Neurodivergents and Flexibility Training
Neurodivergents is an inclusive term that celebrates the attributes and positive impact of individuals with different ways of interacting and understanding the world while recognising challenges, stigmas and biases they face. It's most commonly used to describe autistic people (Autism Spectrum Disorder (ASD)) and Attention Deficit Hyperactivity Disorder (ADHD) but encapsulates all those with differences in cognition, perception, learning, development and communication.
If you identify as neurodivergent and train flexibility, you will recognise that you are not alone. Not only does flexibility training encourage positive expression of favourable attributes, it can be a way for neurodivergent individuals to foster self-efficacy by supporting autonomy, relatedness and competence (Self-determination Theory. Deci and Ryan, 1985; Ryan and Deci, 2000).
This blog post will briefly consider factors that commonly influence flexibility training in neurodivergent people and will form the basis for recommendations and accommodations detailed in part two of this series. Everyone is unique, with their own strengths, challenges and preferences. The intent of this series is to encourage inclusive, safe and meaningful flexibility training for neurodivergent people.
NB: First person language will be used throughout this blog. Often research is 'pathology focused' and conducted on a defined cohort. This cohort will be indicated in parenthese ().
Hypermobility and Connective Tissue Disorders
Neurodivergent people are more likely to have joint hypermobility and connective tissue disorders. The incidence of Ehlers-Danlos syndrome (EDS), especially hEDS, and Hypermobility Spectrum Disorder (HSD) is higher in neurodivergent people (ASD, ADHD) than in the general population (Csecs, 2021).
While the link is not clearly understood, EDS and HDS share common symptoms (with ASD and ADHD), including; joint hypermobility, chronic fatigue, chronic pain, autonomic dysregulation, sleep disorders, coordination and proprioceptive difficulties, and sensory sensitivity (Casinova, 2020). In addition, neurodivergent people (ASD, ADHD) with EDS or HSD have more severe symptoms (Kindgren, 2021).
Neurodivergent people (ASD, ADHD) experience pain differently. They are more likely to experience chronic pain, but the reasons for this are complex and multi-faceted (Failla, 2022)(Kerekes, 2021).
There is a difference between pain sensitivity and pain tolerance. An individual can be sensitive to pain (*think* 'more efficient at experiencing pain') for many biological, psychological and social reasons such as; illness, chronic pain, fatigue, mental illness, stress, reduced socioeconomic status, increased reactivity of the neuroimmune system, low self-efficacy and previous negative experiences associated with pain. On the other hand, pain tolerance relates to the ability to cope with pain, including physical, cognitive, behavioural and attentional strategies that reduce the impact of pain. It's not unusual for those with increased pain sensitivity to display high pain tolerance i.e. they experience a lot of pain but still function well. Conversely, people with high pain thresholds can display less tolerance to pain because they are less experienced with managing pain.
Sensory Hyper/Hypo Sensitivity & Sensory Seeking
Our sensory systems interact to help us understand the world and our space in it. They allow us to see, hear, feel, smell, taste and orientate. However, these systems are not just information in and sensation out. Neural modulation creates meaningful experiences unique to us.
Neurodivergent people (ASD, ADHD) can experience hypo (less) and hyper (more) sensitivity, be less tolerant of inputs and be prone to over-stimulation. 'Sensory overload' can lead to meltdowns, shutdowns and contribute to burnout (Casinova, 2020)(Murray, 2022).
Neurodivergent people often have strong sensory preferences. Preferred sensory experiences tend to confer comfort, consistency and safety, and may include eating familiar foods, deep pressure, rocking, soft music, uncluttered spaces and low light. Similarly, neurodiverse individuals may adopt stimming behaviours to nurture, regulate and self-soothe. Sensory irritants challenge continuity and safety, so they are given more attention. Common sensory challenges can include loud noise, bright lights, rough clothes, strong perfumes, mixed textured foods and unfamiliar foods, although preferences are individual.
Conditions such as postural orthostatic tachycardia syndrome (POT), vasovagal syncope (VVS), and orthostatic hypotension (OH) are overrepresented in neurodivergent people (ASD and ADHD). They impact a person's ability to self-regulate temperature, blood pressure and heart rate, meaning an increased incidence of loss of consciousness (Owens, 2021).
The cause of autonomic dysregulation seems to be sympathoexcitation (Owens, 2021). The sympathetic nervous system (SNS) prepares our bodies in times of perceived threat to fight, flight, freeze or flop by increasing heart rate (HR), increased respiratory rate (RR), blood to our muscles, pain sensitivity, intuitive thinking, and sensory acuity, as a way to drive protective action. However, the SNS also down-regulates the parasympathetic nervous system (PNS), which is responsible for growth, rest and repair by supporting digestion, sleep, immune function, and cognition.
Aside from the risk of syncope, those with autonomic dysregulation are more likely to experience anxiety, sleep disturbance, chronic pain, impaired recovery, and sensory sensitivity, all of which impact flexibility training.
Usual ways of imparting information can make processing more challenging for neurodivergents. People learn through a combination of auditory, visual, reading/writing, or kinesthetic (movement, feeling) presentation. Neurodivergents may have difficulties with focus and attention (hypo/hyper-focus), have a strong preference for one presentation style over others, and/or find it difficult to engage if too much information or too many instructions are given at a time. Neurodivergents may prefer 1:1 interactions or small groups to support their learning, limit distractions, and feel more secure. They can be great creative thinkers who learn through problem-solving and benefit from options and choices.
Factors that commonly influence flexibility training in neurodivergent people include;
- Hypermobility and connective tissue disorders
- Pain hyper and hyposensitivity
- Sensory hyper/hypo sensitivity & sensory seeking
- Autonomic dysregulation
- Learning preferences.
The next post in this series will explore practical considerations and accommodations that encourage inclusive, safe and meaningful flexibility training for neurodivergent people.
Csecs JLL, Iodice V, Rae CL, Brooke A, Simmons R, Quadt L, Savage GK, Dowell NG, Prowse F, Themelis K, Mathias CJ, Critchley HD, Eccles JA. Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain. Front Psychiatry. 2022 Feb 2;12:786916. doi: 10.3389/fpsyt.2021.786916. PMID: 35185636; PMCID: PMC8847158.
Doyle, N. (2020). Neurodiversity at work: a biopsychosocial model and the impact on working adults. British Medical Bulletin, 135(1), 108-125. https://doi.org/10.1093/bmb/ldaa021
Failla MD, Moana-Filho EJ, Essick GK, Baranek GT, Rogers BP, Cascio CJ. Initially intact neural responses to pain in autism are diminished during sustained pain. Autism. 2018 Aug;22(6):669-683. doi: 10.1177/1362361317696043. Epub 2017 May 17. PMID: 28513186; PMCID: PMC6352721.
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 Feb 10;17:379-388. doi: 10.2147/NDT.S290494. PMID: 33603376; PMCID: PMC7882457.
Murray D, Milton D, Green J, Bervoets J. The Human Spectrum: A Phenomenological Enquiry within Neurodiversity. Psychopathology. 2022 Sep 30:1-11. doi: 10.1159/000526213. Epub ahead of print. PMID: 36183692.
Owens, A. P., Mathias, C. J., & Iodice, V. (2021). Autonomic Dysfunction in Autism Spectrum Disorder. Frontiers in Integrative Neuroscience. https://doi.org/10.3389/fnint.2021.787037
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55, 68-78.