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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
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Experience:  MD Psychiatry
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My 8-year-old son started pulling his hair out a few weeks

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My 8-year-old son started pulling his hair out a few weeks ago. I caught him pulling out his eyebrows, and now he has a bald spot in the front of his head. He has been diagnosed with ADHD and uses a transderma Daytrana 25mg. patch to help control symptoms. Could this be a side effect of the meds? Nothing in his life has changed. We are a stable family. He enjoys going to school, but does not do very well because of his inattentiveness. Could it be anxiety induced? Any advice you have would be most appreciated.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 1 year ago.

Hi there,

 

Welcome !

 

I am so sorry to hear about your son's problem, but before i answer your query , i will like to ask you a few queries so as to gain more insight into his problem.

 

1) Since how long a duration ( days/ weeks ) has he been plucking hair ?

 

2) does he say that he gets an irresistable impulse to pluck hair which compels him to do this act ?

 

3) what does he do with his plucked out hairs? does he eat it also ( i know this may sound bizarre but i am trying to reach to a diagnosis for his condition , so kindy answer )?

 

4) since how long has he been on the daytrana patch?

 

5) other than plucking hair , are there any other abnormalities that you have noticed in his behaviour , like being aggressive , violent , disrespectful towards seniors / elders, does not conform to the norms / regulations , muttering to self , doing bizarre hand movements or having vacant stares at ceiling or to a wall for long periods?

 

I will get back to you once you reply to my query.

 

Regards..

 

Customer: replied 1 year ago.

Duration has been approximately one month, give or take a couple weeks. He won't talk about it. He just says his eyebrows are getting in his eyes or his hair is too long (both nonsense). He has been on the Daytrana patch for 7 months. He does not, to my knowledge, eat the plucked hairs. He doesn't have symptoms of autism as you describe above- my other son has severe autism and epilepsy- and my 8 year old has been closely watched. He is basically a good kid- no trouble at school, can be a bit disrespectful, dishonest, and defiant with us, but nothing else. Thanks!

Expert:  Dr. Kaushik replied 1 year ago.

Thanks for the inputs..

 

Well from what you have narrated in response to my queries , it seems like your son has developed a condition called as Trichotilomania , which is a type of Impulse control disorder which is characterised by such kind of plucking of hair fromt he scalp, eyebrows , eyelashes and even other parts of the body.

 

I am sending you a link below for bettr understanding of this condition..

 

http://www.mayoclinic.com/health/trichotillomania/DS00895

 

So far it is not documented that trichotilomania can be precipitated the use of a psychostimulant drug like daytrana patch which has methylphenidate as an active ingredient , but i will not like to discount this drug as a possible reason for the start of this kind of bizarre behaviour because this drug has been associated with many types of bizarre behaviours as it's side effects , so we shall consider this drug induced behaviour problem as one of the differential diagnosis , the other being idiopathic trichotilomania ( cause unknown).

 

Now the solution to this problem is that had this problem started below 6 yrs of age , there were fair enough chances for it to subside within a 12 month period on it's own but the problem is that your son is 8 yrs of age , so an active intervention is warranted.

 

So i will suggest you to get him evaluated from a child psychiatrist for Trichotilomania along with the discussion regarding the daytrana patch being the preciptating factor ( it takes a while , say weeks to even months to produce side effects , so although this drug has been there for 7 months , it may precipitated such a delayed side effect now ).

 

As far as treatment of this condition is concerned , you have two options..

 

1) Counseling , which is considered as the first choice of treatment for managing this condition, which entails use of a specialized counseling technique called as CBT ( Cognitive behvaiour therapy ) and Habit reversal theraapy , which may be offered by a child psychiatrist or a child psychologist and this usually proves to be effective in managing this kind of behavioural problem , taking weeks to even months to control this behaviour.

 

2) Drug therapy is a second option for managing this condition which is used only when the first option mentioned above proves to be ineffective or the condition is getting out of control and becoming very severe , then drug therapy shall be used along with the counseling. Usually in kids , age compatible dose of ssri anti depressants like lexapro or prozac or zoloft with ver low dose of an anti psychotic drug shall be used to control this behaviour problem.

 

So kindly get your child evaluated for this condition of trichotilomania from his child psychiatrist who has diagnosed his ADHD ( if there is none , then consult a child psychiatrist), i am sorry but he is unlikely to grow out of this behaviour , so it is better to be evaluated by the expert. Also discuss with the doctor the treatment options i have mentioned here.

 

I hope this helps..

 

Wish you all the best.

 

Please kindly leave a Positive rating if you are satisfied with the answer as only then will i be credited for my service.

 

Regards..

Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4022
Experience: MD Psychiatry
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