Catatonia in autism and other neurodevelopmental disabilities: a state-of-the-art review

Abstract

Individuals with neurodevelopmental disabilities (NDDs) may be at increased risk for catatonia, which can be an especially challenging condition to diagnose and treat. There may be symptom overlap between catatonia and NDD-associated behaviors, such as stereotypies. The diagnosis of catatonia should perhaps be adjusted to address symptom overlap and to include extreme behaviors observed in patients with NDDs, such as severe self-injury. Risk factors for catatonia in individuals with NDDs may include trauma and certain genetic variants, such as those that disrupt SHANK3. Common etiologic features between neurodevelopmental disabilities and catatonia, such as excitatory/inhibitory imbalance and neuroimmune dysfunction, may partially account for comorbidity. New approaches leveraging genetic testing and neuroimmunologic evaluation may allow for more precise diagnoses and effective treatments.

Fig. 1. A recent increase in publications on catatonia in patients with NDDs.

Data obtained from Timeline feature on https://pubmed.ncbi.nlm.nih.gov/ after searching “catatonia” and (“intellectual disability” or “developmental delay” or “autism” or “neurodevelopmental disorders”) on February 14, 2022.

Fig. 2. Proposed evaluation and treatment of catatonia in patients with NDDs.

BFCRS Bush-Francis catatonia rating scale, ECT electroconvulsive therapy, IEM inborn error of metabolism, PCRS Pediatric catatonia rating scale, Green circles represent entry points, Red circles represent exit points, Yellow diamonds represent decision points, White boxes represent established processes, Blue boxes represent processes novel to our algorithm, “?” represents a potentially informative approach to consider but without sufficient data to fully support implementation.