title: 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.
authors.affiliation: Department of Child and Adolescent Psychiatry, GH Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013, Paris, France. angele.consoli@psl.aphp.fr
authors.forename: Angele
authors.initials: A
authors.lastname: Consoli
authors.forename: Johan
authors.initials: J
authors.lastname: Cohen
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bodeau
authors.forename: Vincent
authors.initials: V
authors.lastname: Guinchat
authors.forename: Lee
authors.initials: L
authors.lastname: Wachtel
authors.forename: David
authors.initials: D
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000523:psychology*; D002648:Child; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000150:complications* / Q000523:psychology; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome