Treatment of catatonia in autism spectrum disorders

Objective: To review the treatment courses of 22 autistic patients diagnosed with catatonia over a 12-year period, including treatment with benzodiazepines and electroconvulsive therapy. Method: Retrospective review of inpatient and outpatient records of 22 autistic youth presenting to a neurobehavioral service who were treated for catatonia. Results: Six girls and 16 boys ranging from ages 8 to 26 years old presenting for neurobehavioral assessment were found to meet criteria for catatonia according to the DSM5 and were treated for such. All but one patient was initially unsuccessfully treated with benzodiazepines in dosages ranging from 1 to 27 mg daily, and all patients underwent electroconvulsive therapy. Mean age of ECT start was 15.6 years old, and the total number of ECT received ranged from 16 to 688, with 13 patients still receiving maintenance ECT at the end of the study period. ECT conferred prominent patient benefit in terms of catatonic symptom reduction, including alleviation of incapacitating, treatment-resistant self-injury. Conclusion: Myriad symptoms of catatonia were seen in this sample of 22 autistic youth. Implementation of anti-catatonic paradigms, particularly electroconvulsive therapy, conferred vast patient benefit.