DOI QR코드

DOI QR Code

Electroconvulsive Therapy for Treatment-Refractory Behaviors Problems in Neurodevelopmental Disorders

발달장애의 치료저항성 행동문제에 대한 전기경련치료 적용의 최근 경향: 임상적 효과에 대한 서술적 고찰

  • Hye-Jin Seo (Department of Psychiatry, Yong-In Mental Hospital) ;
  • Nam Young Lee (Department of Psychiatry, Dongguk University Ilsan Hospital, Dongguk Medical Center) ;
  • Kyu Young Lee (Department of Psychiatry, Nowon Medical Center, Eulji University) ;
  • Geon Ho Bahn (Department of Psychiatry, Kyung Hee University Hospital) ;
  • Soo-Young Bhang (Department of Psychiatry, Nowon Medical Center, Eulji University) ;
  • Hee Cheol Kim (Department of Psychiatry, Keimyung University Dongsan Medical Center) ;
  • Yong Sik Kim (Department of Psychiatry, Nowon Medical Center, Eulji University) ;
  • In Won Chung (Department of Psychiatry, Yong-In Mental Hospital)
  • 서혜진 (용인정신병원 정신건강의학과) ;
  • 이남영 (동국대학교일산병원 정신건강의학과) ;
  • 이규영 (노원을지대학교병원 정신건강의학과) ;
  • 반건호 (경희대학교병원 정신건강의학과) ;
  • 방수영 (노원을지대학교병원 정신건강의학과) ;
  • 김희철 (계명대학교 동산의료원 정신건강의학과) ;
  • 김용식 (노원을지대학교병원 정신건강의학과) ;
  • 정인원 (용인정신병원 정신건강의학과)
  • Received : 2023.09.22
  • Accepted : 2023.10.02
  • Published : 2023.10.31

Abstract

Individuals with developmental disorders exhibit a broad spectrum of aggressive behaviors, including self-directed actions and those directed toward others. These behaviors can lead to physical harm, disruptions in daily life, caregiver stress, and an increased risk for abuse and institutionalization. An integrated and multidisciplinary approach, including psychosocial approaches and pharmacotherapy, has been attempted to treat self-injurious and aggressive behaviors, but has shown limited effectiveness in reducing those behaviors. Recently, the use of electroconvulsive therapy has increased as an alternative treatment for pediatric and adolescent patients with treatment-resistant behavior problems in developmental disorders. This review elucidates the indications and clinical effectiveness of electroconvulsive therapy in the management of self-injurious behavior and catatonia in patients with developmental disorders such as autism spectrum disorders and intellectual disabilities.

Keywords

Acknowledgement

This research was partly supported by the research fund of the Yong-In Institute of Psychiatry affiliated with the Yong-In Hospital Maintenance Foundation, a medical corporation.

References

  1. Rutter MJ, Bishop D, Pine DS, Scott S, Stevenson JS, Taylor EA, et al. Rutter's child and adolescent psychiatry. 5th ed. Hoboken, NJ: John Wiley & Sons;2011. 
  2. Kim BN, Kim Y. Guidelines for the treatment of problem behavior in children and adolescents with developmental disabilities. Chapter 3: understanding problem behavior. Seoul: National Center for Mental Health;2018. p.30-55. 
  3. Gormez A, Rana F, Varghese S. Pharmacological interventions for self-injurious behaviour in adults with intellectual disabilities: abridged republication of a Cochrane systematic review. J Psychopharmacol 2014;28:624-632.  https://doi.org/10.1177/0269881114531665
  4. Furniss F, Biswas AB. Self-injurious behavior in individuals with neurodevelopmental conditions. Cham: Springer;2020. 
  5. Bahji A, Pierce M, Wong J, Roberge JN, Ortega I, Patten S. Comparative efficacy and acceptability of psychotherapies for self-harm and suicidal behavior among children and adolescents: a systematic review and network meta-analysis. JAMA Netw Open 2021;4:e216614. 
  6. Kim BN, Kim Y. Guidelines for the treatment of problem behavior in children and adolescents with developmental disabilities. Chapter 5: medication for autism problem behavior. Seoul: National Center for Mental Health;2018. p.78-87. 
  7. Wachtel LE, Contrucci-Kuhn SA, Griffin M, Thompson A, Dhossche DM, Reti IM. ECT for self-injury in an autistic boy. Eur Child Adolesc Psychiatry 2009;18:458-463.  https://doi.org/10.1007/s00787-009-0754-8
  8. Kim T, Ryu JE, Bahn GH. Brain stimulation and modulation for autism spectrum disorder. Hanyang Med Rev 2016;36:65-71.  https://doi.org/10.7599/hmr.2016.36.1.65
  9. Doruk Camsari D, Kirkovski M, Croarkin PE. Therapeutic applications of invasive neuromodulation in children and adolescents. Psychiatr Clin North Am 2018;41:479-483.  https://doi.org/10.1016/j.psc.2018.04.008
  10. Consoli A, Benmiloud M, Wachtel L, Dhossche D, Cohen D, Bonnot O. Electroconvulsive therapy in adolescents with the catatonia syndrome: efficacy and ethics. J ECT 2010;26:259-265.  https://doi.org/10.1097/YCT.0b013e3181fb3924
  11. Gonzalez-Menendez A, Arboleya Faedo T, Gonzalez-Pando D, Ordonez-Camblor N, Garcia-Vega E, Paino M. Psychological inflexibility in people with chronic psychosis: the mediating role of self-stigma and social functioning. Int J Environ Res Public Health 2021;18:12376. 
  12. Sachs M, Madaan V. Electroconvulsive therapy in children and adolescents: brief overview and ethical issues. Washington, DC: American Academy of Child and Adolescent Psychiatry;2012. 
  13. Jeong SH, Yoon T, Kim YS. Chapter 2. Social implications. In: Kim YS, Kang UG, Ahn YM, Youn T, Chung IW, editors. Electroconvulsive therapy: theory and practice. Seoul: Seoul National University Publication Center;2019. p.27-29. 
  14. Tate BG, Baroff GS. Aversive control of self-injurious behavior in a psychotic boy. Behav Res Ther 1966;4:281-287.  https://doi.org/10.1016/0005-7967(66)90024-6
  15. Cain AC. The presuperego 'turning-inward' of aggression. Psychoanal Q 1961;30:171-208.  https://doi.org/10.1080/21674086.1961.11926204
  16. Fee VE, Matson JL. Definition, classification, and taxonomy. In: Luiselli JK, Matson JL, Singh NN, editors. Self-injurious behavior. Disorders of human learning, behavior, and communication. New York: Springer;1992. p.3-20. 
  17. Goldfarb W. Psychological privation in infancy and subsequent adjustment. Am J Orthopsychiatry 1945;15:247-255.  https://doi.org/10.1111/j.1939-0025.1945.tb04938.x
  18. Wachtel LE, Shorter E, Fink M. Electroconvulsive therapy for self-injurious behaviour in autism spectrum disorders: recognizing catatonia is key. Curr Opin Psychiatry 2018;31:116-122.  https://doi.org/10.1097/YCO.0000000000000393
  19. Simeon D, Favazza AR. Self-injurious behaviors: phenomenology and assessment. In: Simeon D, Hollander E, editors. Self-injurious behaviors: assessment and treatment. Washington, DC: American Psychiatric Association Publishing;2001. p.1-28. 
  20. Schroeder SR, Mulick JA, Rojahn J. The definition, taxonomy, epidemiology, and ecology of self-injurious behavior. J Autism Dev Disord 1980;10:417-432.  https://doi.org/10.1007/BF02414818
  21. Crapper L, Ernst C. Comparative analysis of self-injury in people with psychopathology or neurodevelopmental disorders. Pediatr Clin North Am 2015;62:619-631.  https://doi.org/10.1016/j.pcl.2015.03.001
  22. Richards C, Moss J, Nelson L, Oliver C. Persistence of self-injurious behaviour in autism spectrum disorder over 3 years: a prospective cohort study of risk markers. J Neurodev Disord 2016;8:21. 
  23. Furniss F, Biswas AB. Recent research on aetiology, development and phenomenology of self-injurious behaviour in people with intellectual disabilities: a systematic review and implications for treatment. J Intellect Disabil Res 2012;56:453-475.  https://doi.org/10.1111/j.1365-2788.2012.01534.x
  24. Devine DP. Self-injurious behaviour in autistic children: a neurodevelopmental theory of social and environmental isolation. Psychopharmacology (Berl) 2014;231:979-997.  https://doi.org/10.1007/s00213-013-3279-2
  25. Abrams R, Taylor MA. Catatonia. A prospective clinical study. Arch Gen Psychiatry 1976;33:579-581.  https://doi.org/10.1001/archpsyc.1976.01770050043006
  26. Gelenberg AJ. The catatonic syndrome. Lancet 1976;1:1339-1341.  https://doi.org/10.1016/S0140-6736(76)92669-6
  27. Dellinger-Ness LA, Handler L. Self-injurious behavior in human and non-human primates. Clin Psychol Rev 2006;26:503-514.  https://doi.org/10.1016/j.cpr.2006.03.004
  28. Jones IH, Daniels BA. An ethological approach to self-injury. Br J Psychiatry 1996;169:263-267.  https://doi.org/10.1192/bjp.169.3.263
  29. Sabus A, Feinstein J, Romani P, Goldson E, Blackmer A. Management of self-injurious behaviors in children with neurodevelopmental disorders: a pharmacotherapy overview. Pharmacotherapy 2019;39:645-664.  https://doi.org/10.1002/phar.2238
  30. Fong A, Friedlander R, Richardson A, Allen K, Zhang Q. Characteristics of children with autism and unspecified intellectual developmental disorder (intellectual disability) presenting with severe self-injurious behaviours. Int J Dev Disabil (in press). 
  31. Nock MK. Self-injury. Annu Rev Clin Psychol 2010;6:339-363.  https://doi.org/10.1146/annurev.clinpsy.121208.131258
  32. Whitlock J, Muehlenkamp J, Eckenrode J. Variation in nonsuicidal self-injury: identification and features of latent classes in a college population of emerging adults. J Clin Child Adolesc Psychol 2008;37:725-735.  https://doi.org/10.1080/15374410802359734
  33. Klonsky ED, Olino TM. Identifying clinically distinct subgroups of self-injurers among young adults: a latent class analysis. J Consult Clin Psychol 2008;76:22-27.  https://doi.org/10.1037/0022-006X.76.1.22
  34. Yates TM. The developmental psychopathology of self-injurious behavior: compensatory regulation in posttraumatic adaptation. Clin Psychol Rev 2004;24:35-74.  https://doi.org/10.1016/j.cpr.2003.10.001
  35. Volkmar FR. Self-injurious Behavior. In: Volkmar FR, editor. Encyclopedia of autism spectrum disorders. New York: Springer;2013. p.2730-2734. 
  36. Oudijn M, Linders J, Mocking R, Lok A, van Elburg A, Denys D. Psychopathological and neurobiological overlap between anorexia nervosa and self-injurious behavior: a narrative review and conceptual hypotheses. Front Psychiatry 2022;13:756238. 
  37. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association;2013. 
  38. Favazza AR. Nonsuicidal self-injury: how categorization guides treatment. Curr Psychiatr 2012;11:21-25. 
  39. Nock MK, Favazza AR. Nonsuicidal self-injury: definition and classification. In: Nock MK, editor. Understanding nonsuicidal self-injury: origins, assessment, and treatment. Washington, DC: American Psychological Association;2009. p.9-18. 
  40. Favaro A, Santonastaso P. Self-injurious behavior in anorexia nervosa. J Nerv Ment Dis 2000;188:537-542.  https://doi.org/10.1097/00005053-200008000-00010
  41. Levy KN, Yeomans FE, Diamond D. Psychodynamic treatments of self-injury. J Clin Psychol 2007;63:1105-1120.  https://doi.org/10.1002/jclp.20418
  42. Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al. Two-year randomized controlled trial and followup of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006;63:757-766.  https://doi.org/10.1001/archpsyc.63.7.757
  43. Kahng S, Iwata BA, Lewin AB. Behavioral treatment of self-injury, 1964 to 2000. Am J Ment Retard 2002;107:212-221.  https://doi.org/10.1352/0895-8017(2002)107<0212:BTOSIT>2.0.CO;2
  44. Sandman CA. Psychopharmacologic treatment of nonsuicidal self-injury. In: Nock MK, editor. Understanding nonsuicidal self-injury: origins, assessment, and treatment. Washington, DC: American Psychological Association;2009. p.291-322. 
  45. Dimian AF, Symons FJ. A systematic review of risk for the development and persistence of self-injurious behavior in intellectual and developmental disabilities. Clin Psychol Rev 2022;94:102158. 
  46. Beauchaine TP, Klein DN, Crowell SE, Derbidge C, Gatzke-Kopp L. Multifinality in the development of personality disorders: a biology × sex × environment interaction model of antisocial and borderline traits. Dev Psychopathol 2009;21:735-770.  https://doi.org/10.1017/S0954579409000418
  47. Cicchetti D, Blender JA. A multiple-levels-of-analysis perspective on resilience: implications for the developing brain, neural plasticity, and preventive interventions. Ann N Y Acad Sci 2006;1094:248-258.  https://doi.org/10.1196/annals.1376.029
  48. Gregori E, Rispoli M, Gerow S, Lory C. Treatment of self-injurious behavior in adults with intellectual and developmental disabilities: a systematic review. J Dev Phys Disabil 2018;30:111-139.  https://doi.org/10.1007/s10882-017-9568-7
  49. Chezan LC, Gable RA, McWhorter GZ, White SD. Current perspectives on interventions for self-injurious behavior of children with autism spectrum disorder: a systematic review of the literature. J Behav Educ 2017;26:293-329.  https://doi.org/10.1007/s10864-017-9269-4
  50. Rojahn J, Schroeder SR, Hoch TA. Self-injurious behavior in intellectual disabilities. 1st ed. Amsterdam: Elsevier;2008. 
  51. Baer DM. A case for the selective reinforcement of punishment. In: Neuringer C, editor. Behavior modification in clinical psychology. 1st ed. New York: Appleton-Century-Crofts;1970. p.243-249. 
  52. Godfrey Born C, McClelland A, Furnham A. Mental health literacy for autism spectrum disorder and depression. Psychiatry Res 2019;279:272-277.  https://doi.org/10.1016/j.psychres.2019.04.004
  53. Kahlbaum KL. Catatonia. Levi Y, Pridon T, translator. Baltimore, MD: Johns Hopkins University Press;1973. 
  54. Pfuhlmann B, Stober G. The different conceptions of catatonia: historical overview and critical discussion. Eur Arch Psychiatry Clin Neurosci 2001;251(Suppl 1):I4-I7.  https://doi.org/10.1007/PL00014199
  55. Fink M. Catatonia: a syndrome appears, disappears, and is rediscovered. Can J Psychiatry 2009;54:437-445.  https://doi.org/10.1177/070674370905400704
  56. Bonhoeffer K. Die exogenen reaktionstypen. Arch Psychiatr Nervenkr 1917;58:58-70.  https://doi.org/10.1007/BF02036408
  57. Carroll BT, Anfinson TJ, Kennedy JC, Yendrek R, Boutros M, Bilon A. Catatonic disorder due to general medical conditions. J Neuropsychiatry Clin Neurosci 1994;6:122-133.  https://doi.org/10.1176/jnp.6.2.122
  58. Barnes MP, Saunders M, Walls TJ, Saunders I, Kirk CA. The syndrome of Karl Ludwig Kahlbaum. J Neurol Neurosurg Psychiatry 1986;49:991-996.  https://doi.org/10.1136/jnnp.49.9.991
  59. Bush G, Fink M, Petrides G, Dowling F, Francis A. Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand 1996;93:129-136.  https://doi.org/10.1111/j.1600-0447.1996.tb09814.x
  60. Lohr JB, Wisniewski AA. Movement disorders: a neuropsychiatric approach. New York: Guilford Press;1987. 
  61. Ungvari GS, Kau LS, Wai-Kwong T, Shing NF. The pharmacological treatment of catatonia: an overview. Eur Arch Psychiatry Clin Neurosci 2001;251(Suppl 1):I31-I34.  https://doi.org/10.1007/PL00014198
  62. Leonhard K. Zur unterteilung und erbbilogie der schizophrenien. I. Mitt. Die "typischen" unterformen der katatonie. Allg Z Psychiat 1942;120:1-23. German 
  63. Kleist K, Leonhard KU, Schwab H. Die katatonie auf grund katamnestischer untersuchungen. III. Teil. Formen und verlaufe der eigentlichen katatonie. Z Ges Neurol Psychiat 1940;168:535-586. German  https://doi.org/10.1007/BF02871574
  64. Kleist K. Untersuchungen zur kenntnis der psychomotorischen bewegungsstorungen bei geisteskranken. Leipzig: Klinkhardt;1908. German 
  65. Leonhard K. Classification of endogenous psychoses and their differentiated etiology. Second, revised and enlarged edition. Vienna: Springer;1999.
  66. Cahn CH. Translator's Notes. In: Leonhard K, editor. Classification of endogenous psychoses and their differentiated etiology. Vienna: Springer;1999. p.XVII-XVIII. 
  67. Leonhard K, Beckmann H. Early childhood catatonia. In: Leonhard K, Beckmann H, editors. Classification of endogenous psychoses and their differentiated etiology. Vienna: Springer;1999. p.330-386. 
  68. Neumarker KJ. Classification matters for catatonia and autism in children. Int Rev Neurobiol 2006;72:3-19.  https://doi.org/10.1016/S0074-7742(05)72001-8
  69. Morrison JR. Catatonia. Retarded and excited types. Arch Gen Psychiatry 1973;28:39-41.  https://doi.org/10.1001/archpsyc.1973.01750310023005
  70. Rajagopal S. Catatonia. Adv Psychiatr Treat 2007;13:51-59.  https://doi.org/10.1192/apt.bp.106.002360
  71. Sienaert P, Rooseleer J, De Fruyt J. Measuring catatonia: a systematic review of rating scales. J Affect Disord 2011;135:1-9.  https://doi.org/10.1016/j.jad.2011.02.012
  72. Fink M. Rediscovering catatonia: the biography of a treatable syndrome. Acta Psychiatr Scand Suppl 2013;127:1-47.  https://doi.org/10.1111/acps.12038
  73. Wilcox JA, Reid Duffy P. The syndrome of catatonia. Behav Sci (Basel) 2015;5:576-588.  https://doi.org/10.3390/bs5040576
  74. Benarous X, Raffin M, Ferrafiat V, Consoli A, Cohen D. Catatonia in children and adolescents: new perspectives. Schizophr Res 2018;200:56-67.  https://doi.org/10.1016/j.schres.2017.07.028
  75. Thakur A, Jagadheesan K, Dutta S, Sinha VK. Incidence of catatonia in children and adolescents in a paediatric psychiatric clinic. Aust N Z J Psychiatry 2003;37:200-203.  https://doi.org/10.1046/j.1440-1614.2003.01125.x
  76. Takaoka K, Takata T. Catatonia in childhood and adolescence. Psychiatry Clin Neurosci 2003;57:129-137.  https://doi.org/10.1046/j.1440-1819.2003.01092.x
  77. Cohen D, Flament M, Dubos PF, Basquin M. Case series: catatonic syndrome in young people. J Am Acad Child Adolesc Psychiatry 1999;38:1040-1046.  https://doi.org/10.1097/00004583-199908000-00021
  78. Ghaziuddin N, Dhossche D, Marcotte K. Retrospective chart review of catatonia in child and adolescent psychiatric patients. Acta Psychiatr Scand 2012;125:33-38.  https://doi.org/10.1111/j.1600-0447.2011.01778.x
  79. Ohta M, Kano Y, Nagai Y. Catatonia in individuals with autism spectrum disorders in adolescence and early adulthood: a long-term prospective study. Int Rev Neurobiol 2006;72:41-54.  https://doi.org/10.1016/S0074-7742(05)72003-1
  80. Billstedt E, Gillberg IC, Gillberg C. Autism after adolescence: population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood. J Autism Dev Disord 2005;35:351-360.  https://doi.org/10.1007/s10803-005-3302-5
  81. Wing L, Shah A. Catatonia in autistic spectrum disorders. Br J Psychiatry 2000;176:357-362.  https://doi.org/10.1192/bjp.176.4.357
  82. Kohlenberg TM, Trelles MP, McLarney B, Betancur C, Thurm A, Kolevzon A. Psychiatric illness and regression in individuals with Phelan-McDermid syndrome. J Neurodev Disord 2020;12:7. 
  83. Santoro SL, Baumer NT, Cornacchia M, Franklin C, Hart SJ, Haugen K, et al. Unexplained regression in Down syndrome: management of 51 patients in an international patient database. Am J Med Genet A 2022;188:3049-3062.  https://doi.org/10.1002/ajmg.a.62922
  84. Poser HM, Trutia AE. Treatment of a Prader-Willi patient with recurrent catatonia. Case Rep Psychiatry 2015;2015:697428. 
  85. Stredny CM, Hauptman AJ, Sargado S, Soccorso C, Katz T, Gorman MP, et al. Development of a multidisciplinary clinical approach for unexplained regression in Down syndrome. Am J Med Genet A 2022;188:2509-2511.  https://doi.org/10.1002/ajmg.a.62870
  86. Faedda GL, Wachtel LE, Higgins AM, Shprintzen RJ. Catatonia in an adolescent with velo-cardio-facial syndrome. Am J Med Genet A 2015;167:2150-2153.  https://doi.org/10.1002/ajmg.a.37087
  87. Butcher NJ, Boot E, Lang AE, Andrade D, Vorstman J, McDonald-McGinn D, et al. Neuropsychiatric expression and catatonia in 22q11.2 deletion syndrome: an overview and case series. Am J Med Genet A 2018;176:2146-2159.  https://doi.org/10.1002/ajmg.a.38708
  88. Cornic F, Consoli A, Tanguy ML, Bonnot O, Perisse D, Tordjman S, et al. Association of adolescent catatonia with increased mortality and morbidity: evidence from a prospective follow-up study. Schizophr Res 2009;113:233-240.  https://doi.org/10.1016/j.schres.2009.04.021
  89. Fink M, Taylor MA, Ghaziuddin N. Catatonia in autistic spectrum disorders: a medical treatment algorithm. Int Rev Neurobiol 2006;72:233-244.  https://doi.org/10.1016/S0074-7742(05)72014-6
  90. Dhossche D, Cohen D, Ghaziuddin N, Wilson C, Wachtel LE. The study of pediatric catatonia supports a home of its own for catatonia in DSM-5. Med Hypotheses 2010;75:558-560.  https://doi.org/10.1016/j.mehy.2010.07.029
  91. van der Heijden FM, Tuinier S, Arts NJ, Hoogendoorn ML, Kahn RS, Verhoeven WM. Catatonia: disappeared or under-diagnosed? Psychopathology 2005;38:3-8.  https://doi.org/10.1159/000083964
  92. Lund CE, Mortimer AM, Rogers D, McKenna PJ. Motor, volitional and behavioural disorders in schizophrenia. 1: assessment using the modified Rogers scale. Br J Psychiatry 1991;158:323-327.  https://doi.org/10.1192/bjp.158.3.323
  93. Starkstein SE, Petracca G, Teson A, Chemerinski E, Merello M, Migliorelli R, et al. Catatonia in depression: prevalence, clinical correlates, and validation of a scale. J Neurol Neurosurg Psychiatry 1996;60:326-332.  https://doi.org/10.1136/jnnp.60.3.326
  94. Bush G, Fink M, Petrides G, Dowling F, Francis A. Catatonia. II. Treatment with lorazepam and electroconvulsive therapy. Acta Psychiatr Scand 1996;93:137-143.  https://doi.org/10.1111/j.1600-0447.1996.tb09815.x
  95. Northoff G, Koch A, Wenke J, Eckert J, Boker H, Pflug B, et al. Catatonia as a psychomotor syndrome: a rating scale and extrapyramidal motor symptoms. Mov Disord 1999;14:404-416.  https://doi.org/10.1002/1531-8257(199905)14:3<404::AID-MDS1004>3.0.CO;2-5
  96. Braunig P, Kruger S, Shugar G, Hoffler J, Borner I. The catatonia rating scale I-development, reliability, and use. Compr Psychiatry 2000;41:147-158.  https://doi.org/10.1016/S0010-440X(00)90148-2
  97. Carroll BT, Kirkhart R, Ahuja N, Soovere I, Lauterbach EC, Dhossche D, et al. Katatonia: a new conceptual understanding of catatonia and a new rating scale. Psychiatry (Edgmont) 2008;5:42-50. 
  98. Francis A, Divadeenam KM, Petrides G. Advances in the diagnosis and treatment of catatonia. Convuls Ther 1996;12:259-261. 
  99. Petrides G, Malur C, Fink M. Chapter 13. Convulsive therapy. In: Caroff SN, Mann SC, Francis A, Fricchione GL, editors. Catatonia: from psychopathology to neurobiology. 1st ed. Arlington, VA: American Psychiatric Publishing;2004. p.151-160. 
  100. Pelzer AC, van der Heijden FM, den Boer E. Systematic review of catatonia treatment. Neuropsychiatr Dis Treat 2018;14:317-326.  https://doi.org/10.2147/NDT.S147897
  101. Yeung PP, Milstein RM, Daniels DC, Bowers MB Jr. ECT for lorazepam-refractory catatonia. Convuls Ther 1996;12:31-35. 
  102. Malur C, Pasol E, Francis A. ECT for prolonged catatonia. J ECT 2001;17:55-59.  https://doi.org/10.1097/00124509-200103000-00012
  103. Ungvari GS, Leung HC, Lee TS. Benzodiazepines and the psychopathology of catatonia. Pharmacopsychiatry 1994;27:242-245.  https://doi.org/10.1055/s-2007-1014312
  104. McCall WV, Shelp FE, McDonald WM. Controlled investigation of the amobarbital interview for catatonic mutism. Am J Psychiatry 1992;149:202-206.  https://doi.org/10.1176/ajp.149.2.202
  105. Cho IH, Joung Y, Hong S. A case of lethal catatonia in a 11-yearold boy. J Korean Acad Child Adolesc Psychiatry 1999;10:121-133. 
  106. Taylor MA, Fink M. Catatonia in psychiatric classification: a home of its own. Am J Psychiatry 2003;160:1233-1241.  https://doi.org/10.1176/appi.ajp.160.7.1233
  107. Reinfeld S, Gill P. Diagnostic overshadowing clouding the efficient recognition of pediatric catatonia: a case series. CNS Spectr (in press). 
  108. Matson JL, Turygin NC. How do researchers define self-injurious behavior? Res Dev Disabil 2012;33:1021-1026.  https://doi.org/10.1016/j.ridd.2012.01.009
  109. Simeon D, Hollander E. Self-injurious behaviors: assessment and treatment. Washington, DC: American Psychiatric Association Publishing;2001. 
  110. Dhossche DM, Wachtel LE. ECT for catatonia in autism. In: Ghaziuddin N, Walter G, editors. Electroconvulsive therapy in children and adolescents. New York: Oxford University Press;2013. 
  111. Bartak L, Rutter M. Differences between mentally retarded and normally intelligent autistic children. J Autism Child Schizophr 1976;6:109-120.  https://doi.org/10.1007/BF01538054
  112. Minshawi NF, Hurwitz S, Fodstad JC, Biebl S, Morriss DH, McDougle CJ. The association between self-injurious behaviors and autism spectrum disorders. Psychol Res Behav Manag 2014;7:125-136.  https://doi.org/10.2147/PRBM.S44635
  113. D'Agati D, Chang AD, Wachtel LE, Reti IM. Treatment of severe self-injurious behavior in autism spectrum disorder by neuromodulation. J ECT 2017;33:7-11.  https://doi.org/10.1097/YCT.0000000000000346
  114. Dhossche DM. Autism as early expression of catatonia. Med Sci Monit 2004;10:RA31-RA39. 
  115. Dimian AF, Botteron KN, Dager SR, Elison JT, Estes AM, Pruett JR Jr, et al. Potential risk factors for the development of self-injurious behavior among infants at risk for autism spectrum disorder. J Autism Dev Disord 2017;47:1403-1415.  https://doi.org/10.1007/s10803-017-3057-9
  116. Baghdadli A, Pascal C, Grisi S, Aussilloux C. Risk factors for self-injurious behaviours among 222 young children with autistic disorders. J Intellect Disabil Res 2003;47(Pt 8):622-627.  https://doi.org/10.1046/j.1365-2788.2003.00507.x
  117. Mandell DS. Psychiatric hospitalization among children with autism spectrum disorders. J Autism Dev Disord 2008;38:1059-1065.  https://doi.org/10.1007/s10803-007-0481-2
  118. Minshawi NF, Hurwitz S, Morriss D, McDougle CJ. Multidisciplinary assessment and treatment of self-injurious behavior in autism spectrum disorder and intellectual disability: integration of psychological and biological theory and approach. J Autism Dev Disord 2015;45:1541-1568.  https://doi.org/10.1007/s10803-014-2307-3
  119. Bitsika V, Sharpley CF. Stress, anxiety and depression among parents of children with autism spectrum disorder. J Psychol Couns Sch 2004;14:151-161.  https://doi.org/10.1017/S1037291100002466
  120. Lecavalier L. Behavioral and emotional problems in young people with pervasive developmental disorders: relative prevalence, effects of subject characteristics, and empirical classification. J Autism Dev Disord 2006;36:1101-1114.  https://doi.org/10.1007/s10803-006-0147-5
  121. Lam KS, Aman MG. The repetitive behavior scale-revised: independent validation in individuals with autism spectrum disorders. J Autism Dev Disord 2007;37:855-866.  https://doi.org/10.1007/s10803-006-0213-z
  122. Soke GN, Rosenberg SA, Hamman RF, Fingerlin T, Robinson C, Carpenter L, et al. Brief report: prevalence of self-injurious behaviors among children with autism spectrum disorder-a population-based study. J Autism Dev Disord 2016;46:3607-3614.  https://doi.org/10.1007/s10803-016-2879-1
  123. Steenfeldt-Kristensen C, Jones CA, Richards C. The prevalence of self-injurious behaviour in autism: a meta-analytic study. J Autism Dev Disord 2020;50:3857-3873.  https://doi.org/10.1007/s10803-020-04443-1
  124. Hill AP, Zuckerman KE, Hagen AD, Kriz DJ, Duvall SW, van Santen J, et al. Aggressive behavior problems in children with autism spectrum disorders: prevalence and correlates in a large clinical sample. Res Autism Spectr Disord 2014;8:1121-1133.  https://doi.org/10.1016/j.rasd.2014.05.006
  125. Bodfish JW, Symons FJ, Parker DE, Lewis MH. Varieties of repetitive behavior in autism: comparisons to mental retardation. J Autism Dev Disord 2000;30:237-243.  https://doi.org/10.1023/A:1005596502855
  126. Wachtel LE, Kahng S, Dhossche DM, Cascella N, Reti IM. ECT for catatonia in an autistic girl. Am J Psychiatry 2008;165:329-333.  https://doi.org/10.1176/appi.ajp.2007.07081246
  127. Folch A, Cortes MJ, Salvador-Carulla L, Vicens P, Irazabal M, Munoz S, et al. Risk factors and topographies for self-injurious behaviour in a sample of adults with intellectual developmental disorders. J Intellect Disabil Res 2018;62:1018-1029.  https://doi.org/10.1111/jir.12487
  128. Matson JL, Rivet TT. Characteristics of challenging behaviours in adults with autistic disorder, PDD-NOS, and intellectual disability. J Intellect Dev Disabil 2008;33:323-329.  https://doi.org/10.1080/13668250802492600
  129. Schroeder SR, Marquis JG, Reese RM, Richman DM, Mayo-Ortega L, Oyama-Ganiko R, et al. Risk factors for self-injury, aggression, and stereotyped behavior among young children at risk for intellectual and developmental disabilities. Am J Intellect Dev Disabil 2014;119:351-370.  https://doi.org/10.1352/1944-7558-119.4.351
  130. Wiggins LD, Levy SE, Daniels J, Schieve L, Croen LA, DiGuiseppi C, et al. Autism spectrum disorder symptoms among children enrolled in the study to explore early development (SEED). J Autism Dev Disord 2015;45:3183-3194.  https://doi.org/10.1007/s10803-015-2476-8
  131. Soke GN, Rosenberg SA, Rosenberg CR, Vasa RA, Lee LC, DiGuiseppi C. Brief report: self-injurious behaviors in preschool children with autism spectrum disorder compared to other developmental delays and disorders. J Autism Dev Disord 2018;48:2558-2566.  https://doi.org/10.1007/s10803-018-3490-4
  132. McClintock K, Hall S, Oliver C. Risk markers associated with challenging behaviours in people with intellectual disabilities: a metaanalytic study. J Intellect Disabil Res 2003;47(Pt 6):405-416.  https://doi.org/10.1046/j.1365-2788.2003.00517.x
  133. Cervantes PE, Matson JL. Comorbid symptomology in adults with autism spectrum disorder and intellectual disability. J Autism Dev Disord 2015;45:3961-3970.  https://doi.org/10.1007/s10803-015-2553-z
  134. Siegel M, Milligan B, Robbins D, Prentice G. Electroconvulsive therapy in an adolescent with autism and bipolar I disorder. J ECT 2012;28:252-255.  https://doi.org/10.1097/YCT.0b013e31825cec86
  135. Handen BL, Mazefsky CA, Gabriels RL, Pedersen KA, Wallace M, Siegel M. Risk factors for self-injurious behavior in an inpatient psychiatric sample of children with autism spectrum disorder: a naturalistic observation study. J Autism Dev Disord 2018;48:3678-3688.  https://doi.org/10.1007/s10803-017-3460-2
  136. Burt BA. Definitions of risk. J Dent Educ 2001;65:1007-1008.  https://doi.org/10.1002/j.0022-0337.2001.65.10.tb03442.x
  137. Brinkley J, Nations L, Abramson RK, Hall A, Wright HH, Gabriels R, et al. Factor analysis of the aberrant behavior checklist in individuals with autism spectrum disorders. J Autism Dev Disord 2007;37:1949-1959.  https://doi.org/10.1007/s10803-006-0327-3
  138. Richman DM, Barnard-Brak L, Bosch A, Thompson S, Grubb L, Abby L. Predictors of self-injurious behaviour exhibited by individuals with autism spectrum disorder. J Intellect Disabil Res 2013;57:429-439.  https://doi.org/10.1111/j.1365-2788.2012.01628.x
  139. Cooper SA, Smiley E, Allan LM, Jackson A, Finlayson J, Mantry D, et al. Adults with intellectual disabilities: prevalence, incidence and remission of self-injurious behaviour, and related factors. J Intellect Disabil Res 2009;53:200-216.  https://doi.org/10.1111/j.1365-2788.2008.01060.x
  140. Oliver C, Sloneem J, Hall S, Arron K. Self-injurious behaviour in Cornelia de Lange syndrome: 1. Prevalence and phenomenology. J Intellect Disabil Res 2009;53:575-589.  https://doi.org/10.1111/j.1365-2788.2009.01179.x
  141. Oliver C, Petty J, Ruddick L, Bacarese-Hamilton M. The association between repetitive, self-injurious and aggressive behavior in children with severe intellectual disability. J Autism Dev Disord 2012;42:910-919.  https://doi.org/10.1007/s10803-011-1320-z
  142. Berkson G, Tupa M, Sherman L. Early development of stereotyped and self-injurious behaviors: I. Incidence. Am J Ment Retard 2001;106:539-547.  https://doi.org/10.1352/0895-8017(2001)106<0539:EDOSAS>2.0.CO;2
  143. Rattaz C, Michelon C, Baghdadli A. Symptom severity as a risk factor for self-injurious behaviours in adolescents with autism spectrum disorders. J Intellect Disabil Res 2015;59:730-741.  https://doi.org/10.1111/jir.12177
  144. Paclawskyj TR, Kurtz PF, O'Connor JT. Functional assessment of problem behaviors in adults with mental retardation. Behav Modif 2004;28:649-667.  https://doi.org/10.1177/0145445503259834
  145. Oliver C, Richards C. Practitioner review: self-injurious behaviour in children with developmental delay. J Child Psychol Psychiatry 2015;56:1042-1054.  https://doi.org/10.1111/jcpp.12425
  146. Haq AU, Ghaziuddin N. Maintenance electroconvulsive therapy for aggression and self-injurious behavior in two adolescents with autism and catatonia. J Neuropsychiatry Clin Neurosci 2014;26:64-72.  https://doi.org/10.1176/appi.neuropsych.12110284
  147. Aman MG, Collier-Crespin A, Lindsay RL. Pharmacotherapy of disorders in mental retardation. Eur Child Adolesc Psychiatry 2000;9(Suppl 1):S98-S107.  https://doi.org/10.1007/s007870070023
  148. Masi G. Pharmacotherapy of pervasive developmental disorders in children and adolescents. CNS Drugs 2004;18:1031-1052.  https://doi.org/10.2165/00023210-200418140-00006
  149. Marcus RN, Owen R, Kamen L, Manos G, McQuade RD, Carson WH, et al. A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am Acad Child Adolesc Psychiatry 2009;48:1110-1119.  https://doi.org/10.1097/CHI.0b013e3181b76658
  150. Owen R, Sikich L, Marcus RN, Corey-Lisle P, Manos G, McQuade RD, et al. Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics 2009;124:1533-1540.  https://doi.org/10.1542/peds.2008-3782
  151. McDougle CJ, Scahill L, Aman MG, McCracken JT, Tierney E, Davies M, et al. Risperidone for the core symptom domains of autism: results from the study by the autism network of the research units on pediatric psychopharmacology. Am J Psychiatry 2005;162:1142-1148.  https://doi.org/10.1176/appi.ajp.162.6.1142
  152. Adler BA, Wink LK, Early M, Shaffer R, Minshawi N, McDougle CJ, et al. Drug-refractory aggression, self-injurious behavior, and severe tantrums in autism spectrum disorders: a chart review study. Autism 2015;19:102-106.  https://doi.org/10.1177/1362361314524641
  153. Wachtel LE, Reti IM, Ying H. Stability of intraocular pressure after retinal reattachment surgery during electroconvulsive therapy for intractable self-injury in a 12-year-old autistic boy. J ECT 2014;30:73-76.  https://doi.org/10.1097/YCT.0b013e31829b2d61
  154. Cizadlo BC, Wheaton A. Case study: ECT treatment of a young girl with catatonia. J Am Acad Child Adolesc Psychiatry 1995;34:332-335.  https://doi.org/10.1097/00004583-199503000-00019
  155. Arora M, Praharaj SK, Prakash R. [Electroconvulsive therapy for multiple major self-mutilations in bipolar psychotic depression]. Turk Psikiyatri Derg 2008;19:209-212. Turkish 
  156. Fink M. Electroshock: healing mental illness. 2nd ed. Oxford: Oxford University Press;2009. 
  157. Breen J, Hare DJ. The nature and prevalence of catatonic symptoms in young people with autism. J Intellect Disabil Res 2017;61:580-593.  https://doi.org/10.1111/jir.12362
  158. Wachtel LE, Dhossche DM. Self-injury in autism as an alternate sign of catatonia: implications for electroconvulsive therapy. Med Hypotheses 2010;75:111-114.  https://doi.org/10.1016/j.mehy.2010.02.001
  159. Sajith SG, Liew SF, Tor PC. Response to electroconvulsive therapy in patients with autism spectrum disorder and intractable challenging behaviors associated with symptoms of catatonia. J ECT 2017;33:63-67.  https://doi.org/10.1097/YCT.0000000000000338
  160. Hutton J, Goode S, Murphy M, Le Couteur A, Rutter M. New-onset psychiatric disorders in individuals with autism. Autism 2008;12:373-390.  https://doi.org/10.1177/1362361308091650
  161. Bailine SH, Petraviciute S. Catatonia in autistic twins: role of electroconvulsive therapy. J ECT 2007;23:21-22.  https://doi.org/10.1097/01.yct.0000263256.06421.7a
  162. Fink M, Taylor MA. Catatonia: a clinician's guide to diagnosis and treatment. Cambridge: Cambridge University Press;2003. 
  163. Dhossche DM, Shah A, Wing L. Blueprints for the assessment, treatment, and future study of catatonia in autism spectrum disorders. Int Rev Neurobiol 2006;72:267-284.  https://doi.org/10.1016/S0074-7742(05)72016-X
  164. Mazzone L, Postorino V, Valeri G, Vicari S. Catatonia in patients with autism: prevalence and management. CNS Drugs 2014;28:205-215.  https://doi.org/10.1007/s40263-014-0143-9
  165. Luiselli JK, Bird F, Wachtel LE. Electroconvulsive therapy (ECT) for autism spectrum disorder associated with catatonia and self-injury: a clinical review. Adv Neurodev Disord 2021;5:117-125.  https://doi.org/10.1007/s41252-021-00202-0
  166. Addington D, Addington JM, Ens I. Mentally retarded patients on general hospital psychiatric units. Can J Psychiatry 1993;38:134-136.  https://doi.org/10.1177/070674379303800212
  167. Thuppal M, Fink M. Electroconvulsive therapy and mental retardation. J ECT 1999;15:140-149.  https://doi.org/10.1097/00124509-199906000-00005
  168. Aziz M, Maixner DF, DeQuardo J, Aldridge A, Tandon R. ECT and mental retardation: a review and case reports. J ECT 2001;17:149-152.  https://doi.org/10.1097/00124509-200106000-00012
  169. van Waarde JA, Stolker JJ, van der Mast RC. ECT in mental retardation: a review. J ECT 2001;17:236-243.  https://doi.org/10.1097/00124509-200112000-00002
  170. Ring H, Zia A, Lindeman S, Himlok K. Interactions between seizure frequency, psychopathology, and severity of intellectual disability in a population with epilepsy and a learning disability. Epilepsy Behav 2007;11:92-97.  https://doi.org/10.1016/j.yebeh.2007.04.002
  171. Rutter M, Graham P, Yule W. A neuropsychiatric study in childhood. Cambridge: Cambridge University Press;1970. 
  172. Kishore MT, Nizamie A, Nizamie SH, Jahan M. Psychiatric diagnosis in persons with intellectual disability in India. J Intellect Disabil Res 2004;48:19-24.  https://doi.org/10.1111/j.1365-2788.2004.00579.x
  173. Lund J. The prevalence of psychiatric morbidity in mentally retarded adults. Acta Psychiatr Scand 1985;72:563-570.  https://doi.org/10.1111/j.1600-0447.1985.tb02655.x
  174. Bregman JD, Harris JC. Mental retardation. In: Kaplan S, Sadock B, editors. Comprehensive textbook of psychiatry. Philadelphia, PA: Lippincott Williams and Wilkins;1998. p.2224. 
  175. Moloney M, Hennessy T, Doody O. Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence. BMJ Open 2021;11:e039647. 
  176. Maddox BB, Trubanova A, White SW. Untended wounds: nonsuicidal self-injury in adults with autism spectrum disorder. Autism 2017;21:412-422.  https://doi.org/10.1177/1362361316644731
  177. Katz G, Lazcano-Ponce E. Intellectual disability: definition, etiological factors, classification, diagnosis, treatment and prognosis. Salud Publica Mex 2008;50(Suppl 2):S132-S141.  https://doi.org/10.1590/S0036-36342008000800005
  178. Caroff SN, Mann SC, Francis A, Fricchione GL. Catatonia: from psychopathology to neurobiology. 1st ed. Washington, DC: American Psychiatric Association Publishing;2004. 
  179. Reinblatt SP, Rifkin A, Freeman J. The efficacy of ECT in adults with mental retardation experiencing psychiatric disorders. J ECT 2004;20:208-212.  https://doi.org/10.1097/00124509-200412000-00004
  180. Little JD, McFarlane J, Ducharme HM. ECT use delayed in the presence of comorbid mental retardation: a review of clinical and ethical issues. J ECT 2002;18:218-222.  https://doi.org/10.1097/00124509-200212000-00010
  181. Wachtel LE, Griffin MM, Dhossche DM, Reti IM. Brief report: electroconvulsive therapy for malignant catatonia in an autistic adolescent. Autism 2010;14:349-358.  https://doi.org/10.1177/1362361309350135
  182. Wachtel LE, Jaffe R, Kellner CH. Electroconvulsive therapy for psychotropic-refractory bipolar affective disorder and severe self-injury and aggression in an 11-year-old autistic boy. Eur Child Adolesc Psychiatry 2011;20:147-152.  https://doi.org/10.1007/s00787-010-0155-z
  183. Kessler RJ. Electroconvulsive therapy for affective disorders in persons with mental retardation. Psychiatr Q 2004;75:99-104.  https://doi.org/10.1023/B:PSAQ.0000007564.35985.55
  184. Collins J, Halder N, Chaudhry N. Use of ECT in patients with an intellectual disability. Psychiatrist 2012;36:55-60.  https://doi.org/10.1192/pb.bp.110.033811
  185. Stein ALS, Sacks SM, Roth JR, Habis M, Saltz SB, Chen C. Anesthetic management during electroconvulsive therapy in children: a systematic review of the available literature. Anesth Analg 2020;130:126-140. https://doi.org/10.1213/ANE.0000000000004337