Prevalence, Phenotypic Correlates and Predictive Factors of Catatonia in Adolescents With Autism Spectrum Disorder

Catatonia, a psychomotor syndrome increasingly recognized in individuals with autism spectrum disorder (ASD), remains frequently underdiagnosed due to symptom overlap, particularly in adolescent populations where data remain limited. This study aimed to determine the prevalence, clinical correlates and predictive factors of catatonia in adolescents with ASD, focusing on sociodemographic, behavioural and affective characteristics.

A total of 107 adolescents aged 12-20 years with ASD were evaluated at a tertiary child and adolescent psychiatry outpatient clinic. The diagnosis of catatonia was established using DSM-5 criteria and the Bush-Francis Catatonia Rating Scale (BFCRS). ASD severity, repetitive behaviours and internalizing symptoms were assessed using the Global Assessment Scale, the Autism Behaviour Checklist (ABC), the Repetitive Behaviour Scale-Revised (RBS-R) and the Revised Child Anxiety and Depression Scale-Parent version (RCADS-P). Group comparisons, correlation analyses and binary logistic regression were performed.

Catatonia was identified in 21.5% of participants. The most frequent symptoms were stereotypy (73.8%), impulsivity (37.4%), echolalia (36.4%), verbigeration (30.8%) and agitation/excitement (30.8%). Female sex, greater ASD severity, depressive symptoms and separation anxiety were significantly associated with catatonia. The catatonia group demonstrated higher scores on the ABC-Relationship Building, RBS-R-Stereotyped Behaviour and RCADS-P-Depression subscales. Logistic regression revealed that female gender and clinically significant separation anxiety symptoms were independent predictors of catatonia (Nagelkerke R² = 0.26, p < 0.001).

These findings highlight the importance of targeted screening for catatonia in ASD populations, particularly in females and individuals with co-occurring separation anxiety symptoms. Early recognition and intervention may mitigate functional deterioration and improve clinical outcomes.