Neurodiversity at work

Neurodiversity has always been a feature of work. At its most fundamental level, neurodiversity refers to the diversity in cognition, emotion and sensory perception that we in Psychology would normally term 'individual differences'. As such, it forms the basis for Dr Helen Taylor's evolutionary theory of 'Complementary Cognition' in which humans adapted to cooperate within a balanced community of specialist thinkers and generalist thinkers.

However, since the first mentions of ADHD at the turn of the 19th century (Lange et al., 2010) and the advent of discoveries such as dyslexia (Berlin, 1884) and Autism (Ssucharewa, 1927), humans with unusual neurological profiles have been disabled by the industrial revolution norms of literacy, numeracy, fine motor control, sitting still for hours in busy, overstimulating environments.

As such, it is worth being mindful of a long historical view, in which pre-industrial norms allowed people to be farmers, smiths, traders, bards and bakers through apprenticeships and family (i.e. genetic) heritage. In our current world, the gates to all professions are closed to those who cannot excel in the limited range of cognitive abilities required for modern education. We currently consider them disabled, to a greater or lesser extent as mediated by overall IQ peaks, their family resources and background, any trauma or co-occurring health conditions such as epilepsy, chronic fatigue etc.

This has led to significant occupational exclusion. Only 22 per cent of Autistic people in the UK are employed, compared to a disability average of 53 per cent and an abled average of 83 per cent (ONS, 2019). A quarter of the prison population meets the clinical criteria for ADHD (Young et al., 2018) and a third of long-term unemployed people are dyslexic (Jensen et al., 2000).

The status quo for neurodivergent people is needless exclusion.

Disability discrimination and reasonable adjustments

From the early 1990s, advanced economies began to adopt disability equality legislation, broadly consistent with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD, 2006). The statute confers an obligation for organisations (government, workplaces, schools) to make reasonable accommodations for disability. These involve changes to the environment, tools and processes to reduce adverse impact for disabled people.

For wheelchair users, this led to growth in step-free access, but for neurodivergent people, it has been less tangible. In the workplace, we tend to offer remote or quiet working arrangements, flexibility in schedule, assistive technology, and coaching (McDowall et al., 2023) to support the typical issues with executive functions, well-being, self-advocacy and communication (Doyle & Bradley, 2022). These tend to be reactive – employers hire without disclosure (Achieve Ability, 2016) and wait until someone is failing before they offer support. We also operate a gatekeeping approach – the adjustments aren't offered until there is a diagnosis in place, even though this is not consistent with case law (J v DLA Piper UK LLP, 2010). This is counter-productive because the assessments often cost more than the accommodations and access to diagnosis is often privileged by socio-economic status, gender, sexuality, race and ethnicity (Doyle et al., 2022; Doyle, Nancy et al., 2022; Young et al., 2020).

The legal statutes inspired compliance, but this is reactive and has not moved the dial on labour force participation. However, equality legislation did open up services such as the government's Access to Work scheme, which supports disabled workers through the provision of technology, equipment and coaching. Neurodivergent employees can contact Access to Work for a free assessment and subsidised support.

Deliberate inclusion

Since SAP in 2007 started the first 'Autism at Work' program, this idea has spread throughout tech, defence and government (Bernick, 2021; Philipson, 2014). We learned something fundamental – that if we lift the barriers of the traditional recruitment methods such as interviews, CVs and references, and use work sample testing, it turns out we can hire specialists who turn out to be great at the role! Of course, this is well-known by Occupational Psychologists and it is a source of much frustration that employers persist with the old ways when decades of diligent research has shown them to lack predictive validity.

Autism at Work hiring provoked a sea change in the neurodiversity space. All of a sudden, neurodivergent people were cool! We were being recruited for our strengths, rather than being offered favours because people felt sorry for us. This was a great point of principle, but the follow-up is lacking.

Firstly, the programmes tend to operate in privileged areas, and access is restricted for women, those from the global ethnic majorities, indigenous people (Doyle et al., 2022) and those with other minority neurotypes such as Tourettes or dyspraxia, which aren't as well known or 'cool'.

Secondly, there is reason for caution about the long-term approach here. When we include people on the basis of a diagnosis, what happens to the confidentiality of those individuals? They work in the 'Autism team'. Could this become stigmatised, along the lines of 'special education'? Are these programs positive action or positive discrimination, when other neurominorities cannot apply?

We wouldn't approach any other form of inclusion this way. Imagine if I wanted to improve access in my business for those minoritised by race, and stated I would hire Chinese people for my finance team because I had heard they were good at maths? Or I wanted to improve gender representation and decided to have a project management team of women because they are supposedly better at multi-tasking? 

Autism at Work has been a helpful step in our neuroinclusion journey, but it is time to move on. We need to learn the lesson that work sample testing and designing job roles for specialists works, but including people solely on the basis of a label is risky.

Systemic inclusion

I've worked in this field since the late 1990s, and the changes have been immense. We've moved from a medical model approach where 'specific learning disabilities' and 'neurodevelopmental disorders' were dealt with via Occupational Health and disability support, to a more social model approach where 'neurodiversity' is another category for Equity, Diversity, Inclusion and Belonging teams. However, we're running up against a new problem.

As public awareness and social media influencers proliferate more people come forward as neurodivergent. To be clear, the current diagnosis rates are still nowhere near the estimated population prevalence, so talk of TikTok trends and bandwagons are a long way off; however, the population prevalence in total is estimated at around 15-20 per cent of the workforce (Doyle, 2020). With the current approach of reactive, 1-2-1 adjustments and the odd team of Autistic coders, we are never going to move the dial on inclusion at these numbers.

We need a different, scalable approach. We need to move beyond the gatekeeping approach of the medical model, beyond the individual approach of the social model and into a biopsychosocial model where workplace environments and workflows are personalised to maximise performance for all employees, rather than the homogenous automatons of the industrial era.

The spiky IQ profile that we have come to associate with neurodivergence (Grant, 2009) is relevant to all employees. You know the phrase 'must be able to work independently and be a team player'. Really? Do data analysts need to be team players? Can't we let them work alone with their data being accurate and efficient? 'Must have good literacy'. Really? In an era where all laptops and phones have speech-to-text and spell-checking as standard, should we limit a graphic design role to those who have high passes in English GCSE? In an era where VAR headsets exist, should we be assessing the skills of junior surgeons with multiple-choice quizzes?

Their work isn't literacy-based, it relied on visual acuity, dexterity and rapid processing of multi-sensory input. Hairdressing and bricklaying apprenticeships require GCSE standard English, which these days involves all manner of grammatical sophistication that Gen-Xers (including myself) weren't even taught. Why? We have built so many unnecessary hurdles into professional training, recruitment and appraisal systems. Our neurodivergent colleagues can show us where these barriers are and, rather than giving them a box to stand on, we could just lower the fence.

The disability inclusion community have long promoted the Seven Principles of Universal Design (The Center for Universal Design, 1997) for technology development. Their approach can be co-opted to influence human resources design around the employee life cycle (Doyle & McDowall, 2021). Starting with designing jobs for specialists as well as generalists to form well-balanced teams, through job-relevant recruitment and training, onboarding, wellbeing, talent and performance management, we can apply them to help us identify barriers such as the examples I have shared above.

Universal Design reduces the need for expensive assessments with long waits. It also deals with the disclosure issue – the majority of neurodivergent employees do not disclose for fear of stigma from colleagues or management (McDowall et al., 2023). It won't remediate all performance difficulties, but it can lead us to a more equitable baseline.

Where next?

All of the above are areas that are developing in terms of research and practice. They form the practical side of neuroinclusion, the aspects that make sense and feel more tangible. However, in our UK gap analysis survey conducted in 2022/2023, Professor Almuth McDowall and I found that practical adjustments are only half the story. We ran a regression analysis with 'intention to turnover' as the dependent variable.

Despite adjustment provision being strongly correlated with intention to turnover, it was not a significant predictor compared to the relationship with the line manager, psychological safety and career satisfaction. We liken this to Herzberg's Motivator/Hygiene Factor theory (Herzberg, 1966). Adjustments to working conditions are hygiene factors, they don't motivate in and of themselves, but if they are lacking, they can demotivate. Relationships and career progression / being valued are motivators, they inspire loyalty.

At the Centre for Neurodiversity at Work at Birkbeck, University of London, Professor McDowall and I are considering how to research these aspects. The focus on strengths and career trajectories is reasonably straightforward, but Psychological Safety and relationships are more gnarly. We have significant professional experience of managing neurodivergent staff: within this pool are people with more exposure to trauma and insecure attachments.

Misunderstandings, defensiveness, withdrawal, (passive) aggression can derail a neurodivergent career more quickly and more catastrophically than neurotypical expectations. These issues are difficult for all managers, in any circumstance, and have led to an increase in employment tribunals related to neurodivergence in recent years (Mani Deol, 2022). We need to understand more about how to prevent relationship breakdowns in neurodiverse teams and how to recover from outbursts or loss of trust.

There is a boundary – employers are not counsellors, therapists or clinicians, and navigating this tightrope is a popular referral into my consulting business. The answers are not straightforward. It comes down to clear expectations and boundaries at the start, regular opportunities for feedback and feedforward and raising small niggles directly before they spiral out of control. Line management is an underrated skill, organisations typically promote skilled practitioners based on delivery expertise, without support to develop communication. As neuroinclusion becomes more prevalent, this is an essential area of focus to ensure success.

Another fruitful area of enquiry is Job Crafting (Tims & Bakker, 2010), which is the latest iteration of the Person-Environment Fit Theory (Lewin, 1936), suggesting that a role can be shaped to form a better fit to the individual leading to better engagement, wellness and performance. In the context of neuroinclusion, Job Crafting would be built around the 'peaks' of a spiky profile. Job Crafting is, however, dependent on good team dynamics and building complementary specialists – it's no good if we are all creative geniuses that can't do admin!

We need some people who also excel at logistics, accuracy and planning. This 'balance' occurs quite naturally in the species according to Complementary Cognition Theory. The execution of Job Crafting will involve neuroinclusive measures for assessing the strengths and challenges, of all staff, not just those whose rights are legally protected. Job Crafting portends a more personalised approach to performance management, workflow and job design, which is congruent with the replacement of the automaton, heterogeneous workers of the industrial age.

It is worth remembering that neurodivergent thinkers typically express creativity, problem-solving skills and innovation in greater quantity to neurotypicals (Boot et al., 2020; Carlotta Zanaboni Dina et al., 2017). Such abilities are noted in the World Economic Forum's 'Skills for the 21st Century' report (World Economic Forum, 2020) as lacking across the workforce. So understanding how to personalise working conditions and create cultures in which a wider range of neurotypes can thrive is a key mission for employers.

Occupational Psychology is a rich knowledge base from which to draw insight, with firm foundations in ergonomics, workplace diversity, performance management, relationships and team building. Current calls for Neurodiversity Research in highly rated Journals such as Human Resources Management and the International Journal of Management Reviews should start to pick up the pace in developing the literature to support this rapidly expanding area of practice.

Dr Nancy Doyle is a Visiting Professor at Birkbeck, where she co-directs the Centre for Neurodiversity at Work with Professor Almuth McDowall. A proud ADHDer herself, she has supported thousands of neurodivergent people in prisons, unemployment, career progression and with executive coaching since 2002. Her company, Genius Within was founded in 2010 and operates as a non-profit with over 50 employees and around 200 associates, supporting thousands each year in three continents and providing training and work opportunities for psychologists across the world. Nancy has recently published a new book: Neurodiversity Coaching: A Psychological Approach to Supporting Neurodivergent Talent and Career Potential (Coaching Psychology).

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