Autism and Catatonia

By Tony Attwood

Autism is often associated with hyper-activity, but a very small proportion of autistic adolescents and adults can develop signs of catatonia, that is having considerable difficulty initiating and completing movements. The DSM5 diagnostic criteria include reference to the association between autism and catatonia and we have only recently started to explore this unusual characteristic of autism.

The essential features of catatonia are:

  1. Increased slowness of movement and verbal responses
  2. Difficulty in initiating and completing actions
  3. Increased reliance on physical or verbal prompting by others
  4. Increased passivity and apparent lack of motivation

Other characteristics include:

Fixed facial expression

Freezing in unusual postures in the course of an activity

Walking without arm swinging

Moments of excited overactivity

The symptoms of catatonia usually start between 10 and 19 years and catatonia is usually episodic with relapses and remissions.

There is a deterioration of movement abilities with the person wanting to move his or her body, but the body does not respond. The severity can change within the day and spoken instructions have little effect. The person may need physical prompts, using gentle touch to guide them towards the desired action.

Catatonia in autism was originally described by Lorna Wing and Amitta Shah over 20 years ago and Amitta has a new book Catatonia, Shutdown and Breakdown in Autism: A Psycho-Ecological Approach published in London by Jessica Kingsley Publishers. It is the first comprehensive book to describe how to evaluate the many expressions of catatonia in autism and outlines an approach to alleviate the debilitating characteristics. Clinicians, families and autistic adolescents and adults will now have a much clearer idea of what to do.