The finding:
Catatonia was included as a specifier of Autism Spectrum Disorder in DSM-5. The Pediatric Catatonia Rating Scale (PCRS) has been validated in pediatric populations but may not capture the atypical symptoms in youth with neurodevelopmental disorders (NDD). The authors propose an alternative individualized measure to assess catatonic decline and response to treatment in patients with NDD and catatonia. They suggest clinicians first assess the patient’s current catatonia status using a standardised assessment tool such as the Bush-Francis Catatonia Rating Scale (BFCRS) or PCRS. The personalized baseline score (on the same scale) can then be estimated on the basis of information from family recollection (eg, status of self care), family records (home videos, dated journal entries), specific targeted questions (have repetitive movements/ get stuck in unusual positions) and historical medical data (pediatrician reports, neuropsychological testing, school data). The next step would be to determine catatonic deterioration from baseline. This approach may better reflect treatment efficacy as well. Assessment should include attention to 6 ‘red flag’ symptoms—worsening of stereotypies, new food refusal, worsening of incontinence or toileting frequency, regression of activities of daily living, worsening of self-injurious behaviors, and purposeless agitation. The goal of treatment would be to minimize catatonic deterioration, even when BFCRS/PCRS may remain high.

Strength and weaknesses:
This piece addresses the limitations of existing catatonia assessment instruments for youth with NDDs, but it is limited to expert opinion. The proposed process is time and resource intensive, may need specific training of clinicians, and requires further validation. Estimating baseline score may not be possible for all patients with NDD, such as those with severe symptoms at baseline and subacute onset of catatonia.

Relevance:
Both child and adult psychiatrists treat adolescents and young adults with NDDs, and new DSM-5 criteria have brought renewed attention to the complexity of managing catatonia in this complex patient population. Attention to the patient’s individual baseline functioning and ongoing acute medical needs is of particular importance. This work provides a helpful approach to summarizing and documenting catatonic symptoms for patients with NDD.