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Hospitalizations for pediatric catatonia in neurodivergent and neurotypical patients
James Luccarelli1, Jacqueline A Clauss1, Tasia York2
1Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Insights
Pediatric catatonia treatment shows high improvement rates, with benzodiazepines and ECT used similarly across neurodevelopmental disorder groups. However, neurotypical youth experienced longer hospital stays and better outcomes for non-medical diagnoses.
Area of Science:
- Neuroscience
- Psychiatry
- Pediatric Medicine
Background:
- Catatonia is a neuropsychiatric disorder in children, often co-occurring with neurodevelopmental disorders (NDDs).
- Understanding hospital care patterns and treatment variations for pediatric catatonia is crucial.
Purpose of the Study:
- To describe hospital care for pediatric catatonia.
- To compare treatments and outcomes for neurotypical children versus those with NDDs.
Main Methods:
- Retrospective cohort study (2018-2023) at two academic medical centers.
- Inclusion of patients aged 18 and younger diagnosed with catatonia.
- Assessment of treatment response using Clinical Global Impressions-Improvement (CGI-I) by independent reviewers.
Main Results:
- Over 50% of 165 hospitalized pediatric catatonia patients had an NDD.
- Benzodiazepine and electroconvulsive therapy (ECT) use were similar between groups.
- Neurotypical patients had longer hospitalizations than those with NDDs.
- An 88.3% probability of significant clinical improvement (CGI-I < 3) was observed.
Conclusions:
- Pediatric catatonia shows a high likelihood of treatment response.
- While treatments like benzodiazepines and ECT were administered similarly, neurotypical patients experienced longer hospitalizations.
- Further research is needed for equitable and optimized catatonia treatment in youth.
Introduction:
Catatonia is a neuropsychiatric disorder that occurs in pediatric patients with a range of associated medical, psychiatric, and neurodevelopmental disorders (NDDs). This study describes hospital care of pediatric catatonia patients and compares treatments for neurotypical patients and those with NDDs.
Methods:
Retrospective cohort study from 1/1/2018 to 6/1/2023 of two academic medical centers of patients aged 18 and younger with catatonia. Patients were retrospectively assessed using the clinical global impressions-improvement (CGI-I) by two independent reviewers.
Results:
One hundred sixty-five patients were hospitalized for catatonia, of whom 50.3 % had an NDD. Median age was 15. One hundred sixty-four patients were treated with a benzodiazepine, with a median maximum 24-hour dose of 6 mg lorazepam-equivalents, which did not differ for patients with and without NDDs. Electroconvulsive therapy (ECT) was utilized in 14.5 % of patients. Median length of medical hospitalization was 5 days and hospitalizations were longer in neurotypical patients than in patients with NDDs. In an ordinal regression model, the probability of observing at least "much improvement" (CGI < 3) was 88.3 % (95 % CI: 82.4 % to 92.3 %), with patients with a non-medical primary diagnosis and an NDD having a lower odds of response than non-medical primary diagnosis without an NDD.
Conclusions:
The probability of patients achieving a CGI-I score indicating at least "much improvement" was 88.3 %. Administered benzodiazepine dose and ECT treatment were similar for all patients, but neurotypical patients had longer hospitalizations than those with NDDs and had a higher odds of a more favorable clinical response for patients with non-medical primary diagnoses. Research under controlled conditions is needed to optimize and endure equitable catatonia treatment in youth.
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