Neurodiversity at work: a biopsychosocial model and the impact on working adults

Embracing Neurodiversity in Medicine-Building a More Inclusive Physician Workforce

This Viewpoint discusses advancing physician workforce diversity via neurodiversity, the range of developmental neurocognitive differences that underlie individual variation in thinking, learning, and behavior.

Reasonable adjustments for autistic clinicians: A qualitative study

Autistic people experience barriers to accessing healthcare. Autistic clinical professionals may be able to help improve this situation. Previous research, however, has shown that Autistic clinical professionals experience numerous challenges in the workplace. If there is a 'substantial' and 'long-term' negative effect on the person's ability to do normal daily activities, then Autism may be considered a disability under The Equality Act 2010; the jurisdiction of which covers Great Britain. Autistic clinical professionals working in healthcare settings across England, Wales, and Scotland are therefore entitled to reasonable adjustments to aid them in their clinical practice. This is a qualitative study. We recruited 82 Autistic clinical professionals via social media to complete an online survey. Questions broadly explored: 1) the challenges they faced in their clinical workplaces; and 2) the reasonable adjustments that they needed, had, or needed but did not have. Data were analysed quasi-thematically, also drawing on the principles of content analysis. Respondents reported multiple challenges from our analysis, from which we developed 8 themes: gaining and attending employment, reasonable adjustments under the radar, connecting and integrating (specifically, the communication mismatches between Autistic professionals and non-autistic colleagues, and fitting in socially and professionally), executive functioning, change, working environment, working practices/cultures, and the consequences and effects on Autistic clinical professionals). We recommend that Autistic clinical professionals and their employers individually discuss and iteratively revisit the unique combination of reasonable adjustments suitable for each person. In this way, employers may provide equitable workplaces for their staff which will benefit not only them, but their patients, and healthcare as a whole.

Screening doctors in training for dyslexia: the benefits of an inclusive screening approach

There is a lack of suitable screeners for dyslexia for doctors in training, as the typical adult screeners do not cater for the needs of capable medical graduates. The aim of this research is to create an inclusive screening and training process for doctors with undiagnosed dyslexia. This involved working with doctors to co-create a new dyslexia screener tool. We designed an innovative holistic dyslexia screening, assessment, and support system as part of a 3-year longitudinal study. Qualitative data was collected through the use of a dyslexia screener and case-study interviews with trainees in general practice and psychiatry. Interviews were thematically analyzed to explore dyslexic trainees' experiences of an inclusive approach to dyslexia screening and assessment. Out of the 103 trainees that were screened, 10 were found to have dyslexia, one dyspraxia, and another ADHD trait. Dyslexia-specific coaching, exam, and workplace accommodations were beneficial in dispelling stigma about dyslexia as well as supporting examination success. International Medical Graduate (IMG) trainees were also supported in this process. The case study participants' progression was tracked over 3 years, and all subsequently passed their examinations. We recommend that all trainees are given access to this inclusive, holistic, medical-focused dyslexia screening process. Specifically, this can enable newly diagnosed trainees to access support and exam accommodation. In particular, greater understanding of dyslexia helps dispel stigma and enable better support, which has a positive impact on trainee well-being as well as progression.

Inclusivity in Nursing Education: Mixed Methods Inquiry Into Knowledge and Attitudes of Faculty About Neurodiverse Students

BACKGROUND

Neurodiverse and disabled individuals are underrepresented in nursing education, often facing marginalization, lack of support, and implicit bias.

PURPOSE

This study assessed nursing faculty's preparedness to teach neurodiverse students by examining their knowledge and attitudes about neurodiversity.

METHODS

A convergent parallel mixed methods design was used, involving a survey emailed to 469 nursing faculty at 3 North American institutions. The survey included the Faculty Preparedness Questionnaire-Neurodiversity and open-ended questions.

RESULTS

The study found that faculty has moderate knowledge of neurodiversity but desire more training. Attitudes were generally positive, though some implicit biases were present. Qualitative analysis revealed themes of natural variation, acceptance, and the need for more support and training.

CONCLUSION

Faculty members showed a willingness to learn and support neurodiverse students, but professional development is needed to reduce ableism and enhance inclusive teaching practices.

Improving neurodiversity awareness in school students: a scoping review protocol

OBJECTIVE

This scoping review aims to map and characterize existing programs present in mainstream schools internationally that are targeted at improving children's awareness about neurodiversity.

INTRODUCTION

Neurodiversity is a term used to describe human neurocognitive heterogeneity. Increased understanding and awareness about neurodiversity among school students has the potential to improve general student health and well-being. However, there is currently no standardized approach to raising children's awareness about neurodiversity in schools and the associated literature is diffuse.

INCLUSION CRITERIA

Literature will be included if it describes and/or evaluates programs designed to be delivered in mainstream schools aimed at increasing awareness of neurodiversity among students aged 5 to 18 years, regardless of geographical location. Published, unpublished, and gray literature from 2013 to the present will be considered.

METHODS

An academic literature search will be conducted across 5 databases: MEDLINE, CINAHL, PsycINFO, Embase, and ERIC. A gray literature search will also be performed across sources including ProQuest and Google Scholar, as well as targeted websites, expert opinion, and reference lists of relevant peer-reviewed literature. Articles will be selected based on eligibility criteria. Data extraction will be conducted independently by 2 extractors using a pre-determined form documenting study methods, population, interventions, and outcomes. Analysis and presentation of results will be reported according to the study objectives.

REVIEW REGISTRATION

Open Science Framework https://osf.io/6b378.

Challenges for neurodiverse children in acute medical hospitals and opportunities for the new National Children's Hospital to be 'neurodiversity-friendly'

Neurodiversity refers to the variation in human cognitive, sensory, and communication experiences and reframes deficits as differences. Rates and duration of hospitalisation in neurodiverse children are higher compared to their neurotypical peers. Despite increased admissions, paediatric medical hospitals are poorly equipped to adequately support their unique cognitive, sensory, behavioural, and communication needs, which can have negative impacts on the experiences of patients, families, and staff. The literature supports several innovative and inclusive strategies, which present exciting opportunities for Ireland's new National Children's Hospital (NCH) to become a 'neurodiversity-friendly paediatric hospital'.

Reimagining Physician Assistant Education: Championing Cognitive Diversity to Promote Inclusivity, Neurodiversity Awareness, and a Sense of Belonging

ABSTRACT

Neurodiversity, encompassing conditions such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and dyslexia, represents a significant and often under-recognized segment of the population, including within science, technology, engineering, mathematics, and medicine fields like medicine. Neurodiverse individuals possess unique skills, including enhanced creativity, analytical thinking, and meticulous attention to detail, which are valuable in health care professions. However, failure to recognize and support these individuals can result in missed opportunities, social isolation, and mental health challenges. Despite a growing emphasis on diversity, equity, inclusion, and belonging in higher education, neurodiversity is frequently overlooked, particularly in physician assistant (PA) education. This article examines the unique challenges faced by neurodiverse PA student learners and the existing literature gap regarding neurodiversity in PA education. It underscores the need for greater awareness, reduced stigma, and improved support systems. Recommendations include integrating neurodiversity into the PA curriculum, providing faculty training on inclusive teaching practices, and establishing tailored accommodations to foster a sense of belonging. PA programs can foster a more equitable health care system by creating inclusive learning environments that acknowledge and cater to the unique needs of neurodiverse student learners, thereby enhancing student-faculty interactions and promoting academic success. The aim of this article was to facilitate the reimagining of PA education to champion cognitive diversity. By promoting a more inclusive learning environment, PA programs can cultivate future clinicians who are better equipped to serve diverse patient populations.

Neurodiversity in the healthcare profession

The term neurodiversity was coined in the 1990s to describe a diversity in thinking, learning, and processing the world around us, and is associated with strengths as well as challenges. Rates of diagnosis of neurodivergent conditions are rising rapidly amongst patients and healthcare professionals, largely due to a recent surge in awareness and understanding of neurodiverse conditions and more inclusive diagnostic criteria. Societal adaptation, however, has lagged, and likely explains some of the psychosocial comorbidities of neurodiversity, as individuals are forced to adapt their personality and how they display their emotions to fit societal norms. There remains a lack of awareness and understanding of neurodiversity amongst the healthcare professions. There is also very limited published literature on the challenges and strengths of this group in the clinical environment. Here, we use a case study, focusing on attention deficit hyperactivity disorder to explore the relationship between neurodiversity and work from the perspective of a neurodiverse health care professional. We challenge the notion that neurodiversity itself is a disability, but more likely a result of lack of societal awareness and adaption. We suggest accommodations and training in the clinical environment to raise awareness and support neurodiverse healthcare professionals in order that they flourish rather than struggle in the workplace.

Digitally transforming community mental healthcare: Real-world lessons from algorithmic workforce integration

Community-based high intensity services for people living with severe and enduring mental illnesses face critical workforce shortages and workflow efficiency challenges. The expectation to monitor complex, dynamic patient data from ever-expanding electronic health records leads to information overload, a significant factor contributing to worker burnout and attrition. An algorithmic workforce, defined as a suite of algorithm-driven processes, can work alongside health professionals assisting with oversight tasks and augmenting human expertise. This selective review summarises lessons learned from our five-year experience (2018-22) of algorithmic workforce implementation research in two community mental health services in Australia covering both rural and urban populations. We retrace our implementation journey to illustrate four foundational processes: (i) algorithm design (ii) proof-of-concept validation (iii) workflow integration and (iv) optimization. By examining our previous studies, we discuss insights gained regarding intended human-centricity of services, potential algorithm-human misalignments, and unintended workload and accountability consequences for clinicians and organizations.

A non-systematic overview review of self-focused emotion regulation in autistic individuals through the lens of the extended process model

LAY ABSTRACT

What do we already know about emotion regulation in autism?We know that many autistic children, youth, and adults experience difficulties regulating emotions. Existing research has focused mainly on the differences in emotion regulation capabilities between autistic and non-autistic individuals, the relationships between autistic traits and emotion regulation, and how emotion regulation relates to other outcomes, such as social skills and mental health.What does this paper add?We want to take a new approach to review the existing emotion regulation research through the lens of a specific theoretical model: the extended process model of emotion regulation. Professor James Gross developed this model. It consists of four emotion regulation phases: identification, selection, implementation, and monitoring.Our review revealed specific areas within these emotion regulation phases that could significantly impact the emotion regulation experiences of autistic individuals. We also outline the gaps in the research and propose avenues for future investigation.Implications for practiceBy deepening our understanding of emotion regulation in autistic individuals through the proposed future research, researchers and clinicians can pave the way for the development of tailored support programs. These programs will directly target specific emotion regulation mechanisms, offering a much-needed individualized support approach.

The Neurodiversity Framework in Medicine: On the Spectrum

The term "neurodiversity" refers to the natural heterogeneity in human neurological functioning, which includes neurodevelopmental differences and other mental health conditions (e.g., autism spectrum disorder [ASD], attention-deficit hyperactivity disorder [ADHD], dyslexia, bipolar disorder, schizophrenia, and depression). This new viewpoint has significant consequences for the future of medicine, specifically in psychiatry, neurology, and neurodevelopmental medicine, as it undermines established notions of these conditions as disorders/diseases that may be healed or corrected. The neurodiversity approach, on the other hand, acknowledges these divergences as natural variations, calling for tailored support and interventions that accommodate individual needs. Neurodiversity could impact current medical perspectives by supporting a shift from pathology to identity. Rather than focusing on the difficulties associated with a specific ailment, the neurodiversity approach stresses the strengths and distinct perspectives that come with neurodivergent identities. This shift has significant consequences for research and therapy by fostering the development of innovative treatments aimed at increasing quality of life and improving functional results. This new perspective advocates including neurodivergent people in all sectors of society, including research, clinical practice, and policymaking, by recognizing, accepting, and integrating natural variances in brain functioning. In this article, we review the development of the neurodiversity movement and propose "The Neurodiversity Framework in Medicine," which challenges traditional views by recognizing neurological differences as natural variations, advocating for inclusive, person-centered approaches in healthcare.

Embracing Neurodiversity in the Nursing Workforce

Neurodivergent nurses bring unique strengths that can enhance patient care.

Developmental psychopathology turns 50: Applying core principles to longitudinal investigation of ADHD in girls and efforts to reduce stigma and discrimination

The seminal contributions of Dante Cicchetti to the field/paradigm/metaparadigm of developmental psychopathology (DP) - and its continuing ascendance as a guiding force for multidisciplinary investigation of normative and atypical development - are legion. Our aim is to illustrate a number of DP's core principles in the context of (a) prospective longitudinal research on children (particularly girls) with attention-deficit hyperactivity disorder and (b) theoretical and empirical work dedicated to alleviating the stigma and discrimination toward those experiencing mental health, substance use, and neurodevelopmental challenges. We feature (i) the mutual interplay of perspectives on normative and non-normative development, (ii) reciprocal and transactional processes, and the constructs of equifinaliy and multifinality; (iii) continuities and discontinuities in developmental processes and outcomes, with particular focus on heterotypic continuity; (iv) the inseparability of heritable and environmental risk; (v) multiple levels of analysis, and (vi) the benefits of qualitative perspectives. We highlight that interventions promoting recovery, along with the multi-level facilitation of protective factors/strengths, lie at the heart of both DP and anti-stigma efforts. The ongoing youth mental-health crisis provides a sobering counterpoint to the gains of the DP enterprise over the past half century.

"I Wish They'd Just Let Us Be." Experiences of Indian Autistic Individuals Around Stimming Behaviors at the Workplace

Background

Stereotyped or repetitive motor movements are a core feature of autism. In recent years, autistic individuals have asserted themselves by reclaiming these repetitive movements as "stimming." There is growing evidence in the form of scientific research regarding the usefulness of stereotypie movements. Recent research has captured the perspectives of autistic adults on stimming. However, to date, no research has examined the perspective of Indian autistic individuals around the display of stimming behaviors at the workplace.

Methods

We used semi-structured interviews and online focus groups to ask 20 Indian autistic individuals to share their experiences centered around stimming at Indian workplaces. Data obtained were analyzed using qualitative thematic analysis.

Results

The thematic analysis helped us identify three major themes: (1) stimming as a (beneficial) coping mechanism, (2) repercussions of stim suppression, and (3) (De)stigmatization of stimming.

Conclusion

Most Indian workplaces lack workplace accommodations to reduce sensory overload on autistic employees. Hence, Indian managers open to employing autistic individuals must accept stimming as an autistic individual's attempt at managing overwhelming emotions brought on by sensory overload. Acceptance of stimming behaviors by nonautistic managers would not only benefit the autistic employee by aiding them in better managing their mental and emotional health but also benefit the organization by allowing the autistic employee to function at peak productivity levels. Thus, Indian managers and colleagues of autistic employees should work to accommodate, support, and understand the stimming behaviors of autistic employees as opposed to judging them in a negative light.

ADHD and ASD are Normal Biological Variations as part of Human Evolution and are not "Disorders"

Recent developments driven by people with attention-deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) have highlighted that far from being disorders, ADHD and/or ASD can be seen as natural variations in neurodevelopment. The neurodiversity movement acknowledges that people with ADHD and/or ASD have specific strengths, that can help them outperform neurotypical individuals in certain situations and that these conditions should therefore not be seen as disorders. This view is supported by evolutionary science, which can be used as a framework to understand ADHD and/or ASD as natural variations that were not eliminated by natural selection due to their benefit to the individual and group in certain situations. The evolutionary perspective supports neurodiversity as relevant and important in helping our species thrive.

Resilience in the face of neurodivergence: A scoping review of resilience and factors promoting positive outcomes

Neurodivergent individuals, including a range of conditions impacting neurological function, are at an increased likelihood of poor life outcomes, such as in functional adaptation, mental health, and well-being. Yet, many live meaningful and fulfilling lives. Resilience may provide some explanation for the heterogeneity in outcomes observed in neurodivergent populations. We conducted a scoping review embedded in a neurodiversity-affirmative approach to provide an understanding of resilience in neurodivergent populations. A total of 176 articles were included in this review and were synthesized using a two-phased process. First, findings were synthesized narratively to examine how resilience has been conceptualized and explored in neurodivergent populations. Second, to identify the bio-psycho-social factors important for resilience in neurodivergent individuals, we converted concepts identified in articles to the nomenclature of the World Health Organizations' International Classification of Functioning, Disability and Health (ICF) using a standardized linking process. We find considerable variability in how resilience is conceptualized and measured in neurodivergent populations. We identified 83 unique ICF categories representing resilience factors, of which only 20 appeared in more than 5% of the articles. Identified ICF categories highlight the importance of support systems such as families and friends, community participation and acceptance, and individual capabilities for resilience.

Fundamental intersectionality of menopause and neurodivergence experiences at work

This investigation explores the complex interplay between menopause and neurodivergence in the workplace, employing thematic analysis of qualitative data from 43 participants across the United Kingdom and the United States. Findings reveal that menopause transitions intensify symptoms of neurodivergence, and can interrupt how women engage with paid work. By shining a light on these under-reported experiences at work, we demonstrate how employers can better support their neurodivergent employees during menopause. Applying the Demand-Control model, this research underscores the necessity for workplaces to adopt more inclusive practices and supportive adaptations that go beyond flexible work and that are focused on pressures faced by neurodivergent women during menopause. Participants were more likely to report a decrease in workplace experiences than work performance in response to the disruptive effects of menopause on neurodiversity. This is an important insight for people managers as experiences of work might be less closely monitored than performance. This study advocates for a unified approach of organisational support for the intersectional effects of menopause and neurodiversity.

Autistic Traits, Communicative Efficiency, and Social Biases Shape Language Learning in Autistic and Allistic Learners

There is ample evidence that individual-level cognitive mechanisms active during language learning and use can contribute to the evolution of language. For example, experimental work suggests that learners will reduce case marking in a language where grammatical roles are reliably indicated by fixed word order, a correlation found robustly in the languages of the world. However, such research often assumes homogeneity among language learners and users, or at least does not dig into individual differences in behavior. Yet, it is increasingly clear that language users vary in a large number of ways: in culture, in demographics, and-critically for present purposes-in terms of cognitive diversity. Here, we explore how neurodiversity impacts behavior in an experimental task similar to the one summarized above, and how this behavior interacts with social pressures. We find both similarities and differences between autistic and nonautistic English-speaking individuals, suggesting that neurodiversity can impact language change in the lab. This, in turn, highlights the potential for future research on the role of neurodivergent populations in language evolution more generally.

Homeworking experiences of neuro-divergent workers: systematic review

BACKGROUND

Working from home (WFH) is becoming more common, but little is known about how it specifically affects neuro-divergent workers' psychological and occupational well-being.

AIMS

This review aimed to explore the experiences of neuro-divergent staff WFH, including the challenges they face; the potential benefits of homeworking for this specific population and the support systems they require.

METHODS

We searched six electronic databases, as well as reference lists of included papers, one preprint server and Google, for literature on neuro-divergent workers' experiences of WFH. Results were synthesized using thematic analysis.

RESULTS

We reviewed 25 studies (mostly based on data collected during the coronavirus disease 2019 pandemic), finding very little research statistically analysing the impact of WFH on well-being or productivity, or comparing the impact of WFH across neuro-divergent and neuro-typical populations. The (mostly qualitative) findings showed that neuro-divergent participants described various benefits and challenges of the sensory environment at home; the reduction of commuting; increased flexibility and lack of routine when homeworking; the reduction of 'masking' behaviours; lack of in-person social contact and increased use of technology.

CONCLUSIONS

The findings emphasize the importance of not assuming a one-size-fits-all approach to homeworking and suggest managers should be mindful of workers' individual preferences for working whilst ensuring that all employees are appropriately supported. The results can inform future research and provide insights for employers to help them create more inclusive work environments.

Feeling like an untapped resource. Experiences of working life among nurses with ADHD and/or autism: An interview study

BACKGROUND

ADHD and autism are common and increasing neurodevelopmental disorders in the world and also occur among nurses. However, almost nothing is known about nurses with these diagnoses. To promote high-quality care provision and well-being in the nursing workforce, it is important to discover more about these nurses. Therefore, in the present study, we aimed to describe how nurses with ADHD and/or autism experience their working life.

METHODS

The study was descriptive in design. Nurses were invited via Swedish Facebook groups targeting nurses. Semi-structured individual interviews were conducted with 17 nurses with ADHD and/or autism, online or by telephone. Data were analyzed using qualitative content analysis.

RESULTS

One overarching theme and seven subthemes emerged from the analysis. The theme "feeling like an untapped resource" reflected the subthemes: 1) Being passionate about one's job, 2) having strengths and talents to use in working life, 3) a stressful and disturbing work environment inhibits personal strengths, 4) managers show goodwill but lack knowledge and resources, 5) feeling appreciated but socially different among colleagues, 6) using a variety of strategies to facilitate working life and 7) toward an uncertain future.

CONCLUSION

Nurses with ADHD and/or autism experience having abilities and talents that are useful in the nursing profession. However, they feel that the physical and organizational working conditions and lack of managerial support entail challenges that prevent them from making optimal use of their strengths.

Views of Genetic Testing for Autism Among Autism Self-Advocates: A Qualitative Study

BACKGROUND

Autism self-advocates' views regarding genetic tests for autism are important, but critical questions about their perspectives arise.

METHODS

We interviewed 11 autism self-advocates, recruited through autism self-advocacy websites, for 1 h each.

RESULTS

Interviewees viewed genetic testing and its potential pros and cons through the lens of their own indiviudal perceived challenges, needs and struggles, especially concerning stigma and discrimination, lack of accommodations and misunderstandings from society about autism, their particular needs for services, and being blamed by others and by themselves for autistic traits. Their views of genetic testing tended not to be binary, but rather depended on how the genetic test results would be used. Interviewees perceived pros of genetic testing both in general and with regard to themselves (e.g., by providing "scientific proof" of autism as a diagnosis and possibly increasing availability of services). But they also perceived disadvantages and limitations of testing (e.g., possible eugenic applications). Participants distinguished between what they felt would be best for themselves and for the autistic community as a whole. When asked if they would undergo testing for themselves, if offered, interviewees added several considerations (e.g., undergoing testing because they support science in general). Interviewees were divided whether a genetic diagnosis would or should reduce self-blame, and several were wary of testing unless treatment, prevention or societal attitudes changed. Weighing these competing pros and cons could be difficult.

CONCLUSIONS

This study, the first to use in-depth qualitative interviews to assess views of autism self-advocates regarding genetic testing, highlights key complexities. Respondents felt that such testing is neither wholly good or bad in itself, but rather may be acceptable depending on how it is used, and should be employed in beneficial, not harmful ways. These findings have important implications for practice, education of multiple stakeholders, research, and policy.

The Gestalt of functioning in autism revisited: First revision of the International Classification of Functioning, Disability and Health Core Sets

LAY ABSTRACT

Autistic people experience individual strengths and challenges as well as barriers and facilitators in their environment. All of these factors contribute to how well autistic people can cope in everyday life, fulfill the roles they choose, and meet their needs. The World Health Organization has developed a system aiming to capture the many factors within people (like how someone thinks and feels) and outside of people (things around a person) that influence their daily living, called the International Classification of Functioning, Disability and Health. The International Classification of Functioning, Disability and Health can be used for different purposes in research and practice to assess people's situations and plan support measures. Previously in 2019, the International Classification of Functioning, Disability and Health was adapted to autism by developing so-called Core Sets, which are shorter International Classification of Functioning, Disability and Health versions for use in specific conditions. Here, we present the first revisions of the International Classification of Functioning, Disability and Health Core Sets for autism, based on research, development results, and community feedback. Some factors influencing daily life for autistic people were added to the Core Sets, and other factors deemed less relevant were removed. Changes were also made in Core Sets designed for different age groups (0-5, 6-16, and ⩾17 years). Particularly, contents for sensory processing (like smell, touch, seeing, hearing) were added. We recommend these updated Core Sets for future use in autism research and practice. These changes to the Core Sets after 4 years indicate that there should be ongoing updates based on research and experience from practice and involvement of stakeholders.

Inclusivity of patients in early phase breast cancer clinical trials

INTRODUCTION

Studies have shown that certain groups of patients are underrepresented in clinical trials including non-Caucasian ethnicity, poor fluency in English, low socioeconomic status, older age, neurodivergence, and large Body Mass Index (BMI). There is a need to ensure adequate representation of these groups so that the results of any trial accurately reflect the population. The aim of this study was to review the pathway of patients recruited into two early phase breast cancer clinical and determine the inclusivity of patients from the aforementioned sub-groups.

METHODS

The Breast Cancer Research Database was reviewed, and the characteristics of all patients who were screened for eligibility in two early phase clinical trials was examined. The English Indices of Deprivation was used to populate the Index of Multiple Deprivation (IMD) for each patient using their postcode.

RESULTS

In total, 392 patients were eligible to participate, between September 2020 to May 2023. Of these, 144 (36.7 %) were recruited to these two trials. In all, 100 % of patients eligible for these trials were approached and screened for participation. Eligible patients had a mean age of 53.5 years. Recruited patients were younger on average than those not recruited (49.1 years vs 56.0 years, p<0.0001). Only one recruited patient required an interpreter, compared with 24 (9.7 %%) of those who were not recruited (p<0.001). There was no difference in the IMD (p=0.38), BMI (p=0.34) and neurodiversity (p=0.10) between patients recruited into clinical trials and those who were not.

CONCLUSION

Older age and poor fluency in the English language remain barriers to participation in early-phase clinical trials despite implementing a clear pathway to trial recruitment. There is a pressing need to address these barriers by raising awareness, improve appropriate training and providing comprehensive trial information to patients in the language of their choice.

Nurses with dyslexia: overcoming challenges and thriving in the profession

Dyslexia is a specific learning difficulty impacting reading, writing and spelling. Practising nursing requires a unique set of skills that encompass effective communication, critical thinking, and organisational skills. This article focuses on the experiences of nurses with dyslexia, shedding light on the distinct challenges they encounter and the resilient strategies they employ to navigate their roles and excel in the health profession.

Harnessing real-life experiences: the development of guidelines to communicate research findings on Developmental Coordination Disorder/dyspraxia

Developmental Coordination Disorder (DCD), also known as dyspraxia, affects 5-15% of school-aged children (Hamilton and Sutton, Am Fam Physician 66:1435, 2002) and significantly impacts a child's ability to learn motor skills and perform everyday activities efficiently and effectively (Zwicker et al., Eur J Paediatr Neurol 16:573-81, 2012). These motor deficits can have a negative impact on academic performance, vocational choices and leisure pursuits (Zwicker et al., Eur J Paediatr Neurol 16:573-81, 2012) and profoundly impact quality of life (Izadi-Najafabadi et al., Res Dev Disabil 84:75-84, 2019). DCD persists into adulthood (Kirby et al., J Adult Dev 18:107-13, 2011), impacting motor as well as emotional and behavioural status (Tal Saban and Kirby, Curr Dev Disord Rep 5:9-17, 2018). Despite the continued increase in research in the field of DCD, awareness of DCD remains poor (O'Kelly NL., From invisibility to invincibility: Guidelines for supporting families through the diagnosis and journey with developmental coordination disorder, 2012) even though it has higher prevalence rates when compared to, for example, autism spectrum disorder (Yan et al., J Autism Dev Disord :1-7, 2024), which in part may be due to a lack of accessible research findings. A fundamental feature of the research process is disseminating research findings. This should involve community members in design and delivery to ensure the accessibility of research findings.In 2022 the DCD-UK committee established a DCD Research Advisory Group (DCD-RAG) which met over the course of 12 months to: (1) identify issues of inaccessible research findings; (2) determine the need for a repository for research summaries; (3) co-create guidelines for authors and (4) agree a process for reviewing research summaries to be housed on the Movement Matters website. The new co-produced research repository, author guidelines and process were launched at the DCD-UK conference in Manchester 2023 and subsequently shared on social media and through the DCD research email list. The creation of the DCD-RAG and the process that we undertook together to create a non-academic repository for DCD research summaries are described. It is hoped that this repository will enable the wider public, community members and professionals to be able to readily benefit from accessible research, increasing a deeper and broader understanding of the evidence in the field.

Applied human neuroscience: Fostering and designing inclusive environments with the 3E-Cognition perspective

The conventional medical paradigm often focuses on deficits and impairments, failing to capture the rich tapestry of experiences and abilities inherent in neurodiversity conditions. In this article, we introduce the 3E-Cognition perspective, offering a paradigm shift by emphasizing the dynamic interplay between the brain, body, and environment in shaping cognitive processes. The perspective fosters a more inclusive and supportive understanding of neurodiversity, with potential applications across various domains such as education, workplace, and healthcare. We begin by introducing the 3E-Cognition principles: embodied, environmentally scaffolded, and enactive. Then, we explore how the 3E-Cognition perspective can be applied to create inclusive environments and experiences for neurodiverse individuals. We provide examples in the realms of education, workplace, and healthcare. In all of these domains, spaces, methodologies, epistemologies, and roles that cater to diverse needs and strengths can be designed using the 3E principles. Finally, we discuss the challenges and benefits of implementing the 3E-Cognition perspective. We focus on the need for technological advancements and research in complex real-world scenarios; we suggest mobile brain/body imaging is a possible solution. We furthermore highlight the importance of recognizing and valuing the diverse manners of experiencing and interacting with the world, the promotion of diverse well-being, and the facilitation of innovation and creativity. Thus, we conclude that the 3E-Cognition perspective offers a groundbreaking approach to understanding and supporting neurodiversity: by embracing the inherent interconnectedness of the brain, body, and environment, we can create a more inclusive and supportive world.

Childhood neurodivergent traits, inflammation and chronic disabling fatigue in adolescence: a longitudinal case-control study

OBJECTIVES

To test whether inflammatory processes link the expression of childhood neurodivergent traits to chronic disabling fatigue in adolescence.

DESIGN

Longitudinal case-control study.

SETTING

We analysed data from The Avon Longitudinal Study of Parents and Children (ALSPAC).

PARTICIPANTS

8115 and 8036 children of the ALSPAC cohort at ages 7 and 9 years, respectively, 4563 of whom also completed self-report measures at age 18 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed if children scoring above screening threshold for autism/attention deficit hyperactivity disorder (ADHD) at ages 7 and 9 years had increased risk of chronic disabling fatigue at age 18 years, computing ORs and CIs for effects using binary logistic regression. Mediation analyses were conducted to test if an inflammatory marker (interleukin 6 (IL-6)) at age 9 years linked neurodivergent traits to chronic disabling fatigue at age 18 years.

RESULTS

Children with neurodivergent traits at ages 7 and 9 years were two times as likely to experience chronic disabling fatigue at age 18 years (likely ADHD OR=2.18 (95% CI=1.33 to 3.56); p=0.002; likely autism OR=1.78 (95% CI=1.17 to 2.72); p=0.004). Levels of IL-6 at age 9 were associated with chronic disabling fatigue at age 18 (OR=1.54 (95% CI=1.13 to 2.11); p=0.006). Inflammation at age 9 years mediated effects of neurodivergent traits on chronic disabling fatigue (indirect effect via IL-6: ADHD b=1.08 (95% CI=1.01 to 1.15); autism b=1.06; (95% CI=1.03 to 1.10)). All effects remained significant when controlling for the presence of depressive symptoms.

CONCLUSIONS

Our results indicate higher risk of chronic disabling fatigue for children with neurodivergent traits, likely linked to higher levels of inflammation. The implementation of transdiagnostic screening criteria to inform support strategies to counteract risk early in life is recommended.

"Capable of much more": The effects of vocational training on caregiver expectations for neurodivergent dependents in Thailand

Neurodivergence encompasses a spectrum of natural variations in neurological development, including autism, ADHD, and other expressions of cognitive diversity. Caregiver experiences while supporting their neurodivergent dependents critically influence the quality of life outcomes for neurodivergent dependents across life stages, including during the search for work. However, research on caregiver experiences during this stage remains scarce, especially within lesser studied developing contexts like Thailand. This study explored perspectives of Thai caregivers preparing neurodivergent dependents for employment through a focus group (n = 10) of pre-vocational training caregivers and interviews (n = 13) with post-training caregivers. Analysis revealed significant sociocultural factors introducing stigma that affected acceptance, diagnosis, interventions, and policy support. Both groups reported systemic barriers, doubts about future independence, and hopes to increase advocacy and inclusive attitudes. However, caregivers whose dependents had received the training showed marked shifts in their expectations for their dependents' success. Tailored vocational preparation helping dependents exhibit strengths may transform societal views on neurodiversity from deficiency to natural diversity and enable more meaningful, sustainable futures. These insights elucidate caregiver challenges and aspirations, which can better inform supportive research and interventions in Thailand and other non-Western locales.

The positive impact of identity-affirming mental health treatment for neurodivergent individuals

Introduction

The medical and social definitions of neurodivergence have become a common topic of discussion in recent years, and the ways that we define, measure and report on conditions within the neurodivergent umbrella are changing. The objective of this study was to analyze differences in mental health symptom presentation at intake and compare treatment outcomes among three groups: clients with an affirming neurodivergent diagnosis, clients without an affirming diagnosis, and neurotypical clients.

Methods

Data were collected at intake and discharge. Clients self-reported neurodivergent identity, neurodivergent diagnoses, as well as the severity of depression symptoms, anxiety symptoms and self-harm frequency. One-way multivariate analysis of variance tests were run to assess differences in mental health symptoms at intake and discharge based on neurodivergent identity and corresponding diagnosis. When MANOVAs indicated significant differences, follow-up univariate one-way ANOVAs were conducted for each dependent variable.

Results

Neurodivergent clients reported significantly worse mental health symptoms at intake than neurotypical clients, regardless of diagnosis status. Additionally, clients who identified as neurodivergent but did not report an affirming medical diagnosis reported significantly worse mental health symptoms than those who did report an affirming medical diagnosis. By discharge from IOP treatment, no significant differences were found in symptom change scores between neurodivergent and neurotypical individuals, or neurodivergent individuals with an affirming diagnosis and those without.

Discussion

These findings highlight the importance of acknowledging client identity as a key component of mental health treatment. The act of validating symptoms and experiences, allowing accommodations when requested, and exploring identity formation regardless of diagnosis, allowed all clients who identified as neurodivergent to benefit from treatment.

Supporting neurodivergent nursing students in their practice placements

Neurodivergent conditions such as autism, attention deficit hyperactivity disorder (ADHD), dyslexia, dyspraxia, dyscalculia and Tourette's syndrome are common, and it is highly likely that practice assessors and supervisors will be asked to support neurodivergent nursing students in their practice learning environments. This article details the strengths that neurodivergent students can bring to nursing, as well as some of the challenges they may experience in practice settings. It outlines how practice assessors and supervisors can develop neuro-inclusive learning environments where neurodivergent students can thrive, as well as how to support them if they are not meeting their required proficiencies. The authors also discuss how appropriate reasonable adjustments can be implemented by using a collaborative approach with students.

Maths performance of adults with and without developmental coordination disorder (DCD): The role of working memory and maths anxiety

Previous studies have shown that children with Developmental Coordination Disorder (DCD)/Dyspraxia have poorer maths performance compared to their neurotypical (NT) counterparts. However, no studies have explored the cognitive and emotional factors affecting the maths performance of adults with DCD. This study, therefore, investigated the role of working memory (WM), maths anxiety (MAS), and maths self-efficacy on the maths performance of adults with DCD. We found that adults with DCD had lower WM and maths performance and were more maths anxious than their NT peers. However, there were no significant differences in maths self-efficacy. When looking at the predictors of maths performance, we found a positive relationship between WM resources and the DCD maths performance, possibly indicating that they relied more on WM resources to perform simple mental arithmetic tasks than NTs. On the other hand, MAS had an inverse relationship with the NT maths performance but not with the DCD performance. The reasons and implications of these findings will be discussed.

Is inclusive education for children with special educational needs and disabilities an impossible dream?

BACKGROUND

Countries have been implementing inclusive educational practices for children with special educational needs and disabilities (SEND) for at least 30 years.

AIMS

Some issues continue to present as unresolved and will be examined in this paper with possible ways forward suggested. 1. There is still a lack of clarity around the definition of inclusion, its theoretical underpinnings, its implementation in practice and evaluation of success. 2. Teachers often still report the same problems of insufficient resources and express the same concerns about lack of skills and knowledge as reported in the early days. 3. A key question is, do children with SEND achieve better outcomes in inclusive educational settings?

DISCUSSION AND CONCLUSIONS

The paper argues that an overarching executive framework applied to the education of children with SEND is needed to provide a common frame of reference that can be shared by educators, policymakers and researchers. New ways of resourcing inclusion are discussed including supporting collaboration between mainstream and special schools to better utilize the expertise located in special schools. The paper examines the evidence for improved academic and social outcomes for learners with SEND in inclusive schools and proposes that psychological outcomes now need to be measured too. It further suggests that future research needs to drill down to the level of teacher classroom instruction rather than rely on the broader mainstream school-special school comparison.

When pharmacy and theater collide: How diversity can develop inclusive communication skills

BACKGROUND

Effective communication with patients and colleagues is key to a pharmacist's ability to provide effective person-centered care. Neurodivergent patients face many barriers when interacting with health professionals; increased awareness and understanding are therefore paramount to the pharmacist's role. This paper describes an innovative teaching partnership between a school of pharmacy and an inclusive theater company which aims to develop awareness and skills of undergraduate pharmacy students in relation to communicating with patients with autism and/or learning disabilities.

EDUCATIONAL ACTIVITY

Forum theater and role-plays were used to complement existing communication skills teaching in Years two and four of the undergraduate MPharm (Master of Pharmacy) program. The sessions were designed and delivered in partnership between academic teaching staff and a theater company of neurodivergent actors. An online evaluation form was used to obtain student feedback on these sessions (two Likert-style questions and three open format questions).

CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY

Of the 241 students who attended a session in 2021, 70 (29%) provided feedback. Feedback was positive, with 99% of respondents finding the session useful. Students spoke about how they found the sessions supportive and enlightening, helping them to reflect on their own communication skills. As a result, the teaching has been developed and now expanded through all years of the undergraduate program. While conscious of challenges such as funding and finding the right partner, the authors recommend this rewarding initiative to fellow academics.

Neurodiversity and cognitive load in online learning: A focus group study

It is widely accepted that cognitive load plays a crucial role in online learning. However, despite neurodevelopmental conditions being the largest category of qualifying disabilities in education, and the rise of online learning, there is little understanding of the factors impacting cognitive load in online learning for neurodivergent students and how these factors differ from those affecting neurotypical students. This study used qualitative comparison groups with neurotypical and neurodivergent students to examine their experiences of cognitive load in online learning. A sample of 26 university students (14 neurotypical and 12 neurodivergent) participated in focus group discussions. While neurodivergent students reported many similar experiences of cognitive load in online learning compared to their neurotypical peers-such as confusion in navigating the content and technical issues-some difficulties were more present for neurodivergent students-such as transcripts including mistakes and inaccessible content presentation-creating additional barriers in effectively engaging with the educational content. The results suggest that neurotypical and neurodivergent students experience similar challenges, albeit to differing degrees of intensity, and that more research is needed to explore the relationship between neurodiversity and cognitive load in online learning.

Opportunities and obstacles in non-invasive brain stimulation

Non-invasive brain stimulation (NIBS) is a complex and multifaceted approach to modulating brain activity and holds the potential for broad accessibility. This work discusses the mechanisms of the four distinct approaches to modulating brain activity non-invasively: electrical currents, magnetic fields, light, and ultrasound. We examine the dual stochastic and deterministic nature of brain activity and its implications for NIBS, highlighting the challenges posed by inter-individual variability, nebulous dose-response relationships, potential biases and neuroanatomical heterogeneity. Looking forward, we propose five areas of opportunity for future research: closed-loop stimulation, consistent stimulation of the intended target region, reducing bias, multimodal approaches, and strategies to address low sample sizes.

The viability of a proposed psychoeducational neurodiversity approach in children services: The PANDA (the Portsmouth alliance's neuro-diversity approach)

People with Neurodevelopmental (ND) conditions are often unfairly stereotyped by society, without fully appreciating their strengths. As a result, their advantageous behaviours may be overlooked or ignored. Despite wide psychoeducation on ND in society there is a push from the scientific and ND community to move from a binary diagnostic system to an approach that encompasses the spectrum experienced by individuals. In view of this, we have developed the Portsmouth Alliance Neuro-Diversity Approach (PANDA), a coproduced method which helps facilitate understanding, communication and early support for individuals who may be Neuro-Diverse. 51 young people, their parents and attached professionals participated in the approach's feasibility to improve wellbeing and symptom management measured by quantitative and qualitative means. Results showed a significant improvement in the child's wellbeing, but not symptom management. Overall, this indicates the PANDA could facilitate a more holistic approach for referrals, information gathering, psychoeducation and cross-system relationship building to be used in conjunction with a traditional pathway. Though, this study is limited in scope, its main purpose is to inform future development of the approach. Additionally, more research investigating the specific narrative, and separate structure of the PANDA would be required to highlight the strengths and limitations of implementation.

Bringing the autistic lifeworld to supportive technology design: an enactive approach

Supportive technologies for autistic individuals are promising in principle, yet their uptake remains limited. Critics argue that in current designs of supportive technologies, autism is mostly framed as a 'disorder' whose limitations can be pragmatically compensated for. To increase uptake, designers should get a better handle on how to incorporate the full richness of the autistic experience into the design process. This paper presents an integrative framework of the autistic lifeworld, called Autistic Lifeworld Design (hereafter: ALD). ALD evolved in a transdisciplinary research setting, substantiated by 11 design case studies with autistic young adults as well as theoretical inquiries into enactivism, design and autism. It consists of four dimensions of experience - sensory, habitual, social, and affective -, each providing specific pointers on how to better understand how autistic people experience the world and how supportive technologies may complement that experience. By adopting an enactive approach, ALD enables a reframing of supportive technology as helping to sustain different levels of homoeostasis. It offers a novel lens that allows designers to put the lived experiences of autistic individuals at the centre of the design process, with special attention to the role of bodily structures and processing in shaping these experiences.

How to target disturbed identity in borderline patients? Self-identification program: A case study

Borderline personality disorder (BPD) is a severe and relatively prevalent psychiatric disorder, responsible for high rates of suicidal behaviors. Disturbed identity appears as at the very core of this disorder, being inter-related with all other BPD features. Notably, from a dimensional perspective on mental disorders, one should realize that it is from our usual self-representation that we live all our daily experiences. Then, if the understanding of self-concept (or identity) is impaired, all the interventions implemented to decrease the self's suffering will subsequently be impaired. The purpose of the present case study was to illustrate the nine identity diffusion categories described by Jørgensen & Bøye (2022) and how the level of identity function can be improved in a third-wave cognitive and behavioral therapy targeting progressive correct self-identification.

Navigating the multiple dimensions of the creativity-mental disorder link: a Convergence Mental Health perspective

BACKGROUND

This paper discusses a paradox in mental health. It manifests as a relationship between adverse "bad" effects (suffering, clinical costs, loss of productivity) in individuals and populations and advantageous "good" aspects of mental disorders. These beneficial aspects (scientific, artistic and political accomplishments) emanate at the societal level through the frequently unprecedented creativity of people suffering from mental disorders and their relatives. Such gains can contribute to societal innovation and problem-solving. Especially in times of accelerated social-ecological change, approaches are needed that facilitate best-possible mental health care but also recognize creative ideas conducive to beneficial clinical and social-ecological innovations as soon as possible.

DISCUSSION

This paper emphasizes the need to account for creativity as a crucial component in evolving mental health systems and societies. It highlights the need for wide-ranging approaches and discusses how research targeting multiple facets (e.g., brain level, cognitive neuroscience, psychiatry, neurology, socio-cultural, economic and other factors) might further our understanding of the creativity-mental disorder link and its importance for innovating mental health systems and societies.

CONCLUSION

Our discussion clarifies that considerable research will be needed to obtain a better understanding of how creativity associated with mental disorders may help to create more sustainable societies on a fast-changing planet through innovative ideas. Given the current-state-of-the-art of research and healthcare management, our discussion is currently speculative. However, it provides a basis for how pros and cons might be studied in the future through transdisciplinary research and collaborations across sectors of society.

Development and adaptation of a strength-based job interview training tool for transition age youth on the autism spectrum using community engaged methods

Introduction

Kessler Foundation Strength Identification and Expression (KF-STRIDE) is a strength-based job interview training tool developed for young adults on the autism spectrum. The intervention is based on a positive psychology framework to increase knowledge of character strengths, and how to relate them to a future employer. The current study sought to evaluate the acceptability, usability and feasibility of KF-STRIDE, as well as to guide adaptations to improve the tool's ability to meet the needs of those on the spectrum.

Methods

Mixed methods (post-intervention surveys, and semi-structured interviews with key stakeholders) were used to inform the evaluation and consequent adaptations of KF-STRIDE.

Results

The major findings of the study were that KF-STRIDE was found to be largely acceptable and usable. Importantly, however, our qualitative analysis revealed modifications that could help to better suit the needs of young adults on the spectrum, which included the incorporation of additional skills (i.e. etiquette, practicing hygiene) and more opportunities to practice job interviewing. Thus, we altered the implementation of the intervention to be web-based to improve accessibility. We incorporated the presence of an animated character to deliver the content, to eliminate the need for a highly trained interventionist.

Discussion

KF-STRIDE was modified to increase access by incorporating feedback from the autism community. Future directions include assessing the efficacy of KF-STRIDE in young adults on the spectrum to identify whether employment outcomes are improved after using the tool.

Neurodiversity in elite sport: a systematic scoping review

The objective of this systematic scoping review is to understand the extent and scope of evidence regarding neurodiversity in elite sport. This systematic scoping review considered epidemiological studies, com mentary and viewpoints papers, systematic review and meta-analyses, and any intervention or clinical treatment, management and practice studies in relation to neurodiversity in elite sport. Case studies and grey literature were ineligible for review. Neurodivergence included neurodevelopmental disorders such as autism spectrum disorder, attention-deficit hyperactivity disorder (ADHD) and specific learning disorders. Elite sport was defined as Olympic, Paralympic, national, international, professional and semiprofessional sport. The final 23 studies included in this review comprised 10 observational studies, 4 systematic/narrative reviews, 6 commentary/position statements and 3 qualitative studies. The literature reflected a major focus on ADHD as a risk factor for concussion and prognosis for postconcussion recovery. Further, there was a focus on the medical management of ADHD, regarding adherence to sporting antidoping regulations. One study focused on the experience of autism in athletes in elite sport settings through qualitative interviews. One study focused on anxiety disorders in elite athletes, with ADHD emerging as a major risk factor. There is a strong rationale for future research to build on the evidence for neurodiversity in elite sport to foster supportive and inclusive elite sporting environments.

Autistic Employees' Technology-Based Workplace Accommodation Preferences Survey-Preliminary Findings

BACKGROUND

There has been an increase in the number of research studies focused on the design of accommodations aimed at improving the well-being and work performance of autistic employees. These accommodations took various forms; some of them were based on modification of management practices, for example, support in the area of effective communication, or involved modifications to the physical working environment aimed at limiting sensory vulnerabilities. Many of these solutions were based on digital technology.

METHODS

This quantitative research aimed to learn about the opinions of the autistic respondents as potential end users and their assessment of the proposed solutions within four main challenge areas: (1) effective communication; (2) time management, task prioritizing, and organization of work; (3) stress management and emotion control; and (4) sensory sensitivities.

RESULTS

Respondents gave the highest ratings to solutions aimed at limiting overstimulation and a flexible approach toward working time, support of a job coach, remote work, and support by allowing electronic-mediated communication based on non-direct contact.

CONCLUSIONS

The results can be the starting point for further research on the highest rated solutions dedicated to improving working conditions and the well-being of autistic employees and can be an inspiration for employers who plan to introduce such solutions.

Neurodivergence-informed therapy

The neurodiversity movement is a social movement that emerged among autistic self-advocates. It has since spread and has been joined by many with diagnoses of attention-deficit/hyperactivity disorder, dyslexia, and developmental coordination disorder among others. By reconceptualizing neurodiversity as part of biodiversity, neurodiversity proponents emphasize the need to develop an 'ecological' society that supports the conservation of neurological minorities through the construction of ecological niches-that is, making space for all. This is an alternative to the drive to eliminate diversity through attempts to 'treat' or 'cure' neurodivergence. So far, neurodiversity theory has not been formally adapted for psychotherapeutic frameworks, and it is not the role of the therapist to make systemic changes to societal organization. Still, there is room for fruitfully drawing on a neurodiversity perspective for therapists working with neurodivergent people in clinical settings. Here, we draw on the example of autism and synthesize three key themes to propose the concept of neurodivergence-informed therapy. First, the reconceptualization of dysfunction as relational rather than individual. Second, the importance of neurodivergence acceptance and pride, and disability community and culture to emancipate neurodivergent people from neuro-normativity. Third, the need for therapists to cultivate a relational epistemic humility regarding different experiences of neurodivergence and disablement.