Maternal Mental Health During Pregnancy and Postpartum / Electroconvulsive Therapy Studies / Treatment of Major Depression · Journal article

Prevalence, Phenotypic Correlates and Predictive Factors of Catatonia in Adolescents With Autism Spectrum Disorder

Journal of Intellectual Disability Research · August 18, 2026

Promising Why this matters to you Expert discussion

Encouraging direction, but not yet definitive.

AI Summary

Catatonia was identified in 21.5% of 107 adolescents with ASD in a tertiary clinic setting. Female gender and clinically significant separation anxiety were independent predictors (Nagelkerke R² = 0.26, p < 0.001), though the modest explanatory power and single-centre design limit generalizability and require prospective validation before clinical implementation.

What was studied

Cross-sectional observational study. Adolescents aged 12–20 years with autism spectrum disorder attending a tertiary child and adolescent psychiatry outpatient clinic.. n = 107. Single tertiary child and adolescent psychiatry outpatient clinic (specific location not stated)..

Key findings

Catatonia prevalence: 21.5% (23 of 107 participants) Most frequent symptoms: stereotypy (73.8%), impulsivity (37.4%), echolalia (36.4%), verbigeration (30.8%), agitation/excitement (30.8%) Independent predictors: female gender and separation anxiety symptoms (Nagelkerke R² = 0.26, p < 0.001)

Safety

Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.

Who this may help

Clinicians should consider targeted screening for catatonia in adolescents with ASD, particularly females and those with separation anxiety symptoms, to support early recognition and intervention. However, the modest predictive model and single-centre recruitment limit confidence in applying these findings to other settings without validation.

Plain-language summary

A single-centre cross-sectional study identifying catatonia prevalence and predictive factors in adolescents with ASD using validated diagnostic criteria, with a modest effect size (Nagelkerke R² = 0.26) that requires confirmation in larger, prospective cohorts.

Study design

As stated by the source record.

Methods107 adolescents aged 12–20 years with ASD were evaluated at one tertiary clinic. Catatonia diagnosis was established using DSM-5 criteria and the Bush–Francis Catatonia Rating Scale (BFCRS). ASD severity, repetitive behaviours and internalizing symptoms were assessed using the Global Assessment Scale, Autism Behaviour Checklist (ABC), Repetitive Behaviour Scale–Revised (RBS-R) and Revised Child Anxiety and Depression Scale–Parent version (RCADS-P). Group comparisons, correlation analyses and binary logistic regression were performed.

DesignCross-sectional observational study

PopulationAdolescents aged 12–20 years with autism spectrum disorder attending a tertiary child and adolescent psychiatry outpatient clinic.

Sample size107

SettingSingle tertiary child and adolescent psychiatry outpatient clinic (specific location not stated).

Reported figures

Quoted from the source exactly as published.

Prevalence of catatonia21.5%

Sample size107

Stereotypy symptom frequency73.8%

Impulsivity symptom frequency37.4%

Echolalia symptom frequency36.4%

Verbigeration symptom frequency30.8%

Agitation/excitement symptom frequency30.8%

Nagelkerke R²0.26

Clinical bottom line

Caveats

Single-centre tertiary clinic sample; prevalence may not generalise to primary care or community-based ASD populations.
Cross-sectional design precludes causal inference; temporal and directional relationships between catatonia and predictive factors not established.
Nagelkerke R² of 0.26 indicates that female gender and separation anxiety explain only 26% of variance in catatonia; other unmeasured factors are substantial.
No inter-rater reliability, sensitivity or specificity of BFCRS application, or comparison to non-ASD populations reported.

Evidence assessment

Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.

Study design

moderate

Cross-sectional design with validated diagnostic criteria (DSM-5, BFCRS); no comparator arm.

Directness

strong

Directly addresses catatonia diagnosis and predictive factors in target population using established instruments.

Consistency

insufficient

Single study; no comparison to prior prevalence data or replication reported in text.

Risk of bias

limited

Tertiary clinic sample may overrepresent severe cases; cross-sectional design precludes causal inference.

Sample adequacy

moderate

N=107 adequate for prevalence and correlation; logistic regression model modest (R²=0.26).

Source abstract

ABSTRACT Background Catatonia, a psychomotor syndrome increasingly recognized in individuals with autism spectrum disorder (ASD), remains frequently underdiagnosed due to symptom overlap, particularly in adolescent populations where data remain limited. This study aimed to determine the prevalence, clinical correlates and predictive factors of catatonia in adolescents with ASD, focusing on sociodemographic, behavioural and affective characteristics. Methods A total of 107 adolescents aged 12–20 years with ASD were evaluated at a tertiary child and adolescent psychiatry outpatient clinic. The diagnosis of catatonia was established using DSM‐5 criteria and the Bush–Francis Catatonia Rating Scale (BFCRS). ASD severity, repetitive behaviours and internalizing symptoms were assessed using the Global Assessment Scale, the Autism Behaviour Checklist (ABC), the Repetitive Behaviour Scale–Revised (RBS‐R) and the Revised Child Anxiety and Depression Scale–Parent version (RCADS‐P). Group comparisons, correlation analyses and binary logistic regression were performed. Results Catatonia was identified in 21.5% of participants. The most frequent symptoms were stereotypy (73.8%), impulsivity (37.4%), echolalia (36.4%), verbigeration (30.8%) and agitation/excitement (30.8%). Female sex, greater ASD severity, depressive symptoms and separation anxiety were significantly associated with catatonia. The catatonia group demonstrated higher scores on the ABC‐Relationship Building, RBS‐R‐Stereotyped Behaviour and RCADS‐P‐Depression subscales. Logistic regression revealed that female gender and clinically significant separation anxiety symptoms were independent predictors of catatonia (Nagelkerke R 2 = 0.26, p < 0.001). Conclusions These findings highlight the importance of targeted screening for catatonia in ASD populations, particularly in females and individuals with co‐occurring separation anxiety symptoms. Early recognition and intervention may mitigate functional deterioration and improve clinical outcomes.

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Banu KaymakMaternal Mental Health During Pregnancy and PostpartumNisa Didem ZenginYağmur Özgür KarabiyikioğluEsra YürümezDidem Behice ÖztopElectroconvulsive Therapy StudiesTreatment of Major DepressionRahime Duygu Temeltürk