Mahgoub Y, Hamlin D, Kindt H, Francis A. Catatonia and autism spectrum disorder: A common comorbid syndrome or a core feature? World J Psychiatry 2025; 15(5): 103967 [DOI: 10.5498/wjp.v15.i5.103967]
Corresponding Author of This Article
Yassir Mahgoub, MD, Associate Professor, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Dr, Hershey, PA 17033, United States. ymahgoub@pennstatehealth.psu.edu
Research Domain of This Article
Psychiatry
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. May 19, 2025; 15(5): 103967 Published online May 19, 2025. doi: 10.5498/wjp.v15.i5.103967
Catatonia and autism spectrum disorder: A common comorbid syndrome or a core feature?
Yassir Mahgoub, Dallas Hamlin, Hailey Kindt, Andrew Francis
Yassir Mahgoub, Dallas Hamlin, Andrew Francis, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
Hailey Kindt, Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA 19107, United States
Author contributions: Mahgoub Y contributed to conceptualization and writing the original draft; Hamlin D contributed to conceptualization, writing, reviewing, and editing; Kindt H contributed to reviewing and editing; Francis A contributed to supervision, reviewing, and editing.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yassir Mahgoub, MD, Associate Professor, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Dr, Hershey, PA 17033, United States. ymahgoub@pennstatehealth.psu.edu
Received: December 6, 2024 Revised: February 27, 2025 Accepted: March 28, 2025 Published online: May 19, 2025 Processing time: 146 Days and 6.1 Hours
Abstract
Autism spectrum disorder (ASD) is an early-onset neurodevelopmental disorder marked by persistent deficits in social communication and interaction, alongside restricted, repetitive patterns of behaviors (RRB), interests, or activities. It often co-occurs with various neuropsychiatric disorders, though their frequency varies widely due to unclear boundaries between the core features of ASD and common comorbidities. Catatonia, increasingly noted in neurodevelopmental conditions like ASD, shares striking similarities with ASD in symptomatology, brain mechanisms, and treatment responses, prompting the question of whether it is a core feature of ASD or a distinct condition. This paper delved into this overlap, exploring the relationship between catatonia and ASD through a narrative review of peer-reviewed literature from 1943 to 2024, sourced from PubMed and psychiatric journals. Focusing on ASD diagnostic evolution, symptom overlap with catatonia, and shared neurobiological and therapeutic characteristics, we used thematic analysis to synthesize findings into key areas such as historical nosology, phenomenological overlap, neurobiological parallels, and treatment response. The evidence revealed weak support for separating catatonia from overlapping RRB features of ASD, suggesting that some RRB might align more with comorbid catatonia than intrinsic ASD traits. However, this idea needs further validation through rigorous clinical trials. Clarifying this relationship could refine diagnostic approaches and open doors to targeted treatments, potentially improving outcomes for those affected.
Core Tip: Catatonia and autism spectrum disorder (ASD) share similarities in phenomenology, neurobiology, and treatment response, with catatonia occurring frequently with ASD. Evidence linking these shared features to the core definition of ASD remains weak. Viewing catatonia as a distinct comorbid condition offers a more convincing framework. ASD and catatonia can be differentiated by detecting changes in severity or patterns to identify catatonia. Yet this leaves chronic, unchanging cases unresolved. Resolving this distinction is crucial for clinical care and research, as it could reveal new treatment options, like lorazepam or electroconvulsive therapy, for restrictive and repetitive behaviors in ASD, which were previously dismissed as intrinsic and untreatable due to their persistence.
