title: ECT for self-injury in an autistic boy.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  ECT should be considered in the treatment algorithm of refractory cases of severe self-injury in autism.
authors.affiliation: Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA. wachtel@kennedykrieger.org
authors.forename: Lee E
authors.initials: LE
authors.lastname: Wachtel
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Contrucci-Kuhn
authors.forename: Merrie
authors.initials: M
authors.lastname: Griffin
authors.forename: Ainsley
authors.initials: A
authors.lastname: Thompson
authors.forename: Dirk M
authors.initials: DM
authors.lastname: Dhossche
authors.forename: Irving M
authors.initials: IM
authors.lastname: Reti
mesh_terms: D001321:Autistic Disorder / Q000150:complications*; D002648:Child; D004565:Electroconvulsive Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D016728:Self-Injurious Behavior / Q000150:complications* / Q000628:therapy*