Is Electroconvulsive Therapy Unsuitable for Children and Adolescents?

By Baldwin, Steve; Jones, Yvonne | Adolescence, Fall 1998 | Go to article overview

Is Electroconvulsive Therapy Unsuitable for Children and Adolescents?


Baldwin, Steve, Jones, Yvonne, Adolescence


ABSTRACT

Electroconvulsive therapy (ECT) as a treatment option for adults with affective disorders has a long history. ECT with children and adolescents, however, has not been widely used, and no empirical studies or controlled evaluations have been conducted. A review of the literature on ECT with minors reveals that it has an unknown mechanism of action, with a domain of applicability diminished yearly by legislation, litigation, and a wide range of intervention alternatives.

HISTORICAL REVIEW

Few treatment approaches have caused as much controversy as electroconvulsive therapy (ECT). Since its first documented use in the 1940s (Cerletti, 1956; Slater, 1951), there has been ongoing discourse about its effectiveness. This debate has generated much heat but insufficient light to permit conclusive recommendations about the limits of its application.

In the 1950s, ECT was viewed by many physicians as harm-free and potentially useful for a wide range of disorders and client populations. It was considered helpful in the treatment of affective disorders, in particular chronic depression--"cases in which the clear-cut, dynamically understandable and approachable neurosis has been overlaid by a serious depressive affect" (Gallinek, 1952). In the treatment of neurotic disorders, ECT was viewed by some psychiatrists as of decisive benefit; it often marked a turning point from therapeutic failure to perceived therapeutic success. Other clinical problems, such as anorexia nervosa, were also considered potentially resolvable by ECT. Similarly, client populations with schizo-affective disorders, narcotic addiction, and obsessive-compulsive behavior were included in many early clinical trials. The literature on ECT with minors was sparse, although some children and young adults were included in treatment populations (e.g., Gallinek, 1952).

ECT research and practice during the 1960s was characterized by efforts to understand how it produced results, with further attempts to specify optimum client populations (Abrains & Fink, 1969; Mendels, 1967; Sargent & Slater, 1963). Although there was more interest in the establishment of experimental designs to evaluate the effectiveness of ECT, many of these were unsophisticated trials with poor methodologies, producing inconclusive results. Most studies were based on ad hoc variations of normal clinical practice.

In the 1970s, increasing concern in the mental health field about client rights prompted a series of surveys and studies about ECT and its applications. This closer examination of ECT was associated with a narrowing of clinical focus to specific disorders with more discrete populations. The seminal task force report on ECT in Massachusetts influenced a generation of clinicians. It found that "most authoritative publications appear to be in agreement that symptoms associated with the depressed phase of manic-depressive illness or involutional melancholia are treated most effectively by ECT" (Frankel, 1973). Nonetheless, the report noted continuing disagreement in the field with regard to the use of ECT with adults who had schizophrenia, its combined use with psychotropic drugs, and questions about subsequent brain damage. The use of ECT in childhood and adolescent disorders similarly was viewed as an area of unresolved debate.

An analysis of responses to the task force questionnaire (from which the report was written) indicated that all respondents assigned some value to ECT in the treatment of severe depression, especially when risk for suicide was present. Some practitioners stated that it would be appropriate to consider ECT when psychotherapy or use of medication had been unsuccessful, or when a poor response to other therapies had rendered the person nonfunctional. Most respondents indicated the need to complete extensive pretreatment examinations (typically including an ECG, a chest x-ray, an EEG, a spine x-ray, a brain scan, and additional neurological tests) to determine the suitability of ECT for individual clients. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • A full archive of books and articles related to this one
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Is Electroconvulsive Therapy Unsuitable for Children and Adolescents?
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

    Already a member? Log in now.