Clinical characteristics of catatonic symptoms in children with autism spectrum disorder

Objective To investigate the presentations and related clinical characteristics of catatonic symptoms in children with autism spectrum disorder （ASD） by using the Attenuated Behavior Questionnaire （ABQ） and related functional and emotional behavior questionnaires. Methods Children who were diagnosed with ASD in the Third Affiliated Hospital of Sun Yat-sen University or other tertiary hospitals from November 2021 to December 2023 were selected. Reports from parents or long-term caregivers of children with ASD were collected through an online questionnaire. Children with ASD were divided into the ABQ screening positive and negative groups using ABQ questionnaire. Sheehan Disability Scale， Repetitive Behavior Scale-Revised， Children’s Simplified Emotion Scale and Spence children’s Anxiety Scale were used to assess children’s functional impairment and related emotional behavior. Results Four hundred and forty-one valid questionnaires were collected. 166 children with ASD were screened positive by using the ABQ. The total scores of the first six core symptoms， motor symptoms， emotional changes and behavior changes in the ABQ questionnaire of ASD children in the positive group were significantly higher than those in the negative group （all <i>P &lt; </i>0.001）. All six core motor symptoms were commonly reported in the positive group， with “requiring prompts to complete actions” being the most reported， followed by “immobility， getting stuck， slowness in movement， and problems stopping actions once started”. Over 50% of the children in the positive screening group exhibited these symptoms. The days of functional loss and inefficiency in study/work， social life， family life/family responsibilities， and the proportion of “moderate” or above degree of disability of ASD children in the ABQ-positive group were higher than those in the negative group， and the differences were statistically significant （all <i>P &lt; </i>0.001）. The scores of stereotypical behaviors， self-injurious behavior， compulsive behavior， sameness/ritual behavior （all <i>P &lt; </i>0.001）， simplified emotion scale （<i>P &lt; </i>0.001） and anxiety scale （both <i>P &lt; </i>0.01） in the ABQ-positive group were significantly higher than those in the ABQ-negative group， and the differences were statistically significant. Conclusions Catatonic symptoms are not uncommon in children with ASD. ASD children complicated with such symptoms tend to exhibit more emotional and behavioral problems， as well as more severe functional impairment， underscoring the need for early identification and intervention.