Dysautonomia, POTS, Ehlers-Danlos Syndrome (EDS), Chiari Malformation, and Related Disorders

Conditions such as dysautonomia, postural orthostatic tachycardia syndrome (POTS), Ehlers-Danlos syndrome (EDS), Chiari malformation, and related disorders are often complex, overlapping, and under-recognized. While these diagnoses are commonly associated with fatigue, pain, and cardiovascular or connective tissue symptoms, they can also significantly affect voice, swallowing, cognition, and communication. Speech-language pathologists (SLPs) play an important role in identifying these challenges and providing targeted, functional support.

Many individuals with these conditions also have a high rate of overlap with ADHD, autism, and other forms of neurodivergence, which can further impact communication, processing, and daily functioning.

Common Communication and Swallowing Challenges

Voice and Upper Airway Changes
Autonomic dysfunction, connective tissue differences, muscle fatigue, and reduced breath support may affect voice quality and endurance. Individuals may experience:

• Vocal fatigue or strain

• Hoarseness or reduced vocal stability

• Difficulty projecting the voice

• Voice changes that worsen with exertion or prolonged speaking

These challenges can impact work, social participation, and self-advocacy.

Swallowing Difficulties (Dysphagia)
Swallowing difficulties can occur due to differences in muscle coordination, sensation, structural factors, or autonomic regulation. Symptoms may include:

• Difficulty initiating a swallow

• Sensation of food sticking in the throat

• Coughing or throat clearing during meals

• Reflux-related symptoms or globus sensation

• Fatigue during meals or prolonged mealtimes

Dysphagia in these populations may fluctuate, requiring a flexible and individualized treatment approach.

Cognitive-Communication Changes (“Brain Fog”)
Many individuals describe cognitive symptoms commonly referred to as brain fog, which may include:

• Difficulty with attention and focus

• Reduced processing speed

• Word-finding challenges

• Memory and recall difficulties

• Mental fatigue and reduced stamina

• Difficulty with organization, planning, and multitasking

These challenges can be especially frustrating when they fluctuate or are misunderstood by others.

Neurodivergence and Overlapping Diagnoses

There is a well-documented overlap between dysautonomia, EDS, POTS, and ADHD and autism. Individuals may experience lifelong differences in attention, sensory processing, communication style, or executive functioning that interact with medical symptoms.

SLP services are provided with a neurodiversity-affirming approach, recognizing that therapy is not about changing who someone is, but about supporting effective communication, self-understanding, and participation in daily life.

How a Speech-Language Pathologist Can Help

SLP intervention focuses on practical, individualized strategies that respect fluctuating symptoms and energy levels.

Voice Therapy

• Improve vocal efficiency and endurance

• Reduce strain and compensatory muscle tension

• Support breath coordination for speech

• Develop pacing strategies for work and social demands

Swallowing Evaluation and Treatment

• Assess swallow safety and efficiency

• Provide strategies to reduce fatigue and improve coordination

• Support safe swallowing across variable symptom days

• Address reflux-related and sensory components of swallowing

Cognitive-Communication Support

• Address attention, memory, and executive functioning challenges

• Develop personalized strategies for managing brain fog

• Support work, school, and daily routines

• Improve self-advocacy and communication in medical and professional settings

Education, Counseling, and Whole-Person Support

Living with complex, overlapping conditions can be exhausting and isolating. Education and counseling are a core component of care and may include:

• Education about how these conditions affect communication and cognition

• Validation of fluctuating and invisible symptoms

• Training care partners, employers, or educators in supportive strategies

• Counseling related to identity, burnout, and adjustment

• Support with healthcare navigation and self-advocacy