Clinical Presentation of, Treatment Approaches for, and the Impact of Social Determinants of Health on Pediatric Catatonia: A Structured Qualitative Synthesis and Targeted Literature Review

Catatonia is a complex neuropsychiatric syndrome with diverse presentations, including stuporous, excited, malignant, and periodic forms.While well documented in adults, pediatric catatonia remains underrecognized, with limited literature addressing its presentation, treatment, and the influence of social determinants of health (SDOH).This structured qualitative synthesis and targeted literature review examine eight pediatric patients with catatonia to identify clinical patterns, contributing factors, treatment strategies, and the impact of SDOH on diagnosis and outcomes.Clinical presentations ranged from mutism and waxy flexibility in stuporous catatonia to agitation and selfinjurious behavior in excited forms.Neurodevelopmental and psychiatric conditions, including autism spectrum disorder (ASD) and psychotic disorders, were common predisposing factors.SDOH and other contextual factors, including trauma, mental-health stigma, barriers to specialized care, and socioeconomic hardship, were variably reported and, in several cases, were associated with delayed recognition or access to treatment.Benzodiazepines, particularly lorazepam, were effective in symptom management across cases, while antipsychotic medications provided adjunctive benefit in patients with prominent psychotic features.Electroconvulsive therapy (ECT) was a life-saving intervention in refractory cases but remained limited by systemic and legislative barriers.Supportive measures, including hydration and enteral feeding, were critical in severe presentations.Long-term management required individualized pharmacologic strategies to reduce relapse risk.This synthesis highlights the importance of early recognition, trauma-informed care, and addressing systemic inequities to improve outcomes in pediatric catatonia.