Catatonia in Autism and Neurodevelopmental Disorders: A Scoping Review for Advancing Identification, Practice, and...

Area of Science:

• Neuroscience
• Psychiatry
• Developmental Pediatrics

Background:

• Catatonia is a complex psychomotor syndrome.
• It frequently co-occurs with autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDDs).
• Understanding its presentation and mechanisms in this population is crucial.

Purpose of the Study:

• To systematically review the clinical presentation, prevalence, neurobiological mechanisms, and treatment strategies for catatonia in individuals with ASD and NDDs.
• To inform clinical care and future research directions.

Main Methods:

• A systematic literature search was conducted in PubMed, Embase, and Cochrane Library (November 2024).
• Included were peer-reviewed articles published after 2000 assessing catatonia in ASD or related NDDs.
• Data were extracted and synthesized using a narrative approach following PRISMA-ScR guidelines.

Main Results:

• 227 studies were included, suggesting a pooled catatonia prevalence of 10.4%, though true prevalence is uncertain.
• Overlapping symptoms between ASD and catatonia complicate diagnosis and intervention.
• Pathogenic factors include neurotransmitter imbalances, neuroimmune dysregulation, and genetic/environmental interactions.
• Benzodiazepines and electroconvulsive therapy are primary treatments, often requiring higher doses/durations than in neurotypical individuals.

Conclusions:

• Catatonia in ASD/NDDs is underrecognized, leading to delayed care and poor outcomes.
• Standardized diagnostics, robust studies, and targeted interventions are essential.
• Progress is hampered by heterogeneous study designs and limited clinical trials; future efforts must refine diagnostics and therapies.