Electroconvulsive Therapy Effective in Children With Autism

ECT wires on bed
ECT wires on bed
Electroconvulsive therapy (ECT) has been used for refractory psychiatric conditions in the United States since 1938. Despite this, few practitioners are comfortable recommending ECT for minors.
The following article is part of conference coverage from the 2018 American Psychiatric Association (APA) Annual Meeting in New York, New York. Psychiatry Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in psychiatry. Check back for the latest news from APA 2018.

NEW YORK — Results of a meta-analysis presented at the American Psychiatric Association 2018 Annual Meeting, held May 5 to 9, 2018, in New York City, showed that many children with autism do not improve with oral medications, but respond to electroconvulsive therapy (ECT).

“[ECT] has been used for refractory psychiatric conditions in the U.S. since 1938. Despite this, few practitioners are comfortable recommending ECT for minors,” the researchers wrote. “Ghazzudin et al. reported that 75% of surveyed child and adolescent psychiatrists felt uncomfortable providing a 2nd opinion for ECT in children.”

The investigators performed a systematic review involving 3 databases (Cochrane, Embase, and Pubmed). Of the studies examined, 22 were included in the systematic review. Those written in languages other than English, or those with participants older than 18 years, were excluded.

The researchers found that children with autism who received ECT had symptoms that were not well controlled, and were therefore offered ECT. They were between ages 8 and 17 (mean age, 14.86 years; 73% boys). Most children had a comorbid diagnosis of catatonia (82%); others had comorbid diagnoses of mood disorder with psychosis (14%), bipolar disorder (9%), major depressive disorder (5%), schizophrenia (5%), or Tourette syndrome (5%).

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The children had been treated with several psychotropic and neurotropic medications with minimal effect, including: first- and second-generation antipsychotics (8/19 [42.1%] and 12/19 [63.2%], respectively), selective serotonin reuptake inhibitors (13/21 [61.9%]), monoamine oxidase inhibitors (1/21 [4.8%]), tricyclic antidepressants (3/21 [14.3%]), benzodiazepines (12/20 [60%]), stimulants (5/21 [23.8%]), and mood stabilizer/anticonvulsants (12/20 [60%]; total>100% secondary to polypharmacy). Both bilateral ECT (19 reported cases) and unilateral ECT (3 reported cases) were used.

The children received anywhere from 10 to 156 treatments of ECT. Induction agents included propofol (9% total cases) and methohexital (55% total cases); 36% were unreported. Neuromuscular blockers included succinylcholine (59% total cases); 41% were unreported. Anticholinergic agents included glycopyrrolate (32% total cases); 68% were unreported. ECT-induced seizures lasted from 26 to 206 seconds, as measured by EEG.

Overall, ECT was well tolerated; rare side effects included fatigue, hunger, and postemergent agitation. All the children benefited from ECT. Eleven patients reported data on school attendance, and all of them attended school after ECT.

“Many children with chronic mental illness do not improve with oral medications and respond to ECT,” the researchers wrote. “We believe that ECT may be an underutilized treatment in minors. Education must be provided to practitioners and to families who are affected.”

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Poulsen RJ, Saltz SB, Sacks S, Furst J, Barkin H, Regan J. Electroconvulsive therapy (ECT) in children with autism: a systematic review of the ECT practice. American Psychiatric Association (APA) 2018 Annual Meeting; May 5-9, 2018; New York City. Poster 47.