Focusing on profound autism: validity of clinical taxonomy and management of treatment-resistant symptoms

The broad-spectrum diagnostic framework for autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) tends to obscure the specific medical and support needs of individuals with severe impairments. In response, the Lancet Commission on the future of care and clinical research in autism proposed the concept of "profound autism" in 2021, referring to individuals with ASD who are aged 8 years or older, have severe intellectual disabilities (IQ < 50) and/or minimal or completely absent verbal communication abilities, and require round-the-clock (24-hour) care. Patients with profound autism often present with occult somatic comorbidities and treatment-resistant psychiatric abnormalities, including life-threatening self-injurious behavior and catatonia, which frequently render traditional stepped-care interventions ineffective. This review systematically summarizes the conceptual definition and clinical phenotypes of profound autism and emphasizes the need to shift the intervention focus toward managing serious comorbidities and establishing augmentative and alternative communication systems. Additionally, the potential application of modified electroconvulsive therapy as a salvage treatment for refractory and life-threatening symptoms is discussed. The aim is to provide evidence-based guidance for multidisciplinary management and the construction of comprehensive lifespan support systems for individuals with profound autism.