When Rejection Feels Bigger Than It Looks: Understanding RSD in Adult Women Have you ever found yourself replaying a conversation over and over in your mind, wondering if you said the wrong thing? Have you ever received a piece of feedback at work and spent the rest of the day feeling unsettled, even though you knew it was meant kindly? Or perhaps you’ve found yourself withdrawing from the people you love after a disagreement, not because you don’t care, but because the emotions feel too big to hold. If any of this feels familiar, you are not alone. For many neurodivergent women, particularly those with ADHD, Rejection Sensitive Dysphoria (RSD) can be a significant yet often unseen part of daily life. It can shape how we experience relationships, work, parenting, friendship, and even the way we see ourselves. And yet, so many women carry these experiences quietly, believing they are simply “too sensitive” or that they need to try harder to cope. What if the reality is something different? What if your nervous system is working incredibly hard to keep you safe? What is Rejection Sensitive Dysphoria? RSD is often described as an intense emotional response to perceived or actual rejection, criticism, exclusion, or failure. The important word here is perceived. A delayed reply. A change in someone’s tone. Constructive feedback from a manager. A partner seeming distracted after a long day. While another person may barely notice these moments, someone experiencing RSD may feel them deeply and intensely. It’s not a choice. It’s not attention-seeking. And it’s certainly not a sign of weakness. For many women, it can feel as though the emotional volume has suddenly been turned all the way up, making a seemingly small interaction feel incredibly painful. The Women Who Carry It Quietly One of the reasons RSD often goes unnoticed in women is because many of us become very skilled at hiding our struggles. We learn to smile. We learn to push through. We learn to over-achieve, overthink, over-apologise and over-accommodate. From the outside, we may appear capable, organised and successful. Inside, however, we might be carrying a constant fear of disappointing others. We may spend hours analysing conversations. We may work twice as hard to avoid criticism. We may say yes when we desperately need to say no. Not because we lack confidence, but because rejection feels genuinely painful. Over time, this can become exhausting. When the Nervous System Shuts Down Something I wish more people understood about RSD is that it doesn’t always look dramatic. Sometimes it looks like silence. Sometimes it looks like disappearing. Sometimes it looks like shutting down. When emotions become overwhelming, many women don’t become outwardly angry or reactive. Instead, the nervous system moves into protection mode. The mind feels foggy. Words become difficult to find. Decision-making feels impossible. Even simple tasks can suddenly require enormous effort. You may find yourself retreating to a quiet room. Ignoring messages. Avoiding conversations. Cancelling plans. Staring at your laptop unable to begin the task you know needs doing. Not because you don’t care. Not because you’re being difficult. But because your nervous system has reached capacity. A shutdown is not a failure. It’s often a sign that your system is overwhelmed and trying to protect itself. The Impact on Family Life Family life can be beautiful, messy, joyful and demanding all at once. For women carrying RSD, family relationships can sometimes feel particularly tender. A child’s frustration may trigger feelings of inadequacy. A partner’s feedback may land much harder than intended. A disagreement can feel less like a momentary conflict and more like evidence that you’ve somehow failed the people you love. When a shutdown follows, there can be an added layer of guilt. You may want connection but feel unable to engage. You may need space but worry others will misunderstand. You may withdraw to regulate your nervous system, only to criticise yourself for doing so. Many women tell themselves they should be able to cope better. But perhaps the kinder question is this: What support does your nervous system need right now? Because needing recovery time does not make you a bad partner, parent or friend. It makes you human. The Workplace Nobody Sees Work can present a unique set of challenges for women experiencing RSD. Performance reviews. Emails that seem abrupt. Meetings where ideas aren’t acknowledged. Mistakes that everyone else forgets but you carry for days. The emotional labour involved in navigating these moments can be immense. Many women become perfectionists, striving to avoid criticism at all costs. Others avoid opportunities altogether, not because they lack ability, but because the possibility of failure feels too painful. And then there are the shutdowns. The days when one difficult interaction makes it impossible to focus. The days when your brain seems to go offline. The days when you’re physically present but emotionally exhausted. These experiences are rarely visible to colleagues, which can make them feel even lonelier. The Weight of Self-Criticism Perhaps one of the hardest parts of RSD is the story we often tell ourselves afterwards. The conversation ends, but the self-criticism begins. Why did I react like that? Why can’t I just let it go? What’s wrong with me? But what if there is nothing wrong with you? What if the goal isn’t to become less sensitive, but to understand your sensitivity differently? Many of the same traits that make rejection feel deeply painful are also connected to empathy, creativity, intuition, passion and a profound capacity for connection. The challenge is learning to offer ourselves the same compassion we so readily offer others. A Gentler Way Forward Understanding RSD doesn’t mean every difficult feeling suddenly disappears. But it can create space for something powerful. Self-understanding. When we recognise that our responses are connected to a sensitive nervous system rather than a personal failing, we can begin to replace shame with curiosity. We can notice our triggers without judging ourselves for having them. We can build recovery into our
Tag: POTs
Is It PDA or RSD? Understanding What Might Be Beneath the Behaviour
Is It PDA or RSD? Understanding What Might Be Beneath the Behaviour In recent years, there has been increasing awareness of Pathological Demand Avoidance (PDA), or more accurately, a PDA profile of autism. Social media has played a significant role in helping families discover language that resonates with their child’s experiences, often bringing a sense of relief and validation after years of confusion. For many parents, reading about PDA can feel like finally finding a missing piece of the puzzle. The intense avoidance of everyday demands. The resistance to requests. The need for autonomy. The emotional responses that can seem disproportionate to the situation. The anxiety that appears to sit beneath it all. However, as awareness of PDA has grown, another important question has emerged: Is it always PDA? Or could some children and teenagers be experiencing something that looks similar on the surface but is being driven by a different underlying mechanism? One possibility worth considering is Rejection Sensitive Dysphoria (RSD). While PDA and RSD can coexist, and neither experience should be dismissed, there are situations where what appears to be demand avoidance may actually be rooted in a profound fear of criticism, shame, failure, or disappointing others. Understanding the difference can help us provide more effective and compassionate support. What Is PDA? PDA is generally understood as a profile associated with autism in which an individual experiences an intense need to avoid demands and maintain a sense of autonomy. Demand avoidance itself is not unique to PDA. All humans avoid demands at times. What makes PDA distinct is the intensity of the response and the significant anxiety that often sits beneath it. Demands may include: Being asked to complete a task Following instructions Transitions Expectations from others Everyday routines Even activities the individual wants to do For those with a PDA profile, demands can trigger a profound sense of threat, leading to avoidance strategies that are often driven by nervous system activation rather than deliberate oppositional behaviour. What Is RSD? Rejection Sensitive Dysphoria (RSD) is commonly discussed within ADHD communities and refers to an intense emotional response to perceived rejection, criticism, failure, disapproval, or not meeting expectations. While RSD is not currently a formal diagnostic category, it is widely recognised by many ADHD clinicians and individuals with lived experience. For a child or teenager with RSD, experiences that seem minor to others may feel deeply painful. Examples may include: Receiving corrective feedback Making a mistake Losing a game Not achieving a desired result Feeling compared to peers Perceiving disappointment from adults Struggling with a task Importantly, the fear of these experiences can become so overwhelming that avoidance develops as a protective strategy. When RSD Looks Like PDA This is where things become particularly interesting. A child with significant RSD may begin avoiding demands not because the demand itself feels threatening, but because of what the demand represents. The demand may carry the possibility of: Getting it wrong Being corrected Failing Feeling embarrassed Disappointing someone Being judged Being perceived as incapable In these situations, avoidance becomes a form of self-protection. For example: A child refuses to start homework. At first glance, this may appear to be demand avoidance. However, underneath the refusal may be a fear that they will not understand the work, will make mistakes, or will be criticised for getting it wrong. Similarly: Avoiding sports may be driven by fear of poor performance. Avoiding school may be driven by fear of failure or social judgement. Refusing new activities may stem from anxiety about not being immediately successful. From the outside, the behaviour may look remarkably similar to PDA. The internal experience, however, may be very different. The Role of Neurodivergence Many neurodivergent young people experience a lifetime of subtle and not-so-subtle messages that they are getting things wrong. They may have: Been corrected more frequently than peers Struggled with executive functioning Found social situations confusing Experienced sensory overwhelm Felt misunderstood by adults Internalised feelings of inadequacy Over time, this can create a heightened sensitivity to criticism and perceived failure. For children with ADHD in particular, RSD can become a powerful driver of behaviour. The nervous system learns that avoiding the situation feels safer than risking emotional pain. Why Social Media Has Increased the Conversation The recent spotlight on PDA has undoubtedly helped many families access understanding and support. For some children, a PDA profile is absolutely the most accurate explanation for their experiences. However, social media content often focuses on observable behaviours rather than underlying drivers. A child refusing school. A child avoiding homework. A child saying “no” to requests. A child becoming distressed when expectations are placed upon them. These behaviours can occur in PDA. They can also occur in: RSD Anxiety Burnout Trauma Perfectionism Sensory overwhelm Chronic health conditions Executive functioning difficulties Behaviour alone rarely tells the whole story. Understanding the “why” beneath the behaviour is often far more important than the behaviour itself. Questions Worth Exploring Rather than asking: “How do I stop this avoidance?” It can be helpful to ask: What is making this situation feel unsafe? Is there fear of failure? Is there fear of criticism? Is there fear of disappointing others? Is perfectionism playing a role? Has this child experienced repeated experiences of feeling unsuccessful? What happens when mistakes occur? The answers can offer valuable clues about whether RSD may be contributing to the presentation. A Neuro-Affirming Perspective From a neurodiversity-affirming perspective, neither PDA nor RSD should be viewed as problematic behaviours that need to be eliminated. Instead, both can be understood as adaptive responses. The nervous system is always trying to keep the individual safe. If demands feel threatening, avoidance may emerge. If criticism feels unbearable, avoidance may emerge. If failure feels devastating, avoidance may emerge. The behaviour makes sense when we understand the context. Our role is not to force compliance. Our role is to build safety. Supporting Children with RSD When RSD is present, support often focuses on reducing shame and increasing psychological safety. This may include:
Breathwork for Children with Hypermobility: A Neuro-affirming Approach
Why Breathwork Isn’t Always Simple: Supporting Children and Teens with Hypermobility Through Neuro-Affirming Breathwork “Take a deep breath.” It’s one of the most common pieces of advice given to children and teenagers who are feeling anxious, overwhelmed or dysregulated. But what if taking a deep breath isn’t actually as simple as it sounds? For many children and teens living with hypermobility, dyspraxia, autism, ADHD, chronic stress, burnout, or nervous system dysregulation, the ability to access a deep diaphragmatic breath may not come naturally. In fact, for some young people, the neural pathways required to take a full, relaxed breath may need to be developed first. This is why at Little Kneaders, we take a neuro-affirming approach to breathwork, one that recognises that breathing is not simply a skill to be instructed, but a pattern that often needs to be experienced, explored and gently learned. The Diaphragm and Hypermobility Many children and teenagers with Hypermobility Spectrum Disorder or Hypermobile Ehlers-Danlos Syndrome experience altered breathing patterns. This may seem surprising at first. After all, we don’t usually think of breathing as being connected to connective tissue. However, the diaphragm is closely linked to the rib cage, spine, core muscles and connective tissue systems that support posture and movement. When joints are less stable, the body often compensates by creating protective tension. Over time, this can contribute to: Shallow chest breathing Breath holding Upper chest tension Reduced diaphragmatic movement Rib cage restriction A feeling of not being able to take a satisfying breath For many young people, what appears to be a “tight diaphragm” is often the body’s attempt to create stability and protection. The Nervous System Connection The diaphragm is also deeply connected to the nervous system. When a child is living in a state of chronic stress, anxiety, sensory overwhelm or burnout, breathing patterns often become shorter and more shallow. This is not a choice. It is an automatic nervous system response. Many neurodivergent children and teenagers spend significant periods of time navigating environments that place high demands on their sensory, social and cognitive resources. Over time, the nervous system may become accustomed to operating in a heightened state of alertness. The body learns to brace. The shoulders lift. The chest tightens. The diaphragm moves less efficiently. And eventually, shallow breathing becomes the default pattern. Why “Take a Deep Breath” Often Doesn’t Work One of the biggest misconceptions about breathwork is the assumption that everyone automatically knows how to access a deep breath. Many children simply don’t. Particularly those who are: Autistic ADHD Dyspraxic Hypermobile Recovering from burnout Experiencing chronic anxiety Living with persistent pain For some young people, the instruction “take a deep breath” feels confusing because they cannot easily identify what a deep breath should feel like in their body. This is where a neuro-affirming approach becomes so important. Rather than expecting a child to perform a skill they may not yet have developed, we can focus on teaching the skill in a way that makes sense to their nervous system. Creating the Neural Pathways First Before breathwork can become a regulation tool, the brain and body often need opportunities to build familiarity with diaphragmatic breathing. This is where repetition, play and visual learning become incredibly powerful. Every time a child experiences a successful diaphragmatic breath, the brain strengthens the neural pathways associated with that movement pattern. Over time, what once felt unfamiliar becomes more accessible. Rather than forcing breathing techniques, we can focus on creating positive experiences that allow the nervous system to discover breathing naturally. This is often far more effective than asking a child to sit still and follow complex instructions. The Importance of Visuals in Breathwork Many neurodivergent children and teenagers are visual learners. Telling a child to “breathe into your belly” may not create a meaningful image. Showing them what that looks like often does. Visuals help bridge the gap between abstract language and physical experience. Examples may include: Watching a feather move with the breath Placing a soft toy on the tummy and watching it rise and fall Using bubbles Following visual breathing cards Watching scarves move in the air Using imagery such as balloons, waves or clouds These visual cues provide immediate feedback and make breathing more tangible. For many young people, seeing breathing happen is far easier than simply being told how to do it. Feather Breathing: A Playful Way to Build Breathing Skills One of our favourite approaches at Little Kneaders is feather breathing. The concept is beautifully simple. A child holds a feather and uses their breath to gently move it. There is no pressure to perform. No expectation of perfection. Just curiosity. The feather immediately provides visual feedback. Children can see whether their breath is short, strong, gentle or sustained. As they experiment, they naturally begin exploring: Longer exhalations Breath control Diaphragmatic engagement Nervous system regulation Most importantly, it feels playful rather than therapeutic. For many children, this creates far greater engagement than traditional breathing exercises. Breathwork as Co-Regulation Another important consideration is that breathwork is often most effective when taught through connection. Many children learn breathing patterns through co-regulation before they can self-regulate. This means: Breathing together Modelling calm breathing Practising in safe environments Using predictable routines Removing performance expectations The goal is not to force relaxation. The goal is to create conditions where the nervous system feels safe enough to access regulation. A Neuro-Affirming Perspective At Little Kneaders, we believe that if a breathing strategy is not working, the answer is rarely that the child is doing it wrong. More often, the strategy needs adapting to fit the child’s nervous system, sensory profile and developmental stage. Neurodivergent children are not failing at breathwork. Many simply require different pathways into learning it. When we shift our focus from compliance to curiosity, we create opportunities for genuine connection and skill development. Final Thoughts Breathing is one of the most powerful tools we have for supporting nervous system regulation, emotional wellbeing and body awareness. But for children and
Carefully Considered Collaborations: Little Kneaders X Sport Ireland
Carefully Considered Collaborations: Little Kneaders X Sport Ireland At Little Kneaders, every collaboration begins with a question: Will this genuinely support the young people and families we work with? If the answer is yes, we explore it further. If the answer is no, we politely decline. This philosophy sits at the heart of our Carefully Considered Collaborations Series — partnerships that are intentionally designed to support the wellbeing, regulation and lived experiences of neurodivergent young people. Today, I am delighted to share the beginning of a very special collaboration between Little Kneaders and Sport Ireland. Over the next six weeks, we will be supporting a small group of neurodivergent teenage girls through gentle, accessible movement experiences designed to nurture confidence, connection and wellbeing. Our first session has already begun, and we couldn’t have imagined a more fitting start. Beginning with Gentle Yoga Our first class was a beautiful gentle yoga session facilitated by Adrienne McGrath, whose passion for restoring peace, connection and healing through movement was evident from the moment she entered the room. Adrienne created a calm, welcoming environment where the girls could engage at their own pace, free from pressure or expectations. There was no focus on performance. No competition. No requirement to “keep up.” Instead, the emphasis was on listening to the body, exploring movement gently, and experiencing the benefits of being present in a supportive space. For many of the girls attending, this was exactly what was needed. Why This Collaboration Matters This collaboration was deeply intentional. Many of the neurodivergent teenage girls I work with have complicated relationships with movement and exercise. Not because they do not want to move. Not because they are unwilling. But because traditional sports and physical education environments often fail to accommodate their needs. Many of my clients experience challenges such as: Postural Orthostatic Tachycardia Syndrome and autonomic nervous system dysregulation Hypermobility and chronic pain Dyspraxia and motor coordination differences Burnout recovery and depleted energy levels Sensory sensitivities Strong rejection sensitivity profiles Anxiety and reduced confidence in group settings For some young people, PE lessons can become associated with feelings of failure, exclusion, overwhelm or embarrassment. Repeated experiences of struggling to keep up with peers can gradually erode confidence and create understandable avoidance of movement altogether. Yet movement remains one of the most powerful tools we have for supporting mental wellbeing. The challenge is not convincing young people to move. The challenge is creating environments where movement feels safe, accessible and enjoyable. Movement as Part of Holistic Mental Health Support At Little Kneaders, we view wellbeing through a holistic lens. Mental health does not exist separately from the body. The nervous system, sensory system, movement, sleep, hormones, nutrition, social connection and emotional wellbeing are all interconnected. Every young person participating in this programme is either experiencing mental health challenges or actively recovering from them. Many are rebuilding after periods of significant stress, anxiety, burnout, school avoidance or nervous system dysregulation. For these young people, movement is not about fitness goals. It is not about performance. It is not about pushing through discomfort. Instead, movement becomes an opportunity to: Support nervous system regulation Improve mood and emotional wellbeing Build body awareness and proprioception Increase confidence Encourage gentle strength and resilience Reduce stress and overwhelm Reconnect with the body in a compassionate way Small, consistent experiences of success can often be far more transformative than intensive interventions. Creating Space for Friendship and Belonging One of the most important aspects of this programme is something that cannot be measured on a fitness tracker. Connection. The classes are intentionally small, with a maximum of six participants. This allows us to create an environment that feels safe, predictable and supportive. Many neurodivergent teenagers tell us that making and maintaining friendships can feel challenging, particularly after periods of school avoidance, burnout or social isolation. Within a smaller group, there is more opportunity for authentic connection to develop naturally. There is no pressure to socialise. No expectation to perform socially. Just the opportunity to spend time alongside other young people who often share similar experiences and understand one another in ways that can be difficult to find elsewhere. Sometimes healing happens through movement. Sometimes healing happens through being understood. Often, it is both. A Neuro-Affirming Approach to Movement This programme has been designed through a neurodiversity-affirming lens. We recognise that neurodivergent bodies and minds are not broken versions of neurotypical ones. They simply have different needs. That means: Choice is prioritised. Participation is flexible. Rest is respected. Sensory needs are accommodated. Individual pacing is encouraged. Success is defined differently for every participant. For some girls, success may look like participating in the full class. For others, it may mean simply arriving, observing, or trying one new movement. Every step matters. Every experience counts. Looking Ahead This first yoga session marks the beginning of what we hope will be a meaningful journey for the young people participating. We are incredibly grateful to Sport Ireland for supporting this initiative and to Adrienne McGrath for bringing such warmth, expertise and compassion to our opening session. As the programme progresses, we look forward to witnessing the confidence, connection and self-belief that can emerge when young people are given the opportunity to engage with movement in a way that truly honours their individual needs. Because when movement feels safe, supported and accessible, it becomes so much more than exercise. It becomes a pathway back to connection, with the body, with others, and with ourselves. Back To Blog
The Advantages of Gel Nails for those with Hypermobility Syndrome
The Advantages of Gel Nails for People with Hypermobility Syndrome: Proprioception, Function and Everyday Support For many people living with Hypermobility Spectrum Disorder or Hypermobile Ehlers-Danlos Syndrome, everyday tasks can sometimes require more effort than they appear to on the surface. Hypermobility affects connective tissue throughout the body, which can influence joint stability, muscle fatigue, sensory processing, and even how we perceive our own movement. In recent years, there has been growing awareness of the overlap between hypermobility and neurodivergence, including Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. Within this context, even small adaptations — including something as simple as gel nails — can offer meaningful functional and sensory benefits. This is not about aesthetics as a standard of beauty. It is about supporting the body, improving function, and creating sensory and proprioceptive feedback that helps the nervous system feel more anchored in space. Understanding Proprioception and Hypermobility Proprioception is our body’s ability to sense where it is in space. It tells us: Where our joints are positioned How much force we are using How we are moving through the environment In hypermobility, proprioception is often less reliable. Because connective tissue is more elastic, joints may move beyond typical ranges, and the sensory feedback from muscles and joints can be less clear or delayed. This can lead to: Clumsiness or frequent dropping of objects Difficulty judging grip strength Joint overextension without noticing Fatigue from “over-correcting” movement A general feeling of disconnection from the body For neurodivergent individuals, especially those with autism or ADHD, proprioceptive differences may already be part of their sensory profile. When combined with hypermobility, this can create an even greater need for external sensory anchors. How Gel Nails Can Support Proprioceptive Awareness Gel nails may seem like a purely cosmetic choice, but for some people with hypermobility they can function as a subtle proprioceptive tool. Because gel nails are slightly thicker and more structured than natural nails, they can provide: 1. Increased sensory feedback The added structure of gel nails can give clearer tactile feedback when touching objects. This can help improve awareness of grip and contact, particularly for tasks like: Holding pens or pencils Using phones or tablets Picking up small objects Typing or using keyboards 2. Improved grip awareness Some individuals report feeling more “aware” of their fingertips when wearing gel nails. This can help reduce accidental over-gripping or under-gripping, both of which are common in hypermobility due to altered proprioception. 3. Reduced fingertip discomfort For those whose joints are sensitive or easily overloaded, gel nails can act as a light protective layer over the fingertips, reducing discomfort during repetitive tasks. 4. Functional anchoring for the nervous system From a neuro-affirming perspective, sensory tools that help the nervous system feel more organised in space can reduce cognitive load. Small, consistent sensory input — such as the feeling of structured nails — may help the brain maintain a clearer sense of body position during daily activities. Hypermobility, Fine Motor Skills and Fatigue Many people with hypermobility experience fatigue in the hands and fingers, especially when writing, typing, or doing repetitive fine motor tasks. This is often due to: Joint instability in the small joints of the hands Overuse of compensatory muscle tension Reduced proprioceptive efficiency Increased effort required to stabilise movement Gel nails can sometimes support fine motor function by offering: Slight mechanical resistance that helps guide movement Improved tactile awareness of surfaces Reduced micro-adjustments needed during tasks While not a replacement for occupational therapy or clinical support, they can be a low-effort, accessible self-support strategy. A Neuro-Affirming Lens: Supporting, Not Correcting From a neurodiversity-affirming perspective, including the approach used by Little Kneaders, the goal is not to “fix” sensory differences or hypermobility traits. Instead, it is about recognising that: Different nervous systems experience the world differently Sensory needs are valid forms of communication Support can come in small, everyday adaptations Function and comfort matter more than conformity For many autistic and ADHD individuals with hypermobility, sensory regulation is not optional — it is foundational. Tools like gel nails can sit alongside other supports such as weighted items, fidget tools, compression garments, or environmental adjustments. Practical Considerations While gel nails can be supportive for some people, they are not suitable for everyone. A few considerations include: Nail sensitivity or allergies to products Difficulty maintaining appointments if energy is limited Risk of nail damage if removal is not done carefully Individual sensory preferences (some may find them overwhelming) As with all supports, the key is individual experience rather than a one-size-fits-all approach. Final Thoughts For some people living with hypermobility, small sensory supports can make a meaningful difference in daily life. Gel nails may offer more than aesthetic value — they can provide proprioceptive feedback, improve functional awareness, and support the nervous system in feeling more grounded during everyday tasks. In a neuro-affirming framework, this is not about changing the body to fit the world, but about finding ways the world can better fit the body. Sometimes support looks like therapy or clinical intervention. And sometimes it looks like something as simple as how your fingertips meet the world. Back To Blog
The Impact of Hypermobility in Teenage Girls and Women
The Impact of Hypermobility in Teenage Girls and Women: Nervous System, Hormones, Digestion and School Avoidance Hypermobility is often described as “being double-jointed” or “extra flexible,” but for many teenage girls and women it is far more than a physical trait. For those living with Hypermobility Spectrum Disorder or Hypermobile Ehlers-Danlos Syndrome, hypermobility can affect almost every system in the body — from digestion and hormones to energy levels, mood, and the nervous system. Increasingly, clinicians are also recognising a strong overlap between hypermobility and neurodivergence, particularly Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. This connection helps explain why many young people experience symptoms that feel “whole body,” fluctuating, and difficult to fit into one medical category. For teenage girls especially, these symptoms often emerge or intensify around puberty, a time of significant hormonal and neurological change. Hypermobility and the Nervous System The nervous system plays a central role in how hypermobility is experienced. Many individuals with hypermobility show signs of autonomic nervous system dysregulation, including conditions such as Postural Orthostatic Tachycardia Syndrome. This can affect heart rate, blood pressure, temperature regulation, digestion, and energy levels. When the nervous system is in a heightened state (fight, flight, freeze or shutdown), the body may experience: Chronic fatigue or sudden energy crashes Dizziness or “brain fog” Heightened sensory sensitivity Difficulty concentrating Anxiety or overwhelm Feeling “wired but tired” For neurodivergent girls, especially those who are autistic or ADHD, sensory processing differences can amplify these responses. School environments – with noise, social demands, bright lighting, and pressure to perform – can become overwhelming for a dysregulated nervous system. Digestive System and Hypermobility The digestive system is rich in connective tissue and is highly influenced by autonomic nervous system function. Common digestive experiences in hypermobility include: Bloating and abdominal pain Constipation or diarrhoea Nausea or reflux Early fullness or reduced appetite Food sensitivities Fluctuating tolerance to different foods This is partly due to altered gut motility and also the close relationship between the gut and nervous system. When the body is in a stress response, digestion naturally slows or becomes erratic. Over time, this can create cycles of discomfort that further increase nervous system load – a loop that can feel difficult to break. For some individuals, these symptoms may overlap with patterns seen in Mast Cell Activation Syndrome (MCAS), adding another layer of sensitivity and reactivity. Hormones, Puberty and Menstrual Cycles Hormonal changes can significantly influence hypermobility symptoms. Many teenage girls notice that symptoms intensify around puberty, and later fluctuate across the menstrual cycle. Oestrogen influences connective tissue, pain sensitivity, and autonomic nervous system regulation, which may explain why symptoms often worsen: Before menstruation Around ovulation During hormonal fluctuations in puberty During perimenstrual phases later in life In addition, many girls and women with hypermobility experience heavier and more painful periods. This can be partly explained by differences in connective tissue integrity, particularly collagen. Collagen plays a key role in supporting blood vessel structure and uterine tissue stability. When connective tissue is more lax or fragile, the uterine lining may shed more heavily, and blood vessels may be less structurally supported, potentially contributing to increased bleeding and cramping. Dysautonomia, heightened pain sensitivity, and inflammatory responses may also amplify menstrual pain, making periods feel more intense both physically and neurologically. For those with hypermobility, this may present as: Increased joint pain or instability Fatigue and energy crashes Headaches or migraines Digestive flares Emotional sensitivity or overwhelm Increased anxiety or shutdown responses Heavier, more painful menstrual bleeding These cyclical changes can make symptoms feel unpredictable, especially for young people still learning to understand their bodies. Chronic Fatigue and Energy Fluctuations Chronic fatigue is one of the most disabling aspects of hypermobility for many women and teenagers. This is often not simply “tiredness,” but a complex interaction between: Autonomic nervous system load Musculoskeletal effort required for joint stability Digestive energy demands Hormonal fluctuations Sleep disruption Sensory and cognitive overload Many describe a pattern of “boom and bust” energy – periods of relative functioning followed by significant crashes. For neurodivergent individuals, especially those with ADHD, this can be intensified by masking, executive function demands, and difficulty pacing activity. School Avoidance and Hypermobility School avoidance is a growing concern among hypermobile and neurodivergent young people. This is often misunderstood as anxiety or disengagement, but in many cases it reflects genuine physical and neurological overwhelm. Contributing factors may include: Chronic pain or fatigue Sensory overload in classrooms Difficulty with prolonged sitting or standing Brain fog affecting concentration Anxiety from unpredictable symptoms Gastrointestinal discomfort Social exhaustion and masking During heavier and more painful menstrual cycles, some teenage girls may feel unable to attend school due to the intensity of symptoms, particularly when appropriate accommodations (such as rest spaces, flexible attendance, or menstrual support) are not available For autistic and ADHD students, the combination of sensory demands, social complexity, and executive functioning requirements can become overwhelming when layered on top of a physically dysregulated body. Avoidance is not refusal; it is a nervous system protection response. The Overlap Between Hypermobility, Autism and ADHD There is increasing recognition of overlap between hypermobility and neurodivergence, particularly autism and ADHD. This may be linked to differences in: Connective tissue development Interoception (internal body awareness) Sensory processing Nervous system regulation Dopamine and arousal systems For many girls, this combination can lead to late diagnosis, misdiagnosis, or being described as “anxious,” “sensitive,” or “dramatic,” when in reality their body is processing information and stress differently. Understanding this overlap can be deeply validating and can shift the narrative from “something is wrong” to “my system needs different support.” Holistic Support for Hypermobility There is no single approach that works for everyone, but many people benefit from a combination of nervous system support, gentle movement, and sensory-aware strategies. The goal is not to “push through,” but to support regulation, stability, and energy conservation. Nervous System Regulation Supporting the autonomic nervous system can be foundational: Breathwork (gentle, non-forced) Yoga nidra or guided rest Time in low-stimulation environments Predictable routines
MCAS in Women: Understanding Hormones, Food Sensitivites and Holistic Support
MCAS in Women: Understanding Hormones, Food Sensitivities and Holistic Support For many women, living with Mast Cell Activation Syndrome (MCAS) can feel like trying to predict the unpredictable. One day, your body seems relatively settled. The next, you may be navigating digestive discomfort, skin flare-ups, headaches, fatigue, anxiety, dizziness, or reactions to foods that felt completely safe only days before. Many women describe feeling as though their symptoms fluctuate alongside their hormones, yet struggle to find clear answers as to why. As awareness of MCAS grows, researchers and clinicians are beginning to better understand the complex relationship between mast cells, female hormones, digestion, and the nervous system. While every person’s experience is unique, recognising these connections can be an empowering first step towards understanding your body with greater compassion. What Is MCAS? Mast cells are an important part of the immune system. They help protect us by releasing chemical messengers, including histamine, in response to potential threats. In people with MCAS, mast cells can become overly reactive, releasing these chemicals more frequently or inappropriately. Because mast cells are found throughout the body, symptoms can affect multiple systems at once. Common symptoms may include: Digestive discomfort Food sensitivities Flushing and skin reactions Hives or itching Fatigue Headaches and migraines Dizziness Brain fog Anxiety Sinus congestion Sleep disturbances Many women spend years seeking explanations for these seemingly disconnected symptoms before discovering MCAS may be part of the picture. MCAS and Female Hormones One of the most commonly reported experiences among women with MCAS is symptom fluctuation throughout the menstrual cycle. Mast cells and hormones appear to communicate closely with one another. Oestrogen can influence mast cell activity, while mast cells themselves can affect hormone signalling. For some women, this creates a cycle where hormonal changes may contribute to increased mast cell activation and symptom flare-ups. Many women notice worsening symptoms: Before menstruation Around ovulation During periods of significant hormonal change During perimenopause Following pregnancy These fluctuations may show up as increased headaches, skin reactions, digestive symptoms, fatigue, anxiety, or heightened sensitivities. When viewed through a hormonal lens, patterns that once seemed random can sometimes begin to make more sense. MCAS and Menstrual Health For some women, mast cell activation may also contribute to menstrual challenges. Women frequently report: Heavier periods Increased menstrual pain More significant bloating Heightened fatigue during menstruation Premenstrual migraines Increased digestive symptoms around their cycle The inflammatory chemicals released by mast cells can influence many of the systems involved in menstrual health, potentially contributing to these experiences. Keeping a symptom diary that tracks both MCAS symptoms and menstrual cycles can often reveal patterns that might otherwise go unnoticed. Why Are Food Intolerances So Common? One of the most frustrating aspects of MCAS can be food sensitivities that seem to change from week to week. Many individuals find that foods they once tolerated suddenly trigger symptoms such as: Bloating Reflux Nausea Stomach pain Headaches Skin reactions Fatigue Brain fog This does not necessarily mean a true food allergy is present. Instead, mast cells located throughout the digestive tract may react to certain foods, food chemicals, additives, or naturally occurring histamine levels. Common triggers may include: Aged cheeses Fermented foods Alcohol Processed meats Vinegar Tomatoes Citrus fruits Certain food additives Importantly, every person with MCAS is different. A food that causes symptoms for one individual may be perfectly tolerated by another. Rather than focusing on restriction alone, many practitioners now encourage a gentle, individualised approach that prioritises nourishment, nervous system support and identifying personal patterns. The Gut, The Nervous System and Mast Cells The digestive system is home to a significant proportion of the body’s immune activity. Mast cells sit throughout the gut lining, constantly communicating with both the immune system and the nervous system. For many women with MCAS, periods of stress can trigger digestive symptoms, while digestive symptoms can in turn increase feelings of stress and overwhelm. This is not “all in your head.” It is a reflection of the powerful communication that exists between the gut, immune system and nervous system. Supporting one area often helps support the others. Holistic Ways to Support the Body While medical support is an important part of managing MCAS, many women find that holistic wellbeing practices help them feel more regulated and supported alongside their healthcare plan. There is no one-size-fits-all approach to MCAS. The aim is not to “fix” the body but to create conditions that support rest, recovery, resilience and regulation. Understanding the Neuro-Immune Connection Many women living with MCAS also identify as autistic, ADHD, or neurodivergent in other ways. Emerging research suggests there may be important connections between sensory processing, nervous system regulation, immune function and mast cell activity. For some neurodivergent women, heightened sensory sensitivity can mean that changes in temperature, smells, textures, noise levels, stress, hormonal fluctuations, or environmental exposures feel more intense. These same factors may also influence mast cell activation and nervous system responses. Hormonal changes throughout the menstrual cycle, pregnancy, postpartum periods and perimenopause can further affect both sensory experiences and MCAS symptoms. As a result, symptom fluctuations may feel particularly pronounced and sometimes difficult to predict. Understanding these interactions can help women move away from self-judgement and towards greater self-compassion. Rather than seeing symptoms as random or excessive, they can be understood as part of a complex conversation between the nervous system, immune system, hormones and environment. Lymphatic Support The lymphatic system plays an important role in moving fluid, cellular waste and immune cells throughout the body. Unlike the circulatory system, it relies on movement, breathing and muscle contraction to function efficiently. When we are stressed, exhausted, sedentary or recovering from illness, many people report feeling sluggish, puffy or congested. Gentle lymphatic support may include: Dry body brushing Lymphatic drainage massage Rebounding (gentle bouncing on a mini trampoline) Walking in nature Stretching and mobility exercises Adequate hydration Deep diaphragmatic breathing Many women find these practices particularly supportive during times of hormonal change, when feelings of bloating or fluid retention may be more
Hypermobility, POTs, MCAS & Neurodiversity: Understanding the Connection
MCAS, POTs, Hypermobility and Neurodiversity – Understanding the connections As awareness of neurodivergence continues to grow, many families are discovering that autism and ADHD often come with additional physical health challenges that may have previously been overlooked or misunderstood. For some children and adults, challenges such as chronic fatigue, dizziness, digestive difficulties, pain, allergies, sensory sensitivities and fluctuating energy levels may not be separate concerns at all. Increasingly, researchers and clinicians are recognising connections between neurodivergence and conditions including Mast Cell Activation Syndrome (MCAS), Postural Orthostatic Tachycardia Syndrome (POTS), and Hypermobility Spectrum Disorders (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS). While every individual is unique, understanding these connections can help families make sense of symptoms, seek appropriate support, and develop greater self-compassion. What is Mast Cell Activation Syndrome (MCAS)? Mast cells are a normal part of our immune system. They help protect us by releasing chemicals such as histamine when they detect potential threats. In people with MCAS, mast cells can become overly sensitive and release these chemicals inappropriately or excessively. This can create symptoms throughout the body, often affecting multiple systems at once. Common symptoms of MCAS may include: Frequent allergic-type reactions Itching, hives or unexplained rashes Flushing or sudden warmth Digestive difficulties such as nausea, reflux or abdominal pain Headaches and migraines Fatigue Brain fog Sensitivity to foods, medications or environmental triggers Respiratory symptoms such as wheezing or congestion Because symptoms can vary significantly from person to person, MCAS is often difficult to recognise and may take time to diagnose. What is POTS? Postural Orthostatic Tachycardia Syndrome (POTS) is a condition affecting the autonomic nervous system—the system responsible for regulating many automatic body functions including heart rate, blood pressure, digestion and temperature regulation. When someone with POTS moves from lying down or sitting to standing, their heart rate increases significantly, often leading to a range of symptoms. Common symptoms of POTS may include: Dizziness or light-headedness when standing Rapid heartbeat Fainting or near-fainting episodes Extreme fatigue Exercise intolerance Brain fog and concentration difficulties Headaches Digestive symptoms Temperature regulation difficulties Nausea Many children and adults with POTS describe feeling as though their energy levels fluctuate dramatically throughout the day. What is Hypermobility Syndrome? Many people think of hypermobility simply as being “double-jointed” or unusually flexible. However, for some individuals, hypermobility affects far more than their joints. Hypermobility Spectrum Disorders (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS) involve differences in connective tissue, which provides support throughout the body. Common symptoms of hypermobility may include: Joint pain Frequent sprains or injuries Joint instability Fatigue Muscle aches Poor proprioception (body awareness) Digestive difficulties Headaches Coordination challenges Easy bruising Heavy and painful menstrural cycles For some people, symptoms are mild. For others, hypermobility can significantly affect daily life, physical comfort and energy levels. How Are These Conditions Connected? Researchers have observed a notable overlap between MCAS, POTS and hypermobility conditions. Although the exact mechanisms are still being investigated, these conditions frequently appear together. One theory suggests that differences in connective tissue associated with hypermobility may affect blood vessels and autonomic nervous system function, contributing to POTS symptoms. Mast cell activity may also influence inflammation, vascular regulation and nervous system responses, creating further overlap between MCAS and POTS. Many of us working as clinicians now refer to this as a “triad” because these three conditions are so commonly seen together. Not everyone with one condition will develop the others. However, when symptoms seem to span multiple body systems, it can be helpful to explore whether there may be an underlying connection. What Does This Have to Do with Autism and ADHD? Many neurodivergent individuals report experiences that align with one or more of these conditions. Emerging research suggests higher rates of hypermobility, autonomic nervous system differences and immune system dysregulation among autistic and ADHD populations compared with the general population. While we do not yet fully understand why these connections exist, several theories are being explored, including: Shared genetic factors Differences in connective tissue development Nervous system regulation differences Immune system variations Sensory processing differences that increase awareness of physical symptoms It is important to remember that autism and ADHD are not caused by MCAS, POTS or hypermobility, nor do these conditions occur in every neurodivergent person. Rather, they may represent interconnected ways in which the nervous system, immune system and connective tissues develop and function. Looking Beyond Behaviour For neurodivergent children especially, physical symptoms can sometimes be mistaken for behavioural challenges. A child who appears anxious may actually be experiencing dizziness from POTS. A child who struggles with concentration may be dealing with fatigue, pain or brain fog. A child who seems irritable may be coping with digestive discomfort, headaches or mast cell activation symptoms. When we view behaviour as communication, we open the door to understanding what the body may be trying to tell us. A Whole-Person Approach Recognising the potential links between neurodivergence, MCAS, POTS and hypermobility encourages a more holistic understanding of health. Rather than viewing physical, emotional and sensory experiences as separate, we can begin to appreciate how closely connected they often are. For families navigating these complexities, knowledge can be empowering. Understanding the bigger picture may help explain experiences that previously felt confusing or disconnected and support more tailored care and accommodations. Every person’s experience will be different, and no single explanation fits everyone. However, listening carefully to both the body and the nervous system can often provide valuable clues. Learn More About Hypermobility and MCAS One particularly interesting area of ongoing research is the relationship between hypermobility and Mast Cell Activation Syndrome. Many individuals with hypermobility report symptoms commonly associated with mast cell activation, and researchers continue to explore the biological links between connective tissue differences and immune system function. In future blog posts, we’ll take a closer look at hypermobility and MCAS, exploring why these conditions frequently occur together and what families may wish to know when seeking support. Back To Blog