Letter: Restricted Access to Electroconvulsive Therapy in Pediatric and Adolescent Patients—Clinical and Familial Consequences: Case Report

Electroconvulsive therapy (ECT) is a procedure that uses electrical current to induce a brief generalized seizure to treat severe neuropsychiatric illnesses.1 ECT is well tolerated and elicits high response rates for catatonia, treatment-resistant mood, and psychotic disorders.1 Although pediatric data are limited, available studies report favorable outcomes, 2 including in patients with autism spectrum disorder (ASD) and developmental regression-conditions that have lower response rates to conventional treatments.3 Despite this and for various reasons, there is limited access to ECT for pediatric and adolescent patients.In the case presented, such barriers delayed care, resulted in significant morbidity for the child, and substantially disrupted the family's life as they sought effective treatment for their daughter.JB is a 13-year-old girl with CHD8-related neurodevelopmental disorder (CHD8-NDD), a rare autosomal dominant condition associated with developmental delay, intellectual disability, ASD, neuropsychiatric issues, sleep disturbance, and gastrointestinal issues.4 Despite her diagnosis, she integrated well with peers, participating in ballet and swimming, and speaking both English and Spanish.In 2023, she experienced sudden regression, becoming mute, staring unresponsively for prolonged periods, attempting to elope, and losing the ability to perform activities of daily living.Just before age 11, she started to display limb posturing and perseverative behaviors like object shaking, which were attributed initially to her neurodevelopmental condition.