Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism With Intellectual Disability: An Observational Study.

There was no control group, so natural fluctuation of symptoms cannot be ruled out. Patients received multiple treatments simultaneously, including benzodiazepines, other psychotropics, electroconvulsive therapy, and applied behavior analysis. The contribution of any single component cannot be separated. The study was open-label, and the medical director who supervised all clinical assessments was also an author, introducing potential bias. More than half of the patients were diagnosed and started on treatment in an inpatient setting before entering the outpatient clinic, meaning much of the initial improvement may have occurred before the study's baseline assessment. The rating scales used are not validated specifically for autistic individuals with intellectual disability. Telemedicine was used for a large portion of visits, which may affect the accuracy of physical examination findings required for catatonia diagnosis. The sample size was small, and the cohort was highly selected, consisting of patients referred to a specialized tertiary care clinic.

Funding was provided by the National Institute of General Medical Sciences, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute on Deafness and Other Communication Disorders. One author receives funding from Axial Therapeutics and Roche. Another has received consulting fees from Roche. Another holds equity in Revival Therapeutics Inc. The study was not designed or written by these commercial sponsors.

Do not interpret the significant reduction in Bush Francis Catatonia Rating Scale scores as proof that any specific drug or therapy caused the improvement. Patients received multiple treatments at once, many had already started treatment in an inpatient setting before the study baseline, and there was no control group to account for natural symptom fluctuation.