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Treatment of Severe Self-Injurious Behavior in Autism Spectrum Disorder by Neuromodulation

D'Agati, Douglas MD; Chang, Andrew D. MS; Wachtel, Lee E. MD; Reti, Irving M. MBBS

doi: 10.1097/YCT.0000000000000346

An increasing number of case reports and series document the safe and effective use of electroconvulsive therapy (ECT) in children, adolescents, and young adults with autism spectrum disorder who engage in severe, intractable, repetitive self-injurious behavior (SIB) without environmental or operant function. Although the treatment is very effective for such patients, they typically remain highly dependent on frequent maintenance ECT (M-ECT) to maintain suppression of the SIB achieved during the acute course. Some patients receive M-ECT as frequently as once every 5 days. Such a regimen is quite burdensome for the patient and the patient's family, and the long-term effects of such regimens, starting as early as childhood, are unknown. In this review, we explore the expanding literature supporting the use of ECT for suppressing severe SIB associated with autism spectrum disorder. We also focus on the possible development of alternate nonconvulsive focal forms of brain stimulation, which might replace frequent M-ECT or reduce how frequently a patient needs to receive it. Although there are scarce clinical data currently available supporting these latter treatments, future studies are clearly indicated.

From the Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD.

Received for publication April 1, 2016; accepted June 2, 2016.

Reprints: Irving Reti, MBBS, Johns Hopkins University, 600 N Wolfe St, Meyer 3-181, Baltimore, MD 21205 (e-mail:

I.R. reports current or prior research support from The National Institutes of Health, the US Department of Defense, The Hope for Depression Research Foundation, The Simons Foundation Autism Research Initiative, The Dana Foundation, The Johns Hopkins University School of Public Health, Neuronetics, Inc, and Brainsway, Inc. He is also under contract with John Wiley and Sons for editing the volume, Brain Stimulation: Methodologies and Interventions. This study was supported by the Dana Foundation Program in Clinical Neuroscience Research (IMR) and by an Explorer Award from the Simons Foundation Autism Research Initiative (IMR). The other authors have no conflicts of interest or financial disclosures to report.

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