NEURODIVERSITY HANDOUT – Dr Anoushka Sharp 11/10/24

1) Introduction
Neurodiversity is the variation of strengths and struggles across cognitive domains and executive functions in a population.
Neurodivergence is an individual’s deviation from the distribution of strengths and struggles across cognitive domains and
executive functions expected for a member of their population.
Neurodivergent conditions (e.g. Autism, ADHD, Dyslexia, Dyscalculia, Dyspraxia, Tourette Syndrome) describe specific
combinations of strengths and struggles in cognitive domains and executive functions.
Reasonable adjustments are adaptations made by educators, employers, and service providers to minimise individuals facing
unnecessary disadvantages due to their disabilities (which includes struggles encountered due to neurodivergence).

This presentation raises awareness and understanding of neurodiversity and clarifies reasonable adjustment procedures to
maximise neurodivergent individuals working effectively, thus increase efficiency and job satisfaction for all employees.

2) Neurodiversity, Cognitive Domains and Executive Functions

The eight cognitive domains and eight executive functions involved in neurodivergence are illustrated on the cards below.

To celebrate neurodiversity within your workforce, order your 16 cards from your most valuable skill to your most significant
struggle. Compare your order to your colleagues’ orders. Discuss how task distribution could be customised to maximise efficiency
and job satisfaction.
SELF-MONITORING EMOTIONAL CONTROL
Noticing and adapting personal behaviours Regulating thoughts and feelings to fit situations

FLEXIBILITY TASK INITIATION

Adapting thoughts and actions for unexpected situations Starting tasks independently without delay or procrastination

PLANNING TIME MANAGEMENT

Setting goals and designing steps for task completion Estimating tasks’ durations and using time efficiently
WORKING MEMORY SELF-INHIBITION
Retaining and manipulating temporary information Controlling impulses and resisting distractions

PROCESSING SPEED PERCEPTUAL-MOTOR

Interpreting and responding to new information quickly Coordinating sensory information with movements

VISUOSPATIAL ABILITY SOCIAL COGNITION

Comprehending and manipulating objects' positions Interpreting and interacting with other people
ATTENTION MEMORY
Focussing on a specific task or stimulus Recalling recent or historic events and information

EXECUTIVE FUNCTION LANGUAGE

Reasoning, decision-making, problem-solving Understanding spoken or written information
4) Diagnostics and Diagnoses
As demonstrated in the previous section, every individual in a population is, to an extent, neurodivergent. Often, individuals with a
larger difference in proficiency between their most valuable strengths and most significant struggles suffer more from their
neurodivergence because society expects population members to display uniform proficiency across cognitive domains and
executive functions both collectively and individually. Individuals with non-uniform distribution of proficiency across cognitive
domains and executive functions encounter immense frustration when suffering from significant struggles prevents achieving
outcomes from valuable strengths.

Diagnostic assessments for neurodivergent conditions assess proficiency across cognitive domains and executive functions
through interviews and questionnaires (directed at the neurodivergent individual and others around them), cognitive exercises,
practical tasks and periods of observation.

A diagnostic assessment result can be viewed as a vector of 1s and 0s where each 1 or 0 represents the yes or no answer to a
binary question. A neurodivergent condition can also be viewed as a vector of 1s and 0s, answering the same list of binary
questions with characteristic answers for that condition The extent to which an individual fits a neurodivergent condition can be
quantified as the inner product of the vector generated by their diagnostic assessment with the vector describing the
neurodivergent condition. A larger inner product indicates a better match between an individual and a neurodivergent condition. If
the inner product surpasses a threshold value, an individual is diagnosed as ‘having the neurodivergent condition’. Thus,
predefined neurodivergent conditions suggest approximate information about an individual’s strengths, struggles, and useful
reasonable adjustments.

Distributions of strengths and struggles characteristic of six neurodivergent conditions are illustrated below.
To consider your own neurodivergence, place your cards in order of the condition which you feel fits you most to least.
DYSLEXIA DYSCALCULIA

ADHD AUTISM

DYSPRAXIA TOURETTE SYNDROME

DYSLEXIA DYSCALCULIA

SKILLS
SKILLS
Communication, creativity, empathy, innovation, memory,
Artistic skills, creativity, intuition, organisation, strategic
organisation, problem solving, spatial visualisation
thinking, verbal communication
STRUGGLES
STRUGGLES
Ordering items, reading, spelling, verbal memory, verbal
Following directions, processing numerical information
processing speed, writing

ADHD AUTISM

SKILLS
SKILLS
Honesty, noticing detail, processing information, spatial
Energy, enthusiasm, hyperfocus, passion, personable nature,
visualisation, spotting patterns, tenacity
problem solving, unique thinking
STRUGGLES
STRUGGLES
Articulating emotions, changing routines, interpreting
Appearing rude, feeling bored, impatience, impulsiveness,
behaviour, managing stress, processing sensations, thinking
losing concentration, noticing detail, processing criticsim
flexibly, verbal communication

DYSPRAXIA TOURETTE SYNDROME

SKILLS
SKILLS
Communication, creativity, empathy, problem solving, tenacity
Creativity, empathy, hyperfocus, resilience, verbal
communication
STRUGGLES
Coordination, following sequences of actions, learning
STRUGGLES
procedures, organisation, stress management, time keeping
Managing stress, suppressing tics
It makes intuitive sense that the skills and struggles associated with these neurodivergent conditions might co-exist. For example,
for ADHD, the tendency to infuse excessive passion, energy and focus into an interesting project would logically correlate with
feeling deeply, personally hurt by criticism regarding the project. For a second example, for Dyslexia, struggling to comprehend
written descriptions of concepts might encourage an individual to visualise concepts in 3D, using their imagination instead of paper.
For a third example, for Autism, hypersensitivity to sensory stimuli such as sounds or tastes would logically correlate with a strong
preference to adhere to routines, as a protective mechanism to avoid unexpected sensations.

5) Reasonable adjustments
As mentioned in the previous two sections, reasonable adjustments are adaptations made by educators, employers, and service
providers to minimise individuals facing unnecessary disadvantages due to their disabilities. For neurodivergent individuals in the
workplace, reasonable adjustments minimise suffering from significant struggles to maximise achievement from valuable strengths.

Examples of reasonable workplace adjustments are illustrated on the cards below. To celebrate neurodiversity in the workforce,
place your cards in order of which reasonable adjustment you would find most to least useful, then compare your order to
colleagues’ orders. To consolidate understanding of neurodivergent conditions, match each reasonable adjustment to the
neurodivergent conditions where that adjustment could be useful.
FACILITATE DISABILITY LEAVE PROVIDE ASSISTIVE TECHNOLOGY
E.g. allowing extra time off for medical appointments and E.g. laptop, audio to text converter, ergonomic keyboard,
coaching mobile apps

ADJUST TASK ALLOCATION ADJUST TOTAL HOURS WORKED

E.g. changing job description or transferring job within the E.g. allowing extra breaks and leave within working hours
organisation

PROVIDE ACCESSIBLE INFORMATION ADJUST PHYSICAL ENVIRONMENT

E.g. giving audio alongside written information, typing instead E.g. changing furniture, lighting, windows, temperature, stairs,
of writing food or drink access
ADJUST SHIFT PATTERNS ADJUST PROMOTION CRITERIA
E.g. extra breaks, swapping in and out of hours work E.g. changing requirements to exclude inappropriate tasks

FACILITATE FAIR PAY ADJUST ASSESSMENT PROCEDURES

E.g. adapting contract to incorporate pay for extra breaks E.g. providing extra time, extra rest breaks, different exam
taken at work formats and equipment

FACILITATE REMOTE WORKING

E.g. customising tasks for remote completion and allocating
remote working hours
6) Educational Supervisor (ES) and Clinical Supervisor (CS) Roles
As shown in the previous section, appropriate implementation and effective communication of reasonable adjustments is of
paramount importance for neurodivergent individuals to function effectively during solo work and teamwork. However, this is easier
said than done: neurodivergent conditions comprise invisible disabilities which are difficult for those without background knowledge
of neurodiversity to recognise in themselves and in others. Furthermore, neurodivergent individuals apparently functioning
successfully in adult society often struggle severely with notably basic functions – e.g. reading, timekeeping, concentrating,
socialising, experiencing sensations, following rules. These struggles are much easier to suppress and ignore than to vocalise and
mitigate because they are embarrassing and difficult to explain.

Thus, the ES and CS share the following responsibilities with their supervisees:

1) Space and time to talk

Supervisees should feel able to access support services e.g. Sophie’s Room, and to request CS and ES meetings to discuss
difficulties. Supervisors, supervisees and support service providers should be aware of difficulties caused by undiagnosed
neurodivergence requiring reasonable adjustments. Supervisors and supervisees should be aware that ESNEFT can fund
customised disability coaching through Genius Within

2) Diagnostics
Supervisors should facilitate Occupational Health (OH) and Professional Support and Welfare (PSW) input to support supervisees’
existing and pending diagnoses.

3) Reasonable adjustments design

Reasonable adjustments are recommended by OH, then agreed by the supervisee and their CS, then documented in the
supervisee’s health passport.

4) Reasonable adjustments implementation and communication

Actioning reasonable adjustments requires cooperation and understanding from the whole MDT. Supervisors should encourage
supervisees to customise a health passport for sharing with all MDT members which lists their reasonable adjustments alongside a
short supporting statement describing useful, non-confidential details of why adjustments are required. Health passports should be
shared via email or by displaying a paper or electronic copy, as chosen by the supervisee, to all MDT members prior to starting a
placement. A health passport should be signed by its owner and by their CS.

5) Ongoing support
Supervisees should have regular ES, CS, OH, PSW meetings to evaluate how reasonable adjustments are working. Reasonable
adjustments are re-designed prior to commencing each new rotation and can be re-designed during a rotation if needed.

6) Legal Perspective
Supporting disabled individuals is so extremely important that it is incorporated into the law in the Equality Act of 2010. This
describes ‘protected characteristics’ rendering individuals ‘disabled’ and describes six categories of illegal disability discrimination
for educators, employers and service providers.

These six categories are direct discrimination, indirect discrimination, discrimination arising from disability, harassment,
victimisation, and reasonable adjustment denial. Categories and examples are illustrated in the 12 cards below. To consolidate
your understanding of illegal disability discrimination, match each category card to an examples card
DIRECT DISCRIMINATION INDIRECT DISCRIMINATION
Unfavourable treatment of individuals due to knowledge of Protocol applied to all workers placing disabled workers at an
their disability unnecessary disadvantage

DISCRIMINATION ARISING FROM DISABILITY REASONABLE ADJUSTMENT DENIAL

Unfavourable treatment of individuals due to effects of their Refusal to adapt features threatening disabled individuals that
disabilities is not a proportionate means to a legitimate end

HARASSMENT VICTIMISATION
Intimidation, hostility, offence, humiliation or dignity violation Unfavourable treatment of individuals due to knowledge that
experienced due to a protected characteristic they have escalated violations of the Equality Act
INDIRECT DISCRIMINATION EXAMPLES DIRECT DISCRIMINATION EXAMPLES

A rule that all doctors must complete ward rounds before

A doctor is not selected to represent the trust at a conference
taking a break places a doctor who requires frequent breaks at
due to knowledge that they are Autistic
a disadvantage
A doctor is not selected to teach students due to knowledge
A rule that all doctors must demonstrate proficiency in
that they require extra time in exams
auscultation places a deaf doctor at a disadvantage

REASONABLE ADJUSTMENT DENIAL EXAMPLES

DISCRIMINATION ARISING FROM DISABILITY EXAMPLES

An autistic individual susceptible to sensory overload and

A dyslexic individual who struggles to read numbers on paper burnout requests incorporating 6 hours of remote work within
drug charts is disciplined for repeatedly making mistakes on their 12-hour shifts. This is refused by their employer because
discharge summaries it is not routinely offered to employees

A dyspraxic individual who struggles to juggle locating and An individual with a new requirement to use a wheelchair
carrying drug charts and folders with closing the curtains and requests to change wards to a ground floor ward. This is
documenting is reprimanded for being slow during ward refused by their employer because changing rotations is not
rounds routinely offered to employees

HARASSMENT EXAMPLES VICTIMISATION EXAMPLES

An embarrassing spelling error made by a dyslexic individual A supervisor discourages their supervisee from appealing an
is announced to the MDT during handover ARCP outcome that the supervisee deems discriminatory
under the Equality Act
An autistic individual experiencing sensory overload is teased
for spending too long in the toilet and reprimanded for shirking An individual refuses to sign the TAB form of a colleague who
by taking too long for lunch completed a DATIX against them for disability discrimination
7) Conclusion
This neurodiversity handout is concluded with the following INSERT KEY PUNCHY MESSAGE AND PICTURE

8) Bibliography
Copious resources exist to facilitate wider understanding of neurodiversity and related medicine and law. Here are some
particularly useful ones. All links were accessed on 11/10/2024.

Books
Why Can’t I Just Enjoy Things – by Pierre Novelli
How to be You – by Emily Milton
The Pattern Seekers – by Professor Simon Baron-Cohen
Websites
GeniusWithin - What is Neurodiversity? - Genius Within
Cambridge University Hospitals Neurodiverstiy Guide - Neurodiversity at CUH | CUH
Documents
Diagnostic and Statistical Manual 5th Edition (DSM-5) - DSM-5.pdf | DocDroid
European Human Rights Council (EHRC) 2010 Equality Act -
https://www.equalityhumanrights.com/sites/default/files/employercode.pdf