Electroconvulsive Therapy for Catatonia in Autistic and Non-Autistic Patients: An Observational Study on Course, Efficacy, Aggression, and Self-Injury Outcomes.

This was a single-site observational study with no control group, so it cannot prove that ECT caused the improvements. Raters who scored global improvement and severity were not blinded to the patient's treatment course. All patients were receiving psychiatric medication while receiving ECT, and some were also receiving applied behavior analysis, so the contribution of ECT alone cannot be separated. Autism and intellectual disability were highly correlated: 88.4% of autistic patients had intellectual disability, compared with 11.9% of non-autistic patients, and the autism-without-intellectual-disability group had only five patients. Cognitive adverse effects were not formally tested; memory complaints came from patient or caregiver reports, so true cognitive effects may be missed. Neither the Bush-Francis nor Kanner catatonia scale was formally validated in autistic patients or children with catatonia. Analyses used available data without imputation, and denominators differed across outcomes. ECT technique changed over the 4-year study period, including more frequent second stimulations, although calendar year was adjusted for. Patients entered treatment at different times, creating unequal follow-up and censoring for treatment burden.

Authors declared: J.R.S. received funding from Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Mental Health, Axial Therapeutics, Janssen Pharmaceuticals, Vanda Pharmaceuticals, Bristol Myers Squibb, and Roche. Z.J.W. serves on scientific advisory boards of Autism Speaks and SPARK (Simons Foundation), holds equity in Bristol Myers Squibb, and has received consulting fees from Roche. J.E.W. receives funding from the Department of Veterans Affairs, Bristol Myers Squibb, AC-Immune, and Ono Pharmaceuticals. J.L. receives funding from Harvard Medical School, the Rappaport Foundation, the American Academy of Child and Adolescent Psychiatry, National Institute of Mental Health, and the Foundation for Prader-Willi Research, holds equity and has received consulting income from Revival Therapeutics Inc., and has consulting fees from Soleno Therapeutics. The other authors declared no conflicts of interest. Vanderbilt University Medical Center's Microsoft 365 Copilot was used for statistical code development, documentation, and consistency checks under author supervision.

Do not read the improvement as proof that ECT alone worked. Patients were also receiving psychiatric medication and some received applied behavior analysis, and the study had no control group or blinded raters.