Reviewed by the Josi Health Clinical Team, Licensed Psychologists
If you or your child recently received an autism diagnosis — or if you’ve been exploring the possibility of one — you may have noticed something else showing up alongside it: joint pain, unusual flexibility, fatigue that doesn’t track with how much you’ve slept. This isn’t a coincidence. Research shows that autism and hypermobility co-occur at rates far higher than chance, and understanding this connection can make a real difference in how you seek support.
This article explains what joint hypermobility and Ehlers-Danlos syndrome are, what the current science says about their link to autism, and what this means if you’re navigating evaluations or care.
If you’re looking for support around an autism evaluation, knowing about potential co-occurring physical conditions is a good place to start.
At a Glance
- Research suggests approximately 31% of people with autism have joint hypermobility — far above the general population rate of around 20%.
- Roughly 39% of people with Ehlers-Danlos syndrome or hypermobility spectrum disorders meet criteria for autism on clinical assessment.
- The co-occurrence isn’t coincidental: shared biology — including connective tissue, proprioception, and the autonomic nervous system — links these two conditions.
- People with autism may communicate pain differently, which can lead to hypermobility-related pain going unrecognized and untreated.
- A 2025 genome-wide study found a statistically significant genetic correlation between hypermobile EDS and autism spectrum condition.
What Is Joint Hypermobility — and Where Does EDS Fit In?
Joint hypermobility means your joints move beyond the typical range of motion. It’s more than just being flexible. For many people, it comes with pain, fatigue, and a body that requires more effort to stabilize than most people realize.
Hypermobility exists on a spectrum. At the mild end is generalized joint hypermobility (GJH) — loose joints without significant symptoms. In the middle are Hypermobility Spectrum Disorders (HSD) — symptomatic hypermobility that causes real functional impairment but doesn’t meet the criteria for a specific syndrome. At the more complex end is hypermobile Ehlers-Danlos Syndrome (hEDS), a heritable connective tissue condition.
Ehlers-Danlos syndrome (EDS) is a group of 13 subtypes, all involving collagen — the protein that gives joints, skin, and other tissues their structure and strength. In EDS, collagen doesn’t work the way it should, leading to joint instability, skin that bruises or stretches more easily, and a range of systemic symptoms. According to the American Academy of Family Physicians, hEDS accounts for 80–90% of all EDS cases.
Critically, there is currently no genetic test for hEDS. It’s diagnosed clinically — through physical examination, symptom history, and a standardized scoring system called the Beighton score that measures joint flexibility. This makes it possible to miss, especially when a patient has communication differences.
Key Takeaway: Hypermobility isn’t just flexibility — it’s a spectrum of connective tissue differences that can cause significant physical symptoms. hEDS is the most common subtype, and it’s diagnosed by a clinician, not a lab test.
What the Research Actually Shows About Autism and Hypermobility
The most current evidence comes from a 2025 systematic review and meta-analysis by Baeza-Velasco and colleagues, published in the peer-reviewed journal Autism. Across 20 studies, the researchers found that approximately 31% of people with autism show joint hypermobility when assessed clinically. Looking in the other direction, about 39% of people with EDS or HSD meet diagnostic criteria for autism on clinical assessment.
These figures are much more reliable than a widely-cited “80%” claim that circulates in some communities. That number comes from smaller, methodologically limited studies and is not supported by the current meta-analytic evidence. The real figures are striking enough on their own.
A separate study published in Frontiers in Psychiatry by Csecs and colleagues (2022) found that 51% of neurodivergent adults — including people with autism, ADHD, and Tourette syndrome — showed elevated hypermobility, compared to around 20% of the general population. The odds ratio for hypermobility in the neurodivergent group was 4.51 (95% CI 2.17–9.37), meaning neurodivergent individuals were more than four times as likely to have hypermobility.
A cross-sectional study published on NIH PubMed Central reinforced this with even sharper numbers. The researchers found that symptomatic generalized joint hypermobility — the kind suggestive of HSD or hEDS — was associated with autism at an odds ratio of 4.9, compared to 3.1 for hypermobility without additional symptoms. In other words, the more the hypermobility looks like EDS, the stronger the association with autism.
According to the Ehlers-Danlos Society, this bidirectional relationship is also visible in families: over 20% of mothers with EDS or HSD have children with autism — a rate similar to that of mothers who also have autism. This familial pattern points strongly toward a shared biological basis.
Key Takeaway: Current research consistently shows a strong bidirectional link between autism and hypermobility. Around 1 in 3 people with autism has joint hypermobility, and the connection is especially strong when hypermobility is symptomatic.
Why Do These Conditions Co-Occur? Shared Biology
The co-occurrence of autism and hypermobility isn’t random. Several biological mechanisms appear to be operating simultaneously.
Connective tissue throughout the nervous system. Collagen isn’t just in joints — it’s woven through the brain, spinal cord, and peripheral nerves. A review published on NIH PubMed Central found that autism and EDS/HSD share molecular, cellular, and tissue-level similarities, along with overlapping secondary conditions including ADHD, anxiety, mood disorders, proprioceptive impairment, and sensory sensitivities.
Proprioception — your body’s position sense. Proprioception, or the sense of where your body is in space, is affected both in autism and in hypermobility. In hypermobility, loose joints mean proprioceptive signals are less reliable. In autism, sensory processing differences can make it harder to integrate those signals. A 2022 study on hypermobility spectrum disorders, ASD, and functional neurological disorders found that alexithymia (difficulty identifying internal states), sensory sensitivity, and interoceptive differences are common threads across all three conditions.
Genetic overlap. A 2025 genome-wide association study preprint — currently awaiting peer-reviewed publication — found a statistically significant genetic correlation between hEDS and autism spectrum condition (rg=0.13, P=0.008). While preliminary, this is the first genome-wide signal pointing toward a shared genetic architecture. It also found correlations between hEDS and fibromyalgia, anxiety, depression, ME/CFS, and GI conditions — a cluster of co-occurring experiences that many people with autism will recognize.
Autonomic nervous system dysregulation. A 2026 study found that autonomic reactivity mediated the relationship between connective tissue features and neurodivergence — even after controlling for anxiety. In other words, the way the autonomic nervous system responds may be the shared mechanism linking how joints work to how the brain processes the world.
Key Takeaway: The autism-hypermobility link isn’t superficial. Shared connective tissue biology, proprioceptive differences, autonomic nervous system dysregulation, and emerging genetic evidence all suggest these two conditions share an underlying biology, not just a coincidental overlap.
The POTS Problem: Fatigue, Dizziness, and the Autonomic Trio
One of the most underrecognized aspects of this connection is dysautonomia — specifically POTS, or Postural Orthostatic Tachycardia Syndrome. POTS is a condition where the heart rate increases abnormally upon standing, causing dizziness, fatigue, brain fog, and difficulty with everyday tasks.
The Csecs et al. (2022) study found that the number of hypermobile joints directly mediated the relationship between neurodivergence and symptoms of both dysautonomia and pain. People with more hypermobile joints had more autonomic symptoms — and this was true whether or not they had a formal POTS diagnosis.
The NIH PubMed Central review notes that while dysautonomia in autism typically doesn’t receive a formal diagnostic label, people with EDS frequently receive comorbid diagnoses of POTS, orthostatic hypotension, or mixed presentations. The underlying autonomic dysfunction is often the same — it’s the recognition and labeling that differs.
If you’ve been wondering about the connection between fatigue and autism, dysautonomia may be a contributing factor worth discussing with your healthcare team. Fatigue that seems disproportionate, difficulty standing for long periods, or “crashes” after activity are all worth mentioning in an evaluation context.
Key Takeaway: Autism, hypermobility, and POTS frequently appear together. Autonomic nervous system dysregulation — not just joint laxity — may be a core shared mechanism driving fatigue, dizziness, and exercise intolerance in this population.
Pain, Autism, and Why It Often Goes Unrecognized
For many people with autism, pain doesn’t register or get communicated the way clinicians expect — and this creates a serious clinical gap when hypermobility is also present.
A 2022 review on pain in autism found that people with autism spectrum condition show atypical sensorimotor function and pain reactivity. Some individuals have heightened pain sensitivity; others appear to underreact. Either way, the standard clinical tools for identifying and tracking pain can miss what’s actually happening.
A foundational 2018 review by Baeza-Velasco and colleagues highlighted that pain in autism is frequently disregarded and undertreated — partly because of communication differences and partly because clinicians don’t always know to look for hypermobility-related pain in this population. They noted that over 20% of pediatric patients at a US pain clinic presented with autism traits — a striking figure that underscores how often these co-occur in clinical settings.
For more on how this plays out day-to-day, our article on autism and chronic pain covers the behavioral and physiological patterns that signal pain in people who may not express it verbally.
Key Takeaway: People with autism often experience and express pain differently, which means hypermobility-related pain frequently goes undiagnosed. Clinicians and caregivers should actively look for signs of pain rather than waiting for a patient to self-report in conventional ways.
Getting Evaluated: What to Know If You Think Both Apply
If you’ve been reading this article and recognizing yourself or your child, the next step is figuring out what to do with that information.
A few things worth knowing:
hEDS requires a clinical evaluation — there’s no genetic test. According to the Ehlers-Danlos Society’s diagnostic criteria, diagnosis requires meeting three sets of criteria: generalized joint hypermobility (assessed via the Beighton score), specific connective tissue manifestations, and exclusion of other diagnoses. This means you need a physician — ideally someone familiar with connective tissue conditions — to assess you in person.
Autism evaluations and hypermobility evaluations are separate but related. A psychologist conducting an autism evaluation won’t assess for hEDS, and a rheumatologist assessing for hEDS won’t assess for autism. But awareness of both can shape how each evaluation is conducted and interpreted. Mentioning joint symptoms, pain, fatigue, or family history of hypermobility during an autism evaluation is relevant context.
People with and without autism may experience hEDS differently. A 2026 study by Crompton and colleagues found that people with and without autism who have hEDS or HSD may experience the condition in distinct ways — with implications for what kinds of support are most beneficial. One-size-fits-all management approaches may not serve people with autism as well as individualized, sensory-informed care.
Gender and late diagnosis matter here too. Women and people assigned female at birth are disproportionately affected by both hEDS and missed or late autism diagnoses. The overlap between these two patterns of under-recognition is worth naming — particularly for adults who are only now beginning to connect the dots.
If you’ve already received an autism diagnosis and are now exploring what that means for your physical health, our guide on what happens after a diagnosis covers next steps, including how to communicate with medical providers about co-occurring conditions.
Key Takeaway: If you suspect both autism and hypermobility are present, pursue evaluations through the appropriate specialists — and bring information about both to each appointment. Integrated awareness leads to better outcomes than treating each condition in isolation.
What Helps: Management Approaches
There’s no single treatment for either condition, but there are evidence-supported approaches that work well together.
Physiotherapy is a cornerstone for hEDS and HSD. The goal isn’t stretching (which can worsen joint instability) — it’s strengthening the muscles that stabilize hypermobile joints. A physiotherapist familiar with hEDS can design a program that builds stability without overloading joints.
Occupational therapy is often useful for both autism and hypermobility. For hypermobility, OT addresses joint protection strategies, activity pacing, and adaptive tools. For autism, OT addresses sensory processing, daily living skills, and environmental modifications. When both conditions are present, an OT who understands both can help significantly.
Pacing and energy management are especially important when dysautonomia and fatigue are part of the picture. The AAFP notes that orthostatic intolerance, chronic fatigue, and functional GI issues are all associated features of hEDS that require specific management strategies.
Sensory-informed adjustments — in medical settings, schools, and workplaces — can reduce the stress of managing a body that is both sensory-sensitive and physically unstable. Accommodations that reduce sensory load (like flexible seating, noise management, and predictable routines) often benefit people navigating both conditions at once.
Multidisciplinary care is the standard of care recommendation when multiple body systems are involved. That typically means a team that might include a rheumatologist or geneticist (for hypermobility), a neurologist or cardiologist (for dysautonomia), a psychologist (for autism and mental health), and allied health professionals.
Key Takeaway: Management works best when both conditions are on the table. Physiotherapy, OT, pacing strategies, and coordinated multidisciplinary care are the most supported approaches — and sensory-informed modifications benefit both conditions simultaneously.
What This Means for You
If you or someone you care for has autism, joint hypermobility, chronic pain, fatigue, or a family history of any of the above, this research matters.
The connection between autism and hypermobility — including Ehlers-Danlos syndrome — is no longer a niche observation. According to the CDC, approximately 1 in 31 children in the US has been identified with autism. Given the prevalence rates in the research, a significant number of those individuals also have joint hypermobility that may never be identified or treated.
Understanding the overlap means asking better questions — of doctors, of evaluators, of yourself. It means not dismissing chronic pain or fatigue as “just part of having autism.” And it means knowing that getting one diagnosis doesn’t close the door on other answers.
If you’re looking for support around an autism evaluation, you have options. Josi Health’s licensed psychologists conduct comprehensive telehealth assessments and provide detailed reports you can use with other providers. Learn more about how the evaluation process works or explore what next steps look like after a diagnosis.
This article is for informational purposes only and does not constitute medical advice. Please consult a licensed healthcare provider for guidance specific to your situation.
Reviewed by the Josi Health Clinical Team, Licensed Psychologists.