Association between adult attention-deficit hyperactivity disorder and generalised joint hypermobility: A cross-sectional case control comparison

Glans, Martin; Thelin, Nils; Humble, Mats B.; Elwin, Marie; Bejerot, Susanne

doi:10.1016/j.jpsychires.2021.07.006

Cited by 11 publications

(15 citation statements)

References 22 publications

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“…Fourteen percent among the healthy controls were classified as hypermobile, which is slightly higher compared to other studies using the same BSS cut-off score ( 12 , 20 ) and considerably higher than was reported in an exceptionally large study of British adolescents ( 1 ). However, Reuter and Fichthorn studied 416 American Caucasian white college students and reported 11.5% to be hypermobile ( 20 ).…”

Section: Discussioncontrasting

confidence: 71%

“…However, Reuter and Fichthorn studied 416 American Caucasian white college students and reported 11.5% to be hypermobile ( 20 ). In a recent Swedish study on 417 adults, recruited from the normal population, 11% of the women, and 4.7% of the men were found to be hypermobile ( 12 ). Considering the low age in our sample compared to forementioned studies, a higher rate of GJH can be expected.…”

Section: Discussionmentioning

confidence: 98%

“…Almost 80% of Swedish children with PANS present anxiety at onset, and 43% present hyperactivity ( 11 ). Notably, anxiety and Attention-Deficit/Hyperactivity Disorder (ADHD) are both associated with GJH ( 12 , 13 ). According to a conference report, several individuals suffer from both POTS and PANS, in addition to GJH ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Joint Hypermobility in Paediatric Acute-Onset Neuropsychiatric Syndrome—A Preliminary Case-Control Study

et al. 2021

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Background: Individuals with generalised joint hypermobility (GJH, present in 10–20% of the general population) are at increased risk of being diagnosed with a range of psychiatric and rheumatological conditions. It is unknown whether Paediatric acute-onset neuropsychiatric syndrome (PANS), characterised by childhood onset obsessive-compulsive disorder or restricted eating and typically associated with several comorbid neuropsychiatric symptoms, is associated with GJH. It is also unknown whether extensive psychiatric comorbidity is associated with GJH.Method: This is a case-control study including 105 participants. We compared three groups: Individuals with PANS, individuals with other mental disorders and healthy controls. Joint mobility was assessed with the Beighton scoring system, psychiatric comorbidity with the M.I.N.I. or MINI-KID interview and symptoms of PANS with the PsychoNeuroInflammatory related Signs and Symptoms Inventory (PNISSI).Results: Hypermobility was similar across groups, and high rates of psychiatric comorbidity was not associated with higher Beighton scores.Conclusion: Although GJH is associated with several psychiatric conditions, such as ADHD and anxiety, this does not seem to be the case for PANS according to this preliminary study.

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Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 98%

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Joint Hypermobility in Paediatric Acute-Onset Neuropsychiatric Syndrome—A Preliminary Case-Control Study

et al. 2021

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“…To date, the most solid association is for GJH and anxiety (44), while the evidence for GJH and ADHD is increasing (26,51,52). There are also preliminary links between GJH and obsessive-compulsive personality disorder, developmental A similar approach could be adopted to patients with ASD with comorbid GJH, with the addition of physical features (e.g., marfanoid or androgyne features or minimal physical abnormalities).…”

Section: Gjh As a Biomarker In Psychiatrymentioning

confidence: 99%

The Relationship Between Generalised Joint Hypermobility and Autism Spectrum Disorder in Adults: A Large, Cross-Sectional, Case Control Comparison

et al. 2022

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Autism spectrum disorder (ASD) and generalised joint hypermobility (GJH) share a number of clinical manifestations including proprioceptive impairment, motor difficulties, sensory hypersensitivity, and autonomic dysfunction. Clinical observations suggest that GJH is overrepresented in ASD. However, there are currently few systematic studies available. Knowledge about comorbidities may unfold common aetiopathological pathways underlying the association and improve the clinical management. The aim of this large, cross-sectional comparative study is to evaluate the relationship between ASD and GJH in adults. Data on joint hypermobility, symptoms associated with both hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS), lifetime psychiatric diagnoses, psychiatric rating scales for ASD and attention deficit hyperactivity disorder (ADHD), and socio-demographics was collected for 199 individuals with ASD and 419 non-ASD community controls. Logistic regression models adjusting for covariates (age, sex, ethnicity) revealed a significant relationship between ASD and GJH and between ASD and symptomatic GJH, with adjusted odds ratios of 3.1 (95% CI: 1.9, 5.2; p < 0.001) and 4.9 (95% CI: 2.6, 9.0; p < 0.001), respectively. However, 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. Furthermore, GJH with additional self-reported symptoms, suggestive of HSD/hEDS, showed a stronger association with ASD than did non-specified GJH, indicating that symptomatic GJH plays a greater role in the relationship than non-specified GJH does. Therefore, the current study underscores the need of careful sample subclassifications. ASD with GJH may represent a novel subgroup of ASD in terms of aetiopathology and clinical presentation. Future research should elucidate the aetiological factors behind the association between ASD and GJH and evaluate how the comorbidity of GJH affects ASD outcomes.

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“…The retrospective study by Kindgren, Quiñones Perez, and Knez (2021) in a cohort of 201 children with HSD or hEDS, observed that 16% were diagnosed with ADHD, which is three times higher than that expected in the general population. Glans, Thelin, Humble, Elwin, and Bejerot (2021) for their part, explored JHM in 431 adults with ADHD and in 417 non-ADHD controls. Results showed that ADHD and GJH are highly associated (odds ratios 4.7; 95% CI 3.0-7.2; p < .005) with a fivefold increased odds compared with controls.…”

Section: Attention Deficit/hyperactivity Disordersmentioning

confidence: 99%

Neurodevelopmental atypisms in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers–Danlos syndromes

Baeza-Velasco

2021

American J of Med Genetics Pt C

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Joint hypermobility (JHM), defined as an increased range of joint motion, is a frequent somatic trait in the general population but also the hallmark of many of the hereditary disorders of connective tissue. Ehlers-Danlos syndromes (EDS) belong to this group of diseases and are characterized by tissue fragility, skin abnormalities, and JHM. Between JHM and EDS, there are the so-called hypermobility spectrum disorders (HSD), which is an umbrella term referring to people with symptomatic JHM who do not fulfill criteria for a syndromic connective tissue disorder such as EDS.Among the variety of clinical correlates of JHM/HSD/EDS, neurodevelopmental atypisms are common although often not screened for and identified in the clinical setting. This article reviews the pertinent literature concerning 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. Underlying mechanism hypotheses for such interconnections are also reviewed. The coexistence of connective tissue-altered conditions and neurodevelopmental atypisms increases disability in patients from an early age. Thus, increased awareness among clinicians and researchers is necessary to promote assessment, diagnosis, and develop management strategies to meet the specific needs of those affected.

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Association between adult attention-deficit hyperactivity disorder and generalised joint hypermobility: A cross-sectional case control comparison

Cited by 11 publications

References 22 publications

Joint Hypermobility in Paediatric Acute-Onset Neuropsychiatric Syndrome—A Preliminary Case-Control Study

Joint Hypermobility in Paediatric Acute-Onset Neuropsychiatric Syndrome—A Preliminary Case-Control Study

The Relationship Between Generalised Joint Hypermobility and Autism Spectrum Disorder in Adults: A Large, Cross-Sectional, Case Control Comparison

Neurodevelopmental atypisms in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers–Danlos syndromes

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