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Response to Electroconvulsive Therapy in Patients With Autism Spectrum Disorder and Intractable Challenging Behaviors Associated With Symptoms of Catatonia

Sajith, Sreedharan Geetha MBBS, MD, PgDip, MRCPsych; Liew, Siew Fai MD; Tor, Phern Chern MBBS, M Med

doi: 10.1097/YCT.0000000000000338
Case Report

Background There are several reports of electroconvulsive therapy (ECT) used in autism spectrum disorder (ASD) in the context of catatonic symptoms. We describe response to ECT in two adults with ASD and intellectual disability with intractable aggression and self-injurious behaviors associated with catatonic symptoms who had not responded to standard interventions.

Method Unilateral ECT at a frequency of 3 times a week was given followed by weekly maintenance ECT.

Results Patients' catatonic symptoms included episodes of agitation and echophenomena. Electroconvulsive therapy resulted in significant improvement in their behavior problems but 1 patient relapsed when the ECT was discontinued or frequency of treatment reduced. The second patient required 2 courses of ECT before improvement which was maintained on weekly ECT.

Conclusions Electroconvulsive therapy could be a potentially beneficial intervention in patients with ASD and severe challenging behaviors associated with catatonic symptoms including agitated or excited forms of catatonia.

From the Department of General Psychiatry Institute of Mental Health, Singapore, Singapore.

Received for publication February 9, 2016; accepted May 4, 2016.

Reprints: Sreedharan Geetha Sajith, MBBS, MD, PgDip, MRCPsych, Department of General Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore (e-mail:

The authors have no conflicts of interest or financial disclosures to report.

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