Modified electroconvulsive therapy for treatment-resistant self-injurious behavior in autism spectrum disorder with...

Treatment options for severe self-injurious behavior (SIB) in autism spectrum disorder (ASD) with comorbid intellectual disability (ID) are limited.

A 24-year-old man with ASD and severe ID presented with treatment-refractory SIB (an 11-year history; baseline frequency of 5-6 hand-biting episodes per day during pre-modified electroconvulsive therapy (MECT) hospitalization observation), despite multiple pharmacotherapy trials. On Day 27, baseline assessments and pre-MECT demonstrated a Violence Risk Assessment Scale (VRAS) score of 18, a Brief Psychiatric Rating Scale (BPRS) score of 74, an Activities of Daily Living (ADL) score of 46, and 4-5 h of nocturnal sleep each night. After 12 sessions of MECT administered over 7 weeks, the primary outcome, that is, SIB frequency, completely resolved (no hand-biting episodes each day). Additionally, secondary outcome measures showed marked improvement, including a VRAS score of 7 (a 61.1% reduction), a BPRS score of 47 (a 36.5% reduction), an ADL score of 34 (a 26.1% improvement in functional independence), and 5-6 h of nocturnal sleep each night. At 30 days post-MECT (Day 106, during continued hospitalization), therapeutic gains were sustained and further enhanced: the VRAS score persisted at 7, the BPRS score decreased to 35 (a 52.7% reduction from baseline), and the ADL score improved to 30 (a 34.8% improvement in functional independence from baseline), with complete resolution of SIB (self-directed harmful acts) and aggressive behavior (other-directed harmful acts). The patient scored zero on the VRAS. No serious adverse events were observed during hospitalization.

Based on controlled nursing frequency counts, mental assessment scales, and photographic wound records, this case provides preliminary observational evidence that MECT may reduce treatment-refractory SIB in patients with ASD and severe ID. Further controlled studies using standardized SIB outcome measures are warranted, given the lack of validated SIB-specific instruments and the limitations inherent to a single-case design.