Summary
A single-centre observational preprint reports treatment-associated improvement in several catatonic signs among autistic patients receiving electroconvulsive therapy. The findings highlight how catatonia may resemble worsening autism during later regression.
A single-centre observational preprint reports that several catatonic signs improved during electroconvulsive therapy (ECT) in autistic patients, including patients with intellectual disability. The researchers say the signs can resemble worsening autism during later regression while representing a potentially treatable change from a person’s previous level of functioning.
The study, posted on medRxiv, analysed changes in the 23-item Bush-Francis Catatonia Rating Scale (BFCRS) among patients who received ECT between May 2022 and April 2026.
What the study measured
The cohort included 104 patients with pretreatment BFCRS data: 41 autistic patients and 63 non-autistic patients. Across the cohort, the researchers analysed 993 near-complete repeated assessments. The analysis used a three-level clinical-group model and adjusted comparisons for age, biologic sex and calendar year.
Compared with non-autistic patients, patients with autism and intellectual disability had higher adjusted odds of eight activated, repetitive or behaviourally dysregulated catatonic signs. They had lower odds of immobility or stupor. This pattern suggests that catatonia associated with autism and intellectual disability may present through changes that can be mistaken for a worsening of autistic traits or a broader regression in functioning.
Catatonia is a clinical syndrome involving changes in movement, activity, speech and behaviour. ECT is a medical treatment that uses controlled electrical stimulation to induce a therapeutic seizure under anaesthesia. In this study, the treatment was delivered as part of clinical care rather than assigned by the researchers.
Signs improved during ECT
Paired first-and-last eligible BFCRS assessments were available for 96 patients. Multiple individual items improved in both the autistic and non-autistic cohorts. Generalised estimating equation models also showed longitudinal declines in total BFCRS scores and in multiple psychomotor-domain scores.
The researchers tested several follow-up windows, including unrestricted follow-up and 30-, 60-, 90- and 180-day models. After false-discovery rate correction, none of the clinical-group-by-time interactions remained significant. In practical terms, the analysis found declining catatonia scores over time in the assessed groups without a statistically distinct time pattern between the clinical groups after correction.
An autism-specific Kanner analysis identified seven significant improvements in severity items at the fixed endpoint after correction for multiple testing. Six of those seven improvements were also reproduced in the longitudinal analysis.
Why the distinction matters
The findings place emphasis on recognising a change from baseline rather than assuming that every new or intensified behaviour represents a straightforward progression of autism. In the study’s formulation, catatonia in autistic people with intellectual disability may combine immobility-related changes with repetitive, activated or dysregulated behaviours. Those features can look different from the stereotypical picture of catatonia dominated by stupor.
The evidence is a single-centre observational cohort and a medRxiv preprint. It documents improvement during a period of ECT and supports a treatment-associated relationship, while the design does not provide a randomised comparison of ECT with another treatment. The supplied report also focuses on BFCRS changes; longer-term functional outcomes and patient-level diagnostic implications are not described in the abstract.
The central clinical implication is that catatonic features should be considered when an autistic person experiences marked later regression or a substantial change in movement and behaviour. The study provides a basis for further research into how these signs can be identified and treated, rather than treating the observed changes as evidence that autism itself is worsening.