Autism and Ehlers-Danlos Syndrome: What’s the Connection?

What is Ehlers-Danlos syndrome (EDS)?

The Ehlers-Danlos syndromes are a group of 13 inherited connective tissue disorders, each with its own diagnostic criteria. They are caused by gene changes that affect collagen and related proteins, and three features run across the types: joint hypermobility, skin that stretches further than usual, and tissue fragility.⁠^1,11

Hypermobile EDS (hEDS) is by far the most common type, about 90% of cases, affecting at least 1 in 3,100 to 5,000 people; classical EDS affects about 1 in 20,000 to 40,000 and vascular EDS about 1 in 100,000 to 200,000. Every type can be confirmed with a genetic test except hEDS, whose genetic causes are still unknown, so it is diagnosed on clinical criteria. Family histories suggest hEDS is inherited in a dominant pattern.⁠^1,11

What are the signs and symptoms of EDS?

Joints that move further than usual can also be unstable, which leads to subluxations (partial dislocations), dislocations, sprains and pain. Skin may be unusually soft, stretch further than normal, bruise easily, heal slowly or scar abnormally, and some rarer types make blood vessels, organs or eyes fragile. Pain and fatigue are common across the types, dysautonomia and mast cell disorders often occur alongside, and two people with the same type can have very different symptoms.⁠^1,12

How is hEDS different from hypermobility spectrum disorder (HSD)?

Hypermobility spectrum disorders are diagnosed when joint hypermobility causes problems, such as instability, injury or pain, that are not explained by hEDS or another condition. HSD arrived with the 2017 classification, which retired the labels joint hypermobility syndrome and benign joint hypermobility syndrome. Flexibility alone is not a disorder: most babies and children are naturally very flexible, up to about 20% of people stay hypermobile into adulthood, and hypermobility that causes no symptoms does not need treatment.⁠^1,13

How is EDS diagnosed in a child?

Generalized joint hypermobility is screened with the Beighton score, nine points covering the little fingers, thumbs, elbows, knees and lower spine. A score of 6 or more counts in children before puberty, 5 or more in adults and 4 or more over age 50.⁠^12,13

Because the 2017 hEDS criteria were written for adults, an international working group published a pediatric framework in 2023 for children from age 5 to biological maturity. It sorts hypermobile children into eight groups by whether they have musculoskeletal complications, skin and tissue changes, and core comorbidities such as chronic pain, chronic fatigue, dysautonomia or anxiety, and it reserves hEDS for biologically mature adolescents who meet the 2017 criteria. Other explanations, including the genetically defined types of EDS, have to be ruled out.⁠^12,14

An update to the 2017 classification is scheduled for publication on December 2, 2026, with guidance on hEDS and HSD and a diagnostic pathway planned for March 2027; the Ehlers-Danlos Society notes the timelines may change.⁠¹⁵

How are autism and EDS linked?

The strongest single study is a Swedish national register study. Of 1,771 people with EDS, 52 (2.9%) also had an autism diagnosis, against 72 of 17,710 matched comparisons (0.4%): a risk ratio of 7.4. ADHD was 5.6 times as likely, and siblings without EDS had a raised risk of ADHD too. People with hypermobility syndrome had a smaller rise in autism, a risk ratio of 1.4. The study used hospital-based diagnoses and could not separate the types of EDS, and most of the people with EDS in it were not autistic.⁠²

A 2025 systematic review and meta-analysis pooled 20 studies. Of 15 that tested for a link between autism or autistic traits and hypermobility, HSD or EDS, 12 found one. Across studies, 22.3% of autistic people had joint hypermobility (31% where joints were examined rather than self-reported), and 27.9% had HSD or EDS (39% where assessed clinically). The authors noted large differences between studies and said the association should be confirmed by further research.⁠⁶

Studies of particular groups point the same way. In 199 autistic adults compared with 419 community controls, the odds of generalized joint hypermobility were about three times higher (adjusted odds ratio 3.1) and of symptomatic hypermobility about five times (4.9), though many of the autistic participants also had ADHD, which may drive part of the link.⁠¹⁶ In a Swedish pediatric clinic, 6% of 201 children aged 6 to 18 with HSD or hEDS had a confirmed autism diagnosis.⁠¹⁷

The exception is the general child population. In 207 eleven-year-olds examined at a school health check, a Beighton score of 6 or more sat at about the 95th percentile and was not linked to neurodevelopmental problems; the authors suggest the difference from adult studies may reflect changes around puberty.⁠³

Does EDS cause autism, or do they share a cause?

Nobody knows yet. The studies above show the two occurring together, not one causing the other, and the explanations on offer are hypotheses:

• Shared genes or family factors. Siblings of people with EDS who did not have it themselves had raised rates of some psychiatric diagnoses, which the register study’s authors read as a sign of shared genetic or early environmental influences. A 2020 review counted 35 single-gene syndromes with strong ties to both autism and hypermobility, and preliminary survey work found that more than 20% of mothers with EDS or HSD reported having an autistic child.⁠^2,7
• Body-position sense. In laboratory tests, people with EDS judged where their hand was as accurately as controls but with twice the scatter, and the Ehlers-Danlos Society notes that people with EDS and HSD have reduced proprioception. Some researchers propose that this, with pain and dysautonomia, affects motor and attention skills, and say the idea needs further study.⁠^7,18,19
• Pain and the autonomic nervous system. In 109 neurodivergent adults, hypermobility was more common than in the general population (51% against about 20%), and the number of hypermobile joints helped explain the link between neurodivergence and symptoms of dysautonomia and pain.⁠²⁰
• A subtype of autism? One research group has proposed that hereditary connective tissue disorders represent a subtype of autism; that remains a proposal, not an established finding.⁠⁷

Is the link stronger in autistic girls and women?

Possibly, but the evidence is indirect. In the study of neurodivergent adults, the odds of hypermobility were greater in women than in men. Autism is diagnosed more than 3 times as often in boys as in girls, while hEDS is diagnosed overwhelmingly in women, and autistic women and girls are known to be underdiagnosed, so reviewers suspect autism is under-recognized among people with hEDS.⁠^7,20,21

Are ADHD and EDS linked too?

Yes. In the Swedish register study ADHD was 5.6 times as likely in people with EDS, and siblings without EDS were at higher risk as well. Among 201 children with HSD or hEDS, 16% had a confirmed ADHD diagnosis and another 7% were being assessed; ADHD was more common in hEDS than in HSD and reached 46% at ages 17 to 18 in hEDS. Reviews also describe links between hypermobility and learning, communication and motor problems and tic disorders.⁠^2,17,22

What are the signs of EDS in an autistic child?

Most babies and children are very flexible, so the signs that matter go beyond flexibility.⁠¹³ Worth raising with your child’s doctor:

• Generalized hypermobility past early childhood: a Beighton score of 6 or more before puberty⁠¹²
• Joints that sublux or dislocate without real injury, repeated tendon or ligament injuries, or pain with activity⁠¹²
• Unusually soft or mildly stretchy skin, unexplained stretch marks, atrophic scars or easy bruising⁠^1,12
• Chronic pain, chronic fatigue, gut or bladder problems, or dizziness and a racing heart on standing⁠^12,23
• Clumsiness or coordination difficulties, common in both autism and hypermobility, or delayed motor milestones, which parents of autistic children often report⁠⁷
• A parent or sibling with hypermobility or EDS, since family histories suggest hEDS is inherited in a dominant pattern⁠¹

None of these alone makes a diagnosis; they are reasons to ask for an assessment.

Why can autistic children with EDS struggle to show where it hurts?

Autism’s diagnostic criteria include unusual reactions to sensory input, with apparent indifference to pain or temperature given as one example, so a child may seem unbothered while hurt. Reviews describe pain in autistic children as underdiagnosed because of communication differences, and warn that pain is likely to go unnoticed and untreated in autistic people, which is why knowing about the hypermobility link matters.⁠^4,5,9

Studies disagree on whether pain looks different: some found autistic children’s pain behavior similar to other children’s, while others describe idiosyncratic expressions, motor agitation, negative emotional reactions or vocalizations and a slower recovery after acute pain. Reviewers recommend involving parents in pain assessment; almost half of the studies used an observation checklist built for children who cannot describe pain, mostly completed by parents.⁠⁹

Interoception, the sense of the body’s internal state, often comes up here, but the research is mixed: a 2023 meta-analysis of 15 studies found autistic participants counted their heartbeats less accurately while rating their confidence higher, with no differences on other measures, and a 2025 review called the findings inconsistent.⁠^24,25

What about POTS, fatigue and sleep problems?

Many people with EDS or HSD have dysautonomia, most often orthostatic intolerance: orthostatic hypotension (low blood pressure on standing) or postural orthostatic tachycardia syndrome (POTS), an abnormal rise in heart rate on standing without a drop in blood pressure. Symptoms include lightheadedness, fainting or nearly fainting, palpitations, brain fog, fatigue and feeling worse after exercise.⁠²³

These symptoms cluster with neurodivergence too. Neurodivergent adults reported more orthostatic intolerance than a comparison group, and in a survey of 1,754 UK adults with hEDS or HSD, autistic respondents were more likely to have diagnoses of dysautonomia or POTS, chronic fatigue and mast cell activation syndrome. Among autistic children in the Swedish pediatric clinic study, 92% had sleep problems.⁠^8,17,20

What challenges come with having both autism and EDS?

When autism and EDS occur together, each can make the other harder to see and harder to treat.

• Diagnostic overshadowing. Joint laxity and low tone in an autistic child are often put down to the autism itself unless the signs are severe, and because hEDS is diagnosed mostly in women, autism can be overlooked in them.⁠^7,8
• Different specialists. Autism is seen in psychiatry and developmental pediatrics, hypermobility disorders in musculoskeletal medicine and genetics, so a link between them is rarely made in the clinic.⁠^4,5
• A long road to diagnosis. UK adults with hEDS or HSD reported an average of almost 19 years between their first symptoms and diagnosis, and non-autistic respondents waited longer than autistic ones.⁠⁸
• Coordination on top of instability. In a large parent-report study, 86.9% of autistic children aged 5 to 15 were at risk for motor impairment, yet only 31.6% were receiving physical therapy; hypermobility adds unstable joints and reduced proprioception.⁠^10,26
• Fatigue that limits the day. Fatigue is a common and often underestimated symptom of EDS and HSD, with causes ranging from poor sleep and pain to deconditioning and dysautonomia.⁠²⁷

Should an autistic child be checked for EDS?

Researchers have argued that it should be routine. A 2020 review recommended adding the Beighton score to the physical assessment of anyone on or suspected to be on the autism spectrum, measured with a goniometer because judging joints by eye can miss borderline cases, and referring those with generalized hypermobility to genetics to rule out more serious conditions. The authors of the UK survey suggested screening both ways: for autism after an hEDS or HSD diagnosis, and for hEDS or HSD after an autism diagnosis.⁠^7,8

Who to see: start with your child’s pediatrician. A doctor or physical therapist can assess whether joints are hypermobile, genetic testing confirms every type of EDS except hEDS, and in the UK survey most hEDS and HSD diagnoses were made in rheumatology.⁠^1,8,13

Should a child with EDS or hypermobility be screened for autism?

If there are social, communication or behavior concerns, yes. Autism is diagnosed on the DSM-5 criteria: persistent differences in social communication and interaction in three areas, plus at least two of four kinds of restricted, repetitive behavior, one of which is unusual reactivity to sensory input. The AAP recommends autism screening for every child at 18 and 24 months and whenever a parent or provider has a concern, and the authors of the Swedish pediatric clinic study concluded that children with HSD or hEDS may need routine screening for neuropsychiatric symptoms.⁠^4,17,28

A diagnosis combines parents’ descriptions of development with a professional’s observation, may involve a developmental-behavioral pediatrician, child neurologist or geneticist, and should never rest on a single tool. The CDC lists the early signs of autism by age.⁠^4,29

How do you manage symptoms of both autism and EDS?

There is no disease-specific treatment for any type of EDS, so care targets each symptom, and people with EDS often need several specialists who work together. Autism support also covers co-occurring conditions such as insomnia, ADHD and anxiety, which are more common in autistic children.⁠^1,30

What kind of physical therapy helps a child with EDS and autism?

Physical therapy aims to stabilize joints by strengthening the muscles around them without overstretching them. The Ehlers-Danlos Society recommends exercises that train movement control and the stabilizing muscles with a low load on the joints, starting low and going slow, and lists repeated or excessive stretching among the reasons joints sublux. People with unstable joints are advised to avoid high-impact activities, combat and contact sports, and sports that focus on flexibility.⁠¹⁰

Correct form matters more than usual, because hypermobile people often have reduced proprioception and may not feel when they are moving badly. The research base for physical therapy in hEDS is limited in size and quality, so plans rest on clinical reasoning and the studies that exist. The authors of the SPARK study argue that an autism diagnosis should also trigger motor screening and, where needed, physical therapy for autistic children.⁠^10,26,31

Can occupational therapy help with both autism and EDS?

Yes. The Ehlers-Danlos Society lists what occupational therapists work on with people who have EDS or HSD: joint protection, fatigue, coordination, motor planning, handwriting, fine and gross motor skills, play, school-related difficulties and differences in sensory processing, along with school accommodations, environmental changes and assistive technology. For autism, the American Psychiatric Association describes occupational therapy as addressing daily living skills and handwriting.⁠^30,32

What else helps day to day: braces, pacing or compression garments?

Braces, splints and mobility aids. Proprioceptive braces give light compression to improve body awareness and may reduce pain, and ring splints limit hyperextension in the fingers and thumbs. Rigid splints protect a joint after an injury, but worn for long periods while awake they lead to muscle wasting, so exercise continues alongside any support. Mobility aids may reduce limitations and let a person stay active for longer. Kinesiology tape needs care on fragile skin, and a knowledgeable physical or occupational therapist, orthotist or rehabilitation physician can help choose.⁠¹⁹

Pacing. Taking breaks and not doing too much at once spreads limited energy across the day and can help a person become more active with less fatigue.⁠²⁷

Compression garments. A small French case series of 14 hospitalized autistic patients with severe proprioceptive difficulties, 7 of them hypermobile, reported fewer challenging behaviors and better posture over six weeks of wearing compression garments. It was retrospective, with no comparison group, and hypermobility did not predict who improved.⁠³³

Sensory supports. Unusual reactions to sound, light, touch or texture are part of autism’s diagnostic criteria, so plan for the sensory load of home and school as well as the physical one, using the strategies in autism and noise sensitivity and sensory processing and autism.⁠⁴

How can school support a child with autism and EDS?

Under Section 504, a school must provide regular or special education and related aids and services to a student whose physical or mental impairment substantially limits a major life activity. Covered impairments include musculoskeletal and neurological conditions, and major life activities include walking, performing manual tasks, learning and concentrating; a diagnosis alone does not qualify a student, because the limitation is judged case by case.⁠³⁴

Under IDEA, autism is an eligibility category of its own, and other health impairment covers limited strength, vitality or alertness from a chronic or acute health problem that affects school performance. An occupational therapist can advise on the accommodations a child needs, and IEPs and 504 plans walks through the process.⁠^32,35

Sources

1. The Ehlers-Danlos Society. What is EDS? Checked October 10, 2026.
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   “The Ehlers-Danlos syndromes (EDS) are a group of 13 heritable connective tissue disorders”; “Some features are seen across all types of EDS, including joint hypermobility, skin hyperextensibility, and tissue fragility”; joint instability “can lead to joint subluxations, dislocations, sprains, and other injuries”; skin may show “skin fragility, very thin skin, delayed wound healing, and abnormal scarring”, and tissue fragility “can present as easy bruising and poor wound healing”; “hEDS accounts for about 90% of EDS cases and is thought to affect at least 1 in 3,100-5,000 people,” cEDS “roughly 1 in 20,000-40,000” and vEDS “about 1 in 100,000-200,000”; “Some symptoms are common across all types of EDS, such as joint hypermobility, pain, and fatigue,” with “types of dysautonomia and mast cell diseases” often seen alongside; “Even within the same type of EDS, people can experience very different symptoms”; “there is currently no genetic test available to diagnose hEDS”; “The 2017 classification also introduced the hypermobility spectrum disorders (HSD),” and joint hypermobility syndrome and benign joint hypermobility syndrome “are outdated terms that should no longer be used when making a diagnosis”; “family histories suggest this condition has a dominant inheritance pattern”; and “There are no disease-specific treatments for any type of EDS,” so people “often require multiple providers in different specialties.”
2. Cederlöf M, Larsson H, Lichtenstein P, Almqvist C, Serlachius E, Ludvigsson JF. Nationwide population-based cohort study of psychiatric disorders in individuals with Ehlers-Danlos syndrome or hypermobility syndrome and their siblings. BMC Psychiatry. 2016;16:207. PMID 27377649. Checked October 10, 2026.
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   “Individuals with EDS (n = 1,771) were matched with comparison individuals (n = 17,710)”; “52 (2.9 %) EDS patients and 72 (0.4 %) comparison individuals were diagnosed with ASD” (RR 7.4, 95% CI 5.2 to 10.7); ADHD “RR 5.6, CI 4.2–7.4”; “EDS siblings were at increased risk of ADHD: RR 2.1”; in hypermobility syndrome, 1.6% against 1.2% “were diagnosed with ASD” (RR 1.4, 95% CI 1.1 to 1.6); the authors suggest “part of the risk increase may be due to shared genetic or early environmental influences”; and the limitations include that “the Swedish Patient Registry does not distinguish between various forms of EDS” and that “we only had data on EDS and hypermobility syndrome in a hospital-based setting.”
3. Glans MR, Aziz A, Kindgren E, Knez R, Landgren M, Landgren V. No association between joint hypermobility, musculoskeletal pain and neurodevelopmental problems in a school-based sample of 11-year-old children. BJPsych Open. 2025;11(6):e262. PMID 41178087. Checked October 10, 2026.
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   An in-school study at the fourth-grade health check: “Of 348 eligible children from eight schools, 223 (64%) participated, with Beighton scores measured in 207 (59%). The median Beighton score was 1”; “A Beighton score of ≥6 approximated the 95th percentile in both sexes. No significant association was found between high Beighton scores and NDPs” (neurodevelopmental problems); the findings “suggest that GJH in children of this age is not linked to NDPs, differing from findings in adults. This may reflect developmental changes during puberty.”
4. Centers for Disease Control and Prevention. Clinical Testing and Diagnosis for Autism Spectrum Disorder. Page dated May 8, 2025. Checked October 10, 2026.
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   “no single tool should be used as the basis for diagnosis”; diagnostic tools “usually rely on two main sources of information”, “parents’ or caregivers’ descriptions of their child’s development and a professional’s observation of the child’s behavior”; specialists “include neurodevelopmental pediatricians, developmental-behavioral pediatricians, child neurologists, geneticists”; and under the DSM-5 “a child must have persistent deficits in each of three areas of social communication and interaction” plus “at least two of four types of restricted, repetitive behaviors,” one of them “Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment,” with examples including “apparent indifference to pain/temperature” and “adverse response to specific sounds or textures.”
5. Baeza-Velasco C, Cohen D, Hamonet C, Vlamynck E, Diaz L, Cravero C, et al. Autism, joint hypermobility-related disorders and pain. Frontiers in Psychiatry. 2018;9:656. PMID 30581396. Checked October 10, 2026.
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   “These conditions are seen by different medical fields, such as psychiatry in the case of ASD, and musculoskeletal disciplines and genetics in the case of hypermobility-related disorders. Thus, a link between them is rarely established in clinical setting, despite a scarce but growing body of research suggesting that both conditions co-occur more often than expected by chance”; and “Considering the high probability that pain remains disregarded and untreated in people with ASD due to communication and methodological difficulties, increasing awareness about the interconnection between ASD and hypermobility-related disorders is relevant.”
6. Baeza-Velasco C, Vergne J, Poli M, Kalisch L, Calati R. Autism in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers-Danlos syndromes: a systematic review and prevalence meta-analyses. Autism. 2025;29(8):1939–1958. PMID 40145613. Checked October 10, 2026.
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   “Twenty articles met the inclusion criteria”; “Out of 15 studies examining the association between autism spectrum disorders/autistic traits and joint hypermobility/hypermobility spectrum disorders/Ehlers-Danlos syndrome, 12 reported significant results. The overall prevalence of joint hypermobility in autistic individuals was 22.3%, but it was higher (31%) when only studies assessing joint hypermobility clinically (excluding self-reports) were considered. The overall prevalence of hypermobility spectrum disorders/Ehlers-Danlos syndrome in autistic samples was 27.9%, but 39% if hypermobility spectrum disorders/Ehlers-Danlos syndrome were assessed clinically. Despite the heterogeneity of studies, these results suggest an association between autism and joint hypermobility/hypermobility spectrum disorders/Ehlers-Danlos syndrome that should be confirmed in further research.”
7. Casanova EL, Baeza-Velasco C, Buchanan CB, Casanova MF. The relationship between autism and Ehlers-Danlos syndromes/hypermobility spectrum disorders. Journal of Personalized Medicine. 2020;10(4):260. PMID 33271870. Checked October 10, 2026.
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   A review: “although developmental-behavioral pediatricians may test for hypotonia and joint laxity in autistic children during initial assessment, unless signs are severe and suggestive of an underlying genetic disorder they are usually ascribed to the autism itself, a result of diagnostic overshadowing”; “Because hEDS is overwhelmingly diagnosed in women, it is therefore likely that autism spectrum conditions are underrecognized in this clinical subpopulation”; “more than 20% of mothers with EDS/HSD reported having autistic children” (preliminary work); “We have collected 35 such monogenic syndromes” with strong associations to autism and hypermobility; “Delays in motor milestones have been consistently reported by parents” in autism, and “EDS/HSD also frequently presents with coordination and proprioceptive deficits”; hypermobility, dysautonomia, chronic pain and proprioceptive impairment “may ultimately affect aspects of neurodevelopment” and “These hypotheses require further scientific exploration”; the authors “have proposed that hereditary connective tissue disorders represent a subtype of autism”; and “we strongly recommend that the Beighton scoring system be integrated into the standard physical assessment for those individuals on or suspected to be on the autism spectrum,” with “the use of a goniometer” and, for those who meet criteria, referral “to a genetics clinic for genetic testing and further assessment for HCTD in order to rule out more serious health conditions.”
8. Crompton CJ, Efthimiou TN, Dockrell DM, Berg KM. Health experiences and outcomes of autistic and non-autistic adults with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder. BMC Medicine. 2026;24(1):193. PMID 41736062. Checked October 10, 2026.
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   An online survey of UK residents over 16: “A total of 1754 participants completed an online questionnaire”; “Around 25% of respondents were autistic”; “Participants reported significant delays between symptom onset and diagnosis” (an average of 18.85 years), longer in the non-autistic group (mean 19.40) than the autistic group (17.65); “Most diagnoses were made in rheumatology (74.58%)”; “Autistic respondents were also more likely to have a diagnosis of several co-occurring physical health conditions, including dysautonomia/POTS, chronic fatigue/ME, and mast cell activation syndrome”; and “Future work may focus on the integration of both screening for autism after a hEDS/HSD diagnosis and screening for hEDS/HSD after an autism diagnosis,” because “for both conditions, diagnostic overshadowing is common” and “hEDS/HSD are overwhelmingly diagnosed in females, and so autism is often overlooked.”
9. Salabura C, Sourty A, Bat-Pitault F, Regnery K, Mayen S, Colson S. Pain assessment for children and adolescents with autism spectrum disorders (ASD): a systematic review. L’Encéphale. 2025;51(1):87–94 (article in French). PMID 38971646. Checked October 10, 2026.
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   From the English abstract: “Pain in children and adolescents with autism spectrum disorders remains underdiagnosed due to their inherent communication difficulties”; “Three studies showed pain-related behaviours in autism spectrum disorders to be similar to control groups. Other studies showed specific behavioural responses in autism spectrum disorders with a longer physiological and behavioural recovery time associated with an episode of acute pain,” with “idiosyncratic expressions, hypervigilance, motor agitation, negative emotional reactions, or vocalizations”; a pain checklist for non-communicating children “was used by almost half of the studies in hetero-assessment, mostly by parents”; and “Studies recommend the inclusion of parents in the assessment in order to optimise the evaluation process.”
10. The Ehlers-Danlos Society. Physical Therapy. Checked October 10, 2026.
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    “Exercise is important for people with EDS and HSD because it improves muscle strength, which helps stabilize hypermobile joints”; “Exercises that focus on movement control and strengthening the stabilizing muscles are generally suitable for people with EDS and HSD. Exercises with a low load on the joint are preferred. As a general rule, it is recommended to start low” and “go slow”; “People with unstable joints should avoid high-impact activities (such as running and jumping), combat sports, high-contact sports, and sports that focus on flexibility”; subluxations and dislocations have causes including “Repeated or excessive stretching”; and hypermobile people “often have decreased proprioception, which is the ability to sense the position and movement of the body. Poor proprioception can make it harder for hypermobile people to sense when they are moving incorrectly.”
11. Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, et al. The 2017 international classification of the Ehlers-Danlos syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 2017;175(1):8–26. PMID 28306229. Checked October 10, 2026.
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    The syndromes are “a clinically and genetically heterogeneous group of heritable connective tissue disorders (HCTDs) characterized by joint hypermobility, skin hyperextensibility, and tissue fragility”; the consortium “proposes a revised EDS classification, which recognizes 13 subtypes”; and “the definite diagnosis of all EDS subtypes, except for the hypermobile type, relies on molecular confirmation.”
12. The Ehlers-Danlos Society. 2023 Diagnostic Framework for Pediatric Joint Hypermobility. Checked October 10, 2026.
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    The framework assesses “people from five years old through to biological maturity”; “A Beighton score greater than or equal to 6 points is evidence of GJH in children before puberty”; children fit “one of the following eight categories”; musculoskeletal complications include “Episodic activity-related pain,” “Recurrent joint dislocations, recurrent joint subluxations in the absence of trauma” and “Soft tissue injuries”; the core comorbidities are chronic primary pain, chronic fatigue, functional gastrointestinal and bladder disorders, primary dysautonomia and anxiety; skin involvement includes “Unusually soft skin,” “Mild skin hyperextensibility,” “Unexplained stretch marks” and “Atrophic scarring”; and other explanations, including “genetically-defined types of Ehlers-Danlos syndrome,” must be ruled out.
13. The Ehlers-Danlos Society. What is HSD? Checked October 10, 2026.
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    “The hypermobility spectrum disorders occur when a person has symptomatic joint hypermobility that cannot be explained by other conditions”; “Most babies and children are naturally very flexible. Many people become less flexible as they grow, but hypermobility continues into adulthood for some, up to about 20% of people”; hypermobility without symptoms “does not need to be treated”; “A doctor or physical therapist can evaluate a person’s joints to determine if they are hypermobile”; and “A positive Beighton score is any score greater than or equal to 5/9 points in adults, 6/9 points in children (before puberty), and 4/9 points in adults over age 50.”
14. Tofts LJ, Simmonds J, Schwartz SB, Richheimer RM, O’Connor C, Elias E, et al. Pediatric joint hypermobility: a diagnostic framework and narrative review. Orphanet Journal of Rare Diseases. 2023;18(1):104. PMID 37143135. Checked October 10, 2026.
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    “criteria developed for adults are difficult to use in children and biologically immature adolescents”; “A Beighton score of ≥ 6/9 best identifies children with GJH at 2 standard deviations above average”; “The framework generates 8 subgroups, 4 pediatric GJH, and 4 pediatric generalized hypermobility spectrum disorders. hEDS is reserved for biologically mature adolescents who meet the 2017 criteria.”
15. The Ehlers-Danlos Society. The Road to 2026: A Path Toward Progress. Checked October 10, 2026.
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    An update of the classification criteria for all types of EDS and HSD “will be published on December 2, 2026”; information on hEDS and HSD “will be published in March 2027,” as will “A diagnostic pathway for clinicians”; and “updates and revisions to content, terminology, and timelines may occur throughout the development of the final publications.”
16. Glans MR, Thelin N, Humble MB, Elwin M, Bejerot S. The relationship between generalised joint hypermobility and autism spectrum disorder in adults: a large, cross-sectional, case control comparison. Frontiers in Psychiatry. 2022;12:803334. PMID 35211037. Checked October 10, 2026.
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    Data “for 199 individuals with ASD and 419 non-ASD community controls”; models “revealed a significant relationship between ASD and GJH and between ASD and symptomatic GJH, with adjusted odds ratios of 3.1” and “4.9”; “the high prevalence of comorbid ADHD in the study sample reduces the generalizability of the results among individuals with ASD without comorbid ADHD. Possibly, an additional ADHD phenotype is the primary driver of the association between ASD and GJH.”
17. Kindgren E, Quiñones Perez A, Knez R. Prevalence of ADHD and autism spectrum disorder in children with hypermobility spectrum disorders or hypermobile Ehlers-Danlos syndrome: a retrospective study. Neuropsychiatric Disease and Treatment. 2021;17:379–388. PMID 33603376. Checked October 10, 2026.
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    A registry search found “201 children (88 boys, 113 girls) aged 6-18 years”; “16% had a verified ADHD diagnosis and a further 7% were undergoing ADHD diagnostic investigation. Significantly more children with hEDS had ADHD compared to children with HSD”; “among those aged 17-18 years, ADHD was present in 46%” of those with hEDS; “ASD had been verified in 6% of the children. Of those with ASD, 92% had sleep problems”; and “children with HSD or hEDS may need to be routinely screened for neuropsychiatric symptoms.”
18. Clayton HA, Jones SA, Henriques DY. Proprioceptive precision is impaired in Ehlers-Danlos syndrome. SpringerPlus. 2015;4:323. PMID 26180743. “although patients were just as accurate as controls, they were not as precise. Patients showed twice as much scatter than controls at all locations”; an earlier deficit “was positively correlated with the severity of joint hypermobility.” Checked October 10, 2026.
19. The Ehlers-Danlos Society. Braces, Splints & Mobility Aids. Checked October 10, 2026.
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    “Research shows that people with EDS and HSD have decreased proprioception compared to people without these conditions”; “Proprioceptive braces and supports aim to improve body awareness through pressure on the skin. These braces provide light compression and may reduce pain”; “Ring splints can help to limit hyperextension, instability, and associated pain in the finger and thumb joints”; “If rigid braces are used for extended periods of time while awake, muscle wasting is likely to occur”; exercise continues alongside supports because it “helps prevent deconditioning”; for kinesiology tape, “skin fragility and sensitivity should be considered”; mobility aids “may reduce limitations and allow people to engage in activities longer”; and “A knowledgeable physical therapist (PT), occupational therapist (OT), podiatrist, orthotist, or physiatrist” can help choose.
20. Csecs JLL, Iodice V, Rae CL, Brooke A, Simmons R, Quadt L, et al. Joint hypermobility links neurodivergence to dysautonomia and pain. Frontiers in Psychiatry. 2022;12:786916. PMID 35185636. Checked October 10, 2026.
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    In “109 adults with neurodevelopmental condition diagnoses”: “The neurodivergent group manifested elevated prevalence of hypermobility (51%) compared to the general population rate of 20%”, an odds ratio of 4.51, “with greater odds in females than males”; “Neurodivergent participants reported significantly more symptoms of orthostatic intolerance and musculoskeletal skeletal pain than the comparison group. The number of hypermobile joints was found to mediate the relationship between neurodivergence and symptoms of both dysautonomia and pain.”
21. Centers for Disease Control and Prevention. Data and Statistics on Autism Spectrum Disorder. Page dated May 27, 2025. “About 1 in 31 (3.2%) children aged 8 years has been identified with ASD” and “ASD is over 3 times more common among boys than among girls.” Checked October 10, 2026.
22. Baeza-Velasco C. Neurodevelopmental atypisms in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers-Danlos syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 2021;187(4):491–499. PMID 34741402. Checked October 10, 2026.
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    A review of “neurodevelopmental conditions for which there is some evidence of an association with JHM/HSD/EDS. These include hyperactivity and attention deficit, learning, communication, and motor problems including tic disorders such as Tourette syndrome and autism spectrum disorders.”
23. The Ehlers-Danlos Society. Dysautonomia. Checked October 10, 2026.
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    “Many people with EDS or HSD also have a type of dysautonomia”; “People with EDS and HSD most commonly have a form of orthostatic intolerance,” the two most common being orthostatic hypotension (“low blood pressure on being upright”) and postural orthostatic tachycardia syndrome (“an abnormal increase in heart rate when standing without a drop in blood pressure”); symptoms include palpitations, lightheadedness, “Presyncope (a sense of being about to faint),” “Syncope (fainting),” “Brain fog (problems with concentration and memory),” chronic fatigue and “Exercise intolerance and feeling worse after exercise.”
24. Williams ZJ, Suzman E, Bordman SL, Markfeld JE, Kaiser SM, Dunham KA, et al. Characterizing interoceptive differences in autism: a systematic review and meta-analysis of case-control studies. Journal of Autism and Developmental Disorders. 2023;53(3):947–962. PMID 35819587. Checked October 10, 2026.
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    Fifteen studies (467 autistic and 478 neurotypical participants): “Autistic participants showed significantly reduced heartbeat counting performance” and “higher confidence in their heartbeat counting abilities”, “but groups were equivalent on other meta-analyzed outcomes.”
25. Klein M, Witthöft M, Jungmann SM. Interoception in individuals with autism spectrum disorder: a systematic literature review and meta-analysis. Frontiers in Psychiatry. 2025;16:1573263. PMID 40909407. Checked October 10, 2026.
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    “A total of 31 studies” were included; studies in children and adolescents “revealed inconsistent findings-some studies reported reduced, increased, or similar interoceptive abilities in ASD”; “the evidence indicates that ASD is not systematically associated with altered cIA, and the relationship between ASD and other interoceptive dimensions remains unclear.”
26. Bhat AN. Is motor impairment in autism spectrum disorder distinct from developmental coordination disorder? A report from the SPARK study. Physical Therapy. 2020;100(4):633–644. PMID 32154876. Checked October 10, 2026.
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    Parent reports on the DCD questionnaire for children with autism “between 5 and 15 years of age” (final dataset n = 11,814): “The proportion of children with ASD at risk for a motor impairment was very high at 86.9%. Children with ASD did not outgrow their motor impairments and continued to present with a risk for DCD even into adolescence. Yet, only 31.6% of children were receiving physical therapy services”; the analysis “did not involve follow-up clinical assessments”; and “A diagnosis of ASD must trigger motor screening, evaluations, and appropriate interventions by physical and occupational therapists.”
27. The Ehlers-Danlos Society. Fatigue in EDS and HSD. Checked October 10, 2026.
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    “Fatigue is a common and often underestimated symptom of the Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD)”; causes include poor sleep quality, “Chronic pain,” “Deconditioning” and “Dysautonomia”; and “By taking breaks and not doing too much at once, people with fatigue can spread their energy throughout the day. Pacing can help a person become more active and reduce fatigue.”
28. Centers for Disease Control and Prevention. CDC’s Developmental Milestones. Learn the Signs. Act Early. Page dated February 17, 2026. Checked October 10, 2026.
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    “Children reach milestones in how they play, learn, speak, act, and move”; “Learn the Signs. Act Early. resources are not a substitute for standardized, validated developmental screening tools”; “If your child is not meeting one or more milestones, has lost skills he or she once had, or you have other concerns, act early. Talk with your child’s doctor, share your concerns, and ask about developmental screening. The American Academy of Pediatrics recommends that children be screened for general development using standardized, validated tools at 9, 18, and 30 months and for autism at 18 and 24 months or whenever a parent or provider has a concern.”
29. Centers for Disease Control and Prevention. Signs and Symptoms of Autism Spectrum Disorder. Page dated May 16, 2024. Checked October 10, 2026.
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    “People with ASD may also have different ways of learning, moving, or paying attention”; “Most people with ASD have other related characteristics,” listed as including “Delayed language skills,” “Delayed movement skills” and “Delayed cognitive or learning skills”; and “some people without ASD might also have some of these symptoms.”
30. American Psychiatric Association. What Is Autism Spectrum Disorder? Reviewed January 2024. “Occupational therapy: Can address adaptive skills deficits with activities of daily living, as well as problems with handwriting”; and “Children with autism are more likely to experience insomnia, attention-deficit/hyperactivity disorder (ADHD), intellectual disability, anxiety, and depression than peers without autism.” Checked October 10, 2026.
31. Engelbert RH, Juul-Kristensen B, Pacey V, de Wandele I, Smeenk S, Woinarosky N, et al. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 2017;175(1):158–167. PMID 28306230. Checked October 10, 2026.
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    “physical therapy plays a central role in management of individuals with hypermobility related disorders”; “The current evidence-based literature regarding the management of JHS/hEDS is limited in size and quality”; and “Until further multicenter trials are conducted, clinical decision-making should be based on theoretical and the current limited research evidence.”
32. The Ehlers-Danlos Society. Occupational Therapy. Checked October 10, 2026.
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    Occupational therapists “can help manage other symptoms and challenges,” listed as fatigue, coordination, rest and sleep, handwriting, joint protection, motor planning, pain management, school-related difficulties, differences in sensory processing, play, and fine and gross motor skills; they provide training on “School and work accommodations”; and they make recommendations for environmental and activity modifications and assistive technologies.
33. Guinchat V, Vlamynck E, Diaz L, Chambon C, Pouzenc J, Cravero C, et al. Compressive garments in individuals with autism and severe proprioceptive dysfunction: a retrospective exploratory case series. Children. 2020;7(7):77. PMID 32668622. Checked October 10, 2026.
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    “We retrospectively described 14 patients with autism and SPD, including seven with comorbid GJH, who were hospitalized for major challenging behaviors”; each wore a compression garment “for at least 1 h (but most often longer) per day for six weeks”; “We observed a significant effect on most ABC rating scores at two weeks, which persisted at six weeks”; “Postural control in dorsal and profile positions was significantly improved”; “we did not observe a significant change in Dunn sensory scores”; and “A comorbid GJH diagnosis was not associated with a better outcome.”
34. U.S. Department of Education, Office for Civil Rights. Frequently Asked Questions: Section 504 Free Appropriate Public Education (FAPE). Page last reviewed June 30, 2025. Checked October 10, 2026.
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    Section 504 FAPE “consists of the provision of regular or special education and related aids and services”; a physical or mental impairment includes conditions affecting body systems such as “neurological; musculoskeletal”; major life activities include “caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working,” plus “concentrating”; and “A medical diagnosis of an illness does not automatically mean a student can receive services under Section 504.”
35. U.S. Department of Education. 34 CFR 300.8: Child with a disability. Electronic Code of Federal Regulations. Checked October 10, 2026.
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    “Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three”; and “Other health impairment means having limited strength, vitality, or alertness,” due to “chronic or acute health problems,” that “Adversely affects a child’s educational performance.”

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child.