When looking at the literature on hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome, it becomes clear that there is a relationship between those conditions and a patient also presenting with comorbid autism spectrum disorder and/or ADHD. This also extends out to the wider spectrum of Ehlers-Danlos Syndromes of other types, with it appearing to be a commonality across the syndrome family. Therefore, it can be considered within the range of “normal” for those conditions to be presented with that comorbidity.
Some of the literature showing this link includes, but is not limited to:
- “Lack of attention is now considered a common feature in children with gJHM and JHS/EDS-HT, as documented by the high rate of attention deficit (and hyperactivity) disorder in these conditions.”
Neurodevelopmental attributes of joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type: Update and perspectives – Ghilbellini, Brancati & Castori (2015) – https://doi.org/10.1002/ajmg.c.31424
- “Psychiatric conditions in which there is some evidence of an association with JH/HDCT are anxiety disorders, depression, schizophrenia, neurodevelopmental disorders (autism, attention deficit/hyperactivity disorder, and developmental coordination disorder), eating disorders, personality disorders and substance use/misuse.”
Joint hypermobility and the heritable disorders of connective tissue: clinical and empirical evidence of links with psychiatry – Baeza-Velasco, Pailhez, Bulbena & Baghdadli (2015) – https://doi.org/10.1016/j.genhosppsych.2014.10.002
- “Children with ASDs had significantly greater joint mobility (p < .002), more gait abnormalities (p < .0001), and on average walked 1.6 months later than their non-autistic peers.”
Abnormalities of joint mobility and gait in children with autism spectrum disorders – Shetreat-Klein, Shinnar & Rapin (2012) – https://doi.org/10.1016/j.braindev.2012.02.005
- “EDS was associated with ASD: risk ratio (RR) 7.4, 95 % confidence interval (95 % CI) 5.2-10.7; bipolar disorder: RR 2.7, CI 1.5-4.7; ADHD: RR 5.6, CI 4.2-7.4; depression: RR 3.4, 95 % CI 2.9-4.1; and attempted suicide: RR 2.1, 95 % CI 1.7-2.7, but not with suicide or schizophrenia. EDS siblings were at increased risk of ADHD: RR 2.1, 95 % CI 1.4-3.3; depression: RR 1.5, 95 % CI 1.1-1.8; and suicide attempt: RR 1.8, 95 % CI 1.4-2.3. Similar results were observed for individuals with hypermobility syndrome and their siblings.”
Nationwide population-based cohort study of psychiatric disorders in individuals with Ehlers-Danlos syndrome or hypermobility syndrome and their siblings – Cederlof, Larsson, Lichtenstein, Almqvist, Serlachius & Ludvigsson (2016) – https://doi.org/10.1186/s12888-016-0922-6
- “This article reviews the pertinent literature concerning neurodevelopmental conditions for which there is some evidence of an association with JHM/HSD/EDS. These include hyperactivity and attention deficit, learning, communication, and motor problems including tic disorders such as Tourette syndrome and autism spectrum disorders.”
Neurodevelopmental atypisms in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers–Danlos syndromes – Baeza-Velasco (2021) – https://doi.org/10.1002/ajmg.c.31946
- “ADHD was the third more common neurodevelopmental disorder in our sample as it occurred in 13% of the cases, compared to 5% in the pediatric population (APA, 2013). Our observation confirms the slight rate increase (7%) of ADHD in EDS adults reported by Hershenfeld et al. (2016). A recent nationwide population-based study in Sweden demonstrated an increased risk of ADHD in people with EDS or JHS, and their siblings (risk ratio 5.6 and 2.1, respectively) (Cederlof et al., 2016).”
Exploring relationships between joint hypermobility and neurodevelopment in children (4–13 years) with hereditary connective tissue disorders and developmental coordination disorder – Piedimonte, Penge, Morlino, Sperduti, Terzani, Giannini, Colombi, Grammatico, Cardona & Castori (2018) – https://doi.org/10.1002/ajmg.b.32646
Referencing:- Psychiatric disorders in Ehlers-Danlos syndrome are frequent, diverse and strongly associated with pain – Hershenfeld, Wasim, McNiven, Parikh, Majewski, Faghfoury & So (2016) – https://doi.org/10.1007/s00296-015-3375-1
- Nationwide population-based cohort study of psychiatric disorders in individuals with Ehlers-Danlos syndrome or hypermobility syndrome and their siblings – Cederlof, Larsson, Lichtenstein, Almqvist, Serlachius & Ludvigsson (2016) – https://doi.org/10.1186/s12888-016-0922-6
- “Considerable interest has arisen concerning the relationship between hereditary connective tissue disorders such as the Ehlers-Danlos syndromes (EDS)/hypermobility spectrum disorders (HSD) and autism, both in terms of their comorbidity as well as co-occurrence within the same families. […] Together, these data highlight the potential relatedness of these two conditions and suggest that EDS/HSD may represent a subtype of autism.”
The Relationship between Autism and Ehlers-Danlos Syndromes/Hypermobility Spectrum Disorders – Casanova, Baeza-Velasco, Buchanan & Casanova (2020) – https://doi.org/10.3390%2Fjpm10040260
- “All EDS cases could be classified as hEDS. Of the entire study cohort, 16% had a verified ADHD diagnosis and a further 7% were undergoing ADHD diagnostic investigation. Significantly more children with hEDS had ADHD compared to children with HSD (p=0.02). In the age group 15– 16 years, 35% of those with hEDS had ADHD and, among those aged 17– 18 years, ADHD was present in 46%. Children with coexisting ADHD showed a significantly higher proportion of associated symptoms such as fatigue, sleep-problems, and urinary tract problems. ASD had been verified in 6% of the children. Of those with ASD, 92% had sleep problems. This study shows a strong association between HSD or hEDS and ADHD or ASD. Therefore, children with HSD or hEDS may need to be routinely screened for neuropsychiatric symptoms.”
Prevalence of ADHD and Autism Spectrum Disorder in Children with Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome: A Retrospective Study – Kindgren, Quinones & Knez (2020) – https://doi.org/10.2147/NDT.S290494
- “The neurodivergent group manifested elevated prevalence of hypermobility (51%) compared to the general population rate of 20% and a comparison population (17.5%). Using a more stringent age-specific cut-off, in the neurodivergent group this prevalence was 28.4%, more than double than the comparison group (12.5%).”
Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain – Csecs, Iodice, Rae, Brooke, Simmons, Quadt, Savage, Dowell, Prowse, Themelis, Mathias, Critchley & Eccles (2022) – https://doi.org/10.3389/fpsyt.2021.786916
- “ASD and HRDs, specially hEDS, are conditions with a strong genetic component, a polymorphic clinical presentation, appearing both in infancy, and sharing several phenotypical features. Although existing data does not allow to ascertain increase prevalence of ASD in HRDs, as well as shared underlying patho-mechanisms between both conditions, there is increasing evidence suggesting that these co-occur more often than expected by chance.”
Autism, Joint Hypermobility-Related Disorders and Pain – Baeza-Velasco, Cohen, Hamonet, Vlamynck, Diaz, Cravero, Cappe & Guinchat (2018) – https://doi.org/10.3389/fpsyt.2018.00656
- “We demonstrate for the first time that rates of hypermobility and symptoms of autonomic dysfunction are particularly high in adults with neurodevelopmental diagnoses.”
Joint Hypermobility and Autonomic Hyperactivity: Relevance to Neurodevelopmental Disorders – Eccles, Iodice, Dowell, Owens, Hughes, Skipper, Lycette, Humphries, Harrison, Mathias & Critchley (2014) – http://dx.doi.org/10.1136/jnnp-2014-308883.9
- “We speculate that associations exist between connective tissue diseases and autistic disorders, and that connective tissue abnormalities may contribute to autistic symptoms.”
High-functioning autistic disorder with Ehlers-Danlos syndrome – Takei, Mera, Sato & Haraoka (2011) – https://doi.org/10.1111/j.1440-1819.2011.02262.x
- “The results of this study support that joint hypermobility may be associated with ADHD, and this condition should be taken into consideration in assessing the complaints of patients with ADHD-related musculoskeletal symptoms.”
Benign Joint Hypermobility Syndrome in Patients with Attention Deficit/Hyperactivity Disorders – Koldas Dogan, Taner & Evcik (2011) – https://doi.org/10.5152/tjr.2011.029
- “These data suggest that EDS/HSD and autism share aspects of immune/autonomic/endocrine dysregulation, pain, and some tissue fragility, which is typically more severe in the former. This overlap, as well as documented comorbidity, suggests some forms of autism may be hereditary connective tissue disorders (HCTD).”
Immune, Autonomic, and Endocrine Dysregulation in Autism and Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorders Versus Unaffected Controls – Casanova, Sharp, Edelson, Kelly, Sokhadze & Casanova (2019) – https://doi.org/10.1101/670661
- “GJH was assessed by physical examination following the Beighton scoring system (BSS). Furthermore, musculoskeletal symptoms and skin abnormalities were queried to create a proxy for symptomatic GJH (e.g., Hypermobility spectrum disorders and Ehlers-Danlos syndrome) to differentiate this from non-specified GJH defined by BSS only Logistic regression examined the influence of ADHD and candidate covariates (age, sex, ethnicity) on GJH and symptomatic GJH, respectively. ADHD was significantly associated with GJH, as defined by the BSS, with adjusted odds ratios of 4.7 (95% confidence interval [CI] 3.0–7.2, p < .005). Likewise, ADHD was significantly associated with symptomatic GJH, as defined by the BSS and additional symptoms, with adjusted odds ratios of 6.9 (CI 95% 4.1–11.9, p < .005). Our results suggest that GJH may represent a marker for an underlying systemic disorder involving both connective tissue and the central nervous system. GJH with additional musculoskeletal symptoms and/or skin abnormalities has a considerable stronger link to adult ADHD than non-specified GJH has, and may need awareness in ADHD management. Future studies should investigate the mechanisms behind this association and how comorbid GJH affects ADHD outcome.”
Association between adult attention-deficit hyperactivity disorder and generalised joint hypermobility: A cross-sectional case control comparison – Glans, Thelin, Humble, Elwin & Bejerot (2021) – https://doi.org/10.1016/j.jpsychires.2021.07.006
- “Joint laxity was discovered in 74.4% of children with attention deficit hyperactivity disorder and in 12.8% of healthy controls. The prevalence of benign joint hypermobility syndrome was high in children with attention deficit hyperactivity disorder, which shows a new basis for further studies.”
Evaluation of the Prevalence of Joint Laxity in Children with Attention Deficit/Hyperactivity Disorder – Shiari, Saeidifard & Zahed (2013) – https://doi.org/10.5455/apr. 032420131219
- “The significant findings in the SCT scale and observed trends in other attention-related scales indicate that larger future studies are needed to further elucidate the relationship between EDS-HT and attention problems. An association between EDS-HT and ADHD may influence clinical management of patients with both disorders.”
Pilot Study of Attention Deficit Hyperactivity Disorder-related Behaviors in a Pediatric Ehlers-Danlos Syndrome-Hypermobility type Population (Thesis) – Reinert (2015) – https://etd.ohiolink.edu/apexprod/rws_etd/send_file/send?accession=ucin1427796903&disposition=inline
- “While this study cannot address rates of ASD and GJH co-occurrence because of the way in which respondents were recruited, the comorbidity itself reinforces etiological links between autism and connective tissue disorders. Both cytokines and hormones play recognized roles in neurogenesis, neuritogenesis, synaptogenesis, and ongoing plasticity. In addition, some researchers have proposed that autoantibodies to brain-specific proteins may also disrupt neurodevelopment, leading to increased autism risk. Finally, endocrine disruption, either via endogenous or exogenous effectors, is likewise a growing area of research into autism’s etiology. All of these topics highlight the crosstalk between the immune and endocrine systems and strengthen their combined links to ASD.”
A Cohort Study Comparing Women with Autism Spectrum Disorder with and without Generalized Joint Hypermobility – Casanova, Sharp, Edelson, Kelly & Casanova (2018) – https://doi.org/10.3390/bs8030035
- “Logistic regression models adjusting for covariates (age, sex, ethnicity) revealed a significant relationship between ASD and GJH and between ASD and symptomatic GJH, with adjusted odds ratios of 3.1 (95% CI: 1.9, 5.2; p < 0.001) and 4.9 (95% CI: 2.6, 9.0; p < 0.001), respectively. However, the high prevalence of comorbid ADHD in the study sample reduces the generalizability of the results among individuals with ASD without comorbid ADHD. Possibly, an additional ADHD phenotype is the primary driver of the association between ASD and GJH. Furthermore, GJH with additional self-reported symptoms, suggestive of HSD/hEDS, showed a stronger association with ASD than did non-specified GJH, indicating that symptomatic GJH plays a greater role in the relationship than non-specified GJH does.”
The Relationship Between Generalised Joint Hypermobility and Autism Spectrum Disorder in Adults: A Large, Cross-Sectional, Case Control Comparison – Glans, Thelin, Humble, Elwin & Bejerot (2022) – https://doi.org/10.3389/fpsyt.2021.803334
- “The extent of hypermobility among children with Autism Spectrum Disorder was 60%, that is, 70 out of 117 children had hypermobility. Our results also suggested that the age, height, weight, and BMI of the child had a moderate negative correlation with hypermobility.”
Hypermobility among children with autism spectrum disorders and its correlation with anthropometric characteristics – Shanker Tedla, Asiri, Saeed Alshahrani & Gular (2021) – https://doi.org/10.47391/jpma.436
This overlapping relationship is to note as it adds additional risk factors when managing those with these co-occurring disabilities, most notably in the field of mental health. HSD and hEDS are linked to mental health conditions, as are autism and ADHD, meaning that when there is an intersection of these conditions within one patient, the risk of mental health issues increases.
The Forest Blossom Memoirs 