Neurodivergence and co-occurring chronic illness

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Hey all! We’re back this week to discuss the association between neurodivergence and co-occurring chronic illness. To this end, there is a common link between chronic illness and forms of neurodivergence such as autism, dyspraxia, and ADHD (Csecs et al., 2021; Donaghy et al., 2023). Among autistic adults, there is a strong link between the expression of dysautonomia, joint hypermobility, and pain (Csecs et al., 2021). There are also associations with gastrointestinal issues, fatigue and pain syndromes, and mental health concerns (Csecs et al., 2021). Furthermore, research has pointed out higher rates of neurodivergent children and young adults who experience co-occurring chronic illness, such as gastrointestinal problems and pain (Csecs et al., 2021). 

As a result of such co-occurring conditions, neurodivergent individuals might experience challenges in finding physical and/or mental health care (Donaghy et al., 2023). Individuals might be faced with challenges in communication, misattributing symptoms as part of neurodivergence, or because they have a history of not being believed- thus impacting healthcare seeking behavior (Donaghy et al., 2023). It is important to increase the awareness of the co-occurrence of chronic illness and neurodivergence to help others identify possible symptoms, to find resources/support, and overall to promote understanding and inclusion.

To begin, let’s discuss common conditions that occur among neurodivergent individuals—

 Neurodivergence has been associated with a significant number of co-occurring physical conditions such as dysautonomia, hypermobility, pain, and gastrointestinal problems (Donaghy et al., 2023).

Dysautonomia

 Dysautonomia is prevalent among individuals with joint hypermobility or Ehlers-Danlos Syndrome and is typically associated with a diagnosis of postural orthostatic tachycardia syndrome (POTS) [1]. Postural orthostatic tachycardia syndrome is characterized by exaggerated increases in heart rate upon standing and can be worsened with exercise (Csecs et al., 2021). Individuals with POTS experience dizziness when standing or getting up from bed and have difficulty regulating temperatures and exercising as a result (Csecs et al., 2021).

Ehlers-Danlos Syndrome (EDS)

 Ehlers-Danlos syndromes are a group of complex multi-systematic connective tissue disorders, classified into 13 subtypes (the most common subtype being hypermobile- hEDS). Individuals with EDS present differently and can range from being asymptomatic to being severely affected (Donaghy et al., 2023). Ehlers-Danlos syndromes are difficult to diagnose because of their complexity and the co-occurrence with other conditions, though broad symptoms include joint hypermobility, pain, and fatigue (Donaghy et al., 2023).

Joint Hypermobility and Joint Hypermobility Syndrome

 Joint hypermobility mediates the association between neurodivergence and dysautonomia/pain (Csecs et al., 2021). Joint hypermobility refers to the ability of joints to move beyond “normal” limits, typically the consequence of ligamentous laxity which occurs in connective tissue disorders and other genetic conditions (Csecs et al., 2021). Joint hypermobility syndrome in particular is a genetic connective tissue disorder caused by weakened collagen structures, which increase joint extension beyond the “normal” range (Donaghy et al., 2023). Joint hypermobility syndrome is characterized by symptomatic hypermobility, meaning frequent soft tissue injuries, dislocations, and pain (Donaghy et al., 2023). Symptoms of co-occurring conditions to joint hypermobility syndrome include gastrointestinal problems, chronic fatigue, fibromyalgia, dizziness, and mental health conditions such as anxiety and depression (Donaghy et al., 2023). Joint hypermobility is nearly 4 times (3.52) more likely in autistics and ADHDers- specifically AFAB, compared with neurotypical peers of any gender (Donaghy et al., 2023).

Pain

Donaghy et al. (2023) refers to pain as both a side-effect of medical conditions and as a physical health condition itself, with the risk of chronicity. Chronic pain has 7 subcategories each with specific symptomatology but examples range from headaches and musculoskeletal pain to arthritis and irritable bowel syndrome (Donaghy et al., 2023). Co-occurring with chronic pain conditions are psychiatric conditions which can lead to sleep disturbances, increased fatigue, and brain fog (Donaghy et al., 2023). Autistic children and young adults in particular experience higher rates of pain, therefore, might be at greater risk for potentially developing pain-related conditions (Donaghy et al., 2023). For ADHDers, the experience of pain may negatively impact attention (Csecs et al., 2021).

Gastrointestinal (GI) problems

The role of the gastrointestinal tract is to digest and absorb nutrients as well as to excrete waste (Donaghy et al., 2023). However, there are GI conditions that impact the ability of the GI tract to maintain normal functioning, such as gastroparesis, gastroesophageal reflux disorder (GERD), and psychological distress (Donaghy et al., 2023). Symptoms of GI problems might include constipation, diarrhea, nausea, vomiting, abdominal pain, etc. (Donaghy et al., 2023). In addition to this, individuals might also experience co-occurring mental health conditions and somatic conditions related to food intolerance (Donaghy et al., 2023). Neurodivergent individuals experience high rates of GI problems, with autistic children and young adults in particular reporting a 93.2% instance of GI problems, compared with neurotypical peers (Donaghy et al., 2023). Similarly, younger ADHDers are more likely to experience GI problems (Donaghy et al., 2023).

To conclude, neurodivergent individuals are significantly more likely than neurotypical peers to experience co-occurring chronic illness including (but not limited to) dysautonomia, joint hypermobility, and pain (Csecs et al., 2021). This over-representation of neurodivergent individuals having co-occurring chronic illness is important to further understand, in order to increase identification, diagnosis, and access to care/treatment of physical health conditions. It is also important that friends, family, and healthcare providers provide support to individuals to help alleviate stress as well as to promote understanding and inclusion.  

If you think you are Autistic or an ADHD-er and have other co-occurring chronic illness, we would love to speak to you about Autism Evaluations or ADHD Evaluations! Contact us today.

Sources

 Donaghy, B., Moore, D., & Green, J. (2023) Co-occurring physical health challenges in neurodivergent children and young people: A topical review and recommendation. Child Care in Practice. 29:1, 3-21. 10.1080/13575279.2022.2149471

 Scecs, J.L., Iodice, V., Rae, C.L., Brooke, A., Simmons, R., Quadt, L., Savage, G.K., Dowell, N.G., Prowse, F., Themelis, K., Mathias, C.J., Critchley, H.D., & Eccles, J.A. (2021). Joint hypermobility links neurodivergence to dysautonomia and pain. Front Psychiatry. 10.3389/fpsyt.2021.786916