Chapter 7 - Picking, Hoarding, and Elopement in Prader-Willi Syndrome

Summary

Skin or rectal picking, hoarding of nonfood items, and elopement are common behavioral manifestations in PWS. Early recognition and management of excoriation behaviors by redirection and distraction can help reduce picking behavior. If behavioral interventions including habit-reversal training are ineffective, medication management should be considered. N-Acetyl Cysteine (NAC), topiramate, guanfacine extended-release, and naltrexone are some of the medicines used to manage picking behaviors. Hoarding of nonfood items is another common behavior in PWS that can lead to significant distress to caregivers. The evidence of medications in the management of hoarding in PWS is limited but behavioral management strategies are discussed. Medications may be considered when attempts to limit hoarding leads to aggressive outbursts. Finally, elopement or runaway behavior can be dangerous and potentially life threatening in PWS. In addition to ensuring security and preventing the act of running away, the underlying causes of the behavior whether psychosocial or psychiatric should be explored and treated appropriately.