Neurominorities, Spiky Profiles, and the Biopsychosocial Model at Work

I’m making my way through my second read of the very interesting ”Neurodiversity at work: a biopsychosocial model and the impact on working adults”. There is a lot to digest. It offers:

  • definitions of neurotypical and neurodivergent based on spiky versus flat profiles
  • a taxonomy and timeline of neurominorities
  • an evolutionary critique of the psychomedical model
  • a biopsychosocial model for work
  • occupational considerations of neurodiversity
  • work-related difficulties and strengths attributed to neurominorities

I recommend this to all DEI and HR workers. Selected quotes:

There is consensus regarding some neurodevelopmental conditions being classed as neurominorities, with a ‘spiky profile’ of executive functions difficulties juxtaposed against neurocognitive strengths as a defining characteristic.

An evolutionary critique of the psychomedical model

Given the extent of overlap between the conditions, the under-diagnosis of females who instead present with anxiety, depression or eating disorders, and the estimated prevalence of each condition, a reasonable estimate of all neurominorities within the population is around 15-20%, i.e. a significant minority. Research supports a genetic component to most conditions which, when considered with combined prevalence rates, suggests an evolutionary critique of the medical model: if neurodivergence is essentially disablement, why do we keep replicating the gene pool? The less extensive, yet persistent, body of work indicating specialist strengths within neurodiversity, supports the hypothesis that the evolutionary purpose of divergence is ‘specialist thinking skills’ to balance ‘generalist’ thinking skills (as per the ‘spiky profile’). The evolutionary perspective is congruent with the Neurodiversity movement and essential to understanding the occupational talent management perspective that is currently in vogue.

The psychomedical histories outlined in Table 2 speak to the evolutionary critique for two reasons. Firstly, they demonstrate the consistency of the ‘specific’ rather than ‘general’ nature of impairment (the spiky profile) across all four conditions over time, irrespective of the changing nature of causal theories. The conditions are named and identified according to their most prominent deficits, which are themselves contextualized within our normative educational social history. Dyslexia is discovered around the same time as literacy becomes mainstream through education; ADHD becomes more prevalent with the increasing sedentary lifestyles from the industrial revolution; autism increases in line with modern frequency of social communication and sensory stimulation and DCD as our day-to-day need for motor control of complex tools and machinery becomes embedded. The evolutionary critique of neurodevelopmental disorders is that their perceived pathology is related to what we consider normal in modern times, as opposed to what is normal development within the human species.3,7,53–55 Secondly of interest from the timeline in Table 2 is the final column, wherein we see that, despite consistent observation of similar neurobiological differences, we lack a single unifying theory for any condition.

Towards a biopsychosocial model

The spiky profile may well emerge as the definitive expression of neurominority, within which there are symptom clusters that we currently call autism, ADHD, dyslexia and DCD

Within the biopsychosocial model of neurodiversity, understanding work-related intervention and treatment becomes more about adjusting the fit between the person and their environment than about treating a disorder. Critical review of the extant biopsychosocial research supports the social model proposition that the individual is not disabled, but the environment is disabling.

The legal status of neurodiversity

Disability status is predicated not on diagnosis of condition, but on the assessment of functional impairment, the extent to which the individual is inhibited and excluded.

Many neurominority employees find themselves in need of disability accommodation at work. Irrespective of legal protection, social and occupational exclusion are endemic for neurominorities.

Occupational considerations of neurodiversity

A reductive, medical paradigm of research is incongruent with the legal status of neurominorities as protected conditions in most developed countries, to which organizations must adjust.

Occupational symptomatology

At the functional level, there are similarities between neurominorities in terms of presentation. As alluded to in Table 2, executive functions are a common psychological complaint, resulting in difficulties with short-term and working memory, attention regulation, planning, prioritizing, organization and time management. Self-regulation of work performance is required in many modern employment contexts and therefore these issues present as the most disabling for individuals. There is also commonality among strengths, many related to higher order cognitive functioning reliant on comprehension and creativity.Table 3, adapted again from the British Psychological Society’s 2017 report, describes reported strengths and weaknesses associated with the four main neurominorities. The comparatively fewer references regarding strengths may reflect a research bias as opposed to an accurate representation of lived experience; it certainly is incongruent with the ‘talent’ narrative that is becoming dominant in workplaces.

Accommodations

The aim of occupational accommodations for neurominorities is to access the strengths of the spiky profile and palliate the struggles.

When assessment methods are more matched to the eventual job performance (for example observation of physical examination skills using role play patients) extra time becomes less important. This principle applies across education, recruitment and employment but is poorly understood by lay people or those without an understanding of cognitive functions and the antecedent components of job performance.

Following Diagnosis

Once a condition or conditions have been identified, an individual may feel vindicated, and experience catharsis. Psychology practitioners report their clients’ mental shift following correct diagnosis at the identity level and warn that, done badly, it can lead to disempowerment.12 However, done well, understanding one’s strengths and weaknesses can lead to breaking down barriers and removing self-reproach.

Accessing adjustments

Adjustments tend to be provided as a compliance activity per individual, with few businesses looking systemically at Universal Design for neurominorities as would be recommended in the United Nations Convention on disability. Access to accommodations is thus predicated on individual disclosure, typically occurring following a conflict or episode of poor performance. Individuals are reluctant to voluntarily disclose in advance as they fear discrimination (with some justification) and therefore the aims of the disability legislation programs worldwide are not yet having the intended effect on inclusion.

Accommodations in providing medical treatment

Differences in sensory perception have been reported as a hallmark of neurominority internal experience, which may affect pain management, sleep patterns and increase routine-change difficulties during in-patient care.

Conclusions

From within an emerging paradigm, clinicians and researchers must appreciate the shift in discourse regarding neurodiversity from an active, vocal stake- holder group and embrace new avenues for study and practice that address practical concerns regarding education, training, work and inclusion. This article has provided an overview of the neurodiversity employment picture; namely high percentages of exclusion juxtaposed against a narrative of talent and hope. Understanding the importance of nomenclature, sensory sensitivity and the lasting psychological effects of intersectional social exclusion is key for physicians wanting to interact confidently and positively with neurominorities. The proposed biopsychosocial model allows us to provide therapeutic intervention (medical model) and recommend structural accommodation (legislative obligation) without pathologization (social model). In other words, we can deal pragmatically with the individuals who approach us and strive for the best outcomes, given their profile and environment.

Source: Neurodiversity at work: a biopsychosocial model and the impact on working adults | British Medical Bulletin | Oxford Academic

Via:

Human cognitive diversity exists for a reason; our differences are the genius – and the conscience – of our species.

Dyslexic children often have better imaginations than non-dyslexics, after all, but nobody labels the “normal” children as having an “imagination disability.”

These children’s brains are organizing themselves differently, and it should go without saying that their developmental arc may therefore be different. When we interfere in the process of this organization, when we stigmatize it and test it and remediate it prematurely — when we try to teach dyslexics to think like other children by aggressively drilling them in phonics — Cooper says we are robbing these children of the opportunity to build organically on their many strengths rather than being treated as something broken that needs fixing.

Some simply have a different learning strategy; one that absorbs, considers, consolidates, integrates, and then suddenly blossoms fully formed.

If your learning style doesn’t fit this year’s theory, you will be humiliated, remediated, scrutinized, stigmatized, tested, and ultimately diagnosed and labelled as having a mild defect in your brain.

People all over the world know these things about children and learning, and interestingly, they are as workable for learning how to design software or conduct a scientific experiment or write an elegant essay as they are for learning to hunt caribou or identify medicinal plants in a rainforest.

But we don’t know them any more.

Source: A Thousand Rivers: What The Modern World Has Forgotten About Children And Learning

Ms. Morin herself has neurodivergent children, for whom virtual learning has been “a relief in a lot of ways,” removing the social pressure and sensory overload of an average day. “They’ve been so much calmer about school,” she said.

As nondisabled people rush to return to face-to-face interactions, accessibility threatens to narrow back to pre-pandemic levels. But the window is still open to make accessibility permanent, ideally under the guidance of people with disabilities, who used online tools out of necessity well before they became universal.

Source: Disability, Work and Coronavirus: What Happens Now? – The New York Times

My kids also prefer the sensory and social calmness of schooling at home.

Telemedicine and distributed education are accommodations our disabled and neurodivergent family had to fight for, usually unsuccessfully, that are now no longer accommodations because they have suddenly normalized. I’m cynical enough to expect to go back to fighting as soon as some sense of the old normal is reclaimed.

Disability, Hiring, and the Glass Staircase

I would argue that for a lot of graduate jobs, there’s a significant barrier to entry for neurodiverse and disabled people. I like to call this barrier the “glass staircase”. YouTuber Gem Hubbard is a wheelchair user and has a great video on the concept, but I’d like to extend her metaphor beyond physical impairments because I believe it provides a useful framework to understand the job-hunting process for those with invisible or neurological disabilities too.

For all intents and purposes, the “staircase” is the relatively streamlined application process for jobs, that appears simple to non-disabled people, but which has plenty of obstacles for disabled people.

While it’s possible to negotiate the staircase when companies meet an individual’s access requirements, this often requires disabled applicants to put in significantly more time and effort than their non-disabled peers. We are constantly dependent on other people to allow us to continue in the application process without disadvantage.

Having to explain the same thing again and again at different stages, to different people, at different employers, is mentally strenuous and time-consuming – and used to regularly makes me wonder if what’s at the top is even worth it if it’s so much of a hassle getting there.

Source: Serena Bhandari – Jobstacle Course | Touretteshero

Via:

Learning about neurodiversity at school has potential to support a positive autistic identity. The deficit perspective Maia and Ninja had can lead to negative effects on well-being. Ernie’s autistic identity was more positive and informed by other autistic people. Curricular materials developed from the perspectives of autistic people on how to teach autistic students about neurodiversity and autistic culture need to be available to educators.

Source: INSAR 2020 Virtual Meeting – 419.060 – “They’re like the People That Aren’t Exactly, like, Normal Brained.”: Neurodiversity from the Perspectives of Three Autistic Adolescent Young Women. 

Via:

Neurotypicality is a grounding narrative of exclusion. The neurotypical is the category to which our education systems aspire. It is the category to which our ideas of the nuclear family aspire. And, it is the category on which the concept of the citizen (and by extension participation in the nation-state and the wider global economy) is based.

In the context of education, which is the one I am most knowledgeable about, the mechanisms for upholding the neurotypical standard are everywhere in force. Every classroom that penalizes students for distributed modes of attention organizes learning according to a neurotypical norm. Every classroom that sees the moving body as the distracted body is organized according to a neurotypical norm. Every classroom that teaches predominantly for one mode of perception is organizing its learning according to a norm. Every classroom that knows in advance what knowledge looks and sounds like is working to a norm.

Intelligence, understood as the performance of a certain kind of knowledge acquisition and presentation, is built on the scaffold of neurotypicality as the unspoken norm. To speak of the normative tendencies of education is not new. My concern is with what remains largely unspoken in that conversation. Having “special needs” classrooms upholds neurotypicality, for instance, as the dominant model of existence. Drugging our children because of their attention deficit is upholding a neurotypical norm. Sending our black and indigenous children to juvenile detention centers in disproportionate numbers is upholding a neurotypical norm which takes, as neurotypicality always does, whiteness as the standard.

Source: Histories of Violence: Neurodiversity and the Policing of the Norm – Los Angeles Review of Books

The set of social, political, cultural, and personal rules favors a particular way of thinking, feeling, behaving, and communicating as superior to others: the neurotypical form.

Our parents are ashamed of our differences, and we notice it. They continually repress us when out of instinct we obey our neurology. They deny us reasonable adjustments because according to their own neurology, our differences are meaningless and no one has explained to them that it is a right.

The vast majority of medical interventions around autism are not accepting of autism as one of the many biological possibilities of human diversity. Without evidence, they pathologize our differences, dehumanizing us.

The authorities force us to submit to systems that do not take into account our differences, making access to our human rights difficult.

The neuronorm forces us to camouflage ourselves when it is possible (at a very high cost in health and dignity) and when it is not possible we are denied the presumption of competence and the most basic rights are taken away from us: dignity, freedom, education and even the right to live.

We are the rare ones, the strangers, those who do not share the codes that unite society. We are the epitome of what it means to be “the other,” our way of being considered “not valid.”

NEURONORM: The Neuronorm is the set of social, political, cultural and personal norms that privilege a particular way of thinking, feeling, behaving, and communicating as superior to others.

Source: The Guide is here! Understanding the Autistic Mind 1 » NeuroClastic

The Neurodiversity Movement arose from the resistance of neurominority activists to their exclusion from employment, health, and education etc.

But if the movement is fully understood and used properly, it will find itself humanizing the working conditions of all humans, and providing an adequate standard of living for all, not just those with inherited wealth, paid employment, or entrepreneurial abilities.

Source: NeuroDiversity 2.0: Is “Paid-Employedness” the new “Next to Godliness”?