Catatonia: A Common Cause of Late Regression in Autism.

Mohammad Ghaziuddin

doi:10.3389/fpsyt.2021.674009

Abstract

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication deficits and restricted interests and behaviors which begin very early in life. In about a quarter of cases, the symptoms emerge about 18–24 months after a period of normal development, a phenomenon commonly described as early regression. However, marked functional decline can also occur in persons with autism after a relatively stable childhood. As opposed to early regression, which occurs in normally developing children, late regression occurs typically in adolescents with an established diagnosis of autism. Apart from their occasional mention in the literature, these individuals have not been examined systematically. This Brief Report describes the presentation, comorbidity and short-term outcome of 20 persons with ASD who developed late regression. The mean age of onset of regression was 13 years. One of the earliest symptoms was an increase in obsessive slowing and compulsive rituals. Other symptoms included motor abnormalities, aggression and mood disturbance. The most common comorbid disorder was catatonia occurring in 17 patients. Despite treatment with several modalities, the outcome was often suboptimal. These findings suggest that catatonia is a common cause of late regression in persons with autism. Clinical and research implications are discussed.

Highlights

Autism spectrum disorder (ASD) is a severe handicapping disorder of early childhood characterized by social communication deficits and restricted interests
As opposed to early regression, this process occurs in persons who have already been diagnosed with autism
Most experienced child psychiatrists have come across persons with autism who begin to deteriorate significantly during adolescence after a stable childhood, little attention has been paid to them with some exceptions

Summary

Introduction

Autism spectrum disorder (ASD) is a severe handicapping disorder of early childhood characterized by social communication deficits and restricted interests. As opposed to early regression, this process occurs in persons who have already been diagnosed with autism It differs from commonly occurring behavioral problems of adolescence by its severity and pervasiveness, and by its poor response to treatment. Rutter reported that seven out of 64 (10.9%) patients showed a progressive deterioration during adolescence which began with “a loss of language skills associated with inertia and decreasing activity followed by a general intellectual decline” [1]. In three of these patients, deterioration was accompanied by “epileptic fits and in a fourth with paralysis of the legs.”. In three of these patients, deterioration was accompanied by “epileptic fits and in a fourth with paralysis of the legs.” Six patients were admitted to a long stay hospital and never discharged; one patient, who had severe comorbid obsessive-compulsive disorder, was hospitalized for 6 months and made

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