EXPLORING THE GENETIC AND CLINICAL OVERLAP BETWEEN EHLERS-DANLOS SYNDROME, AUTISM SPECTRUM DISORDER, AND ADHD: A COMPREHENSIVE REVIEW

Keywords: Ehlers-Danlos Syndrome, Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, Comorbidity, Genetic Overlap, Neurodevelopmental Disorders

Abstract

Background: Neurodevelopmental disorders, including Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD), manifest early in life and are characterized by impaired functioning in different life domains. A group of genetic tissue disorders known under the name Ehlers-Danlos Syndrome (EDS) also manifest themselves in early childhood. Recent research points to a possible genetic and symptomatic link between EDS and neurodevelopmental disorders. This review focuses on similar manifestations and co-occurrence of the disorders mentioned above.

Objective: This review investigates the prevalence and significance of comorbid ASD and ADHD in individuals with EDS. Additionally, the genetic and symptomatic connections shared by those conditions are worth exploring, knowing that they could pave the way for joint diagnostic and treatment approaches.

Methods: A systematic literature review was conducted using databases such as PubMed, Cochrane Library, Web of Science, and Google Scholar. Selected studies were chosen based on their focus on the prevalence of ASD and ADHD in EDS patients, genetic or neurobiological links, and statistical analyses of comorbid rates

Results: The prevalence of ADHD in individuals with EDS is significantly higher than in the general population; according to available data, nearly half of EDS patients meet the diagnostic criteria for ADHD. A similar occurrence has been found in individuals diagnosed with EDS - they have a significantly higher chance of being diagnosed with ASD.  Shared gene variations between EDS and ASD/ADHD related to synaptic function and neural development have been identified by several genetic studies. The results indicate the possibility of common neurodevelopmental pathways between those conditions. Furthermore, both EDS and ASD/ADHD present with shared symptoms such as joint hypermobility, proprioceptive issues, and autonomic dysfunction.

Conclusion: Numerous reports highlight the higher than-in-population comorbidity rates of ASD and ADHD in EDS patients. This emphasizes the need to implement routine screening and improve the management of individuals suffering from these conditions. Further research into the genetic and neurobiological connections can help introduce new interventions focused on the complexity of the problem and improve results in patient care and quality of life.

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . Arlington, VA: American Psychiatric Association Publishing; 2013

Spek AA. De invloed van genen en omgeving op het ontstaan van autismespectrumstoornissen [The influence of genes and environment on the development of autism spectrum disorders]. Tijdschr Psychiatr. 2014;56(10):660-667.

Martin J, O'Donovan MC, Thapar A, Langley K, Williams N. The relative contribution of common and rare genetic variants to ADHD. Transl Psychiatry. 2015;5(2):e506. Published 2015 Feb 10. doi:10.1038/tp.2015.5

Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, Bloom L, Bowen JM, Brady AF, Burrows NP, Castori M, Cohen H, Colombi M, Demirdas S, De Backer J, De Paepe A, Fournel-Gigleux S, Frank M, Ghali N, Giunta C, Grahame R, Hakim A, Jeunemaitre X, Johnson D, Juul-Kristensen B, Kapferer-Seebacher I, Kazkaz H, Kosho T, Lavallee ME, Levy H, Mendoza-Londono R, Pepin M, Pope FM, Reinstein E, Robert L, Rohrbach M, Sanders L, Sobey GJ, Van Damme T, Vandersteen A, van Mourik C, Voermans N, Wheeldon N, Zschocke J, Tinkle B. 2017. The 2017 international classification of the Ehlers–Danlos syndromes. Am J Med Genet Part C Semin Med Genet 175C: 8–26.

Malfait, F., Castori, M., Francomano, C.A. et al. The Ehlers–Danlos syndromes. Nat Rev Dis Primers 6, 64 (2020). https://doi.org/10.1038/s41572-020-0194-9

Ehlers-Danlos Society. Hedge C. EDS Genetic Counseling [Internet]. Ehlers-Danlos Society; 2019. https://www.ehlers-danlos.com/hedge/

National Institute of Health About autism. National Human Genome Research Institute. Updated May, 2019 https://www.genome.gov/Genetic-Disorders/Autism

Sieg KG. Autism and Ehlers-Danlos syndrome. J Am Acad Child Adolesc Psychiatry. 1992;31(1):173. doi:10.1097/00004583-199201000-00034

Chatzikonstantinou A, Wolf ME, Hennerici MG. Isolated cortical vein thrombosis: Clinical characteristics, MRI findings and outcomes. J Neurol Sci. 2013;334(1-2):129-32

Battison EAJ, Brown PCM, Holley AL, Wilson AC. Associations between Chronic Pain and Attention-Deficit Hyperactivity Disorder (ADHD) in Youth: A Scoping Review. Children (Basel). 2023;10(1):142. Published 2023 Jan 11. doi:10.3390/children10010142

Riquelme I, Hatem SM, Montoya P. Abnormal Pressure Pain, Touch Sensitivity, Proprioception, and Manual Dexterity in Children with Autism Spectrum Disorders. Neural Plast. 2016;2016:1723401. doi:10.1155/2016/1723401

Kindgren E, Quiñones Perez A, Knez R. Prevalence of ADHD and Autism Spectrum Disorder in Children with Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome: A Retrospective Study. Neuropsychiatr Dis Treat. 2021;17:379-388. Published 2021 Feb 10. doi:10.2147/NDT.S290494

McElhanon BO, McCracken C, Karpen S, Sharp WG. Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics. 2014;133(5):872-883. doi:10.1542/peds.2013-3995

Thwaites PA, Gibson PR, Burgell RE. Hypermobile Ehlers-Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know. J Gastroenterol Hepatol. 2022;37(9):1693-1709. doi:10.1111/jgh.15927

Kedem S, Yust-Katz S, Carter D, et al. Attention deficit hyperactivity disorder and gastrointestinal morbidity in a large cohort of young adults. World J Gastroenterol. 2020;26(42):6626-6637. doi:10.3748/wjg.v26.i42.6626

Malfait F, Francomano C, Byers P, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8-26. doi:10.1002/ajmg.c.31552

Fournier, K.A., Hass, C.J., Naik, S.K. et al. Motor Coordination in Autism Spectrum Disorders: A Synthesis and Meta-Analysis. J Autism Dev Disord 40, 1227–1240 (2010). https://doi.org/10.1007/s10803-010-0981-3

Fliers, E., Rommelse, N., Vermeulen, S. et al. Motor coordination problems in children and adolescents with ADHD rated by parents and teachers: effects of age and gender. J Neural Transm 115, 211–220 (2008).

Celletti C, Camerota F, Castori M, et al. Orthostatic Intolerance and Postural Orthostatic Tachycardia Syndrome in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome, Hypermobility Type: Neurovegetative Dysregulation or Autonomic Failure?. Biomed Res Int. 2017;2017:9161865. doi:10.1155/2017/9161865

Chan, C., Krahe, A., Lee, Y.T. et al. Prevalence and frequency of self-perceived systemic features in people with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type. Clin Rheumatol 38, 503–511 (2019). https://doi.org/10.1007/s10067-018-4296-7

Owens AP, Mathias CJ, Iodice V. Autonomic Dysfunction in Autism Spectrum Disorder. Front Integr Neurosci. 2021;15:787037. Published 2021 Dec 30. doi:10.3389/fnint.2021.787037

Dalla Vecchia E, Mortimer N, Palladino VS, et al. Cross-species models of attention-deficit/hyperactivity disorder and autism spectrum disorder: lessons from CNTNAP2, ADGRL3, and PARK2. Psychiatr Genet. 2019;29(1):1-17. doi:10.1097/YPG.0000000000000211

Wareham, L.K., Baratta, R.O., Del Buono, B.J. et al. Collagen in the central nervous system: contributions to neurodegeneration and promise as a therapeutic target. Mol Neurodegeneration 19, 11 (2024). https://doi.org/10.1186/s13024-024-00704-0

Rae Thomas, Sharon Sanders, Jenny Doust, Elaine Beller, Paul Glasziou; Prevalence of Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis. Pediatrics April 2015; 135 (4): e994–e1001. 10.1542/peds.2014-3482

Zeidan J, Fombonne E, Scorah J, et al. Global prevalence of autism: A systematic review update. Autism Res. 2022;15(5):778-790. doi:10.1002/aur.2696

Bandtlow CE, Zimmermann DR. Proteoglycans in the developing brain: new conceptual insights for old proteins. Physiol Rev. 2000;80(4):1267-1290. doi:10.1152/physrev.2000.80.4.1267

DOĞAN, Şebnem Koldaş; TANER, Yasemen; EVCIK, Deniz. Benign joint hypermobility syndrome in patients with attention deficit/hyperactivity disorders. 2011.

Cederlöf M, Larsson H, Lichtenstein P, Almqvist C, Serlachius E, Ludvigsson JF. Nationwide population-based cohort study of psychiatric disorders in individuals with Ehlers-Danlos syndrome or hypermobility syndrome and their siblings. BMC Psychiatry. 2016;16:207. Published 2016 Jul 4. doi:10.1186/s12888-016-0922-6

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2025-12-11
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Agata Zapałowska, Michał Bielecki, Kamil Kondracki, Anna Bieda, Monika Kondracka, Wojciech Kozłowski, & Milena Szczepańska. (2025). EXPLORING THE GENETIC AND CLINICAL OVERLAP BETWEEN EHLERS-DANLOS SYNDROME, AUTISM SPECTRUM DISORDER, AND ADHD: A COMPREHENSIVE REVIEW. International Journal of Innovative Technologies in Social Science, (4(48). https://doi.org/10.31435/ijitss.4(48).2025.4027