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Review: The Association Between Fibromyalgia, Hypermobility and Neurodivergence Extends to Families: Brief Report
The Brief report focuses on an interesting and clinically important question, but has several limitations concerning study design, inclusions criteria and definition of the disorders. Thus it should be interpreted with caution and not be generalized.
It ist not clearly defined, what „neurodivergence“ means. How it is defined in the study? Did all participants mean the same syndromes when they hear the word „neurodivergent condition“?
Did the authors include patients with Hypermobility spectrum disorders or with hypermobile Ehlers-Danlos syndromes? What were the exact inclusion criteria? Moreover, there are three names mixed in the report (hEDS, hypermobility and HSD), which do not mean the same condition. This will also influence the results. It should be clearly defined and the correct defintion should be uses uniformly in the entire article
The authors state, that „This self-reported small case-control study confirms the association of fibromyalgia, hypermobility and neurodivergence, and suggests that close relatives also exhibit this association“ This conclusion should be interpreted much more cautiously, as it is a very small study and self-assessment of affected trade, so this should not be generalized.
Why was formal ethical approval for this study not considered necessary?
The statement „Psychological distress in early life was suggested as a predisposing factor for chronic pain, especially if adverse childhood experiences (ACE) included lack of parental support or validation which were also associated with personality traits seen in neurodivergence [11] is based on a single paper and could lead to significant stigmatization of parents. I wouldn't leave it that way.
Comments
The term 'neurodivergence' is clearly defined in the first paragraph of the Introduction and all participants were given this definition as is clearly described in the Methods section. Thank you for asking for clarification around the use of the terms hEDS, HSD and hypermobility: we incorporated all patients who were deemed to have met criteria for hypermobility spectrum disorders including the subgroup with hEDS. We used the term 'hypermobility' to denote everyone with a diagnosis of HSD/hEDS. As discussed in some detail, we recognise that this was a small pilot study subject to potential bias although the statistics strongly supported our conclusion. However, we invite others to repeat our work in a larger population sample as this is an important field of research, with ramifications for many. There is a large body of literature suggesting that adverse childhood events predispose to multiple disorders in later life including chronic pain. Lack of parental support or validation has been associated with several personality traits similar to those seen in neurodivergence. Far from stigmatising parents, we are concerned to understand the effects of such behaviour on their offspring's health..