Neuroscience and psychology
Joint hypermobility as a biological mechanism mediating neurodevelopmental disorders
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Ainhoa Pérez
Alumni
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MPH, MSc.
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A strong epidemiological link has been observed between joint hypermobility (or hyperlaxity) and various neuropsychiatric disorders. The relationship between neurodivergence at the central nervous system level and alterations in connective tissue opens up an intriguing perspective. Neurodevelopmental disorders such as autism, ADHD, and Tourette syndrome share sensory, cognitive, and behavioral profiles, as well as a high burden of physical symptoms such as musculoskeletal pain and orthostatic intolerance. Generalized joint hypermobility, a phenotypic expression of connective tissue alterations, may act as a common physiological mechanism, amplifying proprioceptive and interoceptive pathways that can produce neurophysiological and neuropsychological reactivity, as well as regulatory deficits and maladaptive neuroplasticity. Conditions such as Ehlers-Danlos and other connective tissue disorders are in turn associated with autonomic, gastrointestinal, and gynecological dysfunction, as well as a high psychopathological burden, suggesting a relationship between neurodivergence and musculoskeletal connective disorders.
Although the clinical relationship has been previously observed, there are not many systematic studies. For example, a study conducted in the United Kingdom (Csecs et al., 2022) analyzed the prevalence of hypermobility, orthostatic intolerance, and musculoskeletal symptoms in adults with a confirmed diagnosis of autism, ADHD, or Tourette syndrome, showing a higher prevalence of hypermobility in the neurodivergent group. Hypermobility predicted membership of the neurodivergent group, a relationship that intensified when adjusted for sex, showing a very strong association (OR = 6.45). At the diagnostic level, the odds of hypermobility were significantly higher in autism, ADHD, and even higher in Tourette's compared to the control group. In addition, the neurodivergent group reported a higher burden of orthostatic and musculoskeletal symptoms. Other studies have shown similar relationships with a large sample size.
The main contribution of this study lies in showing that the relationship between neurodivergence and physical symptoms is mediated by the degree of joint hypermobility. This points to a shared systemic vulnerability, where reduced collagen integrity and the resulting hypermobility emerge as a transdiagnostic phenotype that modulates the relationship between neurodivergence and the somatic burden with which different symptoms manifest, such as dysautonomia, interoceptive disturbances, orthostatic intolerance, fatigue, pain, etc. This, in turn, can alter aspects of neurodevelopment, producing sensory, psychomotor, learning, affective, social, and other deficits. At the level of neuroplasticity, this can reinforce circuits of avoidance, anticipatory anxiety, or somatic hypervigilance.
This perspective allows us to view neurodivergence in a more integrated way at the somatic level, where connective tissue is a key mediator of body perception, interoception, and sensory integration. At the clinical level, assessing hypermobility and dysautonomia in adults with neurodevelopmental disorders could improve the detection of unexplained symptoms, reduce psychogenic bias, and guide more integrated therapeutic strategies. Clinically, this suggests that therapy targeting somatic, proprioceptive, and kinesthetic exposure, among others, could be therapeutic at the level of global nervous system integration in various disorders and could reduce the avoidance tendencies associated with disorders such as autism. However, studies with genetic analysis, objective tests of autonomic function, and neuroimaging are needed to clarify the shared mechanisms between neurodiversity and somatic dysfunction.
Although the clinical relationship has been previously observed, there are not many systematic studies. For example, a study conducted in the United Kingdom (Csecs et al., 2022) analyzed the prevalence of hypermobility, orthostatic intolerance, and musculoskeletal symptoms in adults with a confirmed diagnosis of autism, ADHD, or Tourette syndrome, showing a higher prevalence of hypermobility in the neurodivergent group. Hypermobility predicted membership of the neurodivergent group, a relationship that intensified when adjusted for sex, showing a very strong association (OR = 6.45). At the diagnostic level, the odds of hypermobility were significantly higher in autism, ADHD, and even higher in Tourette's compared to the control group. In addition, the neurodivergent group reported a higher burden of orthostatic and musculoskeletal symptoms. Other studies have shown similar relationships with a large sample size.
The main contribution of this study lies in showing that the relationship between neurodivergence and physical symptoms is mediated by the degree of joint hypermobility. This points to a shared systemic vulnerability, where reduced collagen integrity and the resulting hypermobility emerge as a transdiagnostic phenotype that modulates the relationship between neurodivergence and the somatic burden with which different symptoms manifest, such as dysautonomia, interoceptive disturbances, orthostatic intolerance, fatigue, pain, etc. This, in turn, can alter aspects of neurodevelopment, producing sensory, psychomotor, learning, affective, social, and other deficits. At the level of neuroplasticity, this can reinforce circuits of avoidance, anticipatory anxiety, or somatic hypervigilance.
This perspective allows us to view neurodivergence in a more integrated way at the somatic level, where connective tissue is a key mediator of body perception, interoception, and sensory integration. At the clinical level, assessing hypermobility and dysautonomia in adults with neurodevelopmental disorders could improve the detection of unexplained symptoms, reduce psychogenic bias, and guide more integrated therapeutic strategies. Clinically, this suggests that therapy targeting somatic, proprioceptive, and kinesthetic exposure, among others, could be therapeutic at the level of global nervous system integration in various disorders and could reduce the avoidance tendencies associated with disorders such as autism. However, studies with genetic analysis, objective tests of autonomic function, and neuroimaging are needed to clarify the shared mechanisms between neurodiversity and somatic dysfunction.
#physiotherapy #jointhypermobility #autism #ADHD #tourettesyndrome #proprioception #neurodevelopmentaldisorders
References:
Csecs, J. L. L et al, 2022. Joint hypermobility links neurodivergence to dysautonomia and pain. Frontiers in Psychiatry, 12, 786916. https://doi.org/10.3389/fpsyt.2021.786916
* The news published on studies do not represent an official position of ICNS, nor a clinical recommendation.
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