulation and sleep.
Magnesium can also be helpful for calming, sleep, and overall regulation — not specific to picking, but supportive.
The Big Picture
Instead of asking “How do I make this stop?” I encourage parents to ask:
“What is my child’s nervous system asking for?”
When we answer that question, we can put tools in place that actually help — without shame, without punishment, and without making kids feel broken.
Kids do well when they can. And so do parents.
Need More Support?
If your child is having trouble with attention, focus, or ADHD, there is so much we can do to help. We take a whole child approach and use objective data to decide on our ongoing management approach.
Our team is currently licensed in Nebraska, Iowa, Kansas, Illinois, Florida, and Texas.
You can get started here: 👉 https://frontierpediatric.care/contact-us
And if you’re interested in taking my ADHD Profile & Compass, you can learn where your child falls across all four ADHD domains — hyperactivity, inattention, executive function, and emotional regulation — here: 👉 https://drphilboucher.com/adhdcompass
~Dr. B
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