Nose picking (may be TMI / gross)

SueBear

DS is in 3rd grade and has Sensory Processing Disorder (non-ASD). 

DH and I noticed in the past that he picks his nose.  When he does, he really is not discreet uses his whole finger, but I would say the frequency was "every so often" - not something that is a habit or frequent.

However, I spoke to his teacher who told me that DS picks his nose A LOT.  So much that the other kids are going to not want to work with him.

He is in a mainstream classroom and shares an aide with another student.  Aside from that he has OT and speech and an after-school social skills group.

I read on the internet that it could be a habit, and in the past DS has had other habits like twirling his hair, chewing his shirt, coughing.  A number of sources recommended giving him some kind of koosh ball or other sensory item.  For the most part, DS does not do this at home, where we let him hold objects he likds and tap them.  But I'm not sure if giving him a ball or other toy will go over with his teacher - obviously it is better than picking, but obviously it makes DS different.

Any suggestions on how to cure this habit, particularly when I am not around to stop him?  I feel so - defeated.  DS has made great progress with social skills, participating and curbing his anxiety, and now he is doing something that is really going to alienate him from other kids.

MirandaHobbes

Ugh, my son is a picker too- and not discreet at all! It's a total habit. He's in kindy but he's done it a LOT in preschool and his teachers were really hardcore about making him was his hands every single time they caught him do it. It made him more conscious and aware that he was doing it. He complains to me now that "but I have dried up mucus in my nose!" I make him go get tissue and blow his nose and usually the effort of having to do all that makes him stop or forget about it.

SueBear

-auntie- said:

SueBear said:

DS is in 3rd grade and has Sensory Processing Disorder (non-ASD). 

Does he have any other comorbid dx? You mention social skills group and anxiety which are often seen with comobids with SPD like ASD, GAD or ADHD rather than SPD itself. Is he served by an IEP?

Per our specialist (pediatric neurologist) - He does not have another dx.  He is not on any medication (the doctor is anti-meds in general, which is not why we chose him but just the way he is). When he was diagnosed with sensory issues, I had taken DS in expecteding to have him diagnosed with ASD.  The specialist said DS had SPD but he could not tell if it was ASD-related or not, and we had to wait an extra 9 months and an additional test for ASD and was told his sensory issues were not part of ASD, just SPD.  He was not diagnosed with anxiety disorder.  I mentioned DS' anxiety to his specialist and he told me that the sensory issues cause the anxiety - when the sensory issues are taken care of (for example through OT), the anxiety will decrease (although there may always be issues).  I was also told that while DS has problems focusing, that is also due to his sensory issues (external), not to ADHD (internal).  The doctor pointed out in a quiet room with little stimuli, DS is not distracted, even when there are a number of items in the room that an ADHD kid could be distracted by (computers, medical equipment, scales, games, etc).

This was all done AFTER he was tested by the school.  The school diagnosed DS with PDD-NOS (which was the result of a 1/2 hour q&a with a psychiatrist and according to the specialist is an outdated dx, but I why DS qualifies for an IEP, OT and social skills class).  

FWIW, I had never heard of SPD before taking DS to the specialist and assumed it was ASD.  I'm a bit confused about the distinction, to be honest.  I don't want to seem in denial about being non-ASD (because I'm sure most people assume DS is on the spectrum anyway) but if there is a different way to approach DS's problems depending on the diagnosis, I wanted to make it clear. 

DS has an IEP. 

DH and I noticed in the past that he picks his nose.  When he does, he really is not discreet uses his whole finger, but I would say the frequency was "every so often" - not something that is a habit or frequent.

However, I spoke to his teacher who told me that DS picks his nose A LOT.  So much that the other kids are going to not want to work with him.

This is a huge issue by 2nd/3rd grade; it's very stigmatizing at this age. Kids and their teachers are going to be put off out by the behavior. This is even something the schools work on around prevention of passing germs and flu around.

I know.  That is why I am want to put an end to it. 

He is in a mainstream classroom and shares an aide with another student.  Aside from that he has OT and speech and an after-school social skills group.

Why is he getting speech and social skills? SPD doesn't usually require these.

DS was getting speech because he has articulation problems.  He talks like Elmer Fudd ("I am going to hunt wabbits")  I was told that "speech is movement" and like OT for his hands and fingers, motor skills improvement for his mouth is needed for speech.  He did not have a speech delay, although his "first words" I recorded were on the late side of average (14 mos) - I think this is because even though he was speaking, I did not understand what he was saying. 

From what I observe at home, he does not have sensory issues with his mouth (meaning, the taste or texture of foods does not bother him more than an average kid), BUT his problems with audio processing may affect his speech.

Sensory issues contributed to DS' social skills issues.  He doesn't like being touched / crowded and doesn't like loud noises / a noisy atmosphere.  When he was in K, he would hide under his desk when it was loud and to separate himself from others in the chaotic atmosphere of 5 year olds.  As he has gotten older and in classrooms where children are expected to be quieter and respect personal space, he has had fewer and fewer issues socially, but is still for lack of a better word "different" because of his need to bang things, his lack of coordination, his tendency to avoid new activities (because, I was told, just being in a classroom and managing his sensory issues is hard enough). 

Social skills also addressed speaking up in class and coached him to speak up.  DS would never raise his hand and speak up in class, although he knew the answers and would answer when called on.  Last year he raised his hand and spoke up and the teacher nearly fell out of her chair.  This year he never shuts up,lol, but the nose thing is a new problem. 

I read on the internet that it could be a habit, and in the past DS has had other habits like twirling his hair, chewing his shirt, coughing.  

In the world of ASD, these behaviors would be seen as a stereotypy- a stim/repetitive behavior. Sometimes coughing and throat clearing can be tics- does he do any other funny sounds or physical movements? Tics and stims are treated very differently, so it might be important to discuss these with his medical or psychological team. Generally, if a child is stimming because of an ASD, you can redirect the stim by offering another activity that would provide a similar tactile experience- these would be the Koosh balls (assuming they're allowed in your school- some schools can't have Latex because of allergies). Stims can also be faded entirely- as they're stigmatizing or restricted to a set time and/or place. If the nose-picking is a stim, you could replace it with nose blowing or restrict it to the privacy of the boys room. If he has allergies or a dry nose, saline spray may get him over the hump of feeling the need to pick.

Tics are ignored, no attention is called to them. Sometimes tics increase after an illness or under stress. Picking isn't going to be a tic, but the cough could have started as part of a viral illness and hung on as a tic. Kids can have both tics and stims.

I was told that the coughing was a tic.  It started off as post-nasal allergies, but long after allergy season ended he was still coughing.  He doesn't make any other sounds.  Last year, the coughing went away, but then was replaced by chewing his shirt. 

DS seeks tactile stimulation by banging or shaking objects (sticks, toys) and when he goes to bed it could be 100 degrees out and he would keep a heavy blanket on.  He does flap his hands when he is super-excited, but that is rare.

The other habits he does not do at home (chewing shirt, twirling hair).  I'm not sure if that is because school is a more sensory-rich environment with more stimuli that he needs to deal with, because he does or because of the anxiety that he has around other people and it is his way of coping. 

It is sometimes hard to know what is going on with DS because he is one way at home and completely different in the classroom.   

 A number of sources recommended giving him some kind of koosh ball or other sensory item.  For the most part, DS does not do this at home, where we let him hold objects he likds and tap them.  But I'm not sure if giving him a ball or other toy will go over with his teacher - obviously it is better than picking, but obviously it makes DS different.

He is different. Having a fidget different is better than nose-picking different. 

You are right.

If it's in his IEP, to have a "fidget" the teacher has to allow it. Best to settle on something that meets his needs to redirect him from picking but not exciting enough to distract him or others. Sometimes something very small like little rubber erasers in his pocket could be enough. Having a Sit'n'Fit or bands on his chair legs to push could be a redirection. A weighted vest might help him settle.

It is not in his IEP, because this wan't an issue before, but his teacher is very accomodating.  I will try out some items and see what works.

Any suggestions on how to cure this habit, particularly when I am not around to stop him?  I feel so - defeated.  DS has made great progress with social skills, participating and curbing his anxiety, and now he is doing something that is really going to alienate him from other kids.

Talk with his team. I know this is humiliating as a parent, but putting a plan together with the teacher and his team can make a huge difference. DS was a picker, he actually had anti-nose picking IEP goals. For DS, a big piece was that he didn't have the Theory of Mind to "get" how repulsive this behavior was to others and how it made them feel towards him. This is a classic ASD spin on the behavior; MGW Social Thinking really helped in this regard. Is your social skills leader using this curriculum?

I'm not sure, I would have to ask.  His social skills leader is the school social worker. 

That you so much for all of the information and guidance!