A Systematic Review of Interventions for Autistic Catatonia

Background:  Around 8% of people with autistic spectrum disorders (ASD) present with catatonic symptoms, typically developing in mid-adolescence. Core features include being very still for long periods of time, getting ‘stuck’ when trying to do something, difficultly stopping actions once they have been started, difficulties in initiating actions, moving very slowly and taking a long time to finish actions and requiring physical and /or verbal prompts to finish actions. These symptoms have a significant impact on patients’ quality of life and independence. Various treatments for autistic catatonia have been proposed, and treatment guidelines published. However, the existing literature is limited and has not been systematically reviewed

Objectives: The aim of the review was to systematically examine treatments that have been used to address catatonic symptoms in ASD, and to consider the evidence for the safety and efficacy of these interventions.

Methods: A systematic review of the existing literature was conducted, including search of three major online databases. Search terms included autism and catatonia, along with similar and related terms. Reference sections of included papers were hand searched for additional results. Any paper describing treatment of catatonic symptoms in at least  one patient with an ASD was included in the review.  So-called “grey literature” and non-English language papers were excluded. Study quality was also assessed and methodological limitations considered  

Results: 22 papers describing a total of 28 cases were included in the final review, encompassing both adult and paediatric cases. All papers described either single case reports or small case series. Treatments utilised included electroconvulsive therapy (ECT), various pharmacological interventions, behavioural and sensory interventions. Study quality was generally low, with particular limitations in outcome measurement, description of treatment and failure to control for confounding variables. There is some evidence for short term benefit of both electroconvulsive therapy and pharmacological interventions, particularly lorazepam. However, any benefit appears to be temporary and symptom remission is usually incomplete. Behavioural interventions also show some promise although evidence is currently limited to a very small number of cases. Side effects and adverse reactions were poorly addressed across the literature. Publication bias is also likely to be a significant issue.

Conclusions: Various treatments have been used to address catatonic symptoms in people with ASD, including ECT, pharmacological and behavioural interventions. However, the existing literature is limited to single case designs with serious methodological limitations. There is therefore little evidence to support any specific treatment. Behavioural interventions seem to show some promise, in that benefit may be better maintained than for other treatments and there is lower risk of serious side effects. Further research is needed to establish effective treatments for catatonic symptoms in ASD.