Direct answer
Casanova, E.L. et al. · Eccles, J.A. et al. · Demmler, J.C. et al. · Verified 2026-08-10
Quick summary
In brief
Key points
The Autism-Hypermobility Connection
A 2020 review by Casanova et al. describes a strong overlap between autism and hypermobility-related conditions. Eccles et al. (2014) 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 and Sensory Integration
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 for autism and hypermobility may focus on proprioception, joint stability, and daily activities. Ask about coverage, private fees, and whether any public or OAP-funded route applies.
Pain Management and Ontario Resources
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 may include GoodHope EDS Program, pediatric rheumatology, chronic pain programs, and regional pain clinics. Ask about referral rules, eligibility, and current waits.
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.
Evidence and sources
Casanova, E.L. et al.
The Relationship between Autism and Ehlers-Danlos Syndromes/Hypermobility Spectrum Disorders. Journal of Personalized Medicine, 2020; 10(4):260
Eccles, J.A. et al.
Joint Hypermobility and Autonomic Hyperactivity: Relevance to Neurodevelopmental Disorders. Journal of Neurology, Neurosurgery & Psychiatry, 2014; 85(8):e3.40 (conference abstract)
Demmler, J.C. et al.
Diagnosed Prevalence of Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder in Wales: A National Registry Study. BMJ Open, 2019; 9(11):e031365
Frequently asked questions
- What is the connection between autism and Ehlers-Danlos syndrome?
- Research shows that autistic individuals are 2.5 times more likely to have generalized joint hypermobility. The proposed mechanism involves shared connective tissue differences that affect both neural development and joint integrity. Both conditions may stem from variations in collagen and related proteins that are present throughout the body and nervous system.
- Is hypermobility assessment covered by OHIP?
- Ask your physician about hypermobility assessment and referrals. Confirm OHIP coverage, current waits, private therapy fees, benefits coverage, and whether OAP funding can be used.
- How does hypermobility affect daily life for autistic individuals?
- Hypermobility compounds autistic sensory processing differences by impairing proprioception — the sense of body position. This can increase clumsiness, fatigue, and injury risk. Chronic joint pain adds to sensory load. Fine motor tasks like handwriting become more difficult. Fatigue from managing unstable joints is added to the existing energy demands of navigating the world as an autistic person.
Where the waitlist stands
Families navigating autism services in Ontario face a documented multi-year wait. Here is the Ontario data — and a two-minute way to push back, when you are ready.
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