Having a chronic illness like a hypermobility disorder commonly comes with different co-morbidities. Dysautonomia problems like PoTS, chronic fatigue and pain, gastrointestinal problems, and visual stress just to name a few. A few co-morbidities that are commonly seen in people with hypermobility is neurodivergent conditions like Autism (ASD) and ADHD. In this blog post I will be exploring the links between hypermobility disorders and neurodiverse people. And how focusing on this can help people and practitioners to manage their conditions moving forward.

Neurodivergence is characterised as a ‘differing in mental or neurological function from what is considered typical or normal’. It is an umbrella term for conditions like, Autism, ADHD, ADD, Dyslexia, Dyscalculia and Dyspraxia. These can co-occur and have overlapping symptoms.

Joint hypermobility is when a person’s joints have an unusually large range of movement. Hypermobility syndromes cause pain and can lead to subluxations or dislocations. Many people can be hypermobile in their joints. However if this causes an individual pain, along with other symptoms like muscle stiffness, fatigue, and recurrent injury, this is then classed as a hypermobility syndrome.

Brain structure

Research using brain imaging of both non-hypermobile and hypermobile patients found that there were structural differences between the groups. Specifically in the structural integrity of the brain centre. There were clear differences in the volume of the bilateral amygdala, which controls a person’s emotional responses, between the groups. There are also structural differences seen in the superior temporal cortex of the brain of people with hypermobility. This is also seen within people with Autism. The imaging suggests processes that alter brain function in neurodivergent people may occur in individuals with hypermobility. This shows a possible correlation between the neural structure within the two conditions (Eccles et al., 2012). 

It was also found that there were differences in the insular cortex between hypermobile and non-hypermobile patients. This part of the brain controls how we perceive information about the body’s current physical state. This information is then used to ensure the body is at an optimal state by adapting to the environment. For example sweating when hot to cool down. Neurodiverse people can have altered insular function. This can cause the signals to get the body to an optimal state to become overloaded. This can then lead to dysautonomia symptoms like dysregulated temperature (Csecs et al., 2022).

Neurodivergent people and dysautonomia

Recent studies have found that there is a clear link between neurodivergence and hypermobility. Neurodivergent people are two times more likely to have hypermobile joints than neurotypical person (Csecs et al., 2022). They also found that hypermobility faced by neurodivergent people is a mediating factor for associated symptoms of dysautonomia and pain. Connective tissue disorders can cause blood pooling in lax peripheral vessels and increasing sensitivity of the stretched and damaged tissue.

The cause is still unknown and more research needs to be done in this area. But understanding there is a link can be very beneficial to patients seeking help with their conditions. Acknowledging that neurodivergence (e.g. Autism/ADHD) is complex. And often comes with comorbidities and overlapping symptoms is important when ensuring a patient gets the best care. This will allow them to manage their symptoms. Therefore, practitioners should be aware of this during diagnosis processes and move past an exclusive approach. Furthering research into the links between conditions should hopefully allow for more efficient diagnoses. Giving patients access to further specialised support from healthcare professionals will provide the most effective care possible. Symptom management may be more effective for neurodivergent people if treatment plans are designed with neurodivergent learning styles in mind.

Improvements in treatment

With the recent Neurodiversity Movement there’s been a big push in listening to neurodivergent individuals and shifting stereotypes. For example, there is the establishment that the neurodivergent individual is an expert within themselves and actions they do. Stimming through repetitive movements (hand flapping), should not be looked down on or discouraged. It is beneficial for the individual. This has led to research being conducted on how to accommodate neurodivergent people in environments like healthcare settings. Practitioners should adapt their approach to healthcare for neurodiverse people by working with patients to provide the most effective care. For example, practitioners should use the person’s preferred communication style. This could be non-verbal as the patient can become overwhelmed if forced to mask or communicate in a way in which they don’t feel comfortable.

ADHD and pain levels (dopamine treatment)

There have been many studies looking at the link between neurodivergent people and chronic pain. People with ADHD and ASD are more likely to experience chronic pain as well as being more sensitive to pain compared to those without. A study on chronic pain within neurodivergent women found that 75% of participants experienced chronic pain in some way. It is theorized that dopamine dysregulation within neurodivergent people could be the cause of their increased pain sensation. This is because dopamine is involved in pain perception in the body. Researchers are now looking into using medication – like Methylphenidate Ritalin – that regulates dopamine levels within the body as a pain management technique for neurodivergent people to reduce chronic pain . However, this is not widely practiced and still fairly experimental at this moment in time (Haddad et al., 2018).

Conclusion

There has been much research conducted on how links between comorbidities and conditions may relate to an individual’s neurodevelopment. From brain imaging shows the correlations between structural differences in hypermobile and neurodivergent people. To looking at how dopamine dysregulation can effect an individual’s pain management. The research done so far in this area doesn’t give us any concrete answers or causes for these links. It is beneficial as it allows practitioners to update their approaches to working with patients. It also provides a starting point for further exploration. This gives us hope for the future. That patients will have a more efficient diagnosis process. And neurodivergent patients can receive care for conditions like hypermobility in a format most effective for them.

About the author

Ronnie Carnelley is a 2^nd year physiotherapy student at The University of Brighton. She is particularly interested in long-term conditions and the complex issues that come from them both physically and mentally. If you have any questions about the blog post or wanted to chat you can contact her on: r.carnelley1@uni.brighton.ac.uk

Further reading

Csecs, et al., (2022). Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain. Frontiers in Psychiatry, 12. doi: https://doi.org/10.3389/fpsyt.2021.786916.

Eccles et al., (2012). Brain structure and joint hypermobility: Relevance to the expression of psychiatric symptoms. British Journal of Psychiatry, 200(6), pp.508–509. doi: https://doi.org/10.1192/bjp.bp.111.092460.

Haddad, et al., (2018). The effects of a dopamine agonist (apomorphine) on experimental and spontaneous pain in patients with chronic radicular pain: A randomized, double-blind, placebo-controlled, cross-over study. PLOS ONE, 13(4), p.e0195287. doi: https://doi.org/10.1371/journal.pone.0195287.