Electroconvulsive therapy for psychotropic-refractory bipolar affective disorder and severe self-injury and aggression in an 11-year-old autistic boy

We report the successful use of electroconvulsive therapy in a 11-year-old boy with autism and a 4-year history of psychotropic-resistant bipolar affective disorder associated with dangerous episodes of self-injurious and aggressive behaviors placing his caregivers and himself at significant safety risk. Extensive behavioral and medication interventions in both inpatient and outpatient settings had been ineffective, and the boy was at risk for acute physical injury and restrictive out-of-home placement. An acute course of eight bilateral electroconvulsive therapies resulted in significant mood stabilization and significant improvement of self-injury and aggression. Maintenance electroconvulsive therapy and psychotropic interventions were then pursued.