European Child & Adolescent Psychiatry

, Volume 18, Issue 7, pp 458–463 | Cite as

ECT for self-injury in an autistic boy

  • Lee E. Wachtel
  • Stephanie A. Contrucci-Kuhn
  • Merrie Griffin
  • Ainsley Thompson
  • Dirk M. Dhossche
  • Irving M. Reti
CASE REPORT
First Online:
Received:
Accepted:

Abstract

Objective

Self-injurious behavior presents a significant challenge in autism, and first-line psychopharmacological and behavioral interventions have limited efficacy in some patients. These intractable cases may be responsive to electroconvulsive therapy.

Clinical picture

This article presents an eight-year-old boy with autism, mental retardation, prominent mood lability and a five-year history of extreme self-injurious behavior towards his head, averaging 109 self-injurious attempts hourly. The patient was at high risk for serious head trauma, and required usage of bilateral arm restraints and protective equipment (i.e., padding on shoulders, arms, and legs). All areas of daily functioning were profoundly impacted by dangerous self-injury.

Treatment

Fifteen bilateral ECT treatments resulted in excellent mood stabilization and reduction of self-injury to 19 attempts hourly, and maintenance ECT was pursued. The patient was able to return to developmentally-appropriate educational and social activities.

Conclusion

ECT should be considered in the treatment algorithm of refractory cases of severe self-injury in autism.

Keywords

self-injury autism ECT mental retardation catatonia 
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Copyright information

© Steinkopff Verlag Darmstadt 2009

Authors and Affiliations

  • Lee E. Wachtel
    • 1
  • Stephanie A. Contrucci-Kuhn
    • 1
  • Merrie Griffin
    • 2
  • Ainsley Thompson
    • 1
  • Dirk M. Dhossche
    • 3
  • Irving M. Reti
    • 4
  1. 1.Kennedy Krieger InstituteJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Department of AnesthesiologyJohns Hopkins School of MedicineBaltimoreUSA
  3. 3.Department of PsychiatryUniversity of Mississippi Medical CenterJacksonUSA
  4. 4.Department of PsychiatryJohns Hopkins School of MedicineBaltimoreUSA

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