Ethics of ECT for children

Assessing the Flynn Effect in the Wechsler Scales

The current study examined the Flynn Effect (i.e., the increase in IQ scores over time) across all editions of the Wechsler Adult Intelligence Scale (WAIS), Wechsler Intelligence Scale for Children (WISC), and Wechsler Preschool and Primary Scale of Intelligence (WPPSI). By reverse engineering the correlation and scale score transformations from each Wechsler edition’s technical manual, we made a mean and covariance matrix using the subtests and age groups that were in common for all editions of a given instrument. The results indicated that when aggregated, there was a FE of 0.44 IQ points/year. This Wechsler instrument used, however, moderates the FE, with the WISC showing the largest FE (0.73 IQ points/year) and the WAIS showing a smallest FE (0.30 IQ points/year). Moreover, this study found that the amount of invariant indicators across instruments and age groups varied substantially, ranging from 51.53% in the WISC for the 7-year-old group to 10.00% in the WPPSI for the 5- and 5.5-year-old age groups. Last, we discuss future direction for FE research based on these results.

Catatonia and autism: a historical review, with implications for electroconvulsive therapy

Current autism research is historically separated from catatonia and other childhood psychotic disorders, although catatonia and autism share several common symptoms (mutism, echolalia, stereotypic speech and repetitive behaviors, posturing, grimacing, rigidity, mannerisms, and purposeless agitation). Electroconvulsive therapy (ECT) effectively treats catatonia and catatonia-related conditions of intractable compulsions, tics, and self-injury in people with autism. We assess the incidence of catatonic symptoms in autism, examine emerging ECT indications in people with autism and related developmental disorders, and encourage ethical debate and legal-administrative action to assure equal access to ECT for people with autism.

Child and adolescent electroconvulsive therapy: a case report

Electroconvulsive therapy (ECT) is a controversial treatment modality that is only rarely performed on children and adolescents. There is a marked paucity of published data relating to the indications, use, clinical outcome and complications of ECT in this age group. The ethical and moral issues surrounding the use and in particular the research of ECT in this group of patients makes controlled data very difficult to come by. The following case report and review of the literature will address some of these issues.

Tratamiento electroconvulsivo en niños y adolescentes

It is well-known that electroconvulsive therapy (ECT) is a safe and effective treatment for some mental disorders in adults. However, its use in children and adolescents is still the cause of some fears which may not be justified. The aim of this article is to clarify and to present the state of this question by reviewing the literature about ECT in children and adolescents, with emphasis on efficacy, indications, adverse effects and limitations. Results from studies in this population group show similar safety and efficacy data as those observed in adults. There exists a misinformation about the ECT technique among child psychologists and psychiatrists. Large follow-up studies are needed.

The use of electroconvulsive therapy in special patient populations

BACKGROUND

Despite its well-established efficacy and its increasing use, electroconvulsive therapy (ECT) remains a controversial treatment. Lack of clarity in the issues related to its use in special patient populations (for example, in children, in adolescents, in pregnant women, in the elderly, and in the medically ill) often contributes to the debate about the use of ECT.

METHOD

The literature on ECT use in special patient populations is reviewed, together with the commonly associated high-risk medical conditions in clinical practice. Specific reference is made in each case to the safety, tolerability, and efficacy of the procedure.

RESULTS

Much of the literature surveyed consists of case studies, although a few controlled trials are available. In general, ECT use in special populations is relatively safe and extremely effective. In small case series, ECT use in children and adolescents is effective but requires further systematic study. In pregnant women, ECT is very effective, and with proper medical care, it is relatively safe in all trimesters of pregnancy, as well as in the postpartum period. The frail elderly are particularly good candidates for ECT because they are often unresponsive to or intolerant of psychotropic medication. Medical conditions that should receive particular attention during a course of ECT are disorders of the central nervous system (CNS), cardiovascular, and respiratory system. With modern anesthesia techniques and careful medical management of each high-risk patient, most can successfully complete a course of ECT. The process of obtaining informed consent also requires special consideration in this group of patients because their capacity to consent to treatment may be compromised.

CONCLUSIONS

With careful attention to each patient's medical and anesthesia needs, ECT is an effective and relatively safe procedure in high-risk special patient populations.