Frontiers in psychiatry · 2026
Modified electroconvulsive therapy for treatment-resistant self-injurious behavior in autism spectrum disorder with severe intellectual disability: a case report.
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Xu Ping, Ding Didi, Han Xuehua, Liu Junjun, Tang Hao
Аннотация
BACKGROUND: Treatment options for severe self-injurious behavior (SIB) in autism spectrum disorder (ASD) with comorbid intellectual disability (ID) are limited.
CASE PRESENTATION: 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.
CONCLUSION: 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.
CASE PRESENTATION: 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.
CONCLUSION: 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.