Autism and Hypermobility: The Ehlers-Danlos Connection

Casanova et al. (2020) found that autistic individuals were 2.5 times more likely to meet criteria for generalized joint hypermobility. Eccles et al. (2022) reported that autistic adults scored significantly higher on the Beighton Hypermobility Scale than matched controls. The relationship appears bidirectional: autistic individuals are overrepresented in EDS clinical populations, and hypermobility is overrepresented in autism clinical populations.

The proposed mechanism involves connective tissue differences affecting the nervous system. Collagen and other connective tissue proteins are present throughout the nervous system, not just in joints and skin. Differences in connective tissue composition may affect neural development and sensory processing. This "neurocutaneous hypothesis" (Casanova et al.) suggests that autism and hypermobility may share underlying biological pathways.

Hypermobility in autistic individuals often goes undiagnosed for years. Joint pain may be attributed to sensory sensitivities. Fatigue may be attributed to autism-related demands. Clumsiness and poor coordination may be attributed to developmental coordination disorder without investigating hypermobility as a contributing factor.

Proprioception — the ability to sense where your body is in space — depends on receptors in joints, muscles, and connective tissue. Hypermobility can impair proprioceptive signaling because lax joints provide less consistent feedback. For autistic individuals who already experience sensory processing differences, impaired proprioception compounds difficulties with motor planning, body awareness, and spatial navigation.

Occupational therapy (OT) addressing both autism and hypermobility focuses on proprioceptive input (weighted activities, compression garments, heavy work), joint stabilization exercises, and adaptive strategies for daily activities. In Ontario, OT is not covered by OHIP except through hospital-based programs. Private OT costs $120-$180 per session. Some families access OT funding through the Ontario Autism Program's core clinical services.

Chronic pain is common in hypermobile autistic individuals. Pain may be underreported due to alexithymia, interoception difficulties, or atypical pain expression. Conversely, some autistic individuals experience amplified pain responses. Pain assessment should use multiple modalities: verbal report, behavioral observation, and functional measures.

Ontario resources include the GoodHope EDS Program at Toronto Western Hospital, one of the few publicly funded EDS clinics in Canada. Pediatric rheumatology at SickKids and McMaster provides hypermobility assessment for children. Chronic pain programs at Toronto Rehabilitation Institute and regional pain clinics may accept referrals. Most specialist services require a physician referral and have wait times of 6-18 months.

Self-management strategies include joint protection education, appropriate exercise (swimming and Pilates are particularly beneficial for hypermobile individuals), ergonomic adaptations for school or work, and pacing strategies to manage fatigue. Ontario physiotherapists with hypermobility expertise can be found through the Ehlers-Danlos Society's provider directory.