Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain

Frontiers in Psychiatry

Psychiatry

Valeria Iodice¹  Christopher J. Mathias²  Nicholas G. Dowell³  Fenella Prowse⁴  Kristy Themelis⁵  Jenny L. L. Csecs⁶  Alice Brooke⁶  Lisa Quadt⁶  Georgia K. Savage⁶  Hugo D. Critchley⁷  Jessica A. Eccles⁷  Rebecca Simmons⁸  Charlotte L. Rae⁹ 

[1]Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, United Kingdom

[2]Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom

[3]Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, United Kingdom

[4]Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom

[5]Pickering Unit, Neurovascular Medicine, St Mary's Hospital, Imperial College London, London, United Kingdom

[6]Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom

[7]Centre for Regenerative Medicine and Devices, University of Brighton, Brighton, United Kingdom

[8]Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom

[9]Department of Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

[10]Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom

[11]Department of Psychology, University of Warwick, Coventry, United Kingdom

[12]Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom

[13]Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom

[14]Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom

[15]Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom

[16]Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom

[17]Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom

[18]School of Psychology, University of Sussex, Brighton, United Kingdom

关键词: autism;    attention deficit hyperactivity disorder (ADHD);    autonomic dysfunction;    joint hypermobility;    Ehlers-Danlos syndrome;    neurodevelopmental conditions;    pain;    Tourette syndrome;   

DOI  :  10.3389/fpsyt.2021.786916

 received in 2021-09-30, accepted in 2021-12-20,  发布年份 2022

来源: Frontiers

【 摘 要 】

ObjectivesAutism, attention deficit hyperactivity disorder (ADHD), and tic disorder (Tourette syndrome; TS) are neurodevelopmental conditions that frequently co-occur and impact psychological, social, and emotional processes. Increased likelihood of chronic physical symptoms, including fatigue and pain, are also recognized. The expression of joint hypermobility, reflecting a constitutional variant in connective tissue, predicts susceptibility to psychological symptoms alongside recognized physical symptoms. Here, we tested for increased prevalence of joint hypermobility, autonomic dysfunction, and musculoskeletal symptoms in 109 adults with neurodevelopmental condition diagnoses.MethodsRates of generalized joint hypermobility (GJH, henceforth hypermobility) in adults with a formal diagnosis of neurodevelopmental conditions (henceforth neurodivergent group, n = 109) were compared to those in the general population in UK. Levels of orthostatic intolerance and musculoskeletal symptoms were compared to a separate comparison group (n = 57). Age specific cut-offs for GJH were possible to determine in the neurodivergent and comparison group only.ResultsThe neurodivergent group manifested elevated prevalence of hypermobility (51%) compared to the general population rate of 20% and a comparison population (17.5%). Using a more stringent age specific cut-off, in the neurodivergent group this prevalence was 28.4%, more than double than the comparison group (12.5%). Odds ratio for presence of hypermobility in neurodivergent group, compared to the general population was 4.51 (95% CI 2.17–9.37), with greater odds in females than males. Using age specific cut-off, the odds ratio for GJH in neurodivergent group, compared to the comparison group, was 2.84 (95% CI 1.16–6.94). 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.ConclusionsIn neurodivergent adults, there is a strong link between the expression of joint hypermobility, dysautonomia, and pain, more so than in the comparison group. Moreover, joint hypermobility mediates the link between neurodivergence and symptoms of dysautonomia and pain. Increased awareness and understanding of this association may enhance the management of core symptoms and allied difficulties in neurodivergent people, including co-occurring physical symptoms, and guide service delivery in the future.

【 授权许可】

Unknown   
Copyright © 2022 Csecs, Iodice, Rae, Brooke, Simmons, Quadt, Savage, Dowell, Prowse, Themelis, Mathias, Critchley and Eccles.