Is Hypermobility Truly a Risk Factor for Autism?

Understanding Hypermobility and Autism

Hypermobility refers to the ability of joints to move beyond the normal range of motion. It can be associated with various conditions, including joint hypermobility syndrome (JHS) and Ehlers-Danlos syndromes (EDS). In recent years, researchers have been exploring the potential link between hypermobility and autism spectrum disorder (ASD).

Link Between Joint Hypermobility and Gastrointestinal Issues

Studies have shown a link between joint hypermobility and gastrointestinal issues. For example, individuals with joint hypermobility syndrome may experience gastrointestinal symptoms such as irritable bowel syndrome (IBS). In some cases, healthcare providers may recommend an exclusion diet to test for food intolerances in individuals with joint hypermobility syndrome.

Relationship Between Autism Spectrum Disorder and Joint Hypermobility

Research has found a significant relationship between autism spectrum disorder (ASD) and generalised joint hypermobility (GJH) in adults. Adjusted odds ratios of 3.1 and 4.9 were observed, indicating an overrepresentation of GJH in individuals with ASD. However, it's important to note that the association between ASD and GJH may be influenced by comorbid conditions such as attention deficit hyperactivity disorder (ADHD). The high prevalence of comorbid ADHD in the study sample may limit the generalizability of the results among individuals with ASD without comorbid ADHD.

Furthermore, neurodivergent individuals, including those with ASD, have been found to have a significantly higher prevalence of joint hypermobility compared to the general population. Rates of joint hypermobility in neurodivergent individuals range from 28.4% to 51%, which is more than double the prevalence in the general population. This suggests a potential association between joint hypermobility and autism.

Understanding the relationship between hypermobility and autism is important in order to provide appropriate care and support for individuals on the autism spectrum who may also experience joint hypermobility. Further research is needed to better comprehend the underlying mechanisms and implications of this association.

Prevalence and Impact of Hypermobility

Hypermobility refers to the ability of joints to move beyond their normal range of motion. Understanding the prevalence and impact of hypermobility is crucial in exploring its potential link to autism.

Rates of Generalized Joint Hypermobility

Neurodivergent individuals have a significantly higher prevalence of joint hypermobility (GJH) compared to the general population. Studies have shown that rates of GJH in neurodivergent individuals range from 28.4% to 51%, which is more than double the estimated prevalence of GJH in the general population (20%).

Moreover, there is a notable difference in GJH prevalence between neurodivergent females and males. Neurodivergent females assigned at birth exhibit a prevalence of GJH ranging from 40.5% to 69%, while neurodivergent males assigned at birth have a prevalence ranging from 7% to 22.6%.

Symptoms Associated with Hypermobility

Neurodivergent individuals experience a higher frequency of symptoms related to orthostatic intolerance and musculoskeletal issues compared to individuals in a comparison group. Orthostatic intolerance refers to symptoms arising from changes in body position, such as dizziness or lightheadedness upon standing.

The mean orthostatic intolerance symptom score in the neurodivergent group is 24.2, which is significantly higher than the mean score of 5.1 in the comparison group. Similarly, neurodivergent individuals report a higher mean musculoskeletal symptom score of 6.7, compared to 3.58 in the comparison group [3].

Research suggests that joint hypermobility plays a mediating role in the relationship between neurodivergence and orthostatic intolerance and musculoskeletal symptoms. The number of hypermobile joints, as measured by the Beighton score, is positively correlated with both the orthostatic intolerance symptom score and the musculoskeletal symptom score [3].

Understanding the prevalence of hypermobility and its associated symptoms is crucial in unraveling its potential link to autism. Further research is needed to explore the underlying mechanisms and implications of this association.

Neurodivergence and Hypermobility

Understanding the relationship between hypermobility and neurodivergent individuals is an important aspect of exploring the potential link between hypermobility and autism. Neurodivergent individuals, who may have conditions such as autism spectrum disorder (ASD), exhibit a higher prevalence of joint hypermobility (GJH) compared to the general population.

Higher Prevalence of Joint Hypermobility in Neurodivergent Individuals

Studies have shown that neurodivergent individuals have a significantly higher prevalence of GJH than the general population. The rates of GJH in neurodivergent individuals range from 28.4% to 51%, which is more than double the estimated prevalence of GJH in the general population (20%). This suggests a potential association between neurodivergence and hypermobility.

Furthermore, the prevalence of GJH differs between neurodivergent males and females. Neurodivergent females assigned at birth exhibit a higher prevalence of GJH, ranging from 40.5% to 69%, compared to neurodivergent males assigned at birth, with a prevalence ranging from 7% to 22.6%.

Symptoms and Impacts on Neurodivergent Group

In addition to a higher prevalence of GJH, neurodivergent individuals also experience more symptoms related to hypermobility. Orthostatic intolerance, which refers to symptoms that occur when an individual stands up or sits upright, is more prevalent in the neurodivergent group. The mean orthostatic intolerance symptom score in neurodivergent individuals is 24.2, while in the comparison group it is 5.1. This suggests that individuals with neurodivergence may be more susceptible to symptoms associated with changes in posture.

Musculoskeletal symptoms, including pain, are also more commonly reported by neurodivergent individuals compared to the comparison group. The mean musculoskeletal symptom score in the neurodivergent group is 6.7, while in the comparison group it is 3.58. This indicates that musculoskeletal issues may be more prevalent among those with neurodivergence.

It is worth noting that joint hypermobility appears to play a role in mediating the link between neurodivergence and symptoms of both orthostatic intolerance and musculoskeletal pain. The Beighton score, which measures the number of hypermobile joints, shows a positive correlation with both the orthostatic intolerance symptom score and musculoskeletal symptom score. This suggests that the presence of hypermobility may contribute to the severity of symptoms experienced by neurodivergent individuals.

Understanding the higher prevalence of joint hypermobility in neurodivergent individuals and the associated symptoms can provide valuable insights into the potential connections between hypermobility and conditions like autism spectrum disorder. Further research is needed to fully unravel the puzzle and determine the underlying mechanisms that may link hypermobility to neurodivergence.

Associations Between Autism and Hypermobility

Exploring the potential link between hypermobility and autism, several studies have shed light on the associations between these two conditions. Understanding these connections can contribute to a better comprehension of the underlying factors and potential shared features.

Joint Hypermobility in Adults with Autism

A significant relationship has been found between Autism Spectrum Disorder (ASD) and generalised joint hypermobility (GJH) in adults. According to a study, the odds ratios for the association between ASD and GJH were found to be 3.1, indicating that GJH is overrepresented in individuals with ASD. The study collected data on joint hypermobility, symptoms associated with hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS), psychiatric diagnoses, psychiatric rating scales, and socio-demographics for individuals with ASD and non-ASD community controls.

Prevalence rates of GJH, as determined by the Beighton Scoring System (BSS), were found to be higher among individuals with ASD compared to non-ASD controls. The rates were 44.7% for women and 21.6% for men among individuals with ASD, compared to 24.0% for women and 7.6% for men among non-ASD controls.

Symptomatic Joint Hypermobility and Autism

The study also revealed a significant association between symptomatic GJH and ASD, with adjusted odds ratios of 4.9. This suggests that individuals with ASD are more likely to experience symptomatic joint hypermobility. Notably, individuals with ASD without comorbid attention deficit hyperactivity disorder (ADHD) showed a significant association with symptomatic GJH, with an odds ratio of 5.4.

Understanding the associations between hypermobility and autism can help healthcare professionals and researchers develop appropriate strategies for diagnosis, treatment, and support. Further research is needed to delve deeper into the underlying mechanisms and potential shared features between these conditions. By integrating the Beighton Scoring System and considering symptomatic GJH in individuals with ASD, healthcare providers can enhance their understanding and provide more tailored support for those affected by both hypermobility and autism.

Neurological Commonalities

When exploring the relationship between hypermobility and autism, it becomes evident that there are shared neurological features between these conditions. Specifically, there are commonalities between autism and Ehlers-Danlos Syndromes (EDS), a group of connective tissue disorders. Additionally, both conditions display coordination problems and sensory issues.

Shared Features Between Autism and Ehlers-Danlos Syndromes

Research indicates that there are significant neurological commonalities between autism and EDS, including neurobehavioral, psychiatric, and neurological features. These features encompass a range of conditions such as ADHD, learning disorders, anxiety, depression, epilepsy, and sleep disorders.

Moreover, there is an extensive overlap between the genetic syndromes associated with autism and hypermobility and the genes associated with EDS. This overlap suggests a potential phenotypic connection between the two conditions, indicating shared underlying genetic factors.

Coordination Problems and Sensory Issues

Individuals with autism and those with EDS commonly experience coordination problems and sensory issues. Motor coordination deficits, proprioceptive impairment, and sensory sensitivities in touch, light, and sound are prevalent in both conditions.

The coordination difficulties in coordination can manifest as challenges in fine and gross motor skills. This can impact activities such as writing, tying shoelaces, or participating in sports. Sensory issues can manifest as heightened sensitivities or aversions to certain stimuli, such as touch, light, or sound. These sensory sensitivities often lead to discomfort or distress in everyday environments.

The presence of these shared neurological features and the coordination problems and sensory issues further emphasize the potential connection between hypermobility and autism. However, more research is needed to fully understand the underlying mechanisms and the extent of this relationship.

Understanding these neurological commonalities can provide valuable insights into the overlapping characteristics of hypermobility and autism. By recognizing these shared features, healthcare professionals can develop comprehensive approaches for assessment, diagnosis, and treatment, ensuring the best possible outcomes for individuals with these conditions.

Implications and Recommendations

The relationship between hypermobility and autism has significant implications for assessment and treatment. Integrating the Beighton scoring system, a measurement of joint hypermobility, into the standard physical assessment for individuals on the autism spectrum is crucial. This integration can help identify individuals who may have underlying Ehlers-Danlos syndromes or hypermobility spectrum disorders and ensure appropriate referral and treatment.

Integration of Beighton Scoring System

The Beighton scoring system is a valuable tool in assessing joint hypermobility. It involves a series of maneuvers to evaluate flexibility and joint mobility. By incorporating this scoring system into the assessment process for individuals with autism, healthcare professionals can identify those who may be at a higher risk of hypermobility-related conditions. The Beighton score can be used as a screening tool to determine if further evaluation and intervention are necessary.

The prevalence rates of generalized joint hypermobility (GJH) according to the Beighton Scoring System were found to be higher in individuals with autism spectrum disorder (ASD) compared to non-ASD controls. In the study, the prevalence rates of GJH were 44.7% for females and 21.6% for males in the ASD group, compared to 24.0% for females and 7.6% for males in the non-ASD control group.

Referral and Treatment Considerations

Identifying hypermobility in individuals with autism is crucial for appropriate referral and treatment. Understanding the link between joint hypermobility and autism can help healthcare professionals develop targeted interventions to address the unique needs of this population.

Individuals with autism and joint hypermobility may experience a range of musculoskeletal symptoms, including back and joint pain, recurrent dislocation of the shoulder or kneecap, and skin abnormalities. Therefore, it is essential to provide comprehensive care that addresses both the neurodevelopmental aspects of autism and the musculoskeletal manifestations of joint hypermobility.

Referral to specialists, such as rheumatologists or geneticists, may be necessary for a thorough evaluation and diagnosis of underlying hypermobility spectrum disorders or Ehlers-Danlos syndromes. These specialists can provide targeted treatment plans and recommendations based on the individual's specific needs.

In addition to specialized care, multidisciplinary approaches that include physical therapy and occupational therapy can be beneficial for individuals with autism and hypermobility. These therapies can focus on strengthening muscles, improving joint stability, and promoting functional independence.

Overall, recognizing the link between hypermobility and autism allows for early intervention and comprehensive care. By integrating the Beighton scoring system into assessments and considering the unique needs of individuals with autism and hypermobility, healthcare professionals can provide more tailored treatment plans and improve the overall well-being of this population.

References

• ‍https://my.clevelandclinic.org/health/diseases/21763-joint-hypermobility-syndrome
• ‍https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8861852/
• ‍https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8847158/
• ‍https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711487/