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:

“for many software people, a good deal of self-actualization is involved with becoming a better software professional.”

—Barry Boehm, Software Engineering Economics

Via: Self-determination Theory: Understanding Human Motivation for Fun and Profit | Dr. Leif Singer

Some suggested professional development:

Design is Tested at the Edges: Intersectionality, The Social Model of Disability, and Design for Real Life

Neurodiversity, the social model of disability, intersectionality, and equity literacy are necessary professional development.

For me, the key significance of the “Autistic Spectrum” lies in its call for and anticipation of a politics of Neurological Diversity, or “Neurodiversity”. The “Neurologically Different” represent a new addition to the familiar political categories of class / gender / race and will augment the insights of the social model of disability.

Source: NeuroDiversity: The Birth of an Idea by Judy Singer

Had a nice chat this afternoon with Boston Children’s Hospital’s inpatient neuroscience folks on autism, the social model of disability, identity first language, and designing for pluralism. The best hospital onboarding I’ve experienced.

I updated “Design is Tested at the Edges: Intersectionality, The Social Model of Disability, and Design for Real Life” with selections from “Histories of Violence: Neurodiversity and the Policing of the Norm – Los Angeles Review of Books” to further emphasize nuance and context.

Neurodiversity is a movement that celebrates difference while remaining deeply nuanced on questions of (medical) facilitation and the necessity of rethinking the concept of accommodation against narratives of cure. The added emphasis on neurology has been necessary in order to challenge existing norms that form the base-line of existence: the “neuro” in neurodiversity has opened up the conversation about the category of neurotypicality and the largely unspoken criteria that support and reinforce the definition of what it means to be human, to be intelligent, to be of value to society. This has been especially necessary for those folks who continue to be excluded from education, social and economic life, who are regarded as less than human, whose modes of relation continue to be deeply misunderstood, and who are cast as burdens to society.

Nonetheless, I think it’s fair to say that this enhanced perceptual field is an aspect of much autistic experience and something neurotypicals could learn a lot from, not only with regard to perception itself, but also as concerns the complexity of experience.

What is needed are not more categories but more sensitivity to difference and a more acute attunement to qualities of experience.

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

Instead of being labeled “children with special needs” they are labeled “children with special rights.”

Source: Reggio Emilia | It’s About Learning

No one knows best the motion of the ocean than the fish that must fight the current to swim upstream.” “By focusing on the parts of the system that are most complex and where the people living it are the most vulnerable we understand the system best.” “When we build things – we must think of the things our life doesn’t necessitate. Because someone’s life does.

Source: Design is Tested at the Edges: Intersectionality, The Social Model of Disability, and Design for Real Life – Ryan Boren

I updated “Compassion is not coddling. Design for real life.”, “Design is Tested at the Edges: Intersectionality, The Social Model of Disability, and Design for Real Life”, “Neurodiversity in the SpEd Classroom”, and “Classroom UX: Bring Your Own Comfort, Bring Your Own Device, Design Your Own Context” with a selection from “From Hostility to Community – Teachers Going Gradeless”.

An education that is designed to the edges and takes into account the jagged learning profile of all students can help unlock the potential in every child.

Source: From Hostility to Community – Teachers Going Gradeless