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:

Strategic Essentialism and Employee Resource Groups

However, antisubordination activists have engaged in a form of strategic essentialism as a means of resistance (Spivak, 1989). Mimicking conventional strategies of nonsubordinated power holders, strategic essentialism is a move by members of a subordinated category to simplify group identity and counter normative expectations.

Source: DisCrit—Disability Studies and Critical Race Theory in Education (Disability, Culture, and Equity Series) (p. 205). Teachers College Press. Kindle Edition.

Strategic Essentialism “…refers to a political tactic in which minority groups, nationalities, or ethnic groups mobilize on the basis of shared gendered, cultural, or political identity to represent themselves. While strong differences may exist between members of these groups, and amongst themselves they engage in continuous debates, it is sometimes advantageous for them to temporarily “essentialize” themselves and to bring forward their group identity in a simplified way to achieve certain goals…

Strategic essentialism is new vocabulary for me. I picked it up recently in my disability studies reading and am still learning how to apply it. I’m particularly interested in how it applies to running an Employee Resource Group.

This first thing that came to mind as I read the paragraph above from DisCrit is John Elder Robison’s piece that talks about using “neurodivergent” instead of diagnostic labels to build coalition.

When schools and workplaces move from autism programs to neurodiversity programs, they include every person with a cognitive difference, not just autistic people. The tent gets bigger, and it has room for all.

Whether your goal is competitive advantage or human service, you should be able to meet your goals better under a Neurodiversity at Work banner, as opposed to an Autism at Work one. In both cases the supports needed are similar, but the neurodivergent population is substantially larger than the “only autistic” population so your chances of success are magnified.

While labels like ADHD, autism, dyslexia, or PDD-NOS may be useful for therapists and childhood educators, the community-sourced alternative “neurodivergent” is probably better suited for colleges and workplaces. In those spaces, medical labels carry stigma that leads to conscious and unconscious marginalization. Expectations are always lower for people with disability diagnoses.

Neurodiversity is a new concept but the underlying reality has been part of human society forever. In the modern era work and school programs designed for the average person have excluded those whose cognitive styles fall outside that narrow midrange. Despite that, workplaces – including colleges – already contain plenty of neurodiversity so a primary program goal should be the better support of those people. Neurodiversity at School and at Work is not just about bringing new people into the fold.

The newest Neurodiversity initiatives recognize this fact.

By embracing the neurodiversity model instead of autism, employers can move toward a more inclusive welcoming environment.

Source: The Next Step for Neurodiversity | Psychology Today

I like to solve for the infinity, foreground complexity as the baseline, design for the edges, and design for pluralism. Sometimes, doing that requires coalition built on strategic essentialism.

…creating coalitions can subvert dominant hierarchies and transform the status quo.

Source: DisCrit—Disability Studies and Critical Race Theory in Education (Disability, Culture, and Equity Series) (p. 205). Teachers College Press. Kindle Edition.

Individuals, however, do not experience identity as a fractured reality. If we start instead with this understanding of intersectionality informed by DisCrit, the multivariant nature of experience may be a place for coalition.

Source: DisCrit—Disability Studies and Critical Race Theory in Education (Disability, Culture, and Equity Series) (p. 212). Teachers College Press. Kindle Edition.

I’m very glad to see the neurodiversity and queer ERGs at my workplace addressing gatekeeping, being broadly inclusive, and working together. This seems like healthy essentialism on which coalition and community can grow.

Community is magic.

Community is power.

Community is resistance.

Source: Disability Visibility: First Person Stories from the 21st Century

Neurodiversity Employee Resource Group at Automattic

Members of Automattic’s neurodivergent community launched this ERG in 2020 to support neurodivergent Automatticians, serve as a resource for Automattic at large, and promote the principles of neurodiversity.

Source: Employee Resource Groups – Automattic

I’m happy to say we have a Neurodiversity ERG at Automattic.

Some of our goals:

  • Advocate for neurodiversity-related improvements to hiring and team practices across the company
    • Work with TalentOps to review and improve onboarding for new hires and new team leads by adding neurodiversity resources
    • Be a resource for team leads, meetup planners, etc. to ask questions, so that it’s not entirely on team members to educate
  • Support our neurodivergent community internally
    • Provide resources for neurodiverseomatticians to learn more about their own neurodivergence
    • Promote ERG members’ accomplishments
  • Support our neurodivergent community externally
    • Put together resources for awareness days/months
    • Bring in neurodivergent speakers for internal talks
    • Attend, sponsor, and support neurodivergent-in-tech events
  • Examine internalized standards regarding competence, communication, and other traits valued at Automattic which are expressed differently by neurodivergent people
  • Stand in solidarity with groups who often overlap with us: physically disabled and mentally ill people in particular

Some things an ERG can help with:

At 90 percent of the companies I examined, ERG members helped new employees to get comfortable during the onboarding process. Studies show that the first 60 to 90 days of employment are a critical time for any new hire, and they can be particularly challenging for members of traditionally underrepresented groups. That short window of time can mean the difference between whether an employee stays for the long run or leaves the organization before the year is out. ERGs can be leveraged to acclimate employees and engender a sense of loyalty and belonging to their new company.

These groups can also be great partners for identifying gaps in an organization’s talent development process.

Many companies also successfully use their ERGs to improve the organization’s leadership development process, to drive results, to forge relationships, and to ensure alignment between their business and diversity strategies.

Source: Are Employee Resource Groups Good for Business?

Employee Resource Groups have evolved from employee support networks created to achieve diversity and inclusion to a strategic resources that enhances business outcomes in the following areas:

  1. Involve employees in recruitment and talent management efforts
  2. Offer leadership development and mentoring opportunities
  3. Capitalize on the knowledge of diverse employees to create consumer sensitive branding and product development
  4. Create an engaged and inclusive work environment
  5. Promote your organization as an employer of choice and community partner

Source: Employee Resource Groups: A Strategic Business Resource for Today’s Workplace

Cultural competence is a business imperative that can no longer be ignored and employee resource groups must serve as the engine to make us all smarter about the future that awaits.

Source: 7 Ways to Enable Your Employee Resource Groups into a Powerful Advancement Platform

A big downside of ERGs that we hope to avoid:

We joined the ERG because we needed help, but we became the help.

Source: Black employee groups in Silicon Valley find that their unpaid second job just got harder – The Washington Post