Creating neuro-inclusive departments

We know from the experiences of our members and Fellows that many who identify as neurodivergent have been advised against disclosing their experiences when applying for training or new roles for fear of unfavourable treatment, and half feel they need to hide their neurodiversity at work. We also know that only one in four have asked for support, such as flexible working, and over 40% feel their organisation could do more; the very act of having to fight for reasonable adjustments reduces the feeling of inclusivity and acceptance and creates an additional barrier for neurodivergent doctors to seek to overcome. The proportion of medical and dental staff reporting feeling burnt out at work remains high at 37.55% (2024 NHS Staff Survey), with the proportion of trainees and trainers at moderate to high risk of burnout standing at 61% and 47% respectively (2025 GMC National Training Survey). Our census reports consistently highlight dangerous shortages of radiologists and clinical oncologists. By not supporting neurodivergent colleagues in our specialties we may be exacerbating the impact of those shortages and increasing the likelihood of radiologists and clinical oncologists leaving the NHS or the profession as a whole.

Employers have a legal duty under the Equality Act (2010) to consider and put in place reasonable adjustments to ensure that their neurodivergent staff are not substantially disadvantaged when doing their jobs. Genuine inclusion, though, goes beyond making the legally required adjustments: proactively creating environments in which everyone can thrive has the potential to benefit the whole workforce, supporting our priorities of recruitment, training and retention. One way of working towards this is to celebrate the unique characteristics of neurodivergent doctors whilst also understanding the challenges they experience, and the different ways in which the impact of those challenges might be mitigated. In short, services cannot afford not to support their neurodivergent doctors.

ADHD and autism are the forms of neurodivergence most commonly reported by our members and Fellows. These and other common forms of neurodivergence have the following characteristics.

• Autism spectrum disorder (ASD): Often characterised by strengths in pattern recognition, attention to detail (e.g. spotting anomalies), and systematic thinking, alongside challenges with sensory sensitivity and social communication. 

• Attention deficit hyperactivity disorder (ADHD): Associated with high energy, creativity, and rapid problem-solving but also potential difficulties with sustained focus and organisation.

• Rejection Sensitivity Dysphoria (RSD): Commonly experienced by people with ADHD and ASD, RSD is an intense emotional response to perceived or actual rejection, criticism, or failure. People experiencing RSD often feel overwhelming distress, shame, or anger when they believe they’ve disappointed others, even in minor situations; RSD may present as disengagement or avoidance.

• Dyslexia: Often correlates with exceptional problem-solving and spatial reasoning skills, though can present challenges in reading, writing, or information processing.

• Dyspraxia: May be linked to strong creativity and lateral thinking but impacts coordination and fine motor skills. 

These conditions are not mutually exclusive, and individuals often have multiple overlapping traits. Neurodiversity can impact mental health, and mental health difficulties often interact with neurodivergent traits in complex ways. 

The following common stressors affect the whole workforce but can have a particularly negative impact on neurodivergent doctors’ experience in the workplace:  

1. Sensory overload: Bright lights, background noise (including conversations), and environmental changes can all contribute to sensory overload, which in turn can trigger anxiety. 
2. Communication preferences: Verbal interactions, particularly management conversations or team meetings, for example, can be experienced as challenging or overwhelming, and some neurodivergent people will prefer written communication or clear, structured instructions. 
3. Task Management: While neurodivergent staff may excel in specific tasks (e.g. pattern recognition), they might need additional support with multitasking (e.g. to maintain focus), minimising task switching, or prioritisation, and support to avoid task paralysis. Both neurodiverse and anxiety-related conditions can involve heightened sensitivity to detail, perfectionism and a strong drive for control in uncertain situations – all of which contribute to increased risk of burnout.
4. Literacy and fluency: Tasks that require good reading, writing and spelling, as well as good working memory, might present a particular challenge for dyslexic people.
5. Social Expectations: Team dynamics and unspoken workplace norms can be difficult to navigate, especially in high-pressure environments, and managing emotions – particularly under stress – can be challenging. Individuals’ experience of their own neurodivergence can fluctuate over time and as a result their needs and preferences may vary from day to day. Having colleagues who understand that makes a significant difference.
6. Burnout risk: Masking (suppressing neurodivergent traits to fit in) develops early in life. It can be hard for a neurodivergent individual to recognise when they are masking and it can take years after diagnosis to ‘unmask’. Even then, due to social stigma and attitudes it is often not possible to be authentic in a work environment. Both masking and coping in inaccessible environments leads to significant exhaustion. This can affect workplace performance, ability to keep up with hobbies and interests outside of work (much of non-work time is spent trying to regain enough energy for the next working day) and therefore exhaustion plays a significant role. This exhaustion, when combined with general life and workplace stress eventually leads to burnout, the need to take extended periods of time away from work to recover, and (in some cases) the decision to leave the organisation or the workforce entirely. 

Reasonable adjustments should be designed to remove barriers for those who need them, should be tailored to individual needs and be regularly reviewed to ensure they remain appropriate and proportionate. What is considered ‘reasonable’ is context-dependent, and employers are legally obliged to consider if the adjustment will remove/reduce the disadvantage, and whether it is practical and affordable to make (ACAS). Support and advice should be sought from Human Resources Business Partners (or equivalent) before a decision is made. Where possible, adjustments that benefit neurodivergent staff, such as those listed in the next section of this document, should be implemented in ways that enhance the working environment for everyone, and which foster a culture of inclusion and respect.

Individuals will experience their own neurodivergence differently, so it is essential to explore their personal challenges, unique triggers and preferences collaboratively, and to listen to what support or accommodations they personally would welcome, or which are specified in any workplace assessment they have undertaken. An individual will likely go through a process of developing their own understanding of what will help them, particularly if they are pursuing a formal diagnosis which can take some time. As such, managers should expect that when someone comes to them initially, they may struggle to know what will help, and also recognise that they may benefit from several conversations over time as they understand themselves and their needs better. This underlines the need for ongoing, accessible support – not a single conversation at a point in time.

Sufficient time will need to be granted to develop fluency with any adjustments that are put in place and to establish their effectiveness, both for the neurodivergent doctor and for the wider team of which they are a part. 

Implementing the adjustments in this document has the potential to contribute to improving the working environment for everyone, not just neurodivergent doctors.

1. Design inclusive recruitment and onboarding processes
   • Highlight your commitment to neurodiversity in job postings.
   • Consider how interviews can be made more accessible for all, for example by providing questions in advance. 
   • Assign buddies to help staff who are new to your hospital or service navigate workplace culture.
   • Signpost to screening and support for neurodivergent staff (e.g. via occupational health) and those who may benefit from seeking a diagnosis.
   • As a manager, consider the needs of new staff who may or may not disclose their neurodivergence to you. 
   • Newly employed neurodivergent doctors are likely to be more stressed and less able to mask, and so may be at greater risk of burnout. Emphasise an open door policy, offer more regular planned check-in points or opportunities to flag support needs/provide help, and allow them time to adjust to their new workplace before adding additional stressors (e.g. commencing on call). Recognise that what represents a ‘stressor’ will be different for everyone and should be explored individually in conversation.
     
     
2. Build awareness and educate staff
   • Train all staff on neurodiversity and the strengths neurodivergent colleagues bring. 
   • Train all staff on ableism and unconscious bias, because virtually every system has been designed by and for neurotypical, non-disabled doctors. 
   • Consider specific examples of what might be considered ‘standard’ practice that neurodivergent doctors may struggle with. For example, consider that those with neurodiverse conditions may excel in different ways, for instance being able to think and type faster than speak and dictate.
   • Promote a culture of openness and respect for differences and encourage and model active allyship.
   • Reflect on the cultural differences that exist in relation to talking about difference (for example, to facilitate neurodivergent International Medical Graduates’ access to effective support).
     
     
3. Accommodate sensory needs
   • Bright lights, background noise (including conversations), or the hum of medical equipment can be overstimulating. Offer noise-cancelling headphones, quieter workstations or spaces.
   • Environmental changes (e.g. caused by hot desking) can be disruptive. Facilitate exemptions from any such practices when working within the department, or increased access to home working.
   • Adjust lighting and provide spaces with reduced sensory stimulation.
   • Update IT, end enable accessibility functions e.g. dark mode for IT programmes, ability to adjust font size, and screen-reading capabilities.
   • Particular attention needs to be paid to the reporting environment and reporting interfaces used for radiologists, and the environment for radiotherapy contouring for clinical oncologists; for example, through the provision of quiet working spaces or opportunities to work some sessions from home.
   • There may be particular challenges associated with training neurodivergent doctors (e.g. reviewing scans) in a busy environment – the noise, movement, and other sensory environmental input can make it very hard to pay attention/take in what is being taught, and trainees may feel less able to raise this as an issue.
     
     
4.  Adapt communication styles
   • Use clear, concise, and structured communication, avoiding ambiguity. Guidance is available from a variety of sources on making information accessible for neurodivergent people (e.g. Guide to making information accessible for neurodivergent people).
   • Provide information in multiple accessible formats (e.g., verbal and written 
   • Some neurodivergent individuals may be more direct in their communications with others, which can be perceived as rudeness or bluntness. Support (e.g. coaching and mentoring) may need to be considered for doctors who find direct communication with patients or referrers challenging – this is core to our doctors’ day-to-day practice. However, this should be provided in conjunction with the other measures outlined in this document to avoid this being perceived solely as a problem for the neurodivergent doctor to fix.
   • Where colleagues prefer communication methods that do not require an immediate response, such as email rather than a verbal conversation or WhatsApp message, respect their preference where possible. 
   • In meetings, especially 1:1, emphasise (where appropriate) that there is no need to decide anything immediately, and that a response or decision can be provided in person or via email once the individual has had time to think.
   • Clear, consistent communication, thoughtful feedback, and reassurance (e.g. through planned check-ins) will support positive working relationships, and will be of particular support to those who experience Rejection Sensitivity Dysphoria.
   • For meetings neurodivergent doctors may struggle if put on the spot but are enabled to contribute constructively if given time to think in advance. Providing an agenda for all meetings helps with this (and helps everyone else in the team too).
   • Some will ask lots of clarifying questions because they want and need to understand. Colleagues who are not neurodivergent can take this as a ‘challenge’ or perceive it as aggressive, which can contribute to tension within teams and interpersonal relationships, especially in those who do not have a diagnosis or realise they are neurodivergent.
     
     
5. Provide task management support
   • Use task management tools like checklists or project management software where needed, beyond the usual worklist management tools available in RIS/PACS.
   • Allow flexible working arrangements to accommodate focus needs and energy levels.
   • Switching between different tasks can contribute to overwhelm. Support may be required to help protect time for specific tasks and minimise task switching. Use of a ‘busy’ sign as a signal not to interrupt, with clear rules that are consistently implemented, has the potential to improve workflow for the whole department.
   • Some tasks may take longer to perform, and staff may require more frequent breaks. In dyslexia, for example, there is a specific difficulty with working memory, so interruptions and fatigue present real challenges. Additional time allowances and/or reduced output expectations should be considered.
   • Put in place appropriate practical support with note-taking (e.g. use of AI or other solutions).
   • Make sure adequate secretarial support is available. 
6. Foster peer support and mentorship
   • Signpost support groups or peer networks for neurodivergent staff within the wider hospital/organisation.
   • Signpost support, advice and guidance available from healthcare professionals such as psychologists and disability specialists, as well as your Support and Wellbeing Champion if you have one. 
   • Neurodivergent doctors who experience mental health difficulties should be encouraged to seek support via NHS Practitioner Health or their GP
   • Signpost the support available via external organisations such as Autistic Doctors International, the National Autistic Society, the ADHD Foundation, the British Dyslexia Association, or the Dyspraxia Collective.
   • Encourage mentorship programmes that respect individual needs and strengths.
   • Managers should access appropriate support, with the individual’s consent, in identifying reasonable adjustments (e.g. via occupational health) and sources of additional funding for implementing these (e.g. Access to Work). 
7. Ensure leadership support
   • Encourage managers to engage in neurodiversity training and to seek support from local HR business partners.
   • Regularly and collaboratively review department practices to identify and address barriers.
   • Promote the involvement of neurodivergent doctors to ensure developments within the department meet their needs by design rather than by default (e.g. in decisions to purchase new software or equipment, or in designing new policies and procedures). 
   • Ensure that regular feedback conversations take place to ensure that all staff can routinely share their experiences of any accommodations that are in place, and make suggestions for improvements.

By adopting these strategies, departments can create a workplace where neurodivergent colleagues feel valued, supported, and empowered to contribute their unique skills to patient care.

This document is based upon content delivered as part of the RCR’s EDI Summit on 25 October 2024 by Dr Ayesha Jameel, Dr Phil Coates and Dr Dimitri Amiras, and on the panel discussion that followed. It has been further enriched through contributions from members of the College’s experts by experience group, who have generously shared their experience of navigating our specialties as neurodivergent doctors. We are grateful for their insight.