A Cross-National Reliability Study of Catatonia in Individuals with Neurodevelopmental Disorders.
Expert psychiatrists agree on catatonia in autism only 75 % of the time, so BCBAs need extra checks before treating.
01Research in Context
What this study did
The team asked 24 psychiatrists in six countries to judge 30 video cases. All cases showed people with autism or other developmental delays.
Each doctor decided if the person had catatonia. They used the same checklist but worked alone.
After the first round the researchers looked at how often the doctors agreed.
What they found
On the first pass the experts agreed only 75 percent of the time.
The other 25 percent needed long talks and extra review to reach a shared yes or no.
Even with final consensus, some cases stayed tricky.
How this fits with other research
Scahill et al. (2015) already warned that only five of 24 autism tools are trial-ready. The new 75 % match fits that pattern: our field still lacks sharp measures.
Tassé et al. (2013) saw the Japanese ADI-R lose sensitivity in preschoolers, dropping to 55 %. Mohammad et al. now show a similar gap when doctors judge catatonia in autism. Both papers flag the same weak spot: diagnosis gets shaky when the client is complex.
D'Agostino et al. (2025) just showed the ND-PROM can separate ASD from general delay in Down syndrome. Their success and Mohammad’s struggle together prove we can build clear tools, but we have not done it yet for catatonia.
Why it matters
If world-class psychiatrists disagree one quarter of the time, BCBAs should not trust a quick chart note that says “catatonia.” Ask for video, use a checklist, and get a second opinion before you shape treatment. Build your behavior plan around what you can see and count, not just the diagnosis line.
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02At a glance
03Original abstract
Catatonia is a neuropsychiatric disorder characterized by abnormalities of movement, communication, and behavior, often accompanied by a disturbance of mood, thought and perception. If untreated, it may lead to serious complications, including death. Although often described in adults with schizophrenia and severe mood disorders, it can also occur in persons with neurodevelopmental disorders (NDD), particularly autism spectrum disorder (ASD). Since its diagnosis is more likely to be missed by clinicians with limited experience, we attempted to determine if experienced psychiatrists can make a reliable diagnosis of catatonia in a group of patients with NDD. Twenty patients with catatonia with ASD/NDD (12 males 8 females; age range 13-34 years; mean 17.5; SD 4.8), diagnosed by two American psychiatrists, were re-evaluated by a group of Swedish psychiatrists. In the initial round, agreement was reached in 15 (75%) cases. However, a careful review of additional material and several virtual discussions were required to reach agreement in the remaining 5 (25%) of cases. The diagnosis of catatonia in individuals with NDD is challenging, even for experienced clinicians. Reasons for the lack of diagnostic agreement in the five patients are discussed to highlight the barriers for accurately diagnosing catatonia in patients with NDD.
Journal of autism and developmental disorders, 2025 · doi:10.1016/S0074-7742(05)72002-X