Having just celebrated Neurodiversity Awareness Week in March, it is appropriate to continue the discussion of neurodiversity—this time with a paramedic specific focus. Beginning with an overview of neurodiversity and what it means to be neurodivergent, the focus then moves on to consider the recognised types of neurodivergent conditions. It then considers neurodiversity in a paramedic workplace context, identifying some approaches which will assist with making paramedic workplaces neurodiversity-friendly for staff and patients.
What is neurodiversity?
Terms such as ‘neurodiverse’ and ‘neurodivergent’ emerged in the 1990s, coined by Judy Singer, an autistic sociologist, who was seeking an alternative to deficit-based language such as ‘disorder’. Neurodivergent refers to a person on the autism spectrum, or as is increasingly the case, a person whose brain processes information in a way that is not typical of most individuals.
Neurodivergent conditions include autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), dyslexia, dyspraxia, also known as developmental coordination disorder (DCD), dyscalculia, dysgraphia, Tourette's Syndrome, and obsessive-compulsive disorder (OCD). As is evident from the range of conditions named, neurodivergence covers a wide spectrum of neurological differences, each with unique strengths and challenges.
Unique strengths and challenges
Recognising and understanding the unique strengths and challenges of the neurological differences experienced by people with neurodivergent conditions allows for an increased awareness, and a reduced level of stigma.
Autism
A neurological developmental condition characterised by repetitive patterns of behaviour and difficulties with social communication, people with autism may struggle with change, mandatory actions, or other points of view. People with autism have particular strengths including attention to detail, efficiency, logical thinking, and retention of information (Exceptional Individuals, 2023).
Attention deficit/hyperactivity disorder
Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition affecting the nervous system, including the brain, during the developmental period between childhood to adulthood. It is important to note that people diagnosed with attention deficit/hyperactivity disorder can have either or both presentations (inattentive or hyperactive-impulsive).
Time management and concentration are common challenges experienced by people with ADHD. However, strengths such as hyperfocus, enthusiasm, and innovation make people with ADHD well suited to employment in paramedicine and other emergency services (Exceptional Individuals, 2023).
Dyslexia
Dyslexia is a learning difficulty, primarily affecting the skills involved in accurate and fluent reading and spelling and can include challenges with short-term memory and information processing. It is important to note that dyslexia does not stem from a deficiency in language or word processing. Rather, it is a consequence of a unique brain processing function.
Common strengths associated with dyslexia include creativity, spatial awareness, communication, and looking at the ‘big picture’ (Exceptional Individuals, 2023). This ‘big picture’ approach is a strength in the paramedic setting as people with dyslexia are able to look past the detail and focus on what really matters.
Dyscalculia
Dyscalculia is a brain-based learning difference, which results in difficulty understanding number concepts, performing calculations and computations. Some of the common challenges associated with dyscalculia include reading analogue clocks and instruments, recalling schedules and differentiating between left and right. Strengths associated with dyscalculia include being good with social interactions, intuitive thinking, strategic thinking, and problem solving (Exceptional Individuals, 2023).
Neurodiversity and inclusivity in the workplace
First and foremost, increasing awareness of neurodiversity and reducing the stigma associated with neurodiversity is key to improving inclusivity for neurodivergent people in the workplace (University of London, n.d.). The spectrum of conditions that fall under the umbrella term of ‘neurodiversity’ is broader than many people realise, and having this awareness goes some way to reducing stigma in respect of neurodiversity. Visibility in the workplace of paramedics who are diagnosed as neurodiverse, and who are open about their diagnosis, is vital to empowering others to be confident in seeking support and be more open about their neurodiversity (University of London, n.d.).
Strengths-based approach
Adopting a strengths-based approach to inclusivity in the workplace allows for the unique strengths of neurodivergent paramedics to be harnessed to improve patient care outcomes. A paramedic with ADHD can appreciate the information being given in few words and in a short amount of time, potentially allowing them to quickly interpret what they are being told and to formulate a management plan for the patient or the situation which is unfolding at an incident scene (St George's University of London, n.d.). The hyperfocus of a neurodivergent person with ADHD, or the ability to focus of a person who falls on the autism spectrum is likely to be beneficial in a paramedic context.
Encouraging conversations about neurodiversity
Encouraging and enabling discussions around neurodiversity allows for light to be shone on neurodiversity and the challenges that individuals are faced with in the workplace and beyond. There is a need to consider accommodations and appropriate resources to ensure that neurodivergent paramedics can not only survive in their role, but thrive. As paramedic education in many countries has now transitioned to the higher education sector, with students undertaking clinical placements in the workplace setting, encouraging conversations about neurodiversity is important to ensuring that the next generations of neurodiverse paramedics are welcomed and embraced by the profession and empowered to flourish.
An example of a neurodiversity-friendly ambulance service
In 2020, the South East Coast Ambulance Service NHS Foundation Trust became the first ambulance service in the world to sign a charter committing to becoming a neurodiversity-friendly employer (South East Coast Ambulance Service, 2020). The charter signed by the South Coast Ambulance Service provides a commitment that reasonable steps must be taken to ensure that policies, practices, and the culture of the organisation do not discriminate against neurodivergent people. Furthermore, the charter recognises the potential discrimination that neurodivergent people face in wider society and the impact this may have on an individual's willingness to disclose a neurodiverse diagnosis. It provides protection, whether a person chooses to disclose or not. The charter also recognises that everyone is unique, and that there is a high degree of overlap between neurodivergent conditions. Recognition of this overlap and the unique experience of each neurodivergent person is key to identifying any support needs and then being able to implement these based on personal evaluation and individual consultation, as opposed to relying on uninformed assumptions and stereotypes.