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Generalised joint hypermobility and neurodevelopmental traits in a non-clinical adult population

Published online by Cambridge University Press:  02 January 2018

Martin Glans
Stockholm County Council, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
Susanne Bejerot*
School of Medical Sciences, Örebro University, Örebro, Sweden; University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Mats B. Humble
School of Medical Sciences, Örebro University, Örebro, Sweden; University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
Susanne Bejerot, School of Medical Sciences, Örebro University, SE-70182 Örebro, Sweden. E-mail:
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Generalised joint hypermobility (GJH) is reportedly overrepresented among clinical cases of attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and developmental coordination disorder (DCD). It is unknown if these associations are dimensional and, therefore, also relevant among non-clinical populations.


To investigate if GJH correlates with sub-syndromal neurodevelopmental symptoms in a normal population.


Hakim-Grahame's 5-part questionnaire (5PQ) on GJH, neuropsychiatric screening scales measuring ADHD and ASD traits, and a DCD-related question concerning clumsiness were distributed to a non-clinical, adult, Swedish population (n=1039).


In total, 887 individuals met our entry criteria. We found no associations between GJH and sub-syndromal symptoms of ADHD, ASD or DCD.


Although GJH is overrepresented in clinical cases with neurodevelopmental disorders, such an association seems absent in a normal population. Thus, if GJH serves as a biomarker cutting across diagnostic boundaries, this association is presumably limited to clinical populations.

Copyright © The Royal College of Psychiatrists 2017


Declaration of interest



1 Juul-Kristensen, B, Schmedling, K, Rombaut, L, Lund, H, Engelbert, RHH. Measurement properties of clinical assessment methods for classifying generalized joint hypermobility: A systematic review. Am J Med Genet Part C Semin Med Genet 2017; 175: 116–47.Google Scholar
2 Castori, M, Colombi, M. Generalized joint hypermobility, joint hypermobility syndrome and Ehlers–Danlos syndrome, hypermobility type. Am J Med Genet Part C Semin Med Genet 2015; 169: 15.Google Scholar
3 Hakim, A, Grahame, R. Joint hypermobility. Best Pract Res Clin Rheumatol 2003; 17: 9891004.Google Scholar
4 Beighton, P, Solomon, L, Soskolne, CL. Articular mobility in an African population. Ann Rheum Dis 1973; 32: 413–8.Google Scholar
5 Hakim, AJ, Grahame, R. A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain. Int J Clin Pract 2003; 57: 163–6.Google Scholar
6 Sinibaldi, L, Ursini, G, Castori, M. Psychopathological manifestations of joint hypermobility and joint hypermobility syndrome/Ehlers–Danlos syndrome, hypermobility type: the link between connective tissue and psychological distress revised. Am J Med Genet Part C Semin Med Genet 2015; 169: 97106.CrossRefGoogle Scholar
7 Baeza-Velasco, C, Pailhez, G, Bulbena, A, Baghdadli, A. Joint hypermobility and the heritable disorders of connective tissue: clinical and empirical evidence of links with psychiatry. Gen Hosp Psychiatry 2015; 37: 2430.Google Scholar
8 Bulbena, A, Baeza-Velasco, C, Bulbena-Cabré, A, Pailhez, G, Critchley, H, Chopra, P, et al . Psychiatric and psychological aspects in the Ehlers–Danlos syndromes. Am J Med Genet Part C Semin Med Genet 2017; 175: 237–45.Google Scholar
9 Celletti, C, Mari, G, Ghibellini, G, Celli, M, Castori, M, Camerota, F. Phenotypic variability in developmental coordination disorder: clustering of generalized joint hypermobility with attention deficit/hyperactivity disorder, atypical swallowing and narrative difficulties. Am J Med Genet Part C Semin Med Genet 2015; 169: 117–22.Google Scholar
10 Baeza-Velasco, C, Grahame, R, Bravo, JF. A connective tissue disorder may underlie ESSENCE problems in childhood. Res Dev Disabil 2016; 60: 232–42.Google Scholar
11 Bulbena, A, Agulló, A, Pailhez, G, Martín-Santos, R, Porta, M, Guitart, J, et al . Is joint hypermobility related to anxiety in a nonclinical population also? Psychosomatics 2004; 45: 432–7.Google Scholar
12 Sanches, SB, Osório, FL, Louzada-Junior, P, Moraes, D, Crippa, JAS, Martín-Santos, R. Association between joint hypermobility and anxiety in Brazilian university students: gender-related differences. J Psychosom Res 2014; 77: 558–61.Google Scholar
13 Mallorquí-Bagué, N, Garfinkel, SN, Engels, M, Eccles, JA, Pailhez, G, Bulbena, A, et al. Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility. Front Psychol 2014; 5: 1162.Google Scholar
14 Plenty, S, Bejerot, S, Eriksson, K. Humor style and motor skills: understanding vulnerability to bullying. Eur J Psychol 2014; 10: 480–91.Google Scholar
15 Bejerot, S, Plenty, S, Humble, A, Humble, MB. Poor motor skills: a risk marker for bully victimization. Aggress Behav 2013; 39: 453–61.Google Scholar
16 Hakim, AJ, Cherkas, LF, Grahame, R, Spector, TD, MacGregor, AJ. The genetic epidemiology of joint hypermobility: a population study of female twins. Arthritis Rheum 2004; 50: 2640–4.Google Scholar
17 Kessler, RC, Adler, L, Ames, M, Demler, O, Faraone, S, Hiripi, E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 2005; 35: 245–56.Google Scholar
18 Fasmer, OB, Halmøy, A, Oedegaard, KJ, Haavik, J. Adult attention deficit hyperactivity disorder is associated with migraine headaches. Eur Arch Psychiatry Clin Neurosci 2011; 261: 595602.Google Scholar
19 Allison, C, Auyeung, B, Baron-Cohen, S. Toward brief ‘red flags’ for autism screening: the short Autism Spectrum Quotient and the short Quantitative Checklist in 1,000 cases and 3,000 controls. J Am Acad Child Adolesc Psychiatry 2012; 51: 202–12.Google Scholar
20 Baron-Cohen, S, Wheelwright, S, Skinner, R, Martin, J, Clubley, E. The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord 2001; 31: 517.Google Scholar
21 Murray, AL, Booth, T, McKenzie, K, Kuenssberg, R. What range of trait levels can the autism-spectrum quotient (AQ) measure reliably? An item response theory analysis. Psychol Assess 2016; 28: 673–83.CrossRefGoogle ScholarPubMed
22 Insel, TR. The NIMH Research Domain Criteria (RDoC) Project: precision medicine for psychiatry. Am J Psychiatry 2014; 171: 395–7.CrossRefGoogle ScholarPubMed
23 Kapur, S, Phillips, AG, Insel, TR. Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Mol Psychiatry 2012; 17: 1174–9.Google Scholar
24 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.CrossRefGoogle ScholarPubMed
25 Malfait, F, Francomano, C, Byers, P, Belmont, J, Berglund, B, Black, J, et al. The 2017 international classification of the Ehlers–Danlos syndromes. Am J Med Genet Part C Semin Med Genet 2017; 175: 826.Google Scholar
26 Eccles, JA, Beacher, FDC, Gray, MA, Jones, CL, Minati, L, Harrison, NA, et al . Brain structure and joint hypermobility: relevance to the expression of psychiatric symptoms. Br J Psychiatry 2012; 200: 508–9.CrossRefGoogle Scholar
27 Gazit, Y, Nahir, AM, Grahame, R, Jacob, G. Dysautonomia in the joint hypermobility syndrome. Am J Med 2003; 115: 3340.Google Scholar
28 Cairney, J, Veldhuizen, S, Szatmari, P. Motor coordination and emotional–behavioral problems in children. Curr Opin Psychiatry 2010; 23: 324–9.Google Scholar
29 Bejerot, S, Humble, MB. Childhood clumsiness and peer victimization: a case–control study of psychiatric patients. BMC Psychiatry 2013; 13: 68.Google Scholar
30 Bulbena, A, Duró, JC, Porta, M, Faus, S, Vallescar, R, Martín-Santos, R. Clinical assessment of hypermobility of joints: assembling criteria. J Rheumatol 1992; 19: 115–22.Google Scholar
31 Moraes, DA De, Baptista, CA, Alexandre, J, Crippa, S, Louzada-Junior, P. Translation into Brazilian Portuguese and validation of the five-part questionnaire for identifying hypermobility. Rev Bras Reumatol 2011; 51: 5369.Google Scholar
32 Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, et al . The epidemiology of major depressive disorder. JAMA 2003; 289: 3095.Google Scholar
33 Moffitt, TE, Caspi, A, Taylor, A, Kokaua, J, Milne, BJ, Polanczyk, G, et al. How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychol Med 2010; 40: 899909.Google Scholar
34 Bulbena, A, Mallorquí-Bagué, N, Pailhez, G, Rosado, S, González, I Blanch-Rubió, J, et al. Self-reported screening questionnaire for the assessment of Joint Hypermobility Syndrome (SQ-CH), a collagen condition, in Spanish population. Eur J Psychiatry 2014; 28: 1726.Google Scholar
35 Remvig, L, Jensen, DV, Ward, RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol 2007; 34: 804–9.Google Scholar
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