Electroconvulsive Therapy in Children

Psychiatry now generally accepts that electroconvulsive therapy (ECT) is effective and necessary in adults with serious depression and other illnesses who do not respond to medication. It may even be preferable to medication in some cases because it works so rapidly and is safe.

But how about children?

There has been an unwritten taboo in psychiatry, and a reaction of shock and horror in the general population, to the idea of giving convulsive therapy to those under 18.

But is this unfavorable reaction wise? Are we denying children access to a treatment that is safe and effective in adults?

This denial is not compatible with good medical ethics, which demand that we make effective treatments of proven benefit available to all, regardless of social class, gender, economic status, or age. We do not deny the elderly hip transplants or heart transplants because they are elderly.

But we deny children access to convulsive therapy -- which often may be the only treatment that really sick children will respond to -- because they are children. This is ageism in reverse, and terribly unfair.

Now, who are the deniers-in-chief here? Partly it’s a portion of the child psychiatrists, some of whom seem enmeshed in a lost world of psychotherapy and Prozac. Partly it’s the parents, who’ve imbibed every uninformed and outdated prejudice around against ECT.

But partly it’s the state legislators as well, because in 13 of the 50 states the practice of ECT is highly regulated by law.

By law. Just imagine. There is no other medical procedure that is legally regulated. You do not have to get separate opinions from two physicians not connected with your institution to start penicillin therapy. Convulsive therapy is the penicillin of psychiatry, but in Florida you need two written reports from outside psychiatrists to get ECT for your child.

In Colorado and Texas, ECT is flat out forbidden for children under 16. Who knew what they were thinking, these legislators who believed themselves capable of deciding who needed ECT and who didn’t. They were “protecting” children. Protecting them from what? From the pediatricians and the child psychiatrists who otherwise would have acted in their little patients’ worst interests?

Such legislative over-reach leaves one open-mouthed. What are parents in Texas and Colorado supposed to do whose children are engaged in the self-injurious behavior of autism, hitting their heads with their fists until their retinas detach or they have strokes? (Their children will dramatically improve with ECT.) Oh, they can just drive over to Mississippi and get it, where the practice is unregulated.

Do you realize how colossally inconvenient that is for parents? Transporting a head-banging child in a four-hour car ride to another state, checking into the local hospital, overnighting in a hotel, driving back the next day? All this because the crackers in the state legislature decided in their wisdom to ban the procedure for children entirely. The arrogance, the provincial, uninformed, know-nothing arrogance, defies the imagination.

In Missouri a court order is needed. No court order is needed in Missouri for penicillin. A judge has to decide if it’s right for your child. Your child may need a lawyer of his own, the parents will need their own lawyer, of course. The lawyers may end up fighting because the child’s lawyer has seen “One Flew” and doesn’t trust the parents’ lawyer. The hospital may have a lawyer of its own. This will cost thousand of dollars.

In Tennesse your child may have ECT only for “mania or severe depression.” Hey, the legislators didn’t know about conditions like catatonia, common in children with autism and Intellectual Disability. They had read an article in the Saturday Evening Post that said ECT was preferable to child suicide, and so they grudgingly accepted it for the heaviest of the mood disorders. That’s right: in Tennessee medical policies are being determined by the Saturday Evening Post (which stopped publishing as a weekly in 1969 but seems just like yesterday in the minds of the local solons).

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Getting laws off the books is comparable to getting oil stains off suede, especially when the Scientologists, under the guise of various front organizations, lobby for tightening the ECT restrictions rather than loosening them. Term like “brain damage” are dropped. ECT does not cause brain damage, but you can find experts out there who will dolefully wrinkle their brows when the subject comes up.

So a lot of forces are in conspiracy against getting the kids better. The sanctimonious, patronizing rhetoric of “protection” is so thick it may be scraped off the walls.

There is one gleam of light: Oxford University Press has just published the first comprehensive guide to Electroconvulsive Therapy in Children and Adolescents, edited by Neera Ghaziuddin, professor of psychiatry at the University of Michigan, and Garry Walter, professor of child and adolescent psychiatry at the University of Sydney. I wrote the first chapter, on the appalling story of how all these restrictions on a needed therapy arose in the first place. If you live in Florida, Texas, Colorado, or any of the other states where benighted legislators have limited the access to ECT, buy a copy and send it – not to them because it will be tossed in the wastebasket – but to the medical reporter of your local paper.