A quarterly publication of the Autism Research Institute

The Autism Research Review International is quarterly publication of the Autism Research Institute

Fall, 2018 | Number 4, Volume 32

Catatonia in individuals with ASD may respond very well to manual prompts with gradual fading

Catatonic-like symptoms are common in individuals with autism spectrum disorder (ASD), affecting as many as 20% of them. A new case study indicates that prompting can be an effective strategy for overcoming this problem. 

Common features of catatonia include increased slowness in speech and movement, passivity, difficulty initiating actions or completing tasks, reliance on prompts, lack of motivation, and deterioration in functional and social behavior. Symptoms can range from mild to severe. Catatonic symptoms in individuals with ASD are often treated with lorazepam, or, when drug treatment fails, with electroconvulsive therapy. 

In the new study by Susan Vener and colleagues, the researchers used positive reinforcement and manual prompts faded over time to address the symptoms of an 18-year-old girl who had developed symptoms of catatonia at the age of 14. Over time, the girl had stopped talking, following verbal directions, and walking and eating independently. She became immobile, needed significant prompts to engage in daily activities, and maintained rigid postures for extended periods. Medications and nutritional supplements resulted in only minimal improvements. 

In the intervention, a therapist initially provided a verbal prompt and full manual guidance during four tasks: blow-drying hair, using a hair barrette, vacuuming, and using a paper shredder. The therapist gradually reduced manual prompts, returning to the previous level if the girl did not successfully perform the activity. Prompts were faded from a firm grasp to a light grasp or touch, and gradually moved from the hand up the arm to the shoulder. Eventually, prompts consisted of shoulder taps, with the therapist using a metronome to gradually decrease the frequency of the taps. Next, the therapist physically moved away from the girl. After that, the researchers changed the setting in which the blow-drying and barrette activities occurred. At each phase, reinforcers and verbal praise were provided only at the completion of the activity. 

The researchers say that at the end of the intervention, the girl was able to perform all four tasks independently with a high degree of success and maintained this ability over a 20-month period. They add that although their paper presented data on  the effectiveness of the procedure for only four activities, “the same prompt-fading procedure was used with 15 other activities throughout the course of [the girl’s] school day, and seven activities while in her home environment with her parent and home therapist… [and] the introduction of the prompt-fading sequence resulted in a marked increase in independent responding across activities, locations, clinicians and adults.” They conclude that the girl is “again a functional member of her classroom and her home environment.”


“Increasing behavior incompatible with catatonia in a young adolescent girl with autism spectrum disorder,” Susan M. Vener, Alison M. Wichnick-Gillis, Diamante Badala, and Claire L. Poulson, Research in Autism Spectrum Disorders, Vol. 57, January 2019. Address: Susan M. Vener, [email protected]


 “The nature and prevalence of catatonic symptoms in young people with autism,” Jennifer Breen and Dougal Julian Hare, Journal of Intellectual Disability Research, Vol. 61, No. 6, June 2017. Address: Jennifer Breen, Department of Psychology, Royal Holloway University of London, Egham, Surrey, UK.