Atypical Presentation of Catatonia in an Adolescent With Autism Spectrum Disorder

Catatonia in individuals with autism spectrum disorder (ASD) can present atypically. Symptoms of catatonia can be difficult to recognize if they are atypical, which can delay proper medical workup and treatment. Comorbid catatonia can occur in individuals with ASD, with reported prevalence rates reaching as high as 12% to 18% in certain studies. However, there is a paucity of research on the management of catatonia in this demographic group. What evidence we currently have indicates that catatonia in individuals with ASD is less responsive to treatment with benzodiazepines than catatonia in individuals without ASD. We present the case report of an adolescent female with ASD presenting with signs of excited catatonia whose treatment spanned multiple inpatient admissions and trials of medications, including antipsychotics, lorazepam, zolpidem, and eventually electroconvulsive therapy. The complexities of treating catatonia that displays atypical symptomatology and is resistant to oral benzodiazepines are discussed.