Do Nurses Know Enough About Neurodiversity? We Spoke With an Expert in the Field

• Associated terms with neurodiversity include neurodivergent, neurodistinct, neuroatypical, and neurodevelopmental.
• Neurodiverse patients and nurses are present in healthcare settings.
• Inclusivity provides reasonable accommodations.
• The global neurodiversity movement aims to move people’s perception of neurodevelopmental differences away from a deficit lens.

Up to 20% of the population, including healthcare workers, may fit on the neurodivergent spectrum.

Are neurotypical nurses equipped for this reality in the workplace with patients and colleagues?

To learn more, NurseJournal recently spoke with Timothy Frawley, DGov., M.Ed., BNS, RPN, RNT, an associate professor in mental health nursing at University College Dublin and lead author of a recent paper in the Journal of Clinical Nursing examining the nursing profession’s awareness of neurodiversity.

“We wanted to highlight the human rights-based model as opposed to a deficit-based orientation. And then, of course, to shine a light on the fact that nursing as a profession, we need to ensure that diversity and inclusion is very much to the fore,” Frawley said.

Neurodivergence: Key Facts and Statistics

Neurodivergent people process information differently than a typical or “neurotypical” person.

Many neurodevelopmental conditions are under the umbrella of neurodivergence, including:

• Autism Spectrum Disorder (ASD): ASD can manifest as a host of conditions, with symptoms including difficulty with communication and socialization, rigidness in routines, repetitive actions, and learning differences. People who present with ASD have a broad range of abilities when it comes to behaviors and communication, among other areas. The World Health Organization reported recently that about one in every 100 children have ASD.
• Attention Deficit Hyperactivity Disorder (ADHD): ADHD can include inattentiveness, hyperactivity, and impulsive behavior. Girls often present differently than boys. Some people may not receive an evaluation and diagnosis until adulthood. Approximately 129 million children between ages 5-19 have ADHD worldwide, while 366 million adults do.
• Dyslexia: Due to a neurological difference, people with dyslexia struggle to connect letters and sounds in a way that enables them to read easily. About 20% of children and adults have dyslexia, which accounts for approximately 80-90% of learning disabilities.
• Dyspraxia: Neurological differences affect coordination of movement.
• Dyscalculia: Those with dyscalculia have a learning disorder related to numbers and math.
• Tourette’s syndrome: Also known as having tics, this nervous system condition causes individuals to make uncontrollable and repetitive movements.

Nursing and Neurodivergence: Differences, Not Deficits

Many people who think and act differently than neurotypical people may feel they can’t fully show themselves or access the world how they want or need to. Acceptable forms of difference in society slowly continue to evolve and find their place. However, neurodiverse people are on the back end of “different” groups still fighting for inclusion and accommodations to live and function in our society.

Recognizing the variations in the human brain’s connections is a starting point for inclusion — and a heightened awareness of the complex daily work of nursing and nurse-patient interaction.

In some cases, this might require a change — ostensibly subtle but with potentially considerable implications — in mindset.

As Frawley put it, “The neurodiversity movement is very much a human rights-based movement, and it is about variation, as opposed to deficit or disease.”

Nurses Caring for Neurodiverse Patients

The move from a “deficit” model of thinking, which aims to correct differences, to a strength-based model may be the mindset nurses and other healthcare professionals need to properly evaluate perceived deficiencies.

According to Frawley, nurses need a comprehensive perspective on the possible neurodivergence types and their implications for patient care and the workplace. Then, nurses and care teams can move forward accordingly.

“Nurses understanding of neurodivergence can be reflected in care plans and treatment contexts — one size does not fit all,” Frawely said. “The individuality of each person is key.”

Nurses Who are Neuroatypical

Little research exists on autistic nurses. Looking through a “deficit” lens, people may find it difficult to believe that autistic people could be nurses because of a perceived lack of empathy on the part of those with autism. Recent research suggests, however, that the tools used to measure empathy may be causing more misconceptions about autistic people than exists.

In short, there may be areas of difficulty for neurodivergent nurses, but they also have many strengths and skills that can be great resources to colleagues.

Many neurodivergent healthcare providers don’t disclose this information in the workplace for fear of discrimination. Neurodivergent healthcare providers — especially women — tend to “mask” or pretend they are neurotypical, possibly impacting their emotional and psychological well-being. They don’t all feel they can show who they truly are.

“I think a lot of people might have perceived ADHD as an experience of childhood. Whereas now it’s recognized that people can experience ADHD in their adulthood and that this can create certain challenges.” Frawley said. “Are we recognizing that it’s not necessarily all of our challenges that people who are neuro distinct or neuro different have a whole gamut of skills and talents, which they might otherwise not have and can bring to bear.”

Nurses and Neurodivergence: Guidance Moving Forward

Moving forward, Frawley suggested that nurses start by challenging any unconscious biases they or others may have around neurodivergence and then request in-service training.

In his paper, he noted, “A growing number of advocates and organizations are calling for mandatory repeated training in neurodiversity for all public-facing professionals as part of continuing professional development. This training should be co-delivered by neurodivergent professionals to ensure better outcomes.”

Frawley also emphasized meeting the need for reasonable accommodations for people with neurodivergence. By law, people with physical disabilities must be able to access medical buildings for care, but not all people needing accommodations are visually apparent. People with neurodevelopmental differences may also need accommodations to receive medical care, such as reducing high sensory input from noise and lights.

Reasonable accommodations need to be in place so all patients can access their medical appointments, said Frawley. Also, with accommodations, aspiring neurodiverse nurses can pursue careers in which they can contribute their unique skills and talents.

Nurses often give appropriate referrals to their patients to help guide them in obtaining valuable resources. The National Institutes of Health has an online Reasonable Accommodation Program Initial Intake Form to request workplace accommodations.

Page last reviewed on December 11, 2023

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