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

To systematically review clinical presentation, prevalence, neurobiological mechanisms, and treatment strategies for catatonia in individuals with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDDs) to inform care and research.

A systematic search of PubMed, Embase, and Cochrane Library was conducted in November 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Peer-reviewed articles published after 2000 were eligible if they assessed catatonia in individuals with ASD or related NDDs. Data on prevalence, clinical features, etiology, and treatments were extracted and synthesized using a narrative approach.

The search yielded 1,966 records; 210 met the inclusion criteria, with 17 additional studies identified through cross-referencing, for a total of 227 included studies. Pooled prevalence estimates for catatonia suggest a rate of 10.4%, but the true prevalence remains uncertain due to research limitations. Overlapping symptoms between ASD and catatonia hinder timely diagnosis and intervention. Key pathogenic factors include excitatory/inhibitory neurotransmitter imbalances, neuroimmune dysregulation, and genetic vulnerabilities and their interplay with environmental exposures. Overlapping neurobiological mechanisms position catatonia as a distinct outcome within a broader spectrum, reflecting shared vulnerabilities among individuals with NDDs. Benzodiazepines and electroconvulsive therapy are the main treatments, with higher doses and longer durations often required than when treating neurotypical patients. Dopaminergic agents must be used cautiously, and evidence supporting immunomodulators is emerging.

Catatonia in autism and other NDDs is underrecognized, causing delays in care and suboptimal outcomes. Addressing this requires standardized diagnostic tools, robust studies, and targeted interventions informed by genetic, immune, and epidemiological research. Despite treatment advances, progress is hindered by heterogeneous study designs, reliance on case series, and limited clinical trials. Future efforts should refine diagnostics and therapies to improve outcomes for this vulnerable population.

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.