Feasibility of reliable, remote assessment of a 13-year-old boy who stopped talking
Creators: name: Kadubandi, Neeraj
name: Elshourbagy, Abdelwahab
name: Smith, Landon
name: Balousha, Abrar
name: Tacik, Pawel
name: Barnett, Jacqueline
name: Brasic, James
Publisher: name: Zenodo
Year: 2025
Subjects: Catatonia
Rating scale
Virtual

description: The initial protocol was performed utilizing three rating tools suitable for children with catatonia (American Psychiatric Association, 2013; Benarous, et al., 2016; Bush, et al., 1996). On their own monitors in different locations, three investigators viewed an edited video of clinical assessments of a 16-year-old boy displayed by the coordinator. The edited video was shown to all raters together once before each rater independently completed rating of each scale. If an item could not be scored based on the clinical video, raters scored the item with and X. First, they rated Bush, et al., 1996, then, Benarous, et al., 2016, and finally, American Psychiatric Association, 2013. After each scale was completed, the coordinator obtained the independent scores of all raters and conducted a consensus conference to attain agreement on the scores for each item. If the raters did not agree on a score, then the consensus score was . (period) to indicate lack of agreement.

 

The investigators then sought to conduct a comprehensive review of all rating scales for catatonia to construct an optimal scale including the crucial items from extant scales. A recent systematic review (Hirjak, et al., 2024) identified two clinical criteria (American Psychiatric Association, 2013; ICD-11 for Mortality and Morbidity Statistics, 2024) and two scales (Bush, et al., 1996; Northoff, et al., 2001) as the most widely utilized scales so those scales were used to construct our optimal scale. Since we aimed to rate videos of a child, we also utilized the Pediatric Catatonia Rating Scale (Benarous, et al., 2016).

 

We then constructed a spreadsheet with the key criteria for each scale and each of the scales identified with a column as follows: ICD11 (ICD-11 for Mortality and Morbidity Statistics, 2024), DSM5 (American Psychiatric Association, 2013), BFCRS (Bush, et al., 1996), NCRS (Northoff, et al., 2001), and PCRS (Benarous, et al., 2016) (Table 1). Because many scales included many specific items, Table 1 was expanded to include all the detailed items of the five target rating procedures (American Psychiatric Association, 2013; Benarous, et al., 2016; Bush, et al., 1996; ICD-11 for Mortality and Morbidity Statistics, 2024; Northoff, et al., 2001) (Table 2).

 

The authors then sought to construct a checklist of behaviors that could be identified on remote viewing of a video of a prior motor assessment of a patient. Since the patient could not be interviewed to determine subjective experiences, items were limited to objective movements and utterances. Since clinical motor assessment examinations were viewed on videotapes, specific durations and repetitious actions and utterances were omitted. The goal was to construct a checklist for items to identify as present with a 1 or absent with a 0 on viewing the videotape (Table 3).

 

The authors then sought to organize the rating form in a manner that could be readily scored by raters viewing virtual motor assessments once (Table 4). The authors further revised the rating form by removing (A) items that could not be readily assessed by viewing a video of a motor assessment and (B) phrases that were unnecessary to convey the crucial concepts in standard English (Table 5).

 

Further efforts to evaluate a proposed instrument to identify catatonia were the remote testing of the novel tool by a team of trained raters utilizing a process for remote scoring of videos shown to the team of raters once by a coordinator followed by independent ratings by each rater and then a consensus conference to attain agreement by discussion by all raters (Elshourbagy, et al., 2023). We utilized the dictum to rate as present only items that are clearly present (Oldham and Francis, 2022). We strived to use terminology commonly used in the literature (Oldham and Francis, 2022). We sought to develop a protocol without a structured interview and examination of the participant suitable for general motor assessments  (Table 6).

 

When catatonia is confirmed, then referral to an organization qualified to provide appropriate interventions is appropriate. Children and adolescents with catatonia may benefit from hospitalization at a facility with the staff and resources required to manage them (Smith, et al., 2024).

 

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5)®, Arlington, Virginia, USA, American Psychiatric Association, 2013, pp 119-121.

 

Benarous X, Consoli A, Raffin M, et al. Validation of the Pediatric Catatonia Rating Scale (PCRS). Schizophr Res 2016; 176:378-386.

 

Bush G, Fink M, Petrides G, Dowling F, Francis A. Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand 1996; 93:129-136.

 

Elshourbagy A, Eltaras MM, Abdalshafy H, Javed S, Sadaney AO, Harrigan TP, Mills KA, Hernandez ME, Brašić JR.  Feasibility of virtual low-cost quantitative continuous measurement of movements in the extremities of people with Parkinson‘s disease. MethodsX 2023; 11: 102230. https://doi.org/10.1016/j.mex.2023.102230

Corrigendum

Elshourbagy A, Eltaras MM, Abdalshafy H, Javed S, Sadaney AO, Harrigan TP, Mills KA, Hernandez ME, Brašić JR. Corrigendum to “Feasibility of virtual low-cost quantitative continuous measurement of movements in the extremities of people with Parkinson’s disease ” [MethodsX 11 (2023) 102230]. MethodsX 2023; 11: 102368. https://doi.org/10.1016/j.mex.2023.102368

 

Hirjak D, Brandt GA, Fritze S, Kubera KM, Northoff G, Wolf RC. Distribution and frequency of clinical criteria and rating scales for diagnosis and assessment of catatonia in different study types. Schizophr Res 2024; 263: 93-98.

 

ICD-11 for Mortality and Morbidity Statistics. Catatonia. 2024. Available at: https://icd.who.int/browse/2024-01/mms/en#486722075 Accessed on 18 June 2024

 

Northoff G, Koch K, Wenke J, et al.Catatonia as a psychomotor syndrome: a rating scale and extrapyramidal motor symptoms. Mov Disord 2001; 14: 404-416.

 

Oldham MA, Francis A. Bush-Francis Catatonia Rating Scale: Training Manual and Coding Guide. 2022. University of Rochester Medical Center, Rochester, New York, USA. Available at https://www.urmc.rochester.edu/psychiatry/divisions/collaborative-care-and-wellness/bush-francis-catatonia-rating-scale (accessed 20 March 2025).

 

Smith JR, York T, Hart S, M Patel A, Kreth HL, Spencer K, Grizzle KB, Wilson JE, Pagano L, Zaim N, Fuchs C. The development of a pediatric catatonia clinical roadmap for clinical care at Vanderbilt University Medical Center.J Acad Consult Liaison Psychiatry 2024; Sep 5:S2667-2960(24)00085-5. https://doi.org/10.1016/j.jaclp.2024.08.003. Online ahead of print.

 

Legends for Figures and Tables

 

Table 1. Representation of key criteria for catatonia in leading clinical criteria and rating scales suitable for children.

 

ICD11 (ICD-11 for Mortality and Morbidity Statistics, 2024); DSM5 American Psychiatric Association, 2013), BFCRS (Bush, et al., 1996), NCRS (Northoff, et al., 2001), PCRS (Benarous, et al., 2016). 1 = present, 0 = absent.

 

Table 2. Representation of detailed criteria for catatonia in leading clinical criteria and rating scales suitable for children.

 

ICD11 (ICD-11 for Mortality and Morbidity Statistics, 2024); DSM5 American Psychiatric Association, 2013), BFCRS (Bush, et al., 1996), NCRS (Northoff, et al., 2001), PCRS (Benarous, et al., 2016). 1 = present, 0 = absent, empty cell = absent.

 

Table 3. Extensive checklist of detailed criteria for catatonia suitable for remote assessments of videos of clinical motor assessments of people.

 

Score each item as follows:

1 = present, 0 = absent.

 

Table 4. Checklist of categories of criteria for catatonia suitable for remote assessments of videos of clinical motor assessments of people.

 

Score each item as follows:

1 = present, 0 = absent.

 

Table 5. Checklist to identify criteria for catatonia suitable for remote assessments of videos of clinical motor assessments of people.

 

Score each item as follows:

1 = present, 0 = absent.

 

Table 6. Checklist to identify criteria for catatonia suitable for remote assessments of videos of clinical motor assessments of people.

 

Score each item as follows:

1 = present, 0 = absent.