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The study, published in BJPsych Open examined 223 eleven-year-old children from eight schools in western Sweden. Conducted by researchers from the Gillberg Neuropsychiatry Centre and Skaraborg Hospital, it is the first population-based investigation to look at joint flexibility, musculoskeletal pain, and neurodevelopmental traits in children simultaneously.

Adults show a connection — but do children?

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Adults with generalised joint hypermobility (GJH)—an unusually large range of movement in several joints—are more likely to have anxiety, ADHD, and autism spectrum traits. Some researchers believe this could be due to shared genetic or developmental pathways affecting both the body’s collagen structure and the brain’s development. But whether these patterns start in childhood was unknown.

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“Many adults with hypermobility experience chronic pain and neurodevelopmental conditions,” said one of the lead authors, Dr. Valdemar Landgren, a researcher at the Gillberg Neuropsychiatry Centre and physician at Skaraborg hospital. “We wanted to see if these associations are already present in school-age children.

The study

The children, all in fourth grade, underwent physical examinations and psychological assessments as part of their routine school health check-ups between 2018 and 2020. Researchers measured flexibility using the Beighton score, a nine-point scale for joint mobility. A score of six or higher is typically considered evidence of generalised joint hypermobility.

They also evaluated neurodevelopmental profiles using:

• Clinical interviews and medical records
• Parent and teacher questionnaires (the Strengths and Difficulties Questionnaire)
• A comprehensive expert case review including psychiatrists, psychologists, and paediatric neurologists

Musculoskeletal pain was assessed through structured interviews asking children about aches in their arms, legs, and joints.

What they found

Out of 207 children assessed, the median Beighton score was 1, with very few scoring above six.
Using the standard threshold, only 6.3% of children—similar numbers of boys and girls—qualified as hypermobile. Even fewer (around 0.5%) met criteria for hypermobility spectrum disorder (GJH combined with weekly musculoskeletal pain).

Importantly, no significant association was found between high Beighton scores and:

• Neurodevelopmental symptoms (including ADHD, autism, or coordination problems)
• General mental health difficulties
• Musculoskeletal pain

“Children with joint hypermobility showed typical developmental patterns,” the authors wrote. “Our findings suggest GJH should not be viewed as a risk factor for neurodevelopmental problems at this age.”

Unexpected finding: pain is common

While hypermobility was not linked to pain, the researchers were surprised by how many children—42% overall—reported some form of weekly musculoskeletal pain, far higher than in previous national surveys.

“This high rate of pain deserves further investigation,” said co-author Dr. Valdemar Landgren. “It may not be related to joint flexibility, but it clearly affects many children’s quality of life.”

Why age matters

The results contrast sharply with adult studies where flexible joints are often tied to anxiety and attention disorders. The researchers believe puberty may play a role, as joint laxity tends to increase in girls and decrease in boys during adolescence, alongside hormonal changes that could influence both physical and neurological development. “It’s possible that the relationship between hypermobility and neurodevelopmental conditions only emerges later in life,” said Landgren. “Our results suggest that in prepubertal children, these factors are still separate.”

Implications and next steps

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The findings support the current age-adjusted Beighton cut-off of six for diagnosing joint hypermobility in children and caution against using joint flexibility as an early biomarker for ADHD, autism, or other developmental conditions.

Still, the team emphasised the need for long-term studies following children through puberty to see if patterns change.

“This is an important reminder,” said Landgren “Flexibility alone doesn’t mean risk—but pain in children, whatever the cause, should never be ignored.”

Text by Anna Spyrou, Communications Officer

Reference

Glans, M. R., Aziz, A., Kindgren, E., Knez, R., Landgren, M., & Landgren, V. (2025). No association between joint hypermobility, musculoskeletal pain and neurodevelopmental problems in a school-based sample of 11-year-old children. BJPsych Open, 11, e262. DOI: