Managing Hair Pulling Behaviour

Behaviour of Concern: Understanding & Managing Hair Pulling Behaviour

Hair pulling presents unique challenges in educational settings and requires specific understanding and support strategies. While some children may engage in hair pulling towards others as a form of communication or distress response, others may display self-directed hair pulling (trichotillomania), which requires a distinct therapeutic approach. This article focuses primarily on supporting children who pull others’ hair, while acknowledging the importance of specialist support for trichotillomania.

The Sensory Perspective

Unlike some other behaviours of concern, hair pulling often has a significant sensory component that requires specific consideration. The tactile feedback from hair can be both stimulating and regulating for some children, making it important to understand the sensory aspects of this behaviour.

Sensory Considerations for Hair Pulling Behaviour

• Tactile Feedback: Hair pulling can offer tactile sensations that some individuals find soothing. This physical feedback may help them process sensory information and feel more grounded in their bodies.
• Proprioceptive Input: Engaging in hair pulling can provide proprioceptive input, which relates to the awareness of body position and movement. This can help individuals develop a better understanding of their physical presence and boundaries.
• Visual Stimulation: The act of pulling hair may also create visual stimuli, as the movement and changes in appearance can attract attention. For some, this visual aspect can be engaging and stimulating.
• Tension Release: Hair pulling can serve as a method for releasing built-up tension or anxiety. The action may provide a temporary sense of relief, helping individuals cope with stress or discomfort.
• Sensory Regulation: For some individuals, hair pulling may be a strategy for self-regulating sensory input. This behaviour can help them manage overstimulation or seek out specific sensory experiences that they find calming.
• Deep Pressure Seeking: Hair pulling might be a form of seeking deep pressure, which some individuals find comforting. This pressure can create a sense of security and help in regulating emotional states.

Distinct Features of Hair Pulling Behaviour

Hair pulling differs from other physical behaviours in several key ways:

• Proximity and Social Boundaries: Hair-pulling typically requires close physical proximity, often occurring during intimate social interactions or care routines. This close-contact nature suggests that the behavior may reflect difficulties in managing social boundaries or regulating impulses in close settings. Given this, prevention and intervention strategies that focus on managing close-proximity interactions are particularly important.
• Sensory Preferences and Targeting: Many children exhibit preferences for specific hair types, textures, or even individual people’s hair, indicating a sensory-driven component to the behavior. This sensory aspect can influence when and where hair-pulling occurs and can be addressed by providing alternative sensory experiences or tailored support strategies.
• Emotional Regulation Component: Hair-pulling may also serve as a form of emotional or sensory regulation, especially during moments of stress or overstimulation. Recognizing this component helps caregivers identify underlying emotional or sensory needs, guiding them to offer more targeted support.

Alternative Sensory Experiences

Given the strong sensory component of hair pulling, providing appropriate alternatives becomes crucial:

Offer tactile experiences that provide similar sensory feedback:

1. Textured Materials: Introducing materials like velvet, faux fur, or textured fabric swatches offers tactile stimulation that can mimic the feeling of hair. These materials can be held, stroked, or rubbed, providing a similar sensory experience that may help satisfy the urge to pull.
2. Resistance Bands: Resistance bands allow for pulling, stretching, and manipulating, offering both tactile and proprioceptive feedback. These activities engage muscles and provide tension, which can be soothing for children seeking a strong sensory experience.
3. Stress Balls with Long Fibers: Stress balls with extended fibers or “hair-like” protrusions simulate the tactile sensation of hair, providing a portable and discreet way for children to engage in repetitive pulling motions. These tools can reduce the urge to pull real hair by meeting the same sensory need.
4. Theraputty or Clay: Using materials like Theraputty or modeling clay can be a satisfying substitute, as they can be pinched, stretched, or manipulated to provide strong tactile and resistance feedback. These materials are versatile and allow children to engage their fingers and hands in ways that mimic pulling motions.
5. Safe Pulling Activities: Safe activities such as pulling ropes, bungee cords, or knotted cloth allow children to exert force in a controlled way. These can be used in play or stress-relief activities, redirecting the urge for pulling into a more acceptable and structured form.
6. Weighted Items: Weighted blankets, lap pads, or wristbands offer deep pressure input, which can have a calming effect on the nervous system and reduce the urge for hair-pulling. The consistent sensory input from weighted items may also support emotional regulation and sensory satisfaction over time.

Preventative Approaches

Environmental Modifications

1. Designated Sensory Stations: Set up specific areas in the classroom where children can freely access sensory materials, such as textured objects, fidget tools, and resistance bands. These stations offer an immediate, accessible outlet for sensory needs and provide an alternative to hair-pulling.

2. Clear Physical Boundaries for Group Activities: During group times (e.g., circle time or carpet activities), establish visible boundaries, like colored mats, small cushions, or taped areas on the floor, for each child’s personal space. This structure helps prevent accidental encroachment, reducing the likelihood of impulsive hair-pulling.

3. Personal Space During Transitions: Transitions often involve close contact that may trigger hair-pulling. Organize transitions with staggered timing, or use floor markers to guide spacing. This approach reduces crowding, helping children feel more secure in their own space and less prone to hair-pulling impulses.

4. Use of Visual and Physical Cues: Visual reminders like “personal space” signs or footprints on the floor help reinforce spatial boundaries. Additionally, using furniture strategically to create natural divisions in activity areas can encourage a sense of personal territory.

5. Flexible Seating and Movement Options: Consider seating arrangements that allow children some degree of movement within their space, such as wiggle seats or lap pads. This provides the opportunity to self-regulate within their own area and helps reduce the need for sensory-seeking behaviors like hair-pulling.

6. Sensory Tools During Group Activities: Offer discreet sensory tools (such as small fidgets or weighted items) for children to use during group times. Having access to these tools in structured settings allows children to meet sensory needs safely while participating in activities without risking impulsive behavior.

Specific Strategic Interventions

Building Safe Physical Interactions

Teaching safe physical interactions requires a systematic approach:

1. Start with clear physical boundaries
2. Practice appropriate touch through structured activities
3. Develop understanding of personal space
4. Build awareness of others’ comfort levels
5. Create success with graduated exposure to proximity

Communication Development

Focus on teaching specific communication skills related to:

• Requesting physical contact appropriately
• Expressing need for sensory input
• Indicating personal space needs
• Communicating overwhelm
• Seeking help or breaks

Staff Guidelines

Staff working with children who display hair pulling behaviour need particular guidance on:

Positioning and awareness becomes crucial when supporting children who display this behaviour. Staff should maintain safe distances, be mindful of hair accessibility, and understand specific release techniques. Regular practice of safety procedures helps build confidence in responding effectively.

Risk Assessment: Hair-Pulling Behavior

Immediate Safety Responses: When hair pulling occurs, immediate response requires careful consideration of both the child pulling hair and the person whose hair is being pulled. The immediate priority is to: Ensure medical attention if needed. We have included a fully editable hair pulling behaviour sample risk assessment to download below. In the risk assessment we address:

• Safely disengage the fingers while supporting both parties
• Use specific release techniques that prevent injury
• Maintain calm and clear communication
• Provide immediate regulation support

The assessment outlines key risk factors and strategies to minimise incidents of hair-pulling, focusing on reducing potential harm to children, staff, and others involved in daily activities.

Proximity Requirements

Risk: Hair-pulling typically requires close physical proximity, increasing the risk during interactions where personal space is minimal (e.g., care routines, group activities).

Management Strategies:

• Structured Space Use: Use floor markings or small mats during group activities to provide clear personal boundaries.
• Staggered Transitions: Schedule transitions with spacing guides to avoid crowding.
• Awareness Training: Educate staff on maintaining safe distances during interactions and recognizing signs of sensory or emotional dysregulation that may lead to hair-pulling.

Activity Modifications

Risk: Certain activities (e.g., circle time, sensory play, group movement exercises) may increase proximity and the risk of hair-pulling.

Management Strategies:

• Alternative Sensory Tools: Provide sensory tools such as fidgets, textured materials, or resistance bands as alternatives to satisfy sensory needs safely.
• Individualised Activity Planning: For children prone to hair-pulling, modify activities by offering designated spaces or seating where they can safely engage without close contact.
• Adaptive Physical Activities: Use activities that involve spaced-out movement to reduce opportunities for close-contact interactions.

Personal Protective Equipment (PPE) for Hair Pulling

Risk: In some cases, close supervision or interactions may be required, heightening the risk of hair-pulling for staff and other children.

Management Strategies:

• Protective Hair Coverings: Provide staff members with protective hair coverings or secure hairstyles to minimise vulnerability during high-risk activities. If you need a cap wear a cap.
• Hooded Clothing: Staff and children may wear hooded tops to reduce provide a quick and easy way to hair-pulling when in close proximity.
• Protective Gear Training: Train staff on appropriate use of PPE without causing distress to children, and ensure they know how to maintain a calm response if hair-pulling does occur.

Environmental Adaptations

Risk: In environments lacking clear physical boundaries, children may struggle with spatial awareness, potentially increasing hair-pulling incidents.

Management Strategies:

• Defined Personal Spaces: Use visual cues, such as floor markers, rugs, or small cushions, to establish individual spaces, particularly during group activities.
• Sensory Stations: Designate sensory areas with tactile materials and tools to provide safe outlets for children who seek sensory input through hair-pulling.
• Flexible Classroom Layout: Arrange furniture to create natural boundaries that promote personal space and minimise opportunities for impulsive behaviours.

Support Ratios

Risk: Hair-pulling incidents may be more challenging to prevent or address in larger group settings with limited supervision.

Management Strategies:

• Higher Supervision Ratios: Maintain lower staff-to-child ratios during high-risk times, such as transitions and group activities, to enable quicker intervention.
• Targeted Support for High-Risk Children: Assign additional support or designate specific staff members for children prone to hair-pulling behaviours, ensuring adequate monitoring.
• Proactive De-escalation Training: Train staff in de-escalation techniques, such as distraction and redirection, to prevent escalation when an incident is imminent.

Emergency Procedures

Risk: If hair-pulling results in injury or escalates to a critical situation, a clear emergency response is essential.

Management Strategies:

• Emergency Protocols: Establish protocols for safely intervening in hair-pulling incidents, including calming techniques and methods to gently disengage the child.
• Communication Plan: Implement a communication plan where staff can signal for additional assistance if an incident occurs.
• Incident Documentation: Document incidents of hair-pulling, including triggers, responses, and outcomes, to inform ongoing risk management and support strategies.
• Parent/Guardian Communication: Communicate with parents or guardians about incidents and follow-up actions, ensuring consistent home and school approaches to reducing hair-pulling.

This assessment covers key areas of potential risk and outlines proactive strategies to minimize and address incidents effectively. Let me know if you’d like to delve deeper into any specific points!

Recording and Monitoring

Create detailed recording systems that capture:

The specific nature of hair pulling incidents requires careful documentation to identify patterns and triggers. Include details about:

• Location of incidents
• Preceding events
• Type of hair targeted
• Duration of incidents
• Successful interventions
• Recovery patterns

Working with Occupational Therapy

Collaboration with occupational therapists is particularly valuable for addressing hair pulling behaviour. They can:

• Provide specific sensory assessments
• Develop targeted sensory diets
• Recommend appropriate alternatives
• Guide environmental modifications
• Support staff training
• Monitor intervention effectiveness

Supporting Peers

Develop specific peer support approaches:

Help peers understand and respond appropriately to hair pulling behaviour while maintaining their own safety. This might include teaching simple responses, creating safe distance rules, and building empathy and understanding.

• Teach Safe Responses: Provide peers with simple, positive ways to respond if hair-pulling occurs, such as calmly stepping back, notifying a teacher, or using a designated signal for help. Emphasize staying calm and respectful to prevent escalation.
• Establish Safe Distance Guidelines: Encourage peers to understand and respect personal space, particularly around children prone to hair-pulling. Use visual aids like floor markers or classroom diagrams to help them grasp safe boundaries during group activities.
• Build Empathy and Understanding: Use age-appropriate language to help peers understand that hair-pulling behavior may be a response to sensory needs or emotional challenges. Activities like role-playing or stories can foster empathy and compassion, allowing peers to support one another in a non-judgmental way.
• Reinforce Positive Social Skills: Recognise and praise peers when they demonstrate understanding, respect personal boundaries, and use appropriate responses. Consistent positive reinforcement helps create a supportive, inclusive environment.

Conclusion

Supporting children who display hair pulling behaviour requires a specific, tailored approach that addresses both the sensory and social aspects of the behaviour. Success comes through careful observation, consistent implementation of appropriate strategies, and ongoing monitoring and adjustment of support plans.