Catatonia in Autistic Spectrum Disorders

by Lorna Wing and Amitta Shah, British Journal of Psychiatry (2OOO), 176, 357-362.

The clinical pictures of autistic spectrum disorders include features described in catatonia. A semi-structured interview schedule was used to collect information from parents or other care-givers concerning 506 referrals to a specialist clinic for autistic spectrum disorders. Individuals with severe exacerbation of catatonic features were compared with a same-age group of referrals without this type of deterioration in skills and behaviour. Seventeen percent of referrals aged 15 or over had severe exacerbation of catatonic features. They were significantly more likely than the comparison group to have had, before the onset of the change in behaviour, impaired language and passivity in social interaction.

Criteria for Catatonia
The essential features were: (a) increased slowness affecting movements and verbal responses; (b) difficulty in initiating and completing actions; (c) increased reliance on physical or verbal Prompting by others; and (d) increased passivity and apparent lack of motivation. Other abnormalities of behaviour often associated were: (e) reversal of day and night; (f)Parkinsonian features: tremor, eye-rolling, dystonia, odd stiff posture, freezing in postures, etc.; (g) excitement and agitation; and (h) increase in repetitive, ritualistic behaviour.

In 15 individuals, the onset was immediately preceded by a period of very disturbed, often aggressive, behaviour. Eight individuals developed obsessive-compulsive symptoms before they became catatonic. Six of these were among those who had shown disturbed, aggressive behaviour before the onset of catatonia. Most of the abnormalities of movement resulted in slowing or stopping activities, but episodes of excitement and sudden impulsive actions also occurred.

Others had occasional visual hallucinations or paranoid ideas that did not fit any particular diagnosis.

In the majority of individuals in this study, the onset of severe catatonia occurred in the years from 10 to 19, although a few had also had brief episodes If freezing, or difficulty crossing thresholds in childhood.

It is important for clinicians to be aware of the possibility of catatonia when investigating reasons for deterioration in skills td behaviour occurring in adolescents and adults with autistic spectrum disorders.