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Side Effect or Compulsive Behavior?
"Is it common for children on methyphenidate and Paxil to pick their cuticles, nails, skin, and so on, to the point of bleeding?"
Approximately 50 percent of children and adolescents with ADHD also have Obsessive-Compulsive Disorder (OCD). One possible characteristic of OCD is picking cuticles, nails, skin, or sores.
Paxil is one of the medications used to treat OCD. If the picking started after starting the stimulant, it is possible that the stimulant brought out latent OCD behaviors. In this case, stopping the stimulant will stop the picking.
The other possibility is that the OCD behaviors were present prior to treating the ADHD. Here, both disorders must be treated. The stimulant will help the ADHD. Paxil along with a specific type of behavioral therapy will help the OCD.
Larry Silver, M.D., is clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C. and director of training in child and adolescent psychiatry at Georgetown University School of Medicine. He is a former acting director and deputy director of the National Institute of Mental Health, as well as the author of Dr. Larry Silver's Advice to Parents on AD/HD and The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities.