Systematic Review of Symptoms of Catatonia in Autism Spectrum Disorder.
Catatonia in autism shows six clear sign groups, and half of them are missing from the current ICD-11 list.
01Research in Context
What this study did
Hasan et al. (2025) read every paper they could find on catatonia in autism. They pulled 45 studies and sorted the signs into six clear groups. The work gives us a map instead of a messy list.
The six groups are: slow or stuck movement, lost speech, sudden skill loss, mental-health flare-ups, body changes like appetite swings, and odd alertness levels. Many of these signs sit outside the current ICD-11 check-list.
What they found
Tics, slurred words, self-hits, and eating less are common in autistic catatonia, yet the official guide misses them. The review shows we may be under-counting cases if we stick to ICD-11 only.
Because the six clusters come from 45 studies, the pattern looks stable across ages and settings.
How this fits with other research
Older papers already hinted at this. Davison et al. (1991) warned that catatonia in autism often signals a separate medical or mood problem, not just "more autism." Syeda’s team keeps that idea alive under the "mental-health cluster.
Hare et al. (2004) coined the term "autistic catatonia" with a single case. The new review keeps the name but swaps the lone story for 45 studies, giving the label real weight.
Walley et al. (2005) showed one teen got better with ECT. Syeda slots ECT response into the "physiological cluster," turning one dramatic case into a repeating theme.
Nyrenius et al. (2025) ran a smaller scoping review the same year. Their 17 papers fit inside Syeda’s 45, so the two teams agree; Syeda simply zooms in closer.
Why it matters
You can use the six clusters as a quick screen. If a client with autism stops talking, eats less, or starts tics, don’t just log "increased behaviors." Check for catatonia and refer on. Catching it early can open doors to treatments like ECT or clozapine and stop dangerous regression.
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02At a glance
03Original abstract
Catatonia is a complex neuropsychiatric syndrome characterized by disturbances in mood, motor function, behavior and speech. It is increasingly recognized in individuals with autism spectrum disorder (ASD), although its identification remains challenging due to the overlapping clinical features of the two conditions. Shared characteristics, such as echophenomena, mannerisms, social indifference and repetitive behaviors can obscure accurate diagnosis. Although reports suggest a significant prevalence of catatonia among individuals with ASD, the condition remains poorly understood and frequently under recognized, leading to substantial diagnostic and treatment challenges. A systematic review was conducted to characterize the symptoms of catatonia in individuals with ASD. The literature search included peer-reviewed journal articles published in English from 1980 onward, focusing on studies examining co-occurring catatonia and ASD. A qualitative framework analysis was implemented to evaluate 45 peer-reviewed studies, with findings interpreted in relation to, and extending beyond, the diagnostic criteria for catatonia outlined in the International Classification of Diseases, 11th revision (ICD-11). The objective was to identify symptom patterns extending beyond current diagnostic frameworks and to support improved clinical recognition and diagnostic precision in ASD populations. The review identified six primary symptom clusters associated with catatonia in individuals with ASD: (1) psychomotor activity, (2) speech disturbances, (3) changes in behavior/skills/functions, (4) mental health symptoms, (5) physiological symptoms, and (6) symptoms related to arousal and awareness. Notably, several symptoms observed within these clusters are not currently included in the ICD-11 diagnostic criteria for catatonia. These additional symptoms include tics, motor compliance, incoherent speech, self-injury, impaired cognition, and appetite changes, suggesting a broader clinical presentation of catatonia in ASD populations than is presently captured in existing diagnostic frameworks. The findings of this review highlight the significance of enhancing clinicians' awareness and understanding of how catatonia manifests in individuals with ASD. Most notably, six symptom clusters, psychomotor changes, speech disturbances, behavioral and functional regression, affective and psychiatric symptoms, physiological symptoms, and arousal/awareness disturbances, were observed. Several symptoms identified in this review are not included in the current diagnostic criteria, and their recognition may facilitate in earlier identification and timely intervention, potentially preventing the severe consequences of untreated catatonia in this population.
Journal of autism and developmental disorders, 2025 · doi:10.1016/j.psychres.2024.116250