Neurodiversity and Bendy Bodies
Fluffy cat sleeping in a comfortable twisted position with arms going one way and legs going the opposite way, not unlike how I sleep
Does your neurodivergent child (or child you suspect might be) have a very bendy body? Do they happen to appear clumsy or get injured more than their peers? Maybe they have difficulty identifying the early body signals that should tell them when they are hungry, have to go to the bathroom, or are at risk of overheating? If so, you are not the only one. This collection of observations is more common than you might think.
Approximately 40% of people with diagnosed autism and ADHD display characteristics of hypermobility, according to a meta-analysis conducted in 2025 (Baeza-Velasco C, Vergne J, Poli M, Kalisch L, Calati R). It is unclear why this is true. But it certainly rings true for what we see in our practice. Why is it important to know about this common co-occurrence? Because if you don’t, you are going to miss the underlying causes of many behaviors, challenges, and experiences, putting the individual at risk of being dismissed, injured, or gaslit. By understanding the quirks, dangers, and sensory experiences of a hypermobile body, we can better understand some of the underlying challenges of our neurodivergent children.
How might you know if your child is hypermobile? Most babies and toddlers are very flexible. They have bones that haven’t fused yet and their tissues are soft and supple. But by preschool age, super flexibility is no longer expected. Your child might be hypermobile if:
they tend to sit in a “w” position when on the floor
they can hyperextend (bend the wrong way) their elbows and/or knees when weightbearing
they have significant difficulty with grasp on utensils, like pencils or forks
they fatigue easily from moderate physical activity
they have experienced significant injury (break, dislocation, serious bruising, etc.) from a minor event
they complain of pain from regular, everyday activities or positions
they appear more clumsy or awkward than their peers
they can get into positions that seem impossible
they tend to slump, lean on furniture, or fall over while seated
they tend to rock or pace while standing “still”
they tend to use too much or too little pressure when handling objects
None of the above observations by itself means your child is hypermobile. An OT, PT, or MD can assess your child’s range of motion and muscle tone to be sure. But these observations can give you an idea of whether hypermobility should be on your mind.
Why does it matter if you are hypermobile?
People who are hypermobile experience differences in how they develop motor skills, in how they process their sensory environments, and in the type of supports and precautions that are required to keep them safe. Hypermobility is a general term that means a person’s body moves more than average. Hypermobility exists as a spectrum from mild to extreme. There are a range of different diagnoses that are associated with hypermobility, including:
Ehlers Danlos Syndrome
Marfan Syndrome
Down Syndrome
Hypermobility Spectrum Disorder
Hypotonia
and many more…
In all of these cases, the joints are hyper-flexible, often with surrounding soft tissue that is supposed to be holding joints together, but is too stretchy to properly do its job. This has a huge impact on sensory processing. Let me explain.
What do loose joints have to do with sensory processing?
Sensory processing is a neurological processing by which:
our brains receive information about our environment
our brains interpret the information, and
our bodies respond accordingly to the information.
An example of functional sensory processing is when you touch something hot, 1) a pain signal goes to your brain, 2) your brain detects danger, 3) your hand moves away.
An example of dysfunctional sensory processing might be if you touch something hot and your brain either doesn’t receive the signal, or doesn’t interpret it as danger, you do not withdraw your hand, and you get burned.
“Proprioception” is a fancy word for “body awareness”
There are sensory receptors in our muscles and joints (called proprioceptors) that are responsible for detecting and transmitting information about our body to our brain. This sensory processing system is called “proprioception.” In a person with average muscle tone and average joint mobility, the receptors in the joints and muscles are easily activated, transmitting ample information to the brain for interpretation. In a person with hypermobile joints and/or low muscle tone, there is more room and less tension surrounding the proprioceptors, making it harder to activate them. In this case the brain receives far less information about the body than average. High intensity impact through muscles and joints may be required in order for the brain to be fully aware of the body and of how and when to move in response to the environment.
Coordination
If you are thinking to yourself, “is this why my child is so coordinated during sports and so clumsy during arts and crafts?” You would be spot on. When hypermobile bodies hold too still (sit too long, stand in one spot, move slowly, etc.) they are at risk of losing awareness, losing balance, or getting injured. The low muscle tone that often accompanies hypermobility also makes it so that more energy is used up maintaining a static posture. Kids are great at accommodating themselves, so if you see a child unable to hold still or use a single position while sitting, ask yourself if they are accommodating a lack of stability and using up too much energy holding still. You might also see your child accommodating themself by moving fast instead of slow - or stomping their feet instead of walking softly.
A personal aside
I accommodate my hypermobile body all day long. It is so hard, and very uncomfortable, for me to sit still in a chair, which I often have to do while at meetings and while working at my computer. I find myself sitting on my feet (giving more stability to and more awareness of my legs), wrapping my legs around each other or the chair legs (allowing the surface tension to hold my legs in their position rather than the muscles) and getting out of my seat frequently to take a run up and down the stairs, or to stretch or jump.
Many hypermobile kids struggle greatly with school rules about rug and table seating expectations. My personal children included. A hypermobile body needs more information in order to stay safe and still. It is not helpful or safe to expect a hypermobile body to maintain an uncomfortable position. (I’m not sure why any school would dictate which position a person’s body should be in to achieve an unrelated goal…but here we are…this may be discussed in a future post.) But sometimes it is necessary to stay in a certain area in order to participate in learning, working, social engagement, family dinner time, etc.
Other ways to accommodate sitting, standing, and holding still:
A vibrating seat cushion provides a huge amount of proprioceptive input and can help a person sit still longer as it increases body awareness
A highly supportive seating option such as a fluffy bean bag chair or a chair with a back rest and arm rests can help decrease postural demands and allow more postural endurance
A resistive type of fidget (such as therapy putty or stretchy worms) can help to increase body awareness while seated or standing still
Wearing compression garments under your clothing can help to increase body awareness and help maintain posture and attention
The ability to change positions (sit - stand - sit - stand , etc.) frequently will help with activity endurance
Using a prone prop, or floor lying position can provide a high level of comfort and relief after being upright too long
When having to stand still, such as standing in line, rocking back and forth on your feet can help maintain body awareness and endurance
Whenever possible, leaning against a wall or furniture while holding still will help provide body awareness and increase endurance
Interoception (aka “why does my child wait until the last minute to go to the bathroom?”)
Just as loose joints lead to diminished sensory awareness of the body, so do hyper-flexible internal organs. Overly stretchy bladder, stomach, and bowels can lead to delayed signals about needing to use the bathroom or feeling hungry. As a result of decreased sensory feedback from the internal organs (interoception), delayed toileting, accidents, and bed wetting are all more common for neurodivergent and hypermobile children than for their peers. Picky eating, under eating and over eating are also common symptoms for this population. And a huge one that many of us are familiar with: CONSTIPATION, is almost ubiquitous in this population. Stretchy bowels lead to more stool being stored in the belly and less activation of peristalsis (the muscle contractions that get things moving), which in turn leads to harder, larger stools which are less likely to move. As many parents are acutely aware, this is a difficult cycle to get out of.
Overlapping symptoms?
You may have noticed that symptoms of hypermobility sometimes look a lot like symptoms of ADHD or autism - at least from a sensory-motor perspective. What often gets labeled as “inattention”, “impulsivity,” or “disengagement,” or “behavior” may turn out to be a misinterpretation of a child accommodating their own body. Sure, you may walk away because you are not interested. But you also may walk away because you are uncomfortable. It is important to remember not to bring judgement to a behavior, especially as it is very likely a way to self-accommodate. Can these symptoms improve? Absolutely! Many of my hypermobile and low tone clients see an increase in their attention and engagement in meaningful activities after targeting postural strength and endurance in therapy. When you are hypermobile (which many of my “inattentive” kiddos are) you have to be extra strong to compensate for the lack of structural stability your body affords you. Likewise, increasing mindfulness of internal sensations can go a long way to helping a child be more responsive to their internal bodily cues. Once we identify the underlying causes of these challenges, the therapy to bridge the gap can be really quite fun and rewarding.
Precautions?
There are some standard precautions that apply to everyone who is hypermobile. It is important to know what NOT to do, since hypermobile bodies are so prone to injury. Here are a few that everyone should be aware of (though, by no means is this an exhaustive list):
NEVER pull a hypermobile child by the arms or legs. Their limbs are at high risk of dislocation. Their joints are also very likely to pop back in on their own, making medical diagnosis nearly impossible - and tissue damage very painful.
ALWAYS provide flexible seating options and the ability to switch between options
REMEMBER that a hypermobile child may be a poor reporter of illness or injury, due to differences in their interoception (internal body awareness). ALWAYS observe them after a fall or accident for signs of injury that may not be initially evident.
Key Takeaways:
There is a significant overlap between neurodivergence and hypermobility. The more we learn about each and how they interact, the better we can support our kids’ development, comfort, confidence, and self-efficacy. Body awareness (proprioception AND interoception) can be significantly impacted for this population and there are certain supports and accommodations that can effectively improve their experience and function across a variety of settings. Consult your occupational therapist, physical therapist, or pediatrician if you have concerns about hypermobility for your child.
Want to learn more?
As always, please get in touch if you have questions or want to learn more. You can find me at The Lark Center - email me at becca@thelarkcenter.com
