A Systematic Examination of Catatonia‐like Clinical Pictures in Autism Spectrum Disorders

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Three studies concerning catatonia‐like clinical pictures in people with autism spectrum disorders (ASDs) referred to clinics are described. The first investigated the frequencies, in children and adults with autistic disorders, of 28 specific disorders of movement, speech, and behavior similar to those occurring in chronic catatonia spectrum conditions. The second compared the frequency of these items among groups of children with, ASDs, learning disabilities, specific language impairment, and a group with typical development, respectively. The third study examined the pattern of catatonia‐like deterioration occurring in a minority of adolescents and adults with ASDs. The studies demonstrated the high frequency of catatonia‐like features in people with autistic disorders. There was some tendency for improvement with increasing age, especially for those with IQ 70 or over. The items were also found in children with learning disabilities and specific language disorders but significantly less often. They occurred least often in the children with typical development. Severe catatonia‐like deterioration occurred in 17% of those with autistic disorders, who were aged 15 years or over when assessed at a diagnostic center. A history of passivity in social interaction and impairment of expressive language were associated with the deterioration. No clear relationship was found between a history of catatonia‐like features, singly or combined, and catatonia‐like deterioration. The findings pose questions for future research.

Introduction

In the early 1940s, Leo Kanner was the first to adopt the term “autism” for a type of childhood developmental disorder (Kanner, 1943). Before Kanner's first paper, children with atypical development and unusual behavior had been described by other authors, but the differences in terminology make comparisons difficult. However, in the historical literature there are a few accounts of children and adolescents with behavior that is reminiscent of autism spectrum disorders (ASDs) combined with marked catatonic features. Henry Maudsley (1867) discussed what he referred to as “insanity” in children. One of the subgroups he suggested was “cataleptoid insanity,” which probably included some children with autism and catatonia. De Sanctis 1908, Earl 1934 also described clinical pictures that might well have included autism and catatonia‐like conditions.

After Kanner's original paper, interest in autism and related conditions has grown exponentially, but few studies have considered the similarities between autism and catatonia spectrum disorders. The committee chaired by Mildred Creak (1964), set up to define the diagnostic criteria for “childhood schizophrenia,” listed nine points. Point 8 was Distortion in mobility patterns and included “immobility as in katatonia.” All the committee's criteria would now be recognized as relevant for autism. Wing and Attwood (1987) briefly described catatonia in autistic disorders. Other papers in the English language on this subject have since been published by Brasic 2000, Dhossche 1998, Dhossche 2004, Ghaziuddin 2005, Hare 2004, Leary 1996, Realmuto 1991, Wing 2000, Zaw 1999. Each of this small group of authors has pointed out the marked overlap between the clinical pictures of, on the one hand, acute and chronic catatonia and, on the other, the unusual patterns of movement, speech, and behavior found in ASDs.

This chapter explores the various manifestations of features of catatonia found in autistic disorders.

Section snippets

Autism Spectrum Disorders

In this chapter, the terms “ASDs” and “autistic disorders” will be used to cover the developmental conditions that have in common a triad of impairments affecting social interaction, social communication, and social imagination. This triad is associated with a narrow, repetitive pattern of activities and/or interests (Wing and Gould, 1979). The spectrum is similar to but wider than the conditions referred to as “pervasive developmental disorders” in Diagnostic and Statistical Manual, 4th ed.

Manifestations of Catatonic Features in ASDs

The motor problems and disorders of speech and behavior found in ASDs include features like those described in the catatonia spectrum (Leary 1996, Wing 2000) together with some that are reminiscent of postencephalitic parkinsonism (Damasio and Maurer, 1978). There are two ways in which these features can be manifested. First, many children and adults in the autism spectrum have one or more such features in early childhood. There is some tendency for these to become less marked with increasing

Three Studies of Catatonic Features in ASD

In each of these studies, permission to use findings anonymously in research was obtained at the time of assessment from parents or caregivers, and the individuals with ASDs if they were able to understand.

Discussion

The DISCO was not specifically designed to cover all the items that various authors have listed as catatonic features. In two of the three studies described, adolescents and adults were included so that the data concerning childhood relied upon parents' memories, in some cases looking back over more than 30 years. However, 28 items related to catatonic features were included in the interview. Every one of the 200 participants in the study had had two or more of these items in marked or moderate

Conclusions

The studies described in this chapter suggest that a small but significant proportion of adolescents and adults with ASDs develop catatonia‐like deterioration. However, the studies pose more questions than answers. Clinical impression suggests that catatonia‐like deterioration is related to events that are experienced as stressful. Why some people with ASDs react in this way while others respond in other ways remains a mystery. What is the relationship between catatonia‐like features that are

References (31)

  • “Diagnostic and Statistical Manual of Mental Disorders,”

    (1994)
  • E. Billstedt et al.

    Autism after adolescence. Population based 13‐ to 22‐year follow‐up study of 120 individuals with autism diagnosed in childhood

    J. Autism Dev. Disord.

    (2005)
  • J.R. Brasic et al.

    Clinical manifestations of progressive catatonia

    Ger. J. Psychiatry

    (2000)
  • G. Bush et al.

    Catatonia. I. Rating scale and standardised examination

    Acta Psychiatr. Scand.

    (1996)
  • M. Creak

    Schizophrenic syndrome in childhood: Further progress report of a working party

    Dev. Med. Child Neurol.

    (1964)
  • A.R. Damasio et al.

    A neurological model for childhood autism

    Arch. Neurol.

    (1978)
  • S. De Sanctis

    Dementia praecocissima catatonica oder katatonie des fruheren kindersalters?

    Folia Neurobiologica

    (1908)
  • D. Dhossche

    Brief report: Catatonia in autistic disorders

    J. Autism Dev. Disord.

    (1998)
  • D. Dhossche

    Autism as early expression of catatonia

    Med. Sci. Monit.

    (2004)
  • C.J.C. Earl

    The primitive catatonic psychosis of idiocy

    Br. J. Med. Psychol.

    (1934)
  • M. Fink et al.

    “Catatonia: A Clinician's Guide to Diagnosis and Treatment.”

    (2003)
  • M. Ghaziuddin et al.

    Catatonia in autism: A distinct subtype?

    J. Intellect. Disabil. Res.

    (2005)
  • D.J. Hare et al.

    Catatonia and autistic spectrum disorders

    Autism

    (2004)
  • C.M. Haw et al.

    Movement disorder in Down's syndrome: A possible marker of the severity of mental handicap

    Mov. Disord.

    (1996)
  • P. Howlin et al.

    The recognition of autism in children with Down syndrome–implcations for intervention and some speculations about pathology

    Dev. Med. Child Neurol.

    (1995)
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