Catatonia in Autism and Other Neurodevelopmental Disorders
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When Catatonia Co-Occurs with Autism and Other Neurodevelopmental Disorders
Catatonia is a serious but underrecognized condition that can co-occur with autism and other neurodevelopmental disorders. While often treatable, it frequently goes undiagnosed — especially in the early stages — because its symptoms can resemble or overlap with existing traits, unfold gradually, or appear in ways that don’t immediately raise concern.
Many individuals lack the speech or cognitive capacity to describe what they’re experiencing, and caregivers, already managing a complex web of needs, may not realize that new behaviors or regression have emerged. Clinicians, too, may miss the signs, as catatonia is still not adequately covered in most medical education. As a result, early symptoms are often misunderstood or dismissed.
When this happens, treatment may be delayed, and catatonia can progress — leading to worsening symptoms, severe disability, or even life-threatening complications. While early recognition can improve outcomes, treatment can still be effective even when catatonia has been present for some time. Increased awareness, education, and persistence in seeking an accurate diagnosis can make a meaningful difference — so that catatonia is considered in the differential diagnosis when assessing new signs and symptoms.
Essential, easy-to-share information on catatonia in autism for families, schools, and care providers
This information sheet was developed by Carol Allread, a mother of a son with autism whose mission is championing autism health equity through family-centered insight, in collaboration with Dr. Joshua Ryan Smith, the University of Washington Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program, the Autism Science Foundation, and SPACES.
We are honored to share it here as a resource for families, educators, and care teams.
Noticing the First Signs of Catatonia
Recognizing the overlap between autism, other neurodevelopmental disorders and catatonia is critical — yet it is often overlooked. Because many symptoms of catatonia can resemble or intensify traits already associated with autism or other neurodevelopmental disorders, the early signs may be dismissed as part of the person’s baseline or attributed to stress, behavioral changes, or developmental fluctuation.
This makes it essential to be alert to any changes that are different from the individual’s usual patterns of behavior, mood, energy, or functioning. Even subtle shifts can be significant. What matters most is not whether the behavior itself is familiar in autism, but whether it represents a change for that specific individual. Such changes may signal the onset of catatonia and should be evaluated promptly.
While catatonia can present in many ways, some of the most important changes to watch for include:
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Alterations in overall behavior, mood, or energy levels
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Episodes of unprovoked aggression
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Emotional changes such as crying spells, irritability, social withdrawal, or suicidal thoughts
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Sudden giddiness or inappropriate laughter
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Intensification of repetitive or self-stimulatory behaviors (“stimming”)
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New or increased self-injurious behavior
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Repetitive or looping thoughts, often with themes of fear or doom
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New or increased echolalia (repetition of words or phrases)
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Regression in cognition, functional skills, or ability to perform activities of daily living (ADLs)
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Reduced interest in food, eating less, or noticeable weight loss
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Mutism or reduced verbal responses when prompted
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Heightened activity levels or non–goal-directed movements (hyperactivity)
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Fixed gaze or staring spells with little eye movement or decreased blinking
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Maintaining unusual or rigid postures for extended periods
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Fluctuation in vital signs such as blood pressure or body temperature
Any sudden or unexplained emergence of these changes — particularly unprovoked aggression, self-injurious behavior, or regression — should prompt consideration of catatonia and a timely clinical evaluation.
What Can Caregivers Do if They See Signs of Catatonia?
If you notice sudden or unexplained changes — especially new self-injurious behavior or unprovoked aggression — it’s important to act quickly. These behaviors can place the individual and others at risk of harm and may be early signs of catatonia. Catatonia can worsen over time, but improvements are often possible with the right evaluation and treatment, even if symptoms have been present for months or years.
The following steps will help you as you navigate the process of securing appropriate care for your loved one:
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Document your loved one’s baseline and what has changed
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Describe what their typical mood, behavior, skills, and activity levels were before you noticed changes (baseline).
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Keep notes on what has shifted: when it began, how often it happens, and what it looks like now.
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Short video clips can help show changes, especially if the behaviors don’t happen during a clinic visit.
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While you may keep detailed notes for your own records, create a brief bulleted summary highlighting the most important changes to give to the provider. Clinicians have limited time to review information, so a concise format helps ensure your key concerns are understood. Click here for a sample.
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Seek a thorough medical evaluation as soon as possible
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Contact your primary healthcare provider, neurologist, or psychiatrist and describe your concerns clearly: “I am concerned my loved one may be showing signs of catatonia.”
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Bring the documentation about your loved one (baseline, changes, video clips, brief bulleted summary) to the appointment.
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If the provider is not familiar with catatonia
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Many clinicians have limited training in recognizing catatonia, especially in autism and other neurodevelopmental disorders.
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If this happens, stay calm and collaborative. You might say: “I know catatonia isn’t always on the radar, but I’ve read it can occur in people with my loved one’s condition, and I’d like to explore that possibility.”
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Bring printed peer-reviewed articles, clinical guidelines, or educational materials (such as from The Catatonia Foundation) to share. Click here for recent articles
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Ask if they would consider consulting with a colleague who has expertise in catatonia or referring you to a specialist.
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Ask for catatonia to be considered
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Request that catatonia be included in the differential diagnosis.
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The Bush–Francis Catatonia Rating Scale (BFCRS) is a widely used tool — ask if it can be administered.
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If appropriate, discuss whether a lorazepam challenge could be used as part of the diagnostic process.
Know when urgent or emergency care is needed
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If your loved one is engaging in self-injury or unprovoked aggression that could cause harm to themselves or others, seek emergency care immediately.
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Urgent evaluation is also needed if they stop eating or drinking, become immobile, or show changes in breathing, heart rate, or temperature.
Advocate for timely treatment
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If catatonia is diagnosed or suspected, ask about first-line treatments such as lorazepam and/or ECT. These can be effective when used appropriately, even in long-standing cases.
Remember: You know your loved one best. Your understanding of their baseline and your observations of change are essential for guiding clinicians toward the right diagnosis and care — whether the changes are recent or have been happening for some time.
Advocacy in Catatonia and Neurodevelopmental Conditions
When catatonia occurs in someone with a neurodevelopmental condition, timely recognition and treatment can be life-changing — but getting there often requires active, persistent advocacy. Many healthcare providers have little training in catatonia, especially when it presents in autism, intellectual disability, or other neurodevelopmental conditions.
As a result, families and caregivers often find themselves needing to bring up the possibility of catatonia as a potential diagnosis — doing so from an informed perspective — while also providing relevant information and advocating for a comprehensive evaluation.
Knowing when and how to advocate is essential
Advocacy may involve presenting clearly documented changes from baseline, requesting that catatonia be considered in the differential diagnosis, asking for specific assessments such as the Bush–Francis Catatonia Rating Scale, or suggesting referral to a clinician with experience in neurodevelopmental conditions and catatonia.
This is not an easy role to take on. It places an unfair burden on caregivers who are already navigating complex daily challenges, distressing behaviors, and sometimes rapid loss of skills in their loved one.
Advocating is challenging but necessary
Advocating for someone with a neurodevelopmental condition who may also have catatonia can be challenging and exhausting. Caregivers are often managing complex needs on a daily basis, and the added burden of ensuring catatonia is recognized and treated can feel overwhelming. Yet, timely and accurate diagnosis often depends on a caregiver’s ability to notice changes, communicate them clearly, and request appropriate evaluation.
The language you use is important
One key aspect of effective advocacy is choosing language that supports accurate diagnosis. The words you use can shape how a provider thinks about symptoms — sometimes in ways that unintentionally lead them away from considering catatonia. To increase the likelihood that catatonia is part of the differential diagnosis, describe behaviors factually and in detail, without defaulting to terms that imply another condition.
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Avoid diagnostic shortcuts – Instead of using terms that imply a psychiatric diagnosis (e.g., “mania” or “depression”), focus on observable signs.
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Be precise about changes from baseline – Quantify the change in behavior so providers can distinguish between longstanding traits and new or intensified signs.
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Provide context – Include when you first noticed the change, how long it has been occurring, and whether symptoms fluctuate over time.
Examples:
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Instead of “mania,” say: “He is constantly moving, can’t settle, and is pacing for hours.”
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Instead of “depression,” say: “She is perseverating on thoughts of doom and crying frequently throughout the day.”
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Instead of “more stimming,” say: “Stimming used to occur 30 minutes a day; now it’s constant and interrupts eating and sleeping.”
This type of precise, objective description allows providers to better understand the scope and nature of the changes, making it more likely they will consider catatonia in their evaluation.
Resources from The Catatonia Foundation
At The Catatonia Foundation, we recognize both the necessity and the toll of advocacy. That’s why we’ve developed resources to help you navigate this process more confidently:
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Advocacy – Click here for practical tips for advocacy.
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The Inside Scoop to Advocacy in Autism – Click here for a deeper dive into effective strategies and real-world scenarios from a psychiatrist who provides the inside scoop to advocacy.
You should not have to carry this responsibility alone — but when advocacy is necessary, having a plan, the right language, and trusted resources can make all the difference.
How Providers Make a Diagnosis
Diagnosing catatonia in individuals with neurodevelopmental conditions can be challenging. Symptoms may overlap with baseline behaviors, change gradually, and wax and wane over time — sometimes the individual may appear agitated, while at other times they may be withdrawn or stuporous. These shifts can make catatonia harder to recognize, especially if different symptoms emerge at different stages. In a brief office visit, a provider may only see part of the picture — particularly if symptoms fluctuate throughout the day or appear only in certain settings.
A thorough evaluation for catatonia may include the following:
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Bush–Francis Catatonia Rating Scale (BFCRS)
A structured assessment that measures the presence and severity of catatonic signs. While widely used, it may be more difficult to apply in neurodevelopmental conditions because some features overlap with pre-existing behaviors. It is important that providers focus on signs that differ from the person’s baseline — whether they are more intense, occur more frequently, or are present when they were not observed before. Even with these challenges, the BFCRS provides a framework for systematically evaluating potential catatonia. Click here for more information on the BFCRS
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Lorazepam Challenge
A test in which a small dose of lorazepam is administered to see if symptoms improve temporarily. A positive response can support a diagnosis of catatonia, but it’s important to note that not everyone responds, and a negative result does not rule out catatonia. Click here for more information on the Lorazepam Challenge
Laboratory tests, imaging, and EEGs may be used to identify these causes. Identifying and addressing an underlying condition can improve treatment outcomes. For caregivers, asking the provider whether these possibilities have been considered is an important part of advocating for a thorough evaluation.
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Underlying Conditions
Providers may need to evaluate for underlying medical and psychiatric conditions that could be triggering or worsening catatonia. These may include:-
Autoimmune encephalitis (such as anti-NMDA receptor encephalitis)
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Infections (e.g., urinary tract infection, pneumonia)
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Metabolic disturbances (e.g., thyroid disease, electrolyte imbalances)
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Neurological conditions (e.g., seizures, stroke)
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Medication effects (including withdrawal)
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Psychiatric conditions (e.g., mood disorders)
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Treatment and Management
The treatment of catatonia in individuals with neurodevelopmental conditions should begin as soon as possible once the diagnosis is suspected or confirmed, as earlier intervention is often linked to better outcomes. In some cases, symptoms can escalate rapidly or become dangerous, making timely evaluation especially important.
Because catatonia can present differently in each individual and symptoms may change over time, treatment often needs to be individualized and adapted as the situation evolves.
Treatment may include a combination of medication, electroconvulsive therapy (ECT), addressing underlying medical or psychiatric conditions, supportive care, ongoing monitoring and maintenance, and a multidisciplinary approach, as described below.
Medication
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Benzodiazepines – Lorazepam is the most commonly used medication and is often highly effective, sometimes producing rapid improvement. Other benzodiazepines, such as diazepam or clonazepam, are sometimes used depending on the individual’s needs and the provider’s informed and educated clinical judgment. Treatment usually starts with a low dose that is increased gradually.
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Higher doses – Managing catatonia with lorazepam often requires higher doses than in other conditions. Published reports describe the use of doses up to, and in some cases, exceeding, 30mg per day to achieve symptom relief. These higher doses are typically well-tolerated by patients with catatonia. It is important that treatment is provided under the care of a physician who can carefully monitor response and adjust dosing as needed.
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Additional medications – In some cases, additional medications may be considered, particularly if benzodiazepines are only partially effective or not tolerated. Amantadine and memantine — both of which affect the brain’s glutamate system — are among the medications that have been used in certain situations under specialist guidance. Other medications may be used as well, either to target the symptoms of catatonia itself or to address underlying psychiatric or medical conditions contributing to the symptoms.
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IMPORTANT CAUTION – Certain medications — including some antipsychotics and other psychiatric drugs — can cause or exacerbate catatonia in some individuals and should be used with caution. Additionally, weaning medications too quickly can trigger or worsen catatonia, so any changes to medication should be done gradually and under close medical supervision.
Electroconvulsive Therapy (ECT)
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What is ECT – A medical procedure performed under anesthesia in which brief, controlled electrical stimulation is applied to the brain. ECT is often highly effective for catatonia, including in individuals with neurodevelopmental conditions, especially when benzodiazepines have not provided enough improvement. It is considered safe when performed by experienced providers.
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Safety of ECT – While ECT can sound intimidating, it is not painful, is done with full monitoring, and has been safely used in children, adolescents, and adults for decades.
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When might ECT be used earlier – Although often considered a second-line treatment, in cases of severe aggression, self-injurious behavior, or malignant catatonia, ECT may be used earlier to rapidly address life-threatening or dangerous symptoms.
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A family's story – To hear from a family whose son with autism and catatonia receives ECT treatment, click here
Addressing underlying causes
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If catatonia is related to a medical, neurological, or psychiatric condition, treating that underlying cause is essential.
Supportive care
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Nutrition and hydration – Individuals with catatonia may eat or drink less, which can quickly become dangerous. Monitoring and supporting adequate intake is critical.
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Movement and positioning – Long periods of immobility can lead to complications like pressure sores or blood clots. Gentle repositioning and range-of-motion exercises may be needed.
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Environmental support – Reducing sensory overload, maintaining a calm environment, and providing reassurance can help lower stress on the nervous system.
Ongoing monitoring and maintenance
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Follow-up care – Catatonia symptoms can wax and wane, even after a positive response to treatment. Regular follow-up allows providers to adjust medication, continue supportive care, and detect any early signs of recurrence.
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Noticing signs of recurrence – Recurrence is possible, so recognizing early changes can help providers intervene more effectively. In some cases — especially in individuals with neurodevelopmental conditions.
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Maintenance ECT – ECT may need to be continued on a maintenance basis for an extended period to preserve its benefits.
A multidisciplinary approach
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Collaboration among healthcare disciplines – Bringing together psychiatry, neurology, primary care, and other specialists — can help ensure that all aspects of health are addressed.
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Engagement with the family as part of the care team – Family and caregivers play an essential role in this process, as they are often the first to notice subtle changes in symptoms and can share valuable insights with the care team.
Transitioning from Pediatric
to Adult Care
For individuals with neurodevelopmental conditions and catatonia, treatment and management often extend over many years. As young people age out of pediatric services, they and their families may face new challenges in transitioning to adult care.
Potential challenges you may face in the transition process include:
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Limited provider expertise – There are often fewer adult psychiatrists, neurologists, and other specialists with direct experience in diagnosing and treating catatonia, particularly in individuals with neurodevelopmental conditions.
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Continuity of treatment – Long-term treatments such as maintenance ECT or ongoing medication management require careful handoff between pediatric and adult providers to avoid lapses in care.
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Consent and legal authority – Guardianship laws vary by state, and in some states guardians may not be able to consent to ECT for an adult. Understanding local regulations well before the transition is essential to prevent treatment delays. In some cases, it may be necessary to work with an attorney and petition the court for the authority to consent on behalf of an adult child.
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Shifts in care models – Pediatric care teams often work in a more integrated, family-centered way. Adult care systems may involve more fragmented services, requiring caregivers to coordinate across multiple providers and facilities.
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Access to specialized facilities – Not all adult hospitals or outpatient centers are equipped to manage catatonia in people with complex developmental and medical needs.
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Less frequent follow-up – Adult providers often see patients less frequently than pediatric teams, which means there may be fewer opportunities to address emerging issues — such as the need for medication adjustments or timely ECT treatments — before symptoms worsen.
Planning ahead can make this process smoother. Ideally, transition planning should begin well before the individual reaches the age limit for pediatric care, allowing time to identify adult providers, address legal consent issues, and ensure treatment plans and records are transferred without interruption.
Accessing Support Services
Caring for a loved one with catatonia and a neurodevelopmental condition is physically, mentally, and emotionally demanding. The responsibilities go far beyond basic care — they can include managing severe behaviors, coordinating medical treatment, advocating with providers, and ensuring safety. While it may feel like no one outside your immediate circle truly understands the effort involved, documenting it in detail can help others — including service providers, case managers, and decision-makers — grasp the level of care required.
Why this matters – Access to services such as respite care, Medicaid-funded supports, and other community resources often depends on demonstrating the true scope of your caregiving responsibilities. The more clearly you can illustrate your daily workload, the easier it is to make a compelling case for help.
How to document the level of care you provide:
Write a detailed daily care log – Include all the activities you do for your loved one, from meals and personal care to medication administration, therapy support, and behavioral interventions.
Track the time spent – Note how many minutes or hours each task takes.
Include the hard moments – Document every incident of severe behavior (aggression, self-injury, agitation) as well as all the time spent managing them.
Capture the invisible work – Add in time spent coordinating appointments, communicating with schools or service providers, managing insurance or Medicaid paperwork, and advocating for services.
Format it for impact – Present your notes in a clear, easy-to-read format, such as a table or bullet list, showing tasks, frequency, and time required. This makes the scale of your work visible at a glance.
For a sample Daily Care Log Template click here
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Next steps
Once you have your documentation, share it with your caseworker, Medicaid service coordinator, and other relevant professionals. Ask specifically about services you may qualify for, such as:
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Respite care to give you short breaks from caregiving
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In-home support staff or community living supports
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Behavioral support services
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Medicaid waivers or other state-based programs
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Transportation assistance for medical or therapy appointments
Exploring and securing these services is not a luxury — it’s a necessary part of sustaining your ability to provide care over the long term.
Obstacles to Diagnosis and Treatment
Even when caregivers recognize changes that could signal catatonia, significant barriers can stand in the way of timely and effective care. These obstacles often compound one another, leaving individuals without the diagnosis or treatment they need.
What are some of the common challenges?
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Shortage of experienced providers – There are not enough clinicians with the expertise to recognize and treat catatonia, especially in individuals with neurodevelopmental conditions.
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Limited professional awareness and training – Many healthcare providers have little or no formal education on catatonia. Without experience, subtle or early signs can be overlooked.
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Misattribution of symptoms – Regression or behavioral changes are often incorrectly assumed to be part of the “natural course” of autism or another neurodevelopmental disorder.
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Gaps in continuity of care – Communication between inpatient and outpatient providers is often lacking. A patient may leave the hospital with no psychiatrist to continue treatment, or an outpatient provider may refer to inpatient care without effective follow-up or coordination.
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Few specialized clinics – Specialty programs for complex or treatment-resistant cases are rare. For example, the University of Michigan offers a Treatment-Resistant Disorders Clinic, but many regions have no comparable resource.
These systemic gaps mean that families frequently bear the burden of navigating care, advocating for appropriate evaluation, and ensuring that treatment plans are carried out across settings.
What Families Can Do
While these obstacles are real and challenging, there are steps caregivers can take to improve the chances of getting effective treatment:
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Document thoroughly – Keep a clear record of changes in behavior, function, and mood compared to baseline, and present this in a concise, easy-to-read format for providers.
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Bring credible resources – Share peer-reviewed articles or reputable medical sources on catatonia in neurodevelopmental conditions with providers who may not be familiar with the condition. (See Advocacy and The Inside Scoop to Advocacy in Autism for recommended materials.)
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Clarify your language – Describe behaviors factually rather than labeling them with terms that may lead to misdiagnosis. (See Choosing Language That Supports Accurate Diagnosis for examples.)
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Seek specialized expertise – If possible, request referral to a provider or clinic with demonstrated experience in diagnosing and treating catatonia.
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Advocate for coordinated care – Encourage communication between inpatient and outpatient teams, and ask for a clear plan for follow-up after discharge
What The Catatonia Foundation Is Doing
The Catatonia Foundation is committed to addressing these obstacles through targeted initiatives, including:
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Raising awareness and educating providers – Offering educational materials, presentations, and training to increase recognition of catatonia across medical, psychiatric, and allied health disciplines.
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Exhibiting at annual conferences – In 2024-2025, The Catatonia Foundation has exhibited at annual meetings of the American Psychiatric Association (APA), International Society for ECT and Neuromodulation (ISEN), and American Academy of Child and Adolescent Psychiatry (AACAP).
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Educating the public – Providing families, caregivers, and community members with resources to recognize the signs and advocate effectively.
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Social media targeted campaigns – The Catatonia Foundation is active on LinkedIn, Instagram, Facebook, and X.
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Identifying and sharing provider expertise – Building a network of clinicians with experience in diagnosing and treating catatonia in neurodevelopmental conditions.
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Advocating for systemic change – Working with stakeholders to improve access, reduce diagnostic delays, and promote continuity of care between inpatient and outpatient settings.
A Family’s Story: Eileen and David
Eileen is a pediatric physiatrist. The only thing she learned about catatonia in her medical training was a brief mention of the stereotypical presentation — a person sitting motionless, barely speaking. She had no idea that catatonia could look completely different in someone with autism.
Her son, David, who has autism, began experiencing severe motor agitation at the age of four, constantly jumping, hopping, rocking, stimming, and laughing. When he was 11, something changed significantly. The motor agitation was still there, but the tone shifted from “happy, laughing David” to “I’m going to kill you David.” Aggression replaced laughter.
When David was finally diagnosed with catatonia at age 14, Eileen was stunned. She didn’t even know catatonia could co-occur with autism. Fortunately, she was able to get him into a hospital with expertise in catatonia. There, she was told that in a typically developing child with catatonia, inpatient ECT treatment might involve 12 sessions to see a reduction in symptoms, but for a neurodivergent child, it can take significantly more — often starting with 18 inpatient sessions. For David, “the magic number” was 36 — 18 inpatient and 18 outpatient sessions — before a significant reduction in catatonia symptoms was achieved.
After completing treatment, David reached a new baseline: calmer, no longer manic or aggressive. Treatment didn’t erase his autism, but it gave him back his ability to live without constant agitation and unprovoked aggression.
David has been receiving maintenance ECT since the initial course of ECT. When he turned 18, his family had to petition for guardianship. Unfortunately, guardianship in Michigan does not allow the guardian to consent to ECT. David’s parents had to hire an attorney and petition the court to allow them to consent to ECT on David’s behalf, because without this treatment, David’s would become severely aggressive again. Fortunately, they were successful with their petition. Maintenance ECT has significantly reduced David's aggression, and while there are still challenging moments, he now spends much more time in a calmer, more regulated state.
Click here to hear their journey
Resources
ECT: Disrupting the Stigma, Video from University of Michigan (2022)
Catatonia and Severe and Challenging Behaviors SIG, Six part webinar series, Autism Science Foundation (2025)
Catatonia in Pediatric and Neurodiverse Populations by Dr. Joshua Ryan Smith | TN NCSA Webinar, 2024
Cure SYNGAP1 Webinar – Catatonia in Neurodevelopmental Conditions like SYNGAP1 (Joshua Ryan Smith, MD): broader NDD context.
AARC Webinar – Catatonia and Autism (research overview; includes Down syndrome): accessible talk for families and clinicians.
Florida BH Center (Guidelines site) – Video lectures include Catatonia (Politte, MD) within ASD/IDD series.
Emerging Co-occurring Disorders with ASD - Catatonia and DMDD 2020
Autism Science Foundation Weekly Science Podcast – “Nobody Ever Talks About Catatonia” (with Martine Lamy, MD): symptoms, tracking, and treatments.
PsychEd (University of Toronto) – Episode 67: Catatonia with Patricia Rosebush, MD: clinical foundations; good for advanced lay listeners and providers.
Psychiatry & Psychotherapy Podcast – “Catatonia in Children and Teens” (with Joshua Ryan Smith, MD): pediatric recognition, BFCRS, treatment.
Let’s Talk about Catatonia, Autism Science Foundation with Joshua Ryan Smith MD and Zachary Williams
Sensory Processing, Autistic Catatonia, Safety, & Love: An Autistic OT's Perspective
with Kim Clair
Amy S. F. Lutz — Each Day I Like It Better: Autism, ECT, and the Treatment of Our Most Impaired Children(Vanderbilt Univ. Press): a parent’s account of catatonia, ECT decisions, and care navigation.
Amy S. F. Lutz — We Walk: Life with Severe Autism (Cornell Univ. Press): essays on life with profound autism; systems navigation and ethics.
Catatonia, Shutdown and Breakdown in Autism: A Psycho-Ecological Approach by Dr. Amitta Shah. A groundbreaking, clinically informed guide combining real case examples and management strategies tailored specifically for autistic individuals experiencing catatonia or breakdown states. Includes a novel clinical framework (ACE-S).
Electroconvulsive therapy in autism spectrum disorders: an update to the literature. Curr Opin Psychiatry, 2025.
Systematic Review of Symptoms of Catatonia in Autism Spectrum Disorder — Journal of Autism and Developmental Disorders, May 6, 2025. Identifies six symptom clusters in ASD catatonia (including features not in ICD-11), useful for earlier recognition and more precise differential.
A Cross-National Reliability Study of Catatonia in Individuals with Neurodevelopmental Disorders — JADD, Apr 16, 2025 (open access). Shows only 75% initial agreement among expert clinicians; stresses documenting change from baseline and using structured scales (e.g., BFCRS).
Catatonia in Autistic Adults in a Tertiary Inpatient and Outpatient Neurodevelopmental Service: A Retrospective Review — JADD, May 3, 2025. Prevalence ~11% in a specialized service; common signs were initiation difficulty, posturing, freezing; authors recommend specific tools (e.g., Wing & Shah criteria) to improve diagnostic accuracy.
Catatonia in ASD: Analysis of Clinical Characteristics, Stressful Life Events, and Validation of the Attenuated Behavior Questionnaire (ABQ) — Psychiatry Research, online ahead of print Jul 13, 2025. Validates ABQ for ASD catatonia; reports screening and diagnostic cut-offs (39.5; 92.5) and links catatonia with late regression and recent stressors—practical for screening and diagnosis.
Catatonia and Autism Spectrum Disorder: A Common Comorbid Syndrome or a Core Feature? — World Journal of Psychiatry, May 19, 2025 (open access). Narrative review focused on how to differentiate ASD traits from superimposed catatonia; emphasizes detecting pattern/severity changes.
Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism With Intellectual Disability — Autism Research, Feb 2025 (PMCID listed). Though treatment-oriented, it uses BFCRS/KCS/KCE serially—helpful exemplars for structured diagnosis and monitoring in ASD.
SHANK3 as risk factor for early-onset catatonia. Int J Neuropsychopharmacology, 2025.
Identifying and Treating Catatonia in Children With Neurodevelopmental Disorders — J Can Acad Child Adolesc Psychiatry. 2024 Nov 1;33(3):215–222.
Neurodevelopmental Disorders Including Autism Spectrum Disorder and Intellectual Disability as a Risk Factor for Delayed Diagnosis of Catatonia — J Dev Behav Pediatr. 2024 Mar-Apr;45(2):e137-e142.
Catatonia in ASD: Prevalence, functional impact, and diagnostic insights — Psychiatry Research, 2024. Highlights subtle catatonic behaviors in ASD — useful cues for early recognition before full syndrome emerges.
The effectiveness of the lorazepam challenge test in pediatric catatonia: A multisite retrospective cohort study. Schizophrenia Research, 2024 (pediatric catatonia; includes neurodivergent patients).
Use of ECT in Autism Spectrum Disorder and/or Intellectual Disability: A Single-Site Retrospective Analysis. J Autism Dev Disord, 2024 (co-author).
Symptoms of Catatonia Observed in Down Syndrome Regressive Disorder. J Autism Dev Disord, 2024. (NDD—DS regression.)
Another Option for Aggression and Self-Injury: Alternative Benzodiazepines for Catatonia in Profound Autism. J Child Adolesc Psychopharmacol, 2023.
Catatonia in Neurodevelopmental Disorders: Assessing Catatonic Deterioration From Baseline — Lancet Psychiatry, Mar 2023. Influential diagnostic framework proposing “personalized baseline” and “deterioration from baseline” concepts—now commonly referenced in ASD catatonia diagnostics.
Evidence-Based Consensus Guidelines for the Management of Catatonia (BAP) — J Psychopharmacol, Apr 2023 (diagnosis section). Standard reference covering diagnostic criteria, recommended rating scales (e.g., BFCRS), exclusion of mimics, and benzodiazepine challenge as a diagnostic/therapeutic probe; applicable to ASD presentations.
Early-onset catatonia associated with SHANK3 mutations: looking at the autism spectrum through the prism of psychomotor phenomena. Frontiers in Psychiatry, 2023.
Catatonia in ASD: Systematic Review & Meta-analysis. Shows pooled catatonia prevalence ~10.4% in ASD; highlights common motor disturbances. Cambridge University Press, 15 December 2021
Catatonia in autism and other neurodevelopmental disabilities. High-level review across NDDs; differential points and management overview Npj Ment Health Res. 14 September 2022
Maintenance ECT is an essential, Medical Treatment for Patients With Catatonia: A COVID-19 Related Experience. Frontiers in Psychiatry (2021). Argues mECT is often necessary and safe to prevent relapse in catatonia linked to ASD/ID.
Catatonia: A Common Cause of Late Regression in Autism. Frontiers in Psychiatry, 2021.
Use of ECT in Autism. 2020 Review supporting safety/effectiveness of ECT for catatonia in youth with autism. J Child Adolesc Psychopharmacol.
Catatonia in Patients with ASD. 2020. Practical review: motor, speech, behavioral domains; emphasizes benzodiazepines and ECT as evidence-based treatments and the need for timely recognition. Child & Adolescent Psychiatric Clinics.
Treatment of catatonia in autism spectrum disorders (review). Acta Psychiatr Scand, 2019.
The multiple faces of catatonia in autism spectrum disorders. Eur Child Adolesc Psychiatry, 2019.
Catatonia in Down syndrome; a treatable cause of regression. Neuropsychiatr Dis Treat, 2015.
ECT for Malignant Catatonia in an Autistic Adolescent. 2010. Case report illustrating rapid, robust response when other treatments failed. Autism.
Maintenance ECT in Autistic Catatonia: Case Series Review. Argues for maintenance ECT to prevent relapse after acute response. Prog Neuro-Psychopharmacol Biol Psychiatry, 30 May 2010
Catatonia and Autism: A Historical Review, With Implications for Electroconvulsive Therapy. J ECT, 2009.
The effectiveness of the lorazepam challenge test in pediatric catatonia: A multisite retrospective cohort study Schizophr Res., 2024.
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