Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 10:17:379-388.
doi: 10.2147/NDT.S290494. eCollection 2021.

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

Erik Kindgren  1   2 , Antonia Quiñones Perez  1 , Rajna Knez  1   3
Affiliations

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

Erik Kindgren et al. Neuropsychiatr Dis Treat. .

Abstract

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.

Keywords: ADHD; Ehlers-Danlos syndrome; autism spectrum disorder; children; hypermobility spectrum disorder.

PubMed Disclaimer

Conflict of interest statement

The authors declare no potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
Percentage of associated symptoms in 201 children with HSD or hEDS, comparing those with and without a diagnosis of ADHD. Analyzed with chi-squared tests. *p<0.05; **p<0.001.
Figure 2
Figure 2
Percentage of associated symptoms in 201 children with HSD or hEDS, comparing those with and without a diagnosis of ASD. Analyzed with chi-squared tests. *p<0.05; **p<0.001.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ehlers-Danlos Syndrom. Socialstyrelsen (the Swedish National Board of Health and Welfare). Available from: https://www.socialstyrelsen.se/ovanligadiagnoser/ehlers-danlossyndrom#an.... Accessed April, 2019.
    1. Tinkle B, Castori M, Berglund B, et al. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome type III and Ehlers-Danlos syndrome hypermobility type): clinical description and natural history. Am J Med Genet C Semin Med Genet. 2017;175(1):48–69. doi:10.1002/ajmg.c.31538 - DOI - PubMed
    1. Scheper MC, Juul-Kristensen B, Rombaut L, Rameckers EA, Verbunt J, Engelbert RH. Disability in adolescents and adults diagnosed with hypermobility-related disorders: a meta-analysis. Arch Phys Med Rehabil. 2016;97(12):2174–2187. doi:10.1016/j.apmr.2016.02.015 - DOI - PubMed
    1. Engelbert RH, Juul-Kristensen B, Pacey V, et al. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. Am J Med Genet C Semin Med Genet. 2017;175(1):158–167. doi:10.1002/ajmg.c.31545 - DOI - PubMed
    1. Ronge E. [EDS and the hypermobility syndrome. Common cause of reduced work capacity]. Lakartidningen. 2011;108(45):2318. - PubMed