Physical Health Challenges in Neurodivergent Children

Neurodivergent children, including those with conditions like autism, ADHD, and dyslexia, often face unique physical health challenges that may not be immediately obvious. Among these challenges are physical conditions like hypermobility, Ehlers-Danlos Syndrome (EDS), and other connective tissue disorders. These conditions often coexist with neurodivergence, complicating both diagnosis and treatment.

Symptomatic Hypermobility and Neurodivergence

Recent research indicates that neurodivergent children are more likely to experience hypermobility—an increased range of motion in the joints. Studies have shown that neurodivergent individuals are more than twice as likely to be hypermobile compared to the general population​. Hypermobile children may experience joint pain, fatigue, and gastrointestinal issues, often without these being recognized as related to their neurodivergent condition. In fact, many health professionals may attribute symptoms like anxiety, stomachaches, or migraines to the neurodivergence alone, a phenomenon known as "diagnostic overshadowing"​​.

Impact of Undiagnosed Physical Conditions

When hypermobility or EDS is undiagnosed, it can lead to a range of challenges, particularly in educational settings. Neurodivergent children with these conditions often experience chronic pain, fatigue, and "brain fog," which can impair their concentration and school attendance​. Physical discomfort can manifest in emotional outbursts or absenteeism, and these behaviors are sometimes misunderstood as purely behavioral issues rather than signs of underlying physical distress​.

For instance, a child who appears to be struggling with concentration or has frequent absences may actually be dealing with severe joint pain or fatigue. Many hypermobile children mask their pain, which can result in co-occurring psychiatric conditions like anxiety or depression. In some cases, neurodivergent children experience what is termed "emotional-based school avoidance" (EBSA), where their physical symptoms, such as stomach pain or migraines, are mistaken for emotional or behavioral issues​.

Managing Physical Health in School

Addressing these challenges requires a multidisciplinary approach that integrates both the child’s neurodivergent and physical health needs. Schools play a crucial role in recognizing and supporting children with these co-occurring conditions. For instance, students with hypermobility or EDS may need accommodations such as flexible seating, modified physical activities, and even mobility aids like wheelchairs on bad pain days​. Schools that support neurodivergent children with hypermobility should also consider flexible attendance policies and alternative learning environments to accommodate frequent medical appointments and days when the child is unable to attend school​.

Additionally, educating teachers and staff about these physical health conditions is critical. Many children with hypermobility excel in certain physical activities, but their abilities may fluctuate. For example, a child may be able to participate in physical education one day but require a wheelchair the next​. Understanding these fluctuations can help prevent misunderstandings and ensure that children receive the appropriate support.

Co-occurring Health Conditions

Neurodivergent children often experience a range of co-occurring health issues. Gastrointestinal problems, headaches, and immune dysfunctions are common among children with EDS or hypermobility​. Dysautonomia, a condition affecting the autonomic nervous system, often overlaps with hypermobility and can exacerbate symptoms like fatigue and dizziness. These health issues can significantly impact a child’s ability to focus, attend school, and engage socially​.

Furthermore, there is growing evidence that physical symptoms like gastrointestinal discomfort or chronic pain can worsen mental health outcomes. Anxiety and depression are common in children with EDS and hypermobility​. This makes it even more crucial for healthcare providers to consider both the physical and mental health needs of neurodivergent children.

Recommendations for Support

1. Multidisciplinary Care: Children with neurodivergence and physical health challenges, such as hypermobility, benefit from care teams that include pediatricians, physical therapists, and mental health professionals. This holistic approach helps manage both the physical and psychological impacts.
2. Educational Adjustments: Schools should offer accommodations like modified PE programs, flexible seating, and accessible classrooms. Flexibility in attendance and the use of blended or online learning can help children keep up with their education during flare-ups of pain or fatigue.
3. Awareness and Training: Educating teachers, healthcare providers, and families about the connection between neurodivergence and physical health challenges is essential. This can reduce instances of diagnostic overshadowing and improve overall support for the child.
4. Student-Centered Approaches: Including the voices of neurodivergent children in developing their care and education plans is crucial. Listening to their experiences with pain and fatigue ensures that interventions are appropriate and effective​​.

Conclusion

Neurodivergent children with conditions like hypermobility and EDS face complex challenges that require both medical and educational interventions. Increased awareness and a multidisciplinary approach are key to ensuring these children receive the support they need to thrive. By recognizing and addressing the physical health challenges that often coexist with neurodivergence, we can help improve the overall quality of life and educational outcomes for these children.

References

• Green, J. (2023). Supporting Neurodivergent Pupils with Symptomatic Hypermobility. Schools Week. Link to article.
• Donaghy, B., Moore, D., & Green, J. (2022). Co-Occurring Physical Health Challenges in Neurodivergent Children and Young People: A Topical Review and Recommendation. Child Care in Practice. Link to article.

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