18 minute read
INTRODUCTION TO NEURODIVERSITY
In this section we introduce neurodiversity – what it is, how it is experienced and how it relates to the work environment.
The section covers five key learnings:
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• The relationship between neurodiversity and productivity is nuanced and should be cleared from stereotypes.
• There is a wide range of conditions in neurodiversity, and each of these conditions has unique requirements of the physical office space.
• There are aspects of the physical office space that impact on how a neurodiverse person navigates the social aspects of work.
• A first-hand perspective of what it is like to be part of the neurodiversity community.
• It is important to understand that a person is not disabled; it is the spaces and the experiences within these spaces that are disabling.
PRODUCTIVITY IN RELATION TO NEURODIVERSITY
Interviewee
Before moving into the details of neurodiversity, it must first be considered how current aspects of productivity influence the expectations about neurodivergent people and even how they are perceived in the context of the work environment.
Many reports on neurodiversity and workspace (or work) focus on and propagate three main factors: • Creating the perception that the neurodiversity community is a monolith that can be supported through a set of universal design practices.
• Including neurodiverse people in the workforce is good practice because of their ‘special skills’ or ‘savant knowledge’.1
• How a neurodivergent person can help raise profits or create a competitive advantage.1, 2
These elements are not only scientifically inaccurate; they actively harm people in the neurodiverse community in various ways: • Setting a deterministic culture around design (where a design of X will lead to Y behaviour or reaction) can be harmful, as people are varied, and they vary on a momentto-moment basis depending on what they are doing and the Neurodiversity – the population, community or movement.
Neurodivergent – an individual.
experiences they have had on that day. A universal design approach can also prevent neurodiverse people from voicing their concerns, as they are being told the space is already designed to help mitigate stressful sensorial experiences. Even the most diverse space will still fall short, and those making these spaces need to recognise that limitation.
• Creating a stereotype of a person can be harmful, as it impedes an individual from being seen as a whole. In addition, if the stereotypical expectation is not met this too can add to mental stress and link to burnout and further social exclusion.3
• In the way that society is organised, employment is a route to acquiring various vital resources; therefore, including neurodiverse people in the workforce is not a matter of productivity or advantage but a matter of equity, health justice and social inclusivity.
• The expectation of needing to produce beyond their peers or what is healthy for the neurodivergent person can have consequences for their self-esteem and self-worth, as well as contribute to burnout.
• Finally, this type of framing of neurodiversity omits that many workspaces are harmful at a biological level, which can contribute to poor health outcomes. Therefore, we all must do this work, not merely to achieve inclusivity but to avoid causing harm.
In this report we have considered all of the above points in order to focus on the following reframings: • Places of work are a necessity and a utility, as they provide access to employment. Therefore, they must apply a ‘no harm’ regulation, meaning that workspaces should not harm the health of people.
• Inclusivity is a human right, not a matter of productivity or the generation of capital. It is mentally harmful to put that weight on the shoulders of a community which already has to over-adapt to various societal prototypes just to survive.
• A person does not carry a disability; it is an environment or situation that disables a person. Therefore, if a work environment, including its culture, does not support neurodiverse people, meaning they are not able to ‘perform’, it is the failing of the ecosystem (not the individual).
• We will be referring to space as part of a wider ecosystem of employment and society, meaning that the onus of change is on the ecosystem, not on the individual.
• Work and being able to experience your potential as a person at a capacity that supports your health and wellbeing are human rights.
• The aim is for an environment that supports and nourishes the health of people, so that all people can flourish.
THE SPECTRUM OF NEURODIVERSITY
Keeping the above listed considerations and reframings in mind, to provide a more nuanced understanding of neurodiversity we focus in this section on how the movement defines itself, the biological underpinnings of the conditions and how they can present in the workplace.
Interviewee
The term neurodiversity (a portmanteau of neurological and diversity) was coined in the late 1990s by Judy Singer, a sociologist who is on the autism spectrum herself, to describe conditions like attention deficit hyperactivity disorder (ADHD), autism and dyslexia.4 Singer’s intention was to shift the view of neurological diversity as being solely deficits, disorders and impairments, to one of neurodiversity being the result of natural variations in the human genome. Since then, the neurodiversity paradigm has been applied to conditions outside the autistic spectrum, such as bipolar disorder, ADHD, schizophrenia, schizoaffective disorder, sociopathy, circadian rhythm disorder, developmental speech disorders, Parkinson’s disease, dyslexia, dyspraxia, dyscalculia, dysnomia, intellectual disability, obsessive–compulsive disorder and Tourette’s syndrome.4 In this case, we will be following a current broader definition of neurodiversity that includes a wider range of neurological conditions, especially the ones that face similar dynamics of stigma and a similar need for understanding and accommodation in various settings of someone’s daily life.
Interviewees
Neurodiversity is not just a term for describing a set of people, it is also a movement to encourage human rights. The neurodiversity movement is a social justice movement that ‘seeks civil rights, equality, respect and full societal inclusion for the neurodivergent’.4 Current advocates of the neurodiversity movement promote support systems that acknowledge and
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foster the needs of neurodivergent people rather than structures that coerce them into ‘normality’ or clinical ideals. Advocates propose that a largely recognised part of this support system is the encouragement of inclusive, non-judgmental language.5 An example of inclusive language would be the difference between identifying someone as an ‘autistic person’ versus ‘a person with autism’. Neither of these is absolutely correct for the community or the individual, so it is recommended to, when possible, directly ask what the person being referred to prefers.
Neurotypical is another term that originated from the autistic community to describe non-autistic people, extending to the neurologically typical people who fall into the typical range of human neurology. Neurotypical people:6
• may not have cognitive, learning or social difficulties that necessitate coping mechanisms • may not have a lack of speech or certain motor impediments • may have the ability to readily identify and respond to social cues
• may not experience sensory issues
• may hit all the mental (and some physical) developmental milestones.
In many cases, the current workplace tends to accept the neurotypical individual’s requirements as good enough, often to the detriment of neurodiverse people. There are two points two consider. First, many spaces also fail to support the health of neurotypical people. Second, when spaces are enhanced to lessen the harm to neurodiverse people, this will be good for everyone (i.e. also for neurotypical people).
Interviewees
One of the main criticisms within and about the neurodiversity movement is the equity of representation between ‘highfunctioning’ individuals with milder forms of a condition and the ‘low-functioning’ people who are often significantly impaired due to their condition and unlikely to function without assistive technologies. By the nature of being less impaired in daily activities, the ‘high-functioning’ individuals have an easier time shaping the narrative of the needs around neurodiversity in environments such as the workplace, communal or residential areas, and public transport. This overrepresentation can lead to the ‘erasure’ of those who cannot easily communicate or be seen when talking about neurodiversity as a whole. While this report focuses specifically on ‘high-functioning’ individuals in the workplace and their needs for feeling comfortable and confident in a professional environment, it is important to understand that there is a wider scope and discourse around neurodiversity.
The discourse around the lexicon of neurodiversity is as important as it is nuanced, and is impacted by the politics and culture of health accessibility. Within the neurodiverse community, there are people who see a great need for diagnoses to exist, while others may not feel comfortable with a diagnosis. People who do prefer official diagnoses may want access to resources or specialists that will help them understand what they need to request from their work environment or share about themselves in social settings to foster better understanding, safety and agency. Others, who are considered relatively ‘high-functioning’, may see official labels and diagnoses of neurodiversity as a potential obstacle to being seen as credible in a work environment due to stigma or company culture. This internal discourse within the neurodiverse community about labels shows that, even if you are up to date on the lexicon, it is best, if possible, to confirm your language usage with a neurodivergent individual when interpreting their needs in a particular environment.
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There is a wide range of neurological conditions that fit under the neurodiversity umbrella. Here, we look at ADHD, autism, dyspraxia and dyslexia to give an introduction to how these neurodevelopmental conditions manifest biologically, how they can present themselves in a work environment, and their potential health implications.
The traits these conditions have in common are a combination of genetics, the places where people live or grow up, brain structure and brain function variations that, in the ‘higher functioning’, are only as much of an impairment as the environment’s inability to accommodate the individual. This is why many advocates choose to turn these variations into personal strengths at the same time as promoting the usual therapy and the making of reasonable adjustments in the office space. However, there is a distinction to be made: a person highlighting or celebrating their strengths should not be seen as an opportunity for the capital class to exploit that person, and should not be used to stereotype a neurodivergent person as a savant who can overproduce.
Table 1 highlights some conditions that fall under the neurodiversity umbrella to give an idea of the complexity of these types of condition. It is due to this complexity that it is difficult to create a ‘one size fits all’ design solution, and it is necessary that each workspace provides the opportunity to investigate who will be using the space and how their needs can be best met. The final column in the table provides an idea about how health interlinks with the experience of office spaces. We have included work culture aspects to give an idea of how the whole work environment can affect a person, and so provide another layer of understanding to practitioners.
Description Presentation (work context)
Attention deficit hyperactivity disorder (ADHD) Can affect the ability of the brain and body to regulate attention and emotions, which can result in hyperactivity and impulsivity, as well as organisation problems.7 Scientists do not fully understand the cause(s) and the symptoms of ADHD, despite having shown differences in the brain size, networks, neurotransmitters and brain development of children with ADHD.8 There is also a close link between ADHD and having sleep disturbances.9 • Tardiness on tasks.
• Poor time estimation on tasks.
• Hyperactivity. • Poor concentration on certain tasks (often due to perceived distraction in an environment). • Hyper-concentration on certain tasks. • Fatigue or tiredness. • If a person finds themself in an unsupportive environment (culturally and/or physically), this can lead to job loss or formal warnings, which in turn can lower self-esteem.
Autism spectrum disorder (ASD) A highly prevalent neurodevelopmental condition that has a wide range of symptoms and presentations, such as impaired social communication, differences in sensorial perception, sensory motor differences, restricted and repetitive behaviours,10 digestive problems and altered immune function.11 Early white matter differences in the brain might explain atypically connected brain networks. Accelerated expansion of the cortical surface area of the grey matter in ASD seems to be associated with impaired maturation of the cortical white matter.10 ASD is a very wide spectrum with an array of comorbidities that include depression, anxiety, anorexia, dyspraxia and ADHD. These factors contribute to how a person experiences the condition and presents at work. • Not being able to read and react to complex social interactions.
• Difficulty understanding unexpected changes, especially when stressed. • Needing to keep routines can cause distraction in an office space that is inflexible.
• Tardiness with work due to an inability to concentrate in an office space that is not adapted to their sensorial needs. • Tardiness to the office due to navigation obstacles in the urban environment.
Table 1 Some conditions that fall under the neurodiversity umbrella Potential health implications
• ADHD often has comorbidities with anxiety and depression. A poorly designed physical space can exacerbate the symptoms of these comorbidities through various biological pathways. • Hyper-concentration on tasks may look productive, but it can often mean neglecting personal tasks, such as eating, hydration or rest.
• Burnout can come from working long hours to make up for time lost, especially in a distracting office space. • Burnout can also be linked to poor sleep quality, which can be exacerbated by biological stress arising from the office space.
• Worsening of comorbid symptoms due to heightened biological stress from external factors.
• Burnout due to working in conditions that are not supportive to mental and physical health.
• Poor sleep due to biological stress. • Diminished immune function due to biological stress, which can lead to more viral and other illnesses.
• Panic attacks due to noise pollution or other overwhelming sensory experiences.
Continued
Description Presentation (work context)
Dyslexia Individuals with dyslexia receive the same information as their neurotypical peers, but they process written language differently.12 This has led researchers to investigate the brain structures and networks involved in the multiple processes that lead to reading written text. Imaging studies show less grey matter and white matter in the left parietal area compared to those without dyslexia. Reduced grey matter in this area may affect how individuals with dyslexia process the different sounds of language, whereas the decreased white matter may impact the reading and processing efficiency of the brain.12 Less known is that dyslexia can affect working memory, navigation and coordination.13–15 Finally, dyslexia can contribute to different sensorial processing.16 • Variation in written language processing can often be misunderstood as a sign of low intelligence; thus, it is important to overcome the stigma associated with reading difficulties and to research dyslexia as a neurodiverse condition.
• Working memory is needed for most tasks, whether remembering directions, recalling a recently read paragraph or remembering a recently learned name. Therefore, without proper support, those with dyslexia can produce incomplete tasks or need a little longer to complete tasks. • Writing, speech or the organising of thoughts can also be affected, especially under stress. This can make certain tasks more challenging. • Situations can become unmanageable if there is a change in environment, such as a new location, new role or communicating with a new team.
Dyspraxia/developmental coordination disorder (DCD)17 A neurodevelopmental disorder that can affect fine and/or gross motor skills. Symptoms vary and may include poor balance and coordination, vision problems, perception difficulties, mood regulation difficulties, difficulty with reading, writing and speaking, and short-term memory impairments.18 Recent imaging studies have shown that the connections between, and activity within, key motor and sensory areas of the brain appear reduced.19 These include frontal and parietal areas (responsible for movement and spatial relationships) and the cerebellum (responsible for balance, coordination and fine muscle control.20 • Potential tardiness due to inaccessible transport links or bad weather that makes mobility difficult. • Tasks could take longer to complete if a person does not have the right work tools. • There could be reading and writing challenges if there is a long reading list or if documents are poorly laid out.
Dyspraxia is commonly comorbid with other neurodevelopmental disorders such as ADHD and autism.17 Potential health implications
• Feelings of shame that affect self-worth if a person is not matching their own expectations or the expectations of their peers. • Frustration, anxiety and stress when being put on the spot. • Feeling overwhelmed by tight deadlines. • Exhaustion from overworking to compensate for slower reading and comprehension rates. • Feelings of stress when disorientated due to poor wayfinding. • Increased risk of accident due to unsuitable floor material or steep staircases. • Discomfort and lack of concentration in noisy environments, which can lead to biological stress and longer work hours.
• Navigating spaces with poor wayfinding can pose a challenge, which in turn can lead to sedentary behaviour. • Poor wayfinding in spaces could physically isolate a person, who could then feel lonely within the office.
• Steep or poorly lit stairs can present a physical hazard. • Certain floor materials can present a fall risk, as can poorly lit spaces. • Not having rest areas or green spaces that are easily accessible can add to long hours of sitting and working without a break. This can have an effect on morale, alertness, fatigue and/or burnout.
Table 1 – continued Some conditions that fall under the neurodiversity umbrella
ANXIETY, DEPRESSION AND PTSD
While these conditions do not lie under the neurodiversity umbrella, it is important they are mentioned, as they often are comorbid with many conditions in neurodiversity.21 For instance, 75% of adults with ADHD will also have other comorbidities, ranging from depression to anxiety.22 In addition, anxiety, depression and post-traumatic stress disorder (PTSD) can also affect how a person experiences an environment. The box below gives a brief breakdown of anxiety, depression and PTSD, and how they relate to the work environment.
A key learning for office designers and builders is that including mental illnesses in the conversation highlights how designing for neurodiversity can help support the health of many others as well, in much the same way as a physical ramp helps make access to a building easier for everyone. The following are quotes from neurodiverse people interviewed for this report, describing some of their experiences in office spaces. ■
“I have been told that I am too sensitive, in patronising tones.
This is infantilising.” “I have to do autistic masking to fit into the workplace on a daily basis, this is exhausting.”
Anxiety
The limbic system is considered to be the emotional and core regulatory part of the brain, and it plays a large part in the development of anxiety through the abnormal activation of key structures, such as the amygdala.23 An individual with anxiety is put into survival mode based on certain internal and/or external triggers that can lead to shortness of breath, disorientation, changes in body temperature and other physiological changes through overactivation of the hypothalamic–pituitary–adrenal (HPA) axis (a system that mediates the stress response).
Anxiety can be triggered by professionally or socially compromising or unpredictable situations, and being overwhelmed by deadlines and responsibilities. Examples include a lack of job security, a lack of perceived control over deadlines and workload, stressful personal relationships with colleagues and frequent ambiguous tasks. General anxiety disorder (GAD) can present as forgetfulness, loss of focus and an inability to meet deadlines, and can spill over into other commitments, such as friends and family.24
Depression
Major depressive disorder (MDD) is characterised by persistent low mood, often accompanied by cognitive dysfunction, physical symptoms and impaired social function.25 Numerous studies that focused on the grey and white matter found significant brain region alterations in MDD patients, such as in the frontal lobe, hippocampus, temporal lobe, thalamus, striatum and amygdala.25
Depression in the workplace is yet to be understood; however, it is a major cause of disability, absenteeism, presenteeism and productivity loss among working-age adults.26 Diagnoses and the identification of specific stressors are important for creating an environment suitable for those with MDD.
PTSD
Both the amygdala and the mid-anterior cingulate cortex become overstimulated in people with PTSD. In contrast, the hippocampus, right inferior frontal gyrus, ventromedial PFC, dorsolateral PFC and orbitofrontal cortex all become hypoactive, sometimes to the point of atrophy.27 PTSD and anxiety have many similarities due to the involvement of similar brain structures and processes, but PTSD can often be attributed to a specific traumatic event or set of events that are recalled to some degree (when triggered).
Along with the usual responses associated with anxiety, PTSD can lead to engaging in more high-risk activities, distorted recall and hypervigilance.27 An individual with PTSD will often, but not always, be aware of their triggers and likely needs support in making sure the workplace environment does not present these triggers and in becoming familiar with ways of immediate relief or removal from triggering environments. ■
