Autism, Joint Hypermobility-Related Disorders and Pain

Baeza-Velasco, Carolina; Cohen, David; Hamonet, C.; Vlamynck, Elodie; Diaz, Lautaro; Cravero, Cora; Cappe, Émilie; Guinchat, Vincent

doi:10.3389/fpsyt.2018.00656

Cited by 60 publications

(63 citation statements)

References 64 publications

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“…Higher pain severity in combination with increased interoceptive sensitivity may have additional emotional consequences such as anxiety and fear, which also may contribute to higher disability levels. Furthermore, recent studies showed the potential role of neurodiversity, such as Attention-deficit/hyperactivity disorder (ADHD) and Autism Spectrum Disorders (ASD) in G-HSD/hEDS [85,86]. The potential connection between these psychiatric disorders and G-HSD/hEDS can be useful in clinical practice since it allows to better identify patients with ASD or ADHD who may be vulnerable for disabling pain.…”

Section: Discussionmentioning

confidence: 99%

Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain

Meulenbroek

Huijnen

Simons

et al. 2020

Scandinavian Journal of Pain

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ObjectivesA significant proportion of adolescents with chronic musculoskeletal pain (CMP) experience difficulties in physical functioning, mood and social functioning, contributing to diminished quality of life. Generalized joint hypermobility (GJH) is a risk factor for developing CMP with a striking 35-48% of patients with CMP reporting GJH. In case GJH occurs with one or more musculoskeletal manifestations such as chronic pain, trauma, disturbed proprioception and joint instability, it is referred to as generalized hypermobility spectrum disorder (G-HSD). Similar characteristics have been reported in children and adolescents with the hypermobile Ehlers-Danlos Syndrome (hEDS). In the management of CMP, a biopsychosocial approach is recommended as several studies have confirmed the impact of psychosocial factors in the development and maintenance of CMP. The fear-avoidance model (FAM) is a cognitive-behavioural framework that describes the role of pain-related fear as a determinant of CMP-related disability.ContentPubmed was used to identify existing relevant literature focussing on chronic musculoskeletal pain, generalized joint hypermobility, pain-related fear and disability. Relevant articles were cross-referenced to identify articles possibly missed during the primary screening. In this paper the current state of scientific evidence is presented for each individual component of the FAM in hypermobile adolescents with and without CMP. Based on this overview, the FAM is proposed explaining a possible underlying mechanism in the relations between GJH, pain-related fear and disability.Summary and outlookIt is assumed that GJH seems to make you more vulnerable for injury and experiencing more frequent musculoskeletal pain. But in addition, a vulnerability for heightened pain-related fear is proposed as an underlying mechanism explaining the relationship between GJH and disability. Further scientific confirmation of this applied FAM is warranted to further unravel the underlying mechanism.In explaining disability in individuals with G-HSD/hEDS, it is important to focus on both the physical components related to joint hypermobility, in tandem with the psychological components such as pain-related fear, catastrophizing thoughts and generalized anxiety.

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Section: Discussionmentioning

confidence: 99%

Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain

Meulenbroek

Huijnen

Simons

et al. 2020

Scandinavian Journal of Pain

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“…On the one hand, how a CG works is challenging to describe. Therefore, the theoretical background justifying the use of CG in our population is speculative and based on: (1) the frequent co-occurrences between ASD and proprioceptive dysfunction [29,30,68] and ASD and joint hypermobility [44][45][46]; and (2) the existing clinical use of CGs in EDS [47,48]. Hypotheses regarding how CGs work include: (1) a better sensing of the limbs in space by stretching the skin.…”

Section: Problems Raised By the Use Of Cgs In Patients With Autismmentioning

confidence: 99%

“…Joint hypermobility and cutaneous hyper-elasticity are the two main criteria for hEDS. Recently, it has been associated with ASD [44][45][46]. The hEDS/ASD comorbidity could account for a deficit of proprioceptive inputs.…”

Section: Introductionmentioning

confidence: 99%

Compressive Garments in Individuals with Autism and Severe Proprioceptive Dysfunction: A Retrospective Exploratory Case Series

et al. 2020

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(1) Background: Compression garments (CGs) are an adjuvant treatment for generalized joint hypermobility (GJH), including the Ehlers–Danlos syndrome/hypermobility types. The effects of CGs are likely to be related to better proprioceptive control. We aimed to explore the use of CGs in individuals with autism and severe proprioceptive dysfunction (SPD), including individuals with GJH, to control posture and challenging behaviors. (2) Methods: We retrospectively described 14 patients with autism and SPD, including seven with comorbid GJH, who were hospitalized for major challenging behaviors with remaining behavioral symptomatology after the implementation of multidisciplinary approaches, including medication, treatment of organic comorbidities, and behavioral restructuring. Each patient received a CG to wear for at least 1 h (but most often longer) per day for six weeks. We assessed challenging behaviors in these participants with the Aberrant Behavior Checklist (ABC), sensory integration with the Dunn questionnaire, and postural sway and motor performance using a self-designed motricity path at baseline, two weeks, and six weeks. (3) Results: We observed a significant effect on most ABC rating scores at two weeks, which persisted at six weeks (total score, p = 0.004; irritability, p = 0.007; hyperactivity, p = 0.001; lethargy, p = 0.001). Postural control in dorsal and profile positions was significantly improved between before and after wearing the CGs (p = 0.006 and 0.007, respectively). Motor performance was also significantly improved. However, we did not observe a significant change in Dunn sensory scores. During the six-week duration, the treatment was generally well-tolerated. A comorbid GJH diagnosis was not associated with a better outcome. (4) Conclusions: CGs appear to be a promising adjuvant treatment for both behavioral and postural impairments in individuals with autism and SPD.

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“…Both ADHD and ASD are neurodevelopmental disorders, 9 , 11 which accounts for their similarities as well as for the differences among them. A recent study by Berenguer et al showed that children with ASD (ASD alone or in co-occurrence with ADHD) showed worse theory of mind skills than children with ADHD, while children with ADHD symptomatology (ADHD alone or with co-occurring ASD) had a more extensive profile of executive functions (EF) deficits than children with ASD only.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of ADHD and Autism Spectrum Disorder in Children with Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome: A Retrospective Study

Kindgren¹,

Pérez²,

Knez³

2021

NDT

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Introduction Hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) are both characterized by generalized hypermobility, in combination with pain, affected proprioception, and pronounced fatigue. Clinical observation indicates that behavioral problems, hyperactivity, and autistic traits are overrepresented in children with those conditions. The purpose of this retrospective study was to establish the prevalence of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) among children with HSD and hEDS treated in our clinic since 2012. Subjects and Methods Since Ehlers-Danlos syndrome (EDS) diagnostic criteria and international classification were changed in 2017, we equate the older diagnosis EDS hypermobility type with the newer hEDS and the older hypermobility syndrome with HSD. A registry search from the computerized medical record system found 201 children (88 boys, 113 girls) aged 6–18 years who were treated at our pediatrics department with the diagnoses HSD or EDS. All medical records (113 with HSD, 88 with EDS) were reviewed, and key symptoms such as fatigue and pain, as well as diagnosis of ADHD/ASD, were recorded. Results All EDS cases could be classified as hEDS. Of the entire study cohort, 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 (p=0.02). In the age group 15–16 years, 35% of those with hEDS had ADHD and, among those aged 17–18 years, ADHD was present in 46%. Children with coexisting ADHD showed a significantly higher proportion of associated symptoms such as fatigue, sleep-problems, and urinary tract problems. ASD had been verified in 6% of the children. Of those with ASD, 92% had sleep problems. Conclusion This study shows a strong association between HSD or hEDS and ADHD or ASD. Therefore, children with HSD or hEDS may need to be routinely screened for neuropsychiatric symptoms.

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Autism, Joint Hypermobility-Related Disorders and Pain

Cited by 60 publications

References 64 publications

Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain

Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain

Compressive Garments in Individuals with Autism and Severe Proprioceptive Dysfunction: A Retrospective Exploratory Case Series

Prevalence of ADHD and Autism Spectrum Disorder in Children with Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome: A Retrospective Study

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