Catatonic Features That May Be Mistaken for Worsening Autism Show Treatment-Associated Improvement: Implications for Later Regression

The study examined catatonia in autistic individuals, which may resemble worsening autism but represents a potentially treatable deviation from normal functioning. The research included 104 patients with catatonia (41 autistic and 63 non-autistic) treated with electroconvulsive therapy (ECT) between May 2022 and April 2026. Patients were evaluated longitudinally using the 23-item Bush-Francis Catatonia Rating Scale (BFCRS). Autistic patients with intellectual disability showed higher prevalence of eight activated, repetitive, or behaviorally dysregulated signs compared to non-autistic patients. Following ECT treatment, multiple signs improved in both patient groups, including psychomotor domain symptoms. Seven autism-specific signs demonstrated significant improvement after treatment. The results suggest that catatonia in autism with intellectual disability is treatable and its symptoms can improve during ECT.