It is estimated that around 1 in 5 people in the UK workplace are neurodivergent and whose thinking skills and behaviour are therefore not neurotypical.

Neurodifference can result in an inconsistency in performance, so an employee can excel at some aspects of their work but struggle with others or can work well for a time followed by persistent periods of poor performance.  Understandably, perhaps, some employers see inconsistent performance as an attitude or motivational issue. However, more recently a range of employers has started to consider neurodiversity in terms of consideration of strengths and a broader range of perspectives rather than deficits and impairments. Individuals may have characteristics of more than one neurodivergent condition, and specific traits and challenges can vary widely.

Neurodifferent employes can bring exceptional ability and creativity to their work. The role of Occupational Health is to help facilitate the employee to work at their best and bring their strengths to the role. Either way an employee with a neurodevelopmental condition is often prompt for a referral to Occupational Health for advice on support and reasonable adjustments.

Who is neurodifferent?

The term neurodifferent includes those whose brains develop or work differently from those who are neurotypical and can include the following:

Autism Spectrum Disorder (ASD) characterised by differences in social interaction, communication and behaviour.

Attention-Deficit/Hyperactivity Disorder – (ADHD) involves challenges with attention, hyperactivity and impulsivity

Dyslexia – A learning difficulty that affects reading and writing skills

Tourettes Syndrome – A neurological disorder that involves involuntary movements and vocalisation’s called tics.

Do labels matter?

Occupational Health is not concerned with the term disorder or syndrome, and professionals are mindful of the descriptions that individuals themselves use to describe the impact of a label or “condition”, and its impact on work. Individuals frequently describe themselves as ADHDer, or Touretter for example, and therefore neurodifference is seen as an umbrella term.

Individuals will have different needs and difficulties and so it is not possible to provide a check list of support or adjustments. Consensus based medical opinion suggests the following areas of areas of difficulty are typical for neurodifferent employees:

    • Memory and concentration -90%
    • Organisation and time management- 75%
    • Managing stress -65%
    • Communication -65% which can include;
      • Written communication and accuracy
      • Written communication and speed
      • Verbal communication difficulty
      • Managing intense emotions and sensory overload

Management Referral for Neurodiverse employee

In terms of health assessment, Occupational Health professionals are competent to assess an individual by means of a Workplace Health Needs Assessment and generally the assessment will focus on adjustments which help support the employee in the workplace. On occasion the referral may also be a matter of fitness for task/duties.

The process, therefore, involves the employee and employer looking at a range of measures to be considered as ‘reasonable adjustments. It is likely to involve OH conducting the assessment in the workplace to gain a detailed understanding of the role and current challenges.

For the range of neurodifferent conditions the most common adjustments are implementing:

A flexible work pattern – some people will find that they work more productively in the morning. Many can work intensively in short bursts rather than attempting to focus on detail for a long period of time, and others that they can work do their best work later in the day with a later start and finish. Allowing time out and short breaks if challenged.

Assistive Technology – For example, Read and Write Software converts text to speech tool-helps with processing information, note taking, reduction of screen glare, highlighting and screen ruler. Consider removing distractions such as notifications.

Quiet Space for Working: A range of adjustments may help here-

Home working – to allow an employee to work in familiar environment, with ability to alter both noise and light levels.

Noise cancelling headphones – allow the employee to lessen noise at work, and lets colleagues know that they are concentrating, so not to disturb.

Booking a meeting pod or quiet space to work- helps with focus on a detailed work and time out.

 

Additional Adjustments to consider –

Communication – over 65% of neurodifferent employees report difficulty with both written and verbal communication. Consider a range of adjustments-

Rather than sending a long project plan consider mind mapping software -instead of a long email send a voice memo –

Organise regular check ins with line manager – one to one

Teams’ meetings – allow employee to turn camera off- record meetings or move around – allow to attend meetings that directly involve them to avoid overload.

Ask the employee what works for them in terms of communication.

Coaching – A range of consultancies offer coaching, for individuals, the line manager and co coaching.

Individual coaching – one to one to build confidence, self-esteem, improve ability to manage challenges and enhance communication and social skills, coping strategies focusing on work and specific role.

Team Coaching – coaching and training for teams and line managers in appreciation of neurodiverse conditions and works best in terms of improving understanding and to upskill managers responsible for neurodifferent employees.

Co coaching – collaborative learning between coworkers and peers.

The legal aspects

Those with the range of neurodiverse conditions may be covered by provisions of the Equality Act, Disability Section (2010) and no formal diagnosis has to be made for a disability to be established. It is a question of functional capacity. The definition of disability is a physical /mental impairment which is long term and has a substantial adverse effect on ability to carry out normal day to day activities, including work activities. As neurodiverse conditions are lifelong, they may well be covered. It is a mental impairment and may substantially and adversely affect day to day activities.

The Employer is not obliged to obtain a specialist diagnosis for a neurodifferent employee and often the cost of adjustments may well be less than the cost of assessment. Diana Kloss, (SOM 2025) legal expert in occupational health law points out that from 2019 to 2022 as many as 30% of EAT cases related to neurodivrgence. Therefore, case law exists which it may be useful to refer to when considering adjustments in an individual case.

What about a formal assessment?

An employee can request a formal diagnosis through their GP, although the wait for assessment is likely to be long. A range of providers offer private formal assessment, and diagnostic professionals must be appropriately qualified and registered with the appropriate body, for example BPS for psychologists and GMC for psychiatrists, prescribing medication. Employers who do commission such reports should consider whether the report produced will be purely clinical or produced with the employer in mind in terms of the workplace and reasonable adjustments, which is generally the role of OH professionals.

Case Studies

Two case studies from our practice, both were complex cases with illustrations of what worked in terms of adjustments. All names have been changed to protect confidentiality.

Case study 1

Julia – age 32 – employee working in the charity sector as Marketing Manager- duties included creative duties, management of content on website, mail shots and elements of fund raising, in addition to training for 2 reports and some admin duties.

Formally diagnosed with ASD (Autism Spectrum Disorder) age 17 she experienced difficulty with concentration, focus and impulse control, time management and organization.

Julia felt that her neurodiverse condition constituted a medical condition due to her being prescribed medication but OH opinion was that it was a neurodevelopmental condition rather than medical condition.

Julia joined at a difficult time for company and had taken over when the previous marketing manager had left some months ago, and so a considerable workload had built up.  She struggled with communication, frequently interrupting others during meetings. Julia was getting behind with aspects of her work, including training and administrative work. She had two reports who found her direction confusing and her management style difficult to cope with.

The OH Assessment identified that her workload was diverse and that she had indeed inherited a back log of work for which no adjustment had been made in terms of time to complete tasks. Julia was becoming overwhelmed at work and was frequently tearful. She was required to attend many Teams and in person meetings when only a small part of the meeting discussions related to her role. Julia excelled at the creative aspects of her role and had implemented a range of changes beneficial to the charity in terms of fundraising.

The Management Referral

Occupational Health advised management to undertake a review of Julia’s role adopting a risk assessment approach. Whilst this review took place, Julia should focus on the creative aspects of her work, whilst the two team members who reported to her, were to report to Julia’s line manager. The training schedules and administrative duties were allocated to others.

Julia’s time in meetings was reduced, and her line manager agreed to update her at weekly catch ups on a need-to-know basis.

Julia had many interests outside work, which she agreed impacted her duties at times. A flexible work pattern was agreed which allowed Julia to alter the pattern of her working day when appropriate. Julia agreed to engage in one-to-one coaching with a specialist coach to explore different methods of communication and coping strategies for managing stress.

In conclusion, Julia was enabled to focus her efforts on the creative and fund-raising elements of her role, whilst other elements were permanently allocated to others. The marketing director met weekly with the team which resulted in a collaborative approach to working together therefore removing Julia’s line management responsibility.

Julia felt she had more control in her role, and coaching improved her communication with others reducing the need for face-to-face meetings that she found challenging.

Case Study 2

Tim aged 22 worked for a micro-brewery in an operational role, having joined this SME from school, aged 17. He did not have a formal diagnosis but felt that he was neuro different and had missed out at school. His parents had helped him request a formal diagnosis through NHS referral from his GP.

Tim had made good progress in his role and was given some responsibilities in which he excelled, in quality control. This involved him identifying kegs used for storing beer which had become worn and damaged. This work involved concentration and was repetitive and task orientated.

Over time, the role changed, and Tim’s duties altered. His behaviour at work was a cause for concern and he was involved in disagreements with others that led to at least one resignation. A specific altercation had led to a disciplinary and a final written warning for Tim.

The Management Referral

Occupational Health was asked by the HR Consultant to assess Tim onsite and provide guidance and advice. The onsite health assessment involved a consultation with Tim and a workplace health assessment and walk through survey. Tim took OH through his role, and at this stage it was clear that there were a range of misunderstandings on new duties.

Tim found it difficult to make eye contact with the OH practitioner and initially gave one-word answers to questions. He was asked about the issues related to the altercation and it became clear that when challenged about his work, Tim found it very difficult to regulate emotions or to agree compromise. Tim did not understand why his duties had changed and it seemed that his need to undertake new duties and processes had not been fully explained to him. This in turn led to him feeling stressed.

Tim got on well with many co- workers and OH advised that he be provided with a Work Buddy who would work with him on the new duties until he developed the confidence and resilience needed to adopt the new operational processes.

The company agreed on a team approach to coaching so that all colleagues understood Tim’s needs and gained a greater understanding of neuro different employees.