Understanding Ehlers-Danlos Syndromes (EDS) and Their Connection to Autism Part 2
What Connects EDS and Autism?
While the strongest clinical connection appears between hypermobile EDS (hEDS) and autism, overlapping features can appear across many subtypes:
| Shared Feature | Seen in Autism | Seen in EDS |
|---|---|---|
| Sensory sensitivity | ✓ | ✓ |
| Motor coordination issues | ✓ | ✓ |
| Fatigue | ✓ | ✓ |
| Autonomic dysfunction (e.g., POTS) | ✓ | ✓ |
| Gastrointestinal issues | ✓ | ✓ |
| Anxiety and panic | ✓ | ✓ |
| Chronic pain or unusual pain response | ✓ | ✓ |
| Connective tissue gene variations | ✓ (emerging research) | ✓ (defined) |
Can You Have More Than One Type of Ehlers-Danlos Syndrome (EDS)?
So many zebras!
Short Answer:
Technically no, not in the way you’d have two different types of EDS simultaneously—because each type of EDS is defined by a specific genetic mutation affecting a particular collagen or extracellular matrix gene.
But There Are Exceptions and Nuances:
Overlap in Symptoms:
Many EDS types share similar features—hypermobile joints, skin issues, chronic pain—which can make it appear that someone has more than one type. But genetically, they would still meet the criteria for only one subtype (or sometimes none, if it’s undiagnosed hypermobility spectrum disorder).
Dual Mutations (Rare):
In extremely rare cases, a person might inherit two different pathogenic variants—one from each parent—affecting two different EDS-related genes. This could theoretically result in a complex phenotype that shares characteristics of more than one subtype, but this would be considered atypical or mixed connective tissue disorder, and would usually be investigated by a geneticist.
EDS + Other Connective Tissue Disorders:
Some people with EDS also carry genetic markers for related conditions like Marfan syndrome, Loeys-Dietz syndrome, or Osteogenesis Imperfecta. These aren’t types of EDS but connective tissue disorders with overlapping symptoms. Co-occurrence is rare but possible.
How Connective Tissue Problems in EDS Affect Gums and Dental Health
Because collagen is a critical component of the structures that support your teeth, gums, jawbone, and periodontal ligaments, defects in connective tissue (like those seen in EDS) can significantly affect oral health. Common Dental and Gum Issues in EDS:
| Symptom or Condition | Explanation |
|---|---|
| Periodontal disease (early-onset gum disease) | Seen in periodontal EDS (pEDS) and sometimes in hEDS. Weak gum tissue can’t hold teeth firmly, increasing tooth loss risk. |
| Fragile, bleeding gums | Collagen abnormalities lead to easy tearing and bleeding during brushing or dental work. |
| Tooth crowding or misalignment | Jaw and facial structures may be underdeveloped or unusually shaped due to connective tissue laxity. |
| TMJ dysfunction (jaw joint instability) | Hypermobility in the temporomandibular joint can cause clicking, pain, or dislocation during chewing or yawning. |
| Palatal abnormalities | High or narrow palate common in hEDS, may impact speech, breathing, and dental alignment. |
| Enamel defects | Some individuals may have weaker or softer enamel, making them more prone to cavities. |
| Poor healing after dental procedures | Skin and mucosa fragility mean that wounds (e.g., after extractions) may reopen or scar poorly. |
| Nerve pain or dental hypersensitivity | May occur due to small fiber neuropathy, common in some EDS subtypes. |
Dental Red Flags That May Suggest Underlying EDS:
Needing braces more than once
Retainers or implants that “don’t hold”
Frequent mouth ulcers or easy tissue tearing
Teeth that appear loose despite good oral hygiene
Multiple extractions before age 30
Gum pain or bleeding even with soft brushing
Chronic jaw clicking or dislocation
What to Do if EDS Affects Dental Health:
Ask your dentist for manual rather than ultrasonic cleaning to reduce tissue trauma
Use non-alcoholic, low-abrasion oral care products
Request additional local anesthetic—people with EDS often metabolize lidocaine differently
Consider periodontal monitoring every 3–6 months
Coordinate with a medical geneticist and a dentist familiar with connective tissue disorders for a long-term care plan
Gastrointestinal (GI) Issues in EDS
Why It Happens:
EDS affects the collagen and connective tissue that supports the entire gastrointestinal tract from the esophagus down to the rectum. This can lead to poor motility, elasticity, and function in the gut, as well as dysfunction in the autonomic nervous system, which controls involuntary bodily functions like digestion.
GI Red Flags in Children with EDS and/or Autism:
Failure to thrive despite eating well
Chronic constipation unresponsive to typical treatments
Severe gag reflex, food aversions, or restricted eating
Frequent stomachaches or “tummy migraines”
Vomiting episodes without infection
Reluctance to eat due to discomfort or pain (often mistaken for behavioral)
Helpful Tests or Referrals:
GI motility studies
Endoscopy (if GERD or esophageal issues suspected)
Nutritionist or feeding therapist familiar with connective tissue disorders
POTS/autonomic testing if symptoms include dizziness, nausea after eating, or bloating
Skin Issues in EDS
Why It Happens:
Connective tissue made from collagen gives skin its elasticity, strength, and structure. In EDS, the collagen is faulty or disorganized, resulting in fragile, stretchy, or slow-healing skin.
Pediatric Skin Signs to Watch For:
Children who scar easily from minor falls or cuts
Frequent unexplained bruises (especially on shins, arms, or chest)
Scars that stretch out over time or heal unusually flat or wide
Skin that feels unusually “soft” or “squishy”
Fear of bandages or adhesive due to skin irritation or pain
Skin Care Considerations for EDS:
Use non-fragranced, sensitive skin products
Avoid prolonged sun exposure (increases skin damage risk)
Treat wounds conservatively — avoid tight bandaging or aggressive closure
Consult dermatologists for management of persistent bruising, scars, or abnormal healing
Consider silicone scar sheets or topical Vitamin E if advised by a physician
Whole-Body EDS Impact Beyond Joints
EDS is a multi-system condition — far more than joint hypermobility. It can affect:
Skin
GI tract
Eyes
Blood vessels
Autonomic function
Gums and teeth
Nervous system (e.g., small fiber neuropathy)
This is especially important in individuals with autism, who may have difficulty communicating symptoms, leading to underdiagnosis or mislabeling (e.g., as “anxiety” or “behavioral”).