Electroconvulsive therapy in adolescents with intellectual disability and severe self-injurious behavior and aggression: a retrospective study

Abstract

Efficacious intervention for severe, treatment-refractory self-injurious behavior and aggression (SIB/AGG) in children and adolescents with intellectual disability and concomitant psychiatric disorders remains a complex and urgent issue. The aim of this study is to assess the efficacy of electroconvulsive therapy (ECT) on severe and treatment-resistant SIB/AGG in young people with intellectual disability and current psychiatric disorder. We reviewed the charts of all patients (N = 4) who received ECT in the context of SIB/AGG with resistance to behavioral interventions, milieu therapy and pharmacotherapy from 2007 to 2011. We scored the daily rate of SIB/AGG per patient for each hospital day. Inter rater reliability was good (intraclass correlations = 0.91). We used a mixed generalized linear model to assess whether the following explanatory variables (time, ECT) influenced the course of SIB/AGG over time, the dependant variable. The sample included two girls and two boys. The mean age at admission was 13.8 years old [range 12-14]. The patients had on average 19 ECT sessions [range 16-26] and one patient received maintenance ECT. There was no effect of time before and after ECT start. ECT was associated with a significant decrease in SIB/AGG scores (p < 0.001): mean aggression score post-ECT was half the pre-ECT value. ECT appears beneficial in severe, treatment-resistant SHBA in adolescents with intellectual disability.

High-Frequency Stimulation at the Subthalamic Nucleus Suppresses Excessive Self-Grooming in Autism-Like Mouse Models

“…In fact, in recent years large population-based studies have estimated that 12-18% of autistic adolescents and young adults manifest some symptoms of catatonia (Billstedt et al, 2005;Ghaziuddin et al, 2012;Wing and Shah, 2000). Consistent with the sensitivity of catatonia to electroconvulsive therapy (ECT; Fink and Taylor, 2006), we and others have found ECT can produce life-changing results in ASD patients with extreme SIB that is unresponsive to traditional pharmacological and behavioral therapies (Wachtel and Dhossche, 2013;Consoli et al, 2013;Haq and Ghaziuddin, 2014). At our clinic, we have observed a 490% reduction in frequency of SIB in ASD patients with the most severe forms of self-injury (Wachtel et al, 2008(Wachtel et al, , 2009(Wachtel et al, , 2010(Wachtel et al, , 2014(Wachtel et al, , 2015.…”

Multidisciplinary Assessment and Treatment of Self-Injurious Behavior in Autism Spectrum Disorder and Intellectual Disability: Integration of Psychological and Biological Theory and Approach

“…ECT is thought to treat SIB by affecting underlying GABA dysfunction. Several case studies have reported significant reductions in drugrefractory SIB, along with mood stabilization, with ECT (Consoli et al 2013;Siegel et al 2012;Wachtel et al 2009. Studies of ECT are promising in the appropriate context as a potential treatment, and future studies will aid in defining its role in the treatment of drug-refractory SIB.…”

“…Electroconvulsive therapy (ECT) has been used as a treatment for drug-refractory SIB in individuals with ASD and other developmental disorders who have catatonia or a concurrent psychiatric disorder (Consoli et al 2013;Wachtel and Dhossche 2010). ECT is thought to treat SIB by affecting underlying GABA dysfunction.…”

From “ready to wear” to “custom-made”: the benefits of multidimensional approaches to tailor targeted interventions

“…In such treatment refractory clinical situations, alternative strategies must to be defined and tested. Using electro-convulsive therapy may be considered, for example in cases of severe self-injurious behavior and aggression [3].…”