Trichotillomania

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She already does sing when she washes her hands. Someone told her to sing happy birthday to get her hands clean and now she ritualistically does it every time. She sings Happy birthday to rinse, then sings it again while sudsing, then again while rinsing.

I know that this probably is OCD related. I don't know how to get through to her that it will be ok if she doesn't do it.

I know a little about this as I have some OCD tendencies myself. I keep them in check for the sake of making things normal for her but I know she does have the genetics for these things to become worse. I also know the OCD could be part of her inability to sleep at night, I have had chronic insomnia my whole life and cannot seem to shut my brain off at night.

We do what we can and take one day at a time....

I developed trichotillomania in middle school and mostly stopped pulling around the end of high school. That is, I don't have bald patched on my head anymore and I have my eyelashes/brows back, but, truthfully, I never stopped pulling from other places on my body.
Some of the impulse to pull is caused by anxiety (for me), some of the impulse is chemical. As previously stated, there are chemicals released when you pull, serotonin is likely one of them (thus the ssri). My psychiatrist prescribed a very low dose of seroquel with my SSRI when I was diagnosed and I went off of it a few years ago. (Use caution with something like seroquel. I don't even know if it can be prescribed to young children, but it does cause drowsiness and it can cause other more serious side effects- it is an atypical antipsychotic- I swear the chemistry makes sense)

A lot of what helped me was CBT and behavior changes. I started carrying around a nut an bolt to fiddle with when I had the urge. It didn't replace the sensation of pulling (which is at least two fold 1)the sensation of seeking out the 'wrong' hair and 2) the sensation when you actually pull it, but I was able to distract sometimes.

I'll be honest. It took years for me to isolate any pulling behavior to less noticeable places (ie legs) and away from my head. But My pulling in general is less frequent and doesn't cause quite as much anxiety because others don't have a way of knowing about it. (The pulling itself actually felt good, not like it hurts and was usually while I was 'zoning'- it's the bald spots that caused anxiety).

If I have an attack, it is usually prompted by stress (but I didn't have to be in a heightened state of arousal at the time), so I definitely recommend the therapy route in collaboration with medication. I hated it at the time, but my mom used to discreetly tell me to stop if she caught me. I don't know if that helped or made me more nervous. Something that mimics the sensation of pressure being released might help (like bubble wrap..if the noise isn't a problem, or some sort of switch or something from a hardware store that she could manipulate with her hands- she could pick it out).

I feel like I've typed in circles, but hopefully you've gotten something out of it...

I have this.
It's related to anxiety, and it helps relieve stress. I can focus on just the sensation and blot everything out. There's also an OCD component to it. I feel the compulsion, I do it, I feel better. I seem happier (to others).

Over the years I've had a thousand "things" wrong with me, this is one of the least harmful, so I let it go.
However, if you want her to stop, try putting a rubber band on her wrist, and telling her to snap it instead of pulling.
Or bite down/chew on a toothpick or lolipop stick.
Or get one of those sliver small snap/clip barrets, and she can snap it open and closed.

Don't aim for a complete stopping of the behaviour, just ask her to try to avoid it when she can.

PS- The habit is similar to biting your nails, it doesn't hurt more than that for me, and I think about it about as much as that. (Which is hardly at all).

Thats very big problem. I have had this. But I solved 6 months ago. The natural oils help to grow again.

Hi, as an autistic girl who has trichotillomania, I can offer up a few tips. First off, are there any triggers for her? Try to eliminate or reduce these stressful situations that may cause her to pull out hair. Second, encourage her to use a fidget toy instead of pulling out her hair. Koosh balls, Tangle toys, and silly putty are just a few options. Find out what works for her. Also (from my experience) it helps if she actually wants to stop pulling. If she has no desire to stop pulling out hair, it will likely be harder to stop that behavior.

Here's something my mom did with me that helped: She set up a reward system. This system really depends on the child, but basically you offer some sort of reward in exchange for a day (or 2 days or a week, etc.) of no pulling. Small rewards like stickers, "mommy time", etc. can be offered for short period of no pulling. Bigger rewards, like eating out, maybe a new stuffed animal, can be offered after a longer period of "pull-free" time. My mom bought me a doll house after I had (mostly) gotten over my Trichotillomania.

The problem is, that for people with Trichotillomania, pulling out a hair feels really good. It feels so good that it can be hard to stop. Because of this, it's important to manage the condition before it gets out of hand.

A good website for resources: https://www.bfrb.org/

I wish you luck!