Neurodiversity is not just for those we work with

The feeling that you shouldn't really be here, that you're going to be found out, seems to be a pretty common experience among psychologists. Thankfully, most of us have colleagues we can confide in, who remind us we all feel like that sometimes, and that we are actually good enough. But for many of us who are neurodiverse, imposter syndrome and the fear of discovery are very real.

As autistic psychologists, we keep meeting strange assumptions which put unnecessary barriers in our way: that autistic people cannot hold down a job; that we should not (or should only) work with autistic people, or that we can fill only specific roles; that we couldn't possibly be an applied psychologist. Here we deal mainly with that final assumption: should the aspiring neurodivergent psychologists among us disclose our diagnoses, on application forms for jobs or training, or in our work or study? Supportive colleagues often reluctantly advise us not to, and divert many of us from the tortuous path to qualification. What about the qualified among us? How will colleagues, managers, and networks react to our diagnoses? Can we ask for reasonable adjustments without our competence being questioned or becoming known as 'the autistic psychologist'?

We write as autistic psychologists, but neurodiversity is far broader than autism, and caring professions broader than applied psychology. Whilst we can only write about our own experiences – and some of us share individual personal reflections throughout this letter – we hear these echoed by other neurodivergent health professionals. We therefore also consider neurodiversity in healthcare more broadly, hoping to extend the conversation.

'When I turn around and tell staff teams that actually "I am autistic" it feels like their heads will explode. Initially they can't handle it but then I explain and demonstrate how I meet the various diagnostic criteria (mainly hidden in my office or away from work) and then they get it.'

Not all our experiences are bad. Not all neurotypical colleagues hold mythical views about neurodiversity. Most of us have given our names to this letter because we are in roles where our neurodiversity is understood, supported, and valued for what it can bring to our teams. Indeed, many of us who are 'out' have had colleagues come to us to confidentially discuss how they relate to some or all of autism. But we recall our past experiences, and continue to hear from others (both pre- and post-qualification) who do not yet feel able to make their neurodivergence public, for fears of how others will react, and how it will affect their career.

'Due to a lack of understanding and support I had significant mental health difficulties as a teenager, including self-harm and hospitalisation. When I was accepted onto the training course an occupational health consultant told me that, "People with your history do not do well on the course", and, "I am strongly advising you not to do the course". This made me feel unable to ask for support or reasonable adjustments throughout my training.'

Why does there seem to be this view that an autistic person can't be a psychologist? First, there may be a conflation of autism and neurodiversity with comorbid mental health difficulties, which are more prevalent in the autistic community (Lugo-Marin et al., 2019). But the stigma of mental health problems need not be a barrier to applied psychology work, as psychologists with lived experience have argued (see the BPS statement from 2020, via tinyurl.com/bpslivedexp).

Second, autism remains something colleagues joke about. 

'I was having lunch with a couple of colleagues and they were discussing someone whose communication had seemed odd to them. There was a negative comment made amongst a bit of giggling, suggesting, "She must've been on the spectrum or something", implying that there was something wrong with being on the autistic spectrum.'

For some, being autistic seems to be synonymous with being socially awkward, which seems incompatible with the idea of an insightful, understanding and empathetic psychologist. Although there is no substance to the myth that autistic people cannot be empathic (Fletcher-Watson & Bird, 2019), when others make this assumption, make a joke out of autism, or speak about autism in a derogatory way, it feels unsafe for us to disclose.

But third – there is a more fundamental problem. Most applied psychologists need excellent social communication skills: by definition, these do not come easily to autistic people. Regardless of how one might reframe the language of diagnostic criteria, it is self-evident that joining most applied psychology professions is a challenge for many autistic people. Would we be better suited to careers which limit our interaction with people?

As autistic psychologists we think we have something valuable to offer. It starts with our interest and motivation. Psychology is a natural field for many autistic people. Many of us have been studying people since we were at school to try and work out how people think and behave. 

'After pre-teen bullying by so-called friends, I became fascinated by observing the outsiders in whichever social group I found. That drove me into psychology, into research on children's peer relationships, and finally into clinical psychology. It was only later in life that I realised that I and many of the other outsiders were probably autistic.'

How can motivation turn into competence? Skills are learned. Struggling with social communication does not stop you developing good skills. Many of us find social interaction challenging, and at times come across as awkward, but we have worked hard to understand how to communicate and socialise in a neurotypical way. The path to qualification is hard for neurotypical psychologists too. However, when there are rigorous and fair admission and training standards, by definition anyone qualified as an applied psychologist has acquired core competencies, and anyone on a training course has a good chance of acquiring them. It follows then that any autistic person in either position will have developed sufficient social communication skills to work in applied psychology.

'By the time I had gained a training place, I knew how to build rapport and communicate with service users, and the written elements of the course were a breeze. While fellow trainees worked hard to brush up their academic and research skills, I put efforts into improving my spoken and non-verbal communication with colleagues and other professionals.'

Applied psychologists are not Mary Poppins – practically perfect in every way – nor do we need to be. Applied psychologists are trained to function in multi-disciplinary teams, or to fill specific roles in a system (e.g. healthcare, education, or business). Functioning systems require the right skill mix, with different people contributing complementary skills to meet the task demands. Autistic psychologists working within systems may add value through our (perhaps more unusual) skills, with other team members bringing skills we may be less proficient in.

Furthermore, within all teams and systems there are toxic relationships and poor communication, which are not caused by autism. Sometimes, attributing some poor communication to miscommunication between neurotypes, rather than to hostile intent, can defuse anger and help teams function well. Equally, whilst autistic people are very diverse, we may naturally have greater strengths than neurotypical colleagues in all sorts of areas – for instance attention to detail, precise written communication, understanding statistics, following correct procedures, integrity, reliability and straight talking.

Do we add anything unique? Consider the service user's perspective. We find that many autistic service users value autistic professionals who they feel understand them. It is not only our lived experience that counts though. The Double Empathy Problem (Milton, 2012) suggests that empathising across neurotypes is challenging for both autistic and neurotypical people, rather than autistic people lacking empathy. We may therefore be better than neurotypicals at empathising with other autistic people (Crompton et al., 2020). We may also be more alert to autistic symptoms among the people we work with, and (where appropriate) may be able to use self-disclosure to destigmatise autism.

'I was recently working with a new client, who, at the start of the assessment, almost immediately apologised for being neurodivergent. It made me sad that he felt the need to apologise for this. I asked him not to apologise and explained I was also neurodivergent, to which he seemed surprised, but relieved.'

To show it can be done, several of us have described our experiences of working as applied psychologists (e.g. Muggleton & Johnston, 2016; Hawker, 2017; Radev, 2020; Welsh, 2020). But it sometimes feels as if we are very few. Many of us earlier in our careers are exhausted by doubts about our practice, working in systems that make our jobs harder, and having to mask our autism. Psychologists who are neurodivergent in other ways (for example, ADHD, dyscalculia, dyslexia, and dyspraxia) report similar experiences. So do neurodiverse colleagues in related professions (including health professionals, teachers, and support workers). As a discipline that prides itself on understanding individual differences, on formulation over diagnosis, and on understanding the mind and behaviour, applied psychology needs to catch up with medicine (c.f. Doherty et al., 2021) in including and valuing neurodiversity within teams.

To come together, two groups need a shared goal to complete (think Sherif's Robbers Cave), which the pressures on services provide. We therefore need to create an environment where our neurodiverse colleagues feel safe to disclose, raising awareness of their presence, and beginning dialogues about how to mobilise their generic, specific, and unique skills.

Acceptance of neurodiverse colleagues is key. Neurodiversity is more than a subject for research, assessment and intervention. It is part of your team and your profession.

The BPS best-practice guidelines on working with autism, in many ways excellent, rightly guide psychologists on advising employers about autistic people with significant intellectual impairments or other difficulties. It is largely silent on how to talk to or be a good colleague to an autistic person; how to ask an autistic employee about what adaptations they might find helpful; how to manage them and make best use of their neurodivergence; what an autistic-friendly workplace might look like; or how to supervise or be supervised by an autistic psychologist. It is a document about 'doing to' autistic people rather than 'working with' autistic people.

Being accepted as an autistic psychologist means neither feeling judged for being autistic, nor being embarrassed by our autism. It means neither having to keep proving we are good enough, nor being rolled out as the token autistic psychologist.

'I applied to join a group writing a guidance document about autism. I talked about being an autistic psychologist in my application, as well as my clinical and research experience in the area, but didn't make the cut. A few weeks later, the group asked me to join as they wanted an autistic person as an expert by experience. I turned it down. Although I wanted to help, it felt like all they were interested in was my autism, and my years of training and experience weren't relevant. I wasn't going to be one of them, I was going to be a subject.'

Acceptance means being invited, included and accepted in informal social interactions between colleagues, whilst recognising these may be harder for us than working with clients. It means providing safe supervision which allows us not only to disclose our autism without automatic questioning of our fitness to practice, but also to reflect on how autism affects our practice, so (like everyone else) we can identify how to build on our strengths and overcome our difficulties. It means local and national leaders valuing diversity in all forms, not tokenism, and making it safer to express and disclose differences.

Diversity means everyone is different and best seen as an individual, not a label. Indeed, many psychologists will not have a formal diagnosis, and may not need one. Some of us need reasonable adjustments to work well, but these are diverse too. Even if you are highly experienced, asking is better than believing you understand autism and know best. Some autistic psychologists are better at narrow or specialist roles; others are not. Some work best with expectations about our work made explicit from the start; others do not need that. Some of us find large meetings helpful; others find them difficult, especially in person, preferring virtual attendance, or to be excused when we are not needed and can read the minutes. Some prefer to form social relationships in a busy office; others prefer a quiet room to work in, or at least a consistent desk. Some find it less stressful to have plenty of notice about changes, and clear information about them; others thrive on spontaneity.

But reasonable adjustments are ineffective or unusable unless we are accepted as we are. The best way to help us is to make us feel fully included in the workforce, understanding if we need to have lunch by ourselves, seek stimulation, or are quiet or slow to get jokes or join in office banter. In an inclusive environment, we can spend more time and energy on our team's shared goals, and less on acting neurotypical.

We need to think more broadly about neurodiversity. It is easy to think of neurodiversity as a topic of study, or a client group we support, and to forget that neurodiverse psychologists are among us. The consequent sense of 'othering' makes it hard for those of us who are neurodivergent to disclose and use our neurodiversity. We are living proof that autistic people can be psychologists. But for each of us who have signed this letter, there are many more psychologists who do not feel safe letting you know they see the world differently. They are not just part of a team but your team, in your workplace. All they want is to be able to go to a colleague on those days when they feel like an imposter, and to be reminded that they are good enough, that they are a valued part of the team, and that they are meant to be here.

If you would like to share your own experiences and join a broader network of neurodivergent psychologists, you are welcome to contact Dr Joshua Muggleton [email protected]

Dr David Hawker, Clinical Psychologist

Dr Joshua Muggleton, Clinical Psychologist

Elizabeth Henshaw, Trainee Clinical Psychologist

Dr Kirsty Horne, Principal Clinical Psychologist

Dr Jake Hutchinson, Senior Clinical Psychologist

Lydia Little, Senior Service Manager

Dr Alice Nicholls, Clinical Psychologist

Dr Patrick Welsh, Senior Clinical Psychologist

On behalf of other autistic psychologists (details supplied to first author where anonymous or pseudonymous): 

Hari Parekh, Trainee Clinical Psychologist

Ms Deborah Sheffield, Trainee Clinical Psychologist

Chrissy Lawrence, Clinical Research Assistant

Karolina Kalisz, Higher Assistant Psychologist

Richard Falcon, Trainee Clinical Psychologist 

Beth Chambers, Psychological Wellbeing Practitioner

Dr NotYetSafeToDisclose, Principal Clinical Psychologist

Sarah Simpson, Highly Specialist Forensic Psychologist

Toni Paterson (pseudonym), Associate Forensic Psychologist

Dr Jennifer Jones (pseudonym), Principal Clinical Psychologist

Sarah Foster, CAMHS Practitioner

Amber Watkins, Trainee Clinical Psychologist

Danielle Goddard, Senior Education Mental Health Practitioner

Alice Holly Payne, Associate Psychological Practitioner

Felicity Eyre, Assistant Psychologist

Ellie Sims, Assistant Psychologist 

Anon, Clinical Associate in Applied Psychology

Dr Catherine Nesbitt, Clinical Psychologist

Patricia Staniland (pseudonym), Senior Clinical Psychologist

Anon, Details supplied

Zoe Hodge, CBT Therapist

Anonymous, Trainee Clinical Psychologist

Cheryl Venart, Trainee Health Psychologist

Anon, Trainee Clinical Psychologist

ST, Assistant Educational Psychologist

Dr Alexander Charles, Clinical Psychologist

Illustration: Tim Sanders

References

Crompton, C.J., Ropar, D., Evans-Williams, C.V.M. et al. (2020). Autistic peer-to-peer information transfer is highly effective. Autism: International journal of research and practice, 27 (7), 1704-1712.

Doherty, M., Johnson, M. & Buckley, C. (2001). Supporting autistic doctors in primary care. British Journal of General Practice, 71, 294-295.

Fletcher-Watson, S. & Bird, G. (2019). Autism and empathy: What are the real links? Autism: International journal of research and practice, 24 (1), 3-6.

Hawker, D. (2017). Practising Clinical Psychology on the Autistic Spectrum. Clinical Psychology Forum 294, 9-13.

Lugo-Marin, J., Magan-Maganto, M., Rivero-Santana, A. et al. (2019). Prevalence of Psychiatric Disorders in Adults with Autism Spectrum Disorder. Research in Autism Spectrum Disorders (59), 22-33.

Milton, D. (2012). On the ontological status of autism: the 'double empathy problem'. Disability & Society, 27(6), 883-887.

Muggleton, J. & Johnston, K. (2017). 'You've hired a psychologist with autism?!': Reflections on being a trainee clinical psychologist with autism. Clinical Psychology Forum 288, 5-8.

Radev, S. (2020). Strengths and weaknesses of being born a 'Little Psychologist'. Clinical Psychology Forum, 326, 49-52.

Welsh, P. (2020). How do I answer that. Clinical Psychology Forum, 335, 21-24.