Category: Autism 101

Autism and Skill Regression

Greetings Earthlings! 🙂

This week I’d like to discuss a common autistic experience that many people may be unaware of- skill regression. I know, it sounds more like something from a video game, but rest assured it’s a thing!

Skill regression is exactly what it says on the tin- the loss of previously acquired skills and abilities such as motor skills, speech, social skills etc. It primarily occurs in early childhood between the ages of 15-30 months, but can also occur in adulthood in times of extreme stress and burnout. Many late diagnosed adults also describe skill regression post-diagnosis either from burnout or simply by learning to unmask for the first time in their lives. Regression is usually short lived, but sometimes skills do not come back or are more difficult to access.

I have personally experienced skill regression at numerous points in my life. After I was first diagnosed, I was so hyperaware of my differences that I struggled to mask during that adjustment period. Whenever I’m under intense stress, I’m less able to socially function as my masks and filters slip resulting in my saying or doing things socially that I wouldn’t ordinarily do. On a more creative and academic level, I used to excel in my childhood at crochet and long division. Fast forward a few semesters and I suddenly was unable to do either. I never did manage to get long division back, but I still try crochet every now and again (but it’s quite hard to tap into and has not come easily since). Also, in one particularly hilarious incident following a sleepless night, I completely forgot how to draw a graph in my Physics lab in college!

So why are autists prone to skill regression?

Generally speaking, regression occurs due to overwhelm where the brain starts shutting off areas it deems to be low priority- like low power mode on devices where background apps and features get turned off to stay alive. In the body when the fight or flight response is triggered, it temporarily shuts down digestion, healing, and immune functions, diverting blood to the muscles to allow for quick movement in response to threat. The brain does something similar by cutting off non-essential skills to survive in a state of overwhelm. This occurs through a process call synaptic pruning where the synapse (the connection between neurons) is broken down or temporarily switched off if a particular neural pathway isn’t being used or isn’t needed. It can be mistaken for laziness, but it’s a neural response to a perceived threat.

As I’ve discussed previously, synaptic pruning is thought to be dysregulated in autism as the brain doesn’t tend to trim off excess brain connections in childhood as happens in the neurotypical brain. Similarly, there is also an over-pruning theory of autism where the brain over actively cuts back brain connections. This dysregulation could explain why skill regression tends to occur more in overwhelming situations in the autistic brain versus neruotypicals. If skills do not return or are harder to access after the period of stress, this can happen as the brain rewired itself through pruning to cope, strengthening important connections and pruning less important ones. The skill may not be gone, but the neural route to access that skill may be less efficient (I wonder what stressor messed up my brains crochet pathway😂).

If you want to understand skill regression a bit more, this video summarizes things very well:

Hope you enjoyed this post dear Earthlings! 🙂

Have a lovely weekend!

Aoife

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Learning and Autism

Greetings Earthlings! 😀

Leading on from my previous posts about autism and memory, IQ, and studying, this week I’d like to talk about the topic of autism and academic learning.

First things first, autism is NOT a learning disability. It’s a neurodevelopmental disorder which impacts how our brain develops and the rate at which it develops having an impact on motor learning, social learning, language learning etc. That being said, ASD‘s can be co-morbid with learning disabilities such as dyslexia, ADHD and dysgraphia.

Everyone’s academic learning journey is unique, especially among autists. Autists can have problems concentrating in classrooms due to sensory sensitivities, issues with social skills can make it harder to interpret teaching cues, and difficulties with executive functioning and information processing can make it hard to process new information.

I’ve always had a passion for academic learning, but even I’ve had my struggles. I struggled hugely with maths in my teenage years. Once letters came into equations I regularly had meltdowns and got overwhelmed when I couldn’t immediately make sense of the topic. One of my most enduring memories of school is throwing my maths book at the wall mid meltdown while doing my homework 🙈

Buuuuuttttt I would usually be able to make sense of the exercises once the meltdown had passed. My teachers unfortunately didn’t understand this (the joys of being undiagnosed) which often made my learning journey challenging. Had I been given the opportunity to work slowly 1:1 with maths, I would have picked topics up a lot quicker.

Everyone’s learning style is different, especially when considering the challenges of autism. There are several different learning styles:

  • Visual learning– where learners take in information better visually through pictures, graphs and mind maps to help make connections
  • Auditory learning– where learners listen to information for optimal processing
  • Verbal learning– using verbal approaches like reading out loud and mnemonic devices
  • Reading/writing learning– classical learning approach by reading and writing
  • Kinesthetic learning– physical learning by doing tasks or needing to move while learning
  • Logical learning– where logic and pattern recognition skills are used to connect concepts
  • Social/Interpersonal learning– where you learn best by observing others, and talking and communicating with a social group
  • Solitary/Intrapersonal learning– where you just need to be by yourself to learn on your own with no distractions

Sometimes a mix of learning styles can be the best approach- I have employed all of these styles at different points in my life, but I would largely fall into the visual and kinesthetic learner categories. Seeing things drawn out and or doing tasks is often the best way for me to process information. For example, I tend to take notes using coloured pens as the visual stimulation from the colours makes it easier to process and retain the information.

There are so many different ways to learn, it’s just a matter of sitting down and figuring out what kind of learning style works for you, or working out a plan to limit classroom issues like sensory challenges that can derail your learning process. Lot’s of apps and supports are available for autists these days that can help make learning a lot easier.

The key thing is to not get discouraged. No two autists are the same and it can take a while to find what learning style works for you. When I took maths and biostatistics in college, the lectures were overwhelming, but once I sat down to a tutorial session where we worked hands on with the sums in an intimate environment, I flew through the work and got excellent marks in my exams. It takes time, but once you find the right approach, learning can be a breeze 😊

Hope you enjoyed this post dear Earthlings! 🙂

Have a lovely weekend!

Aoife

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Autism and the Heart

Greetings Earthlings! 🙂

This week I’d like to focus on the impact of autism on a specific organ of the body- the heart.

People with autism are at an increased risk of developing cardiometabolic diseases such as cardiovascular disease, heart attacks, stroke, diabetes etc. The risk of developing atherosclerotic heart disease in particular (where plaques clog up the blood vessels in the heart causing failure) is an estimated 47% higher in autists. Furthermore, there appears to be a link wherein people born with congenital heart disease (where the heart is not structured properly at birth) are 33% more likely to receive an autism diagnosis in later life.

Fun stuff…

So why autism? Why are there links to heart diseases?

One of the most plausible theories suggests that prolonged activation of the fight or flight response system (autonomic nervous system) in autists in response to stressors may be negatively impacting the heart. We all know that stress is bad, but as I’ve previously discussed, biological stress in autists tends to persist following a stressful situation when compared with their neurotypical peers, damaging the heart over time.

In terms of the link to congenital heart disease, researchers believe that alterations in blood flow to the brain caused by defects in the heart may predispose the brain to injury and developmental delays both in utero and in the postnatal period. These flow changes are thought to cause damage to white matter fibers which act like a train network connecting the brain. As a result, damage to this system could be negatively impacting learning and behaviour.

In addition to the links to heart diseases, alterations in heart systems may also be contributing to autistic symptoms. One theory suggests that alterations in the normal functioning of the fight or flight system may be contributing to a number of autistic behaviours such as meltdowns. Researchers have also noted that autists tend to have lower variability in their heart rate compared with their neurotypical peers. Higher variations in heart rate tend to indicate a more relaxed body where the rest and digest system (parasympathetic nervous system) is more active, but lower variability has been linked to difficulties recognizing emotions and social cues in addition to intellectual issues.

So the heart is seemingly far more connected to autism than we might have realised!

Prolonged periods of stress may indeed damage the heart, but with successful interventions, autists can better navigate life’s stressors. As with all disease risk, just because there is an increased risk, does not mean that it will manifest, but we should all be looking after our hearts- neurotypical and neurodivergents alike. It’s the only one we’ve got 🙂

Hope you enjoyed this post dear Earthlings!

Have a lovely weekend 🙂

Aoife

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Autism and Diabetes

Greetings Earthlings! 🙂

This week I’d like to discuss the topic of diabetes and how it can be linked to autism.

But before we get into that, what is diabetes?

In the body, the hormone insulin is produced by our friend the pancreas (in the image above) to control the absorption of sugar into our cells. Diabetes mellitus is a condition where blood sugar levels are uncontrolled due to insufficient insulin production. Elevated blood sugar levels (hyperglycemia) can cause a range of health issues such as nerve damage in the hands and feet (peripheral neuropathy), permanent damage to eyesight (diabetic retinopathy) and life threatening ketoacidosis (where substances called ketones build up in the body making blood more acidic).

There are a few different types of diabetes:

  • Type 1 or insulin dependent diabetes– this occurs when the pancreas ceases to produce insulin (caused by the immune system attacking insulin producing β cells) leading to high blood sugar levels. Replacement insulin must be injected to keep blood sugar levels stable.
  • Type 2 diabetes– occurs when the body develops insulin resistance so insulin is no longer able to control blood sugar levels. It usually occurs in adulthood as a result of poor diet, obesity and lack of physical exercise
  • Gestational diabetes– this type of diabetes occurs during pregnancy in women who have never previously had diabetes. It usually goes away following birth of the baby, but does increase your risk for type 2 diabetes in later life

That’s great Aoife, but what has all this got to do with autism?

Research suggests that idividuals with autism may have a 57% higher risk of developing diabetes compared with their neurotypical peers; specifically the risk is roughly 64% higher for type 1 diabetes, and a whopping 146% higher for type 2 diabetes!

So why are autists more susceptible?

In the case of type 1 diabetes, as I’ve previously discussed, autists tend to have an overactive immune system (likely due to genetic mutation) which could be damaging the pancreas preventing insulin production. Research has also found that type 1 diabetic mothers are at a higher risk for giving birth to an autistic child as it’s thought that autoimmune diseases like type 1 diabetes produce antibodies that can attack the developing brain in the womb. Similarly, gestational diabetes has been linked to a slightly increased risk in the development of autism and ADHD due to exposure to high blood glucose levels in utero.

The massive type 2 link on the other hand has a lot more to do with lifestyle. Sensory processing issues relating to food can lead to quite a restrictive diet. This diet is often high in sugar which may lead to type 2 diabetes in adulthood. Some autists with ADHD also have impulsive issues with over-eating for sensory stimulation, while others struggle with insatiable hunger (polyphagia), especially those with co-morbid Prader–Willi syndrome. Physical limitations due to co-morbid issues like of dyspraxia can also reduce and limit physical activity increasing the risk for diabetes. In addition, some studies have found genetic links to autism and weight gain which further compound this risk.

As with all things in life, just because there is an increased risk does not mean that the disease will manifest, but it’s useful to be aware of the risk nonetheless.

Hope you enjoyed this post!

Have a lovely weekend!

Aoife

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Autism and Contraception

Greetings Earthlings! 🙂

This week I’d like to talk about a rarely discussed topic when it comes to autism- contraception!

When it comes to autism, the narrative doesn’t tend to discuss sex and relationships due to the archaic perceived notion that most of us are asexual.

Newsflash- autistic people have sex! As such, it’s important to discuss the topic of contraception.

The use of contraception is entirely individual, but for autists there may be additional sensory issues that may influence their decisions. Texture and smell may be issues for latex products, contraceptive patches may aggravate skin sensitivities, and contraceptive injections and implants may freak an autist out (don’t get me started on how much I shudder every time a friend has shown me the contraceptive bar in their arm!😖).

Hormonal contraceptives on the other hand may negatively impact an autists mental state and behaviours. There are no studies on the impact that hormonal contraceptives may have on autists, but as discussed in my previous posts about the impact of hormonal fluctuations during puberty, menopause and menstruation, it’s quite likely that behaviours and mental health could be impacted by their use. I’ve seen many neurotypical friends get knocked about by hormonal contraception, so I can only imagine how much worse these side effects could be for an autist. Some autists have reported that their anxiety issues increased significantly when on certain contraceptive drugs, finding that their panic attacks completely disappeared after switching to a different drug. In contrast, others have found that taking oral contraceptives has improved their mental health as it has made sensory issues and pain around their periods easier to manage, particularly contraceptives that prevent periods. Studies have also found that oral contraceptives may be useful to reduce pica behaviours in autists.

Researchers have also made an interesting connection between hormonal contraceptive use and autism rates. In 2014 a hypothesis was proposed that the increase in autism rates over the last 60 years correlates to the increased use of hormonal contraceptives.

Yep- they are suggesting that contraception may contribute to the development of autism!

The hypothesis suggests that hormonal contraception alone would not cause autism, but a ‘double hit’ mechanism of contraceptive exposure in tandem with other environmental and genetic factors may increase the risk. It’s thought that when an egg is exposed to artificial hormones in the ovary it can cause damage to the egg increasing the autism risk. Hormonal contraceptives work by preventing the release of an egg, and as such, the retention of eggs in the ovaries could be exposing them to these hormones for prolonged periods of time with negative consequences. There are multiple studies on how prenatal exposure to testosterone increases autism risk, so it’s not implausible that the same could be said for other hormones. Progestin (artificial progesterone used for contraception) in particular has been linked to the regulation of brain activity and impaired cognitive responses during foetal development, with animal studies showing autism-like behaviour after prenatal exposure to the synthetic hormone. Much research is needed to confirm that the rise in hormonal contraception is indeed contributing to the increase in autism rates, but it’s a very interesting hypothesis!

Hope you enjoyed this post dear Earthlings! 🙂

Have a lovely weekend!

Aoife

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Autism-Headaches & Migraines

Greetings Earthlings! 🙂

This week I’d like to talk about something that isn’t normally discussed in relation to autism- headaches and migraines.

Anyone can get headaches or migraines, but it appears that there is a link between autism and their frequency , with one study even suggesting that autistic children are twice as likely to experience migraines when compared with neurotypicals. Further studies are required to confirm comorbidity, but the studies that do exist suggest a lot of overlap.

So have they any idea why there is a link?

One of the most popular theories suggests that issues in sensory processing may make autists more susceptible to headaches and migraines. For both autists and migraine sufferers, differences in sensory processing can impair how the brain registers and modulates responses to sensory stimuli like light and sound which can trigger migraines following a sensory overload. There are a lot of structural changes in the brains of both autists and migraine patients which could further explain this sensitivity.

Research has also reported that autists have altered pain sensitivity which can distort their perception of headaches, so, what might be an ignorable ache in a neurotypical individual may be much more severe for an autist.

Interestingly, there may also be a link between headaches/migraines and our digestive health. The gut is innervated by a network of nerves known as the enteric nervous system, often nicknamed a second brain. Migraines are often co-morbid with gastrointestinal problems where issues in the second brain can influence changes in the main brain via the brain-gut axis. GI issues are frequently co-morbid with autism so this could be the most logical explanation for the link. I know I’ve certainly triggered migraines from eating things that didn’t agree with me, only to have the migraine immediately dissipate the minute my stomach hit the ejector button! 😂

Migraines have also been linked to low levels of serotonin in the brain. As previously discussed, serotonin levels are dysregulated in autists so this could also explain the link. This is particularly interesting as 95% of serotonin production occurs in the gut, so this further indicates a gut related link to headaches and migraines in autism.

Joint hypermobility could also be contributing to headaches. People with connective tissue disorders like Ehlers Danlos syndrome (EDS) frequently experience headaches. Weakness in supporting tissues like collagen can cause instability in the neck and spine which can pinch nerves, interrupting the flow of blood to the brain and triggering headaches and migraines. As joint hypermobility can be co-morbid with autism, this could further explain the link.

As with many aspects of the spectrum, susceptibility to headaches and migraines could also be genetic as there is an overlap in some genes linked to both autism and migraines.

Hope you enjoyed this post dear Earthlings!

Have a lovely weekend! 🙂

Aoife

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Autism and Daydreaming

Greetings Earthlings! 🙂

In today’s post, I’m going to discuss the subject of daydreaming (or as my sister likes to call it “staring into the abyss”) and autism.

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*Cue six year old Aoife singing the Monkees ‘Daydream Believer‘ at the top of her lungs!*

Image result for daydream believer gif

All of us daydream at some point or other in our lives, but according to researchers, autists daydream differently to others. When we daydream during times of rest, certain regions of the brain (known collectively as the default mode network) are activated to help us reflect and process emotions. However in the autistic brain, it appears that activity in these daydreaming regions is dampened due to lower levels of brain connectivity. As daydreaming is an essential component for self reflection, researchers believe that autists struggle to create a “normal” internal picture of themselves and others which could be linked to social issues often experienced in autism.

On the other hand, autism and ADHD have also been linked to maladaptive daydreaming. First described in 2002, maladaptive daydreaming is a mental health issues where someone daydreams excessively, sometimes even for hours at a time. People who tend to daydream like this conjure extremely vivid and detailed daydreams, often developed as a coping mechanism or a form of escapism. There is limited research on this topic as the condition has not been officially recognized yet, but some estimate it to effect as many as 20% of those with ADHD which often overlaps with autism. It is thought to be a compulsive issue, which given the issues of impulsivity and autism could explain the link.

In my own life, I’m a terrible woman for daydreaming. My mind is constantly drifting in and out of focus to daydream about potential future scenarios or to create elaborate fantasies to escape from my problems. There were certainly periods during more turbulent times where one might consider my daydreaming to have been maladaptive. If I’m being honest though, I think I tend to daydream more out of boredom than anything else- I just fill my head with all these interesting scenarios to keep my brain stimulated when I’m not doing much else with my time 🤣

So who knows- maybe daydreaming is a spectrum within the spectrum! 🤷‍♂️

Hope you enjoyed this post dear Earthlings!

Have a lovely weekend! 🙂

Aoife

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Autism and Rejection Sensitive Dysphoria (RSD)

Greetings Earthlings! 🙂

This week I’d like to talk about another co-morbid condition with autism and ADHD– rejection sensitive dysphoria (RSD).

So what exactly is RSD?

RSD is an intense or overwhelming emotional sensitivity to rejection and criticism (both perceived and real). This can cause intense emotional pain that can be difficult to bear.

Looking back over my childhood, I really struggled with RSD. Whilst I am well versed in the art of rejection now that I’m in my thirties, growing up as an undiagnosed autist did not make for an easy ride. Even the slightest rejections could trigger meltdowns as my brain struggled to process the situation. Something as simple as someone not immediately having time for me, a passing comment in a raised tone, even constructive criticism could set me off. Once at a family event in a hotel I had a bad meltdown because my uncle was short with me for requesting a different flavour of ice-cream to the one that I had been given. Cue me hiding out in the toilets followed by 3 hours doodling in the back of the car instead of joining the party from my RSD over-reaction (I was 13 by the way! 🙈). I can’t even blame sensory issues for that over-reaction, I just didn’t feel like eating raspberry ripple that day! 😂

So is there any scientific reason for RSD?

RSD, like maladaptive daydreaming, is not a clinical diagnosis so it’s hard to underpin how it works. There isn’t exactly a scientific way to measure rejection. However, as it has been observed in patients with autism and ADHD, psychologists believe that it is caused by alterations in brain structure in the regions that regulate and process emotions such as the frontal lobe and the amygdala- both regions where structural changes have been linked to autistic symptoms.

As discussed previously, autists often have a warped sense of perception and logic so it can be very easy to misconstrue and over-react to rejection. The tendency towards perfectionism and black and white thinking in particular can make us far more susceptible to such negative reactions. For example, if someone told me that they didn’t like my shoes, even though it’s only one component of my outfit and just a passing comment, my younger self would have spiraled.

Life is often all or nothing for an autist, so if someone rejects one small thing, it may skew our entire perception of ourselves.

You don’t like my shoes = you don’t like me.

The shoes are wrong, I chose the shoes, the shoes are on my body, therefore, I’m wrong. The world is black and white so if I’m wearing the wrong shoes, everything else about me has to be wrong by extension- you’re either wrong or right, you can’t be both.

RSV can be pretty exhausting for an autist, so understanding of our responses to rejection is vital to supporting us. If you’re struggling with RSV, cognitive behavioural therapy (CBT) can help you learn how to better process feelings of rejection, but medication such as ADHD drugs and anti-depressants can be useful for more severe cases.

Hope you enjoyed this post dear earthlings!

Have a lovely weekend! 🙂

Aoife

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Autism and the Immune System

Greetings Earthlings! 🙂

This week I’d like to discuss how the immune system can contribute to autism through inflammation and autoimmune diseases.

Really Aoife? I thought the immune system was supposed to protect me from illness and repair the body after injuries?

Yes- ordinarily the immune system functions to protect and heal us from injury and disease, however, dysfunctions in the immune system can cause serious health issues. There are three main categories of immune dysfunction:

  • Immunodeficiency– where one or more parts of the immune system are inactive
  • Autoimmunity– where an overactive immune system is unable to tell the difference between the cells of the body and foreign invaders like bacteria and viruses. This leads to autoimmune disease (such as rheumatoid arthritis) where the immune system attacks healthy cells causing disease
  • Hypersensitivity– similar to autoimmunity where the immune system triggers an undesirable allergic reaction (like asthma and anaphylaxis) which attacks the cells of the body

So how does the immune system relate to autism?

A number have studies have highlighted that abnormal immune system activation could be playing a role in the development of autism. Inflammation is the body’s natural defense against foreign invaders. When the body is under attack from an infection for example, it starts to release pro-inflammatory chemicals called cytokines which triggers inflammation to start the battle. Once the threat has passed, an anti-inflammatory response begins to cool the body back down. This heating/cooling cycle doesn’t always run smoothly for some people leading to persistent inflammation which over time can cause damage to the body. Studies have shown that autists frequently show signs of widespread inflammation, often having high levels of pro-inflammatory chemicals. Postmortem brain samples in particular have shown evidence of enhanced immune activity suggesting that an overactive immune system may be contributing to the autistic brain.

There are also some studies that suggest autists are producing antibodies that attack their own brains- I know I’m my own worst enemy, but that is next level! 😛

Researchers believe that abnormal immune activity during pregnancy in particular could be a contributory factor in autism. Studies have noted that many women that have an autoimmune disease (such as lupus, psoriasis, diabetes etc.) also have a child with autism leading them to this potential link. It’s thought that pregnant women with autoimmune diseases produce antibodies that attack the baby’s brain as the immune system falsely identifies the baby as a foreign invader which can potentially cause autism and ADHD. Moreover, inflammation during pregnancy is also thought to interfere with the development of folds in the brain.

But is there any explanation as to why immune activity is abnormal in autism?

As with most things linked to autism, it’s likely that this activity has a genetic source. A number of the genes that have been linked to autism are also involved with the immune system, so mutations in these genes could explain the correlation.

Hope you enjoyed this post dear Earthlings!

Have a lovely weekend! 🙂

Aoife

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Autism & Joint Hypermobility

Greetings Earthlings! 🙂

This week I’d like to discuss another lesser known comorbidity with autism- joint hypermobility.

So what exactly is joint hypermobility?

It’s a pretty self-explanatory condition where joints have a larger range of motion than normal, more commonly referred to as being “double jointed”. The tissue connecting joints is much more stretchy so joints are highly flexible. This is usually caused by weak collagen- the main protein that makes up connective tissues that provide support in the body such as muscles, tendons, ligaments, bone etc.

Lots of people have hypermobile joints, but some may have hypermobility disorders such as Ehlers-Danlos Syndrome (EDS) which negatively effects connective tissues. There are 13 types of EDS, each with different symptoms, but the most common type is hypermobile EDS with symptoms including painful and clicking joints, excessive bruising, digestive issues, unstable joints and thin stretchy skin. 8% of autists are estimated to have EDS, with even more estimated to have other types of hypermobility disorders. As both of these conditions are assessed by different types of doctors, it’s possible the co-occurrence rate is much higher than we realise.

In my own experience, I’ve always known that I was highly flexible, but I’d never considered that this might not be “normal”. My English teacher once looked at me recoiling in horror as I stared back confused and oblivious. Apparently my thumbs were freaking him out as I’m able to bend them backwards- something that I thought everyone was able to do!

Here’s a closer illustration for context:

I haven’t thought much of my joints for years, but recently both my physiotherapist and chiropractor described them as hypermobile. This seemingly has contributed to many injuries over the years- I’m currently dealing with a “wandering kneecap” among other things 😂. Lo and behold, a few weeks later I came across a study linking hypermobility to ASD’s and ADHD!

So how are the conditions linked?

Again, as with most aspects of the spectrum the link remains unclear, however, it does appear to be genetic. Hypermobility disorders are highly hereditary with 20% of mothers experiencing hypermobility reporting that they have an autistic child. A recent study compared the genes known to be related to hypermobility and autism and found that there was a lot of overlap between these genes and the pathways they interact with which likely explains why the two conditions are co-morbid. Immune system dysregulation has also been linked to both conditions, particularly during pregnancy (I will discuss the immune link to autism in more detail in a later post).

So there you have it, lot’s of autists are highly flexible- which is kind of ironic given how inflexible we can be in other areas of our lives 😜🤣

Hope you enjoyed this post dear Earthlings! 🙂

Have a lovely weekend!

Aoife

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