Brief Report

European Child & Adolescent Psychiatry

, Volume 22, Issue 1, pp 55-62

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

  • Angele ConsoliAffiliated withDepartment of Child and Adolescent Psychiatry, GH Pitié-SalpêtrièreINSERM U-669, PSIGIAM, MDA, GH Cochin Email author 
  • , Johan CohenAffiliated withDepartment of Child and Adolescent Psychiatry, GH Pitié-Salpêtrière
  • , Nicolas BodeauAffiliated withDepartment of Child and Adolescent Psychiatry, GH Pitié-Salpêtrière
  • , Vincent GuinchatAffiliated withDepartment of Child and Adolescent Psychiatry, GH Pitié-Salpêtrière
  • , Lee WachtelAffiliated withJohns Hopkins School of Medicine, Kennedy Krieger Institute
  • , David CohenAffiliated withDepartment of Child and Adolescent Psychiatry, GH Pitié-SalpêtrièreCNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, GH Pitié-Salpêtrière

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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.

Keywords

Electroconvulsive therapy Self-injurious behavior Aggression Intellectual disability Pervasive developmental disorder