Neera Ghaziuddin and Garry Walter have edited the first-ever book devoted exclusively to electroconvulsive therapy (ECT) in children and adolescents. They have done the field (not to mention the patients) a huge service, for the book is excellent and much needed.
A few years ago, such a volume would have been inconceivable. Electroconvulsive therapy for this age group has been done all along of course, but infrequently, sometimes surreptitiously, and almost apologetically. Such is no longer the case. The publication of this volume finally brings ECT for the pediatric population out of the shadows.
The editors themselves, and many of the group of experts they have gathered as contributing chapter authors (some are noted ECT experts, and some are prominent child and adolescent psychiatrists), are largely responsible for having made this moment in history possible. Their work over the past 2 decades has laid the clinical and scientific foundation for the thesis that seriously psychiatrically ill children deserve the opportunity to be treated, when appropriate, with one of the most dramatically effective therapies in all of medicine. The invocation on the frontispiece, “Dedicated to young people, who should never be denied an opportunity to overcome problems and thrive,” says it plainly. In their preface, the editors further state, “This book arose out of our clinical observations and sense of injustice.”
The volume (290 pages) starts with a foreword by Vaughn McCall and the preface by the editors, both nicely setting the stage for the following 12 chapters, 4 of which deal with history, mechanism of action, ethics and stigma, and 8 of which cover various clinical topics. Although the core of the volume is a comprehensive review of the world’s literature on pediatric ECT, the book is far more than a literature review; it is a thoughtful, expert interpretation of that literature, with forthright acknowledgment of the many gaps in our knowledge and a call for research to fill those gaps.
Noted historian Edward Shorter covers the intriguing history of pediatric ECT in the first chapter, and there follows an authoritative chapter by Max Fink on the mechanism of action of ECT, which traces the history of the development of mechanistic theories and explains them in a clinical context. Much of this material will be new, and important, background for the target audience of this book. The next 2 chapters, written by Garry Walter and 3 colleagues, are about stigma, ethics, and consent issues in ECT. They are so good that I would recommend them to all ECT practitioners, not only those who treat children.
The remaining 8 chapters are clinical in nature, devoted to a technical overview of ECT and to the specific clinical indications for ECT in the pediatric population (mood disorders, schizophrenia spectrum disorders, catatonia, and self-injurious behavior in autism). The chapter by Ghaziuddin on mood disorders is particularly thoughtful; the chapters on catatonia and self-injury by Dhossche and Wachtel will be an eye-opener to readers who have little experience with how critically ill some of these patients are and how dramatically beneficial ECT can be for them.
This book is not meant to be a comprehensive text on ECT technique, and a few of the specific anesthesia and procedural technique suggestions are idiosyncratic or outdated. One has the impression that very experienced ECT practitioners might approach certain technical aspects of ECT differently. However, child and adolescent psychiatrists will not be going out and performing ECT after reading it, and such minor shortcomings can easily be overlooked. Readers will certainly gain a comprehensive understanding of which patients to refer and how to educate them and their families about what to expect during and after the procedure.
The volume itself is a handsome medium-sized one, with some excellent reader-friendly features. Each chapter has “key points” listed at the beginning and “questions and answers,” at the end. There are numerous helpful and poignant illustrative “case vignettes” throughout that make very compelling reading. Lee Wachtel’s photographs of children with self-inflicted injuries speak for themselves.
Electroconvulsive Therapy in Children and Adolescents is a milestone publication that should be required reading for ECT practitioners and child and adolescent psychiatrists alike. Drs. Ghaziuddin and Walter are to be congratulated for their successful and courageous effort.
Charles H. Kellner, MD
Icahn School of Medicine at Mount Sinai
New York, NY