Dear neurodivergent woman,
Do you get tired from standing in a queue? Do you slump into chairs, lean on walls, or feel like your body is a bag of sand by 3pm? Maybe you were the clumsy child, the one who struggled in PE, or the adult who can't hold a plank but is told she "just needs to exercise more."
This is rarely talked about, so I want to put it on the table: low muscle tone and fatigue often turn up together in neurodivergent people. I think the link is energy.
What low muscle tone is
Muscle tone is the small amount of tension your muscles hold even at rest. It is what keeps you upright without thinking about it. Low tone (doctors call it hypotonia) can feel like tiring quickly, slumping, loose or achy joints, poor stamina, and a body that takes more effort to run than it should.
It is not the same as being weak or unfit. You can train and still feel it.
What the research says about neurodivergence and muscle tone
A 2025 systematic review pulled together 24 studies of children aged 2 months to 6 years. It found a consistent link between low muscle tone, motor difficulties and a later autism diagnosis, and suggests hypotonia could be an early sign. The authors say more research is needed. Zhang et al., 2025
That research is in children, and mostly boys. There is almost no research on muscle tone in autistic or ADHD women, and that is what we are up against everywhere. Women have been left out of autism and ADHD research for decades, and the criteria were built around boys. So no evidence about us does not mean nothing is there. It means nobody has looked. What we do have is research on the machinery behind muscle.
Why muscles and energy are tied together
Muscle is one of the most energy-hungry tissues you have. Every contraction, including the tiny ones that hold you upright, is paid for with ATP, the fuel your mitochondria make.
A review of mitochondria in autism found that up to 5% of autistic children have a classic mitochondrial disease, and that many more show signs of changed mitochondrial function. Low muscle tone is one of the features seen in the children with the clearest mitochondrial problems. Griffiths and Levy, 2017
Nobody has looked at this in neurodivergent women, so we do not know how many of us are affected. But it does show that, for some of us, how our cells make energy and how our muscles feel may be connected.
How I see it
This is how I think about it with my clients. Two things sit underneath tired, low-tone muscles:
Fuel. If your blood sugar swings up and down, your cells get an unsteady supply. Muscles feel it first: heavy legs, shaky hands, a crash after a meal.
Safety signals. When your body has been in a long stress state, your cells shift towards protection instead of making energy. This is the cell danger response. Spending energy on defence leaves less for holding yourself up.
This is the pattern I see in my clients, and it matches what I went through myself.
What this can look like in daily life
You tire from standing, walking or sitting upright for long
You sit curled up, slouch, or lean on things without noticing
Exercise leaves you wiped out for a day or two afterwards
You feel better lying down than almost anywhere else
You were told as a child you were clumsy or lazy
It is worse in the week before your period, or in perimenopause, when estrogen is changing
What to do with this
You do not need to force more exercise. Pushing a body that is short of energy often makes the crash worse. The place to start is steady fuel and a calmer nervous system, so your cells have the energy to do the work.
If this sounds like you, my post on burnout and your mitochondria goes deeper into why rest alone is not fixing it.
Sources
Zhang et al. (2025). Early muscle hypotonia as a potential marker for autism spectrum disorder: a systematic review. Frontiers in Psychiatry.
Griffiths and Levy (2017). Evidence of mitochondrial dysfunction in autism.
