Neurodiversity in the profession

Over the past few years a much-needed shift in attitudes towards neurodiversity has occurred. Employers from many sectors are starting to realise the benefits of employing neurodivergent people within their organisations.

It’s a statistical certainty that, even in a relatively small profession like ours, a significant number of people are neurodivergent. Should veterinary practices be doing more to encourage and nurture our neurodivergent colleagues? What benefits could a more inclusive employment policy bring to your practice?

What is neurodiversity?

The term “neurodiversity” is relatively new, and was coined to describe the neurocognitive and biological differences that exist within human brains. We all have our own personalities, psyches and ways of looking at the world, but for some, how they express themselves varies from societal definitions of “normal”.

Neurodivergent individuals may or may not have a diagnosis describing their specific characteristics. Some of these include autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), dyslexia and dyspraxia (many more exist and some people have more than one diagnosis).

According to the National Autistic Society, more than 1 in 100 people living in the UK are autistic¹. Autism is described by the National Autistic Society as “a lifelong, developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them”².

Groups of autistic people sharing certain characteristics may have a particular profile of autism. Terminology to describe these profiles is constantly evolving as diagnoses such as Asperger syndrome and high/low-functioning autism are now outdated.

The Pathological Demand Avoidance (PDA) Society works to raise awareness of the PDA profile of autism. It defines autism as “a complex and overlapping pattern of strengths, differences and challenges that present differently from one individual to another and in the same individual over time or in different environments. A cluster of traits can be called a presentation or a profile – in some cases this can be quite different from what some people think autism ‘looks like’”³.

Neurodiversity is more than autism

“Neurodiversity” is often incorrectly referred to as being synonymous with autism. Many non-autistic people are neurodivergent, just as some autistic people are neurodivergent in other ways, too (due to author experience and knowledge, this article does focus on autism).

ADHD is usually diagnosed in children and is defined as “a behavioural disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness”⁴. Symptoms are usually noticed in children and can often improve with age. ADHD can, however, continue into adulthood, and is sometimes associated with sleep and anxiety disorders.

Dyslexia affects 1 in 10 people in the UK⁵. This common learning difficulty causes problems with reading, writing and spelling. It’s usually noticed when a child starts school.

The symptoms of dyspraxia vary between individuals, but it usually manifests as difficulties with coordination, learning new skills, managing emotions and dealing with social situations⁶.

American journalist Harvey Blume commented in The Atlantic in 1998 that ‘‘neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general. Who can say what form of wiring will be best at any given moment?”

What benefits could neurodivergent employees bring to your practice?

For years, tech giants such as Microsoft and Google have been actively recruiting neurodivergent individuals. They run training programmes specifically to support people who may have previously experienced difficulties finding work⁷. While this “deliberate inclusion” helps many people access work, the ideal scenario is “systemic inclusion” where companies operate a universal culture of acceptance and support.

Examples of successful systemic inclusion can be seen within large, multinational companies such as Ernst and Young, and JPMorgan Chase. These companies offer support to all of their neurodivergent employees and in return retain a talented, dedicated workforce. There’s no such thing as a typical autistic person, or person with ADHD, dyslexia or dyspraxia (plus all the other categories of neurodiversity not mentioned here). However, broadly speaking, many autistic people often:

• are very accurate with an excellent attention to detail
• are able to identify errors
• have an excellent memory
• have a high level of concentration
• are very reliable and conscientious
• are loyal employees

According to the ADHD Foundation, adults with ADHD often have the following strengths⁸:

• the ability to “hyperfocus” on things they are interested in
• a willingness to take risks
• spontaneous and flexible
• good in a crisis
• creative ideas – thinking outside the box
• relentless energy
• often optimistic
• being motivated by short-term deadlines – working in sprints rather than marathons
• often an eye for detail

Many neurodivergent individuals, especially autistic people, have a particular affinity with animals. Research carried out into the relationship between animals and autistic people repeatedly reports positive outcomes for both parties from such interactions^9,10. Given the correct support, neurodivergent individuals with a keen interest in animals could make a significant contribution to your team.

What costs are involved in supporting neurodivergent team members?

Most veterinary practices have modest budgets compared to wealthy, multinational firms. The good news is that many of the adjustments suggested in this article cost nothing to implement. An investment of time would be required to educate staff, but from a monetary perspective the cost is low.

Researchers from Curtin University in Perth, Western Australia, carried out a study into the economic impact of employing adults with ASD and concluded that “enhancing the opportunities for adults with ASD to join the workforce is beneficial from a societal perspective not only from an inclusiveness viewpoint, but also from a strict economic standpoint”¹¹.

Why should veterinary practices be supportive of neurodiversity?

Many neurodivergent individuals don’t consider themselves disabled and choose not to disclose their neurodivergence with employers; there’s no legal requirement to do so. If job candidates or employees do share this information then their needs should be considered in line with the Equality Act 2010¹². This law states that “a disability can arise from a wide range of impairments, which can be developmental, such as ASDs, dyslexia and dyspraxia”.

Anyone identifying as neurodivergent has the right to request reasonable adjustments within their workplace and be adequately protected from discrimination, harassment and victimisation. Veterinary practices have a legal obligation to consider these candidates for roles within their organisations.

For many minority groups, society’s opinions and attitudes are changing, and employers are becoming more accepting of “difference” – be it gender, race, sexuality or physical disability. For neurodivergent individuals, much work still needs doing to achieve equality within the workplace.

In 2016 the National Autistic Society carried out an employment survey of 2,000 autistic adults¹³. Only 16% of autistic adults were in full-time employment despite 77% of the unemployed group expressing a strong desire to work.

Mark Lever, the former chief executive of the National Autistic Society, explained some of the issues behind the results: “Autistic people have a huge contribution to make to our economy and society, including in the workplace. But they’ve been repeatedly failed by government and overlooked by employers.

“Not all autistic people are able to work. But many are, and are desperate to find a job that reflects their talent and interests. With a little understanding and small adjustments to the workplace, they can be a real asset to businesses across the UK. Autistic people deserve that chance.”

What are the possible workplace adjustments to support neurodivergent veterinary staff?

Adjustments that help one person may not be suitable for another; communication and regular two-way feedback is essential. Where neurodiversity is concerned, one size definitely doesn’t fit all. The following list of possible adjustments aims to specifically support neurodivergent employees, but many of the suggestions may actually improve the workplace for everyone:

Job advert:

• Consider the language used to advertise positions; keep language clear and avoid jargon. List the essential skills required and avoid listing skills that aren’t necessary to carry out the job.
• Provide a clear application form, and be specific about requests for CVs and references. Provide space for applicants to write about additional support they may need.
• Avoid the use of white paper for application forms and job descriptions; cream is easier for many people with dyslexia to read.

Interview:

• Consider the best form of interview for the job. Would a morning spent working in the practice with a candidate be more beneficial than a formal question and answer style interview?
• Allow candidates to view interview questions in advance if requested.
• Be clear about when and where the interview will be held, and who will be present.
• Avoid open-ended questions. Rather than “tell me about your last job” try “did you do X, Y, Z in your last job?”
• Avoid hypothetical questions. Instead of “if we had an emergency, how do you think you’d cope?”, use “in your last job, what did you do when an emergency case was brought in?”.
• Don’t place too much emphasis on eye contact and body language; these may vary and aren’t indicators of an individual’s skills.

Communication within the workplace:

• Avoid sarcasm and banter; this can cause confusion and misunderstanding.
• Avoid the overuse of idioms such as “throw up” instead of vomit, “bring him round” instead of wake him up, and “all skin and bones” to describe a thin animal. If taken literally, these can cause confusion.
• Issue requests politely and clearly.
• Some people may require detailed instructions to complete a task, others prefer a degree of freedom over how they are completed. Without compromising animal safety it’s possible to decide these approaches collaboratively.
• Allow extra processing time when instructions are issued.
• Consider visual aids rather than written instructions. Practice protocols could be presented diagrammatically.
• Whiteboards can be useful for listing daily tasks.
• Assign a mentor who can provide support on a day-to-day basis and is the “go-to” person to help deal with any issues.
• Autistic employees may not pick up on social cues – hold regular reviews where honest, but sensitive feedback is given. Avoid apportioning blame if complaints arise; discuss grievances calmly and fairly.
• Encourage two-way feedback to assess how adjustments could be modified.
• If preferred, use cream or blue paper for hospital sheets and other in-practice documents.
• Use technology where possible to assist those who require support with spelling.

Sensory considerations:

By the very nature of our work, we’re often surrounded by strong smells and loud noises. There are ways in which the impact of these can be reduced:

• Ear defenders can make loud dog barking more bearable; they don’t prevent conversations from taking place.
• Switch to non-scented cleaning products and hand soap.
• Ask everyone to avoid wearing strongly fragranced perfumes and body sprays.
• Provide a quiet space for breaks; this could be a desk in an office, a chair in a consult room or a separate room entirely if space allows.
• Keep food smells to a minimum; position microwaves away from the main staff room if possible.
• Allow for flexibility where possible; some people may find completing tasks more manageable at certain times of the day.

Veterinary specific:

• Many practices follow set protocols for routine procedures so much of our work follows a predictable pattern. Agree in advance what roles everyone will take when emergency situations arise and practise these “drills”.
• If individuals are unsure of their role during an emergency then one option is to cover another staff member’s duties while the patient is treated.
• Give as much warning as possible when changes to rotas or working hours occur.
• Many roles within veterinary practice involve a significant amount of interaction with the public. Ensure staff members are fully trained to deal with common scenarios; role play is a useful way to practise set phrases and common conversations.

Social:

• Remove the expectation to attend practice social events; all colleagues should understand that attendance is optional.

Staff training:

• Regular training and feedback sessions keep everyone informed of changes to practice policies. Practices could appoint a neurodiversity leader to take responsibility for educating and supporting colleagues. Huge potential exists for large veterinary corporates to adopt the inclusion models used by many non-veterinary firms. Future work could include:
  • centrally designed CPD for all employees as part of their mandatory training
  • neurodiversity practice “champions” to help implement, monitor and review adjustments
  • neurodiversity leaders at senior level to oversee inclusion policies and programmes

Conferences and CPD:

A few adjustments exist that CPD providers and conference organisers could make to support neurodivergent delegates:

• Provide interaction badges that allow delegates to indicate how they would like to interact with others. A coloured name badge could show preferences:
  • green – happy to interact
  • yellow – happy to talk to known people
  • red – would rather not be approached for conversation (though may choose to initiate conversation)¹⁴.
• Assign quiet rooms to allow for sensory breaks and downtime.
• Provide quiet lunch spaces and designated tables to avoid crowded environments.
• Reserve seating towards the back of lecture halls for people who need to leave for a break or prefer a bit more space.
• Allow for questions to be submitted in writing prior to the lecture.

Finally

Being a neurodivergent person working in a neurotypical-biased world presents many challenges. By supporting our colleagues properly, the veterinary profession has the potential to positively impact many lives.

Making adjustments for a neurodivergent employee in your practice doesn’t give him or her an unfair advantage, it merely levels the playing field. Maybe it’s time we started focusing on what our colleagues can do and not what they can’t.

A word about terminology…

I refer to “autistic individuals” rather than “with autism” as many people prefer to have ownership of their diagnosis rather than it be a label. This is in contrast to the common terminology used to describe medical conditions (for example, “a person with diabetes” may not wish to be referred to as “a diabetic person”). If you’re unsure about terminology, ask your colleagues what they prefer.