This paper reviews electroconvulsive therapy (ECT) in children and adults with autism and concomitant psychopathology, including affective illness, catatonia and self-injury. Case examples are highlighted.

A review of the English-language literature on ECT in pediatric, adult, autistic and mentally retarded populations was conducted, with focus on catatonia, drug-resistant psychiatric illness and self-injury. This was combined with the author's experience with two autistic adolescents in catatonic stupor, and an autistic child and young adult with severe affective disturbance and self-injury. All four patients underwent ECT with excellent symptom resolution.

ECT is an effective and safe treatment modality across the lifespan for a wide range of psychopathology. Current literature supports the appropriateness, safety and efficacy of ECT in autistic and intellectually disabled populations, where patients suffer from an increased incidence of psychiatric and behavioral disturbances. The following cases are presented:

Pt 1: An 18-year-old female with autism, MR and self-injury in classic catatonic stupor.

Pt 2: A 15 year-old male with autism and MR in catatonic stupor confounded by bradycardia and arrhythmias.

Pt 3: A 19-year-old male with autism, MR, profound depression, tics, compulsions and catatonic symptoms accompanied by self-injury.

Pt 4: An 8-year-old boy with autism, MR, cyclical mood disturbance and intractable self-injury confined to full-body protective equipment.

Electroconvulsive therapy affords excellent symptom remission in autistic individuals with affective illnesses and catatonia, which may be complicated by dangerous self-injury. Prompt diagnosis and pursuit of ECT significantly improve clinical outcome in this patient population.