Neurodivergent doctors

Until recently, the concept of a neurodivergent doctor may have appeared a misnomer and an oxymoron. However, the number of doctors identifying as neurodivergent is rising. Although neurodivergent doctors are now well recognised, the exact prevalence of neurodivergence within the medical workforce remains unknown. When considering prevalence, it is vital to recognise the current difficulties in accessing diagnoses in the UK, with waiting lists for adults extending to multiple years in some regions. Thus, many neurodivergent doctors may opt to self-identify. Another factor to note here may be a difference in recognition, diagnosis and disclosure rates between older consultants and younger trainees who may have grown up in a more neurodiversity-affirmative world.

Contrary to traditional stereotypes, there are many aspects of psychiatry that could attract neurodivergent doctors. Fascination with understanding human experience and behaviour – as something that did not come naturally to them in childhood – has been reported by autistic doctors. This potential draw towards the specialty is reflected in the existing literature. In the above-mentioned cross-sectional study of autistic doctors, 18% reported psychiatry as their main speciality (Shaw Reference Shaw, Fossi and Carravallah2023a). Furthermore, psychiatry was reported as a career aspiration in a small qualitative study of dyslexic doctors (Shaw Reference Shaw and Anderson2017a).

Many neurodivergent characteristics are sought after in medicine. Within psychiatry, attention to detail, pattern recognition and a strong moral compass can all be beneficial to patient care (McCowan Reference McCowan, Shaw and Doherty2022). See Table 1 for further examples.

TABLE 1

Examples of reported neurodivergent strengths

Neurodivergent doctors face numerous barriers in the workplace. A cross-sectional study of dyslexic doctors found that a quarter of respondents had experienced bullying from their peers and around 90% were unable to access support from their workplaces (Anderson Reference Anderson and Shaw2020). Similarly, the cross-sectional study of autistic doctors found that three-quarters of respondents had experienced challenges in communication with colleagues, despite only a fifth reporting such challenges with patients (Shaw Reference Shaw, Fossi and Carravallah2023a). Considering the clear benefits neurodivergent doctors bring to the workforce, it is paramount that they are appropriately supported, across all career stages.

There is little research on the career outcomes of neurodivergent doctors, with most available data relating to those who are autistic. Most respondents in the cross-sectional study of autistic doctors were successfully in practice – 46% of autistic doctors surveyed were consultants or equivalent and 40% were on training schemes (Shaw Reference Shaw, Fossi and Carravallah2023a). However, the stigma of being neurodivergent persists in many medical/psychiatric settings, which may prevent disclosure at work, with less than a third of respondents having disclosed to colleagues or supervisors. The ableist culture in medicine may result in struggling doctors attempting to cope alone and a situation can appear almost unsalvageable by the time appropriate action is taken. However, viewing any challenges from a neurodivergent perspective offers the possibility to effect enormous change. The difference in presentation between a doctor who is stressed in an unsupportive or even toxic environment and the potential performance that is possible with targeted support may be far greater than is generally appreciated. This is a group at high risk of adverse outcomes: 49% of autistic respondents had self-harmed, 77% had considered and 24% had attempted suicide. Of note, considering autism as a disorder rather than difference was associated with prior suicide attempts. Burnout, long-term sickness absence, early retirement and leaving medicine altogether are real risks for neurodivergent doctors who do not have access to the support they need to thrive.

Support needs

Support needs are dynamic. Many neurodivergent doctors may have low support needs most of the time. However, there may be times when intense support will be required. These periods are often short lived, but responding appropriately can make the difference between a rapid return to baseline, or an escalation that can threaten the person’s career (Gray Reference Gray, Rumball and Happé2025). The degree of emotional upset that can occur in response to a seemingly innocuous event or trigger may be viewed as disproportionate, and erroneous assumptions may be made about a doctor’s psychological stability or indeed fitness to practise. However, understanding issues such as rejection sensitivity dysphoria (Dodson Reference Dodson, Modestino and Ceritoğlu2024) and the need for emotion processing time can allow appropriate support, which minimises disruption and facilitates the resolution of potentially challenging situations (Ameis Reference Ameis, Lai and Mulsant2020).

Neurodivergent people show vastly different abilities, challenges and support needs. What is less often appreciated is how dynamic both strengths and challenges can be, and what a profound effect the environment can have. This heterogeneity can be weaponised against high-achieving autistic people such as doctors and used to deny both the validity of their diagnoses or self-identification and the reality of their support needs (Doherty Reference Doherty2023a). The challenges of masking to fit in with neurotypical expectations are often underestimated. For autistic doctors, fluent communication is expected as a core competency for safe medical practice. However, in the context of high intellectual capacity, specific difficulties such as low working memory or slow processing speed can easily be overlooked. This uneven pattern of cognitive abilities is often termed a ‘spiky profile’ (Wilson Reference Wilson2024). Communication challenges experienced can range from subtle differences in semantic or pragmatic language to situational mutism when under extreme stress.

Lack of understanding from colleagues, alongside shame and stigma, inhibit many from disclosing a neurodivergent identity. As mentioned above, in the study of autistic doctors, less than a third had disclosed to their supervisor or colleagues (Shaw Reference Shaw, Fossi and Carravallah2023a). Many may have made their own informal adjustments and may be performing well, without disclosing to anyone at work. Thus, some may disclose only in the context of performance problems, incidents or requests for reasonable adjustments. Although understandable, this has the unfortunate effect of perpetuating the ‘doctor in difficulty’ stereotype that is commonly but erroneously associated with being neurodivergent in medicine. However, many of those ‘difficulties’ can be reframed as unmet need (Table 2).

TABLE 2

Negative perspectives reframed with possible explanations

ADHD, attention-deficit hyperactivity disorder.

Combating stigma and cultural shift in psychiatry

Over recent years there have been moves to address stigma towards neurodivergent doctors and shift culture. In the UK, several medical Royal Colleges, including Radiology (Elgendy Reference Elgendy2024), Anaesthetics (Muldoon Reference Muldoon and Doherty2023) and Pathology (Hook Reference Hook and Rummery2022) have addressed the needs of neurodivergent doctors in their fields, and the Royal College of General Practitioners (2025) has a Neurodiversity Special Interest Group, whose remit includes working with the deaneries responsible for National Health Service (NHS) postgraduate medical training to support neurodivergent trainees.

The Royal College of Psychiatrists (RCPsych) has been particularly active in driving forward this change after members of Autistic Doctors International wrote to the British Journal of Psychiatry to raise awareness that autistic psychiatrists did in fact exist (McCowan Reference McCowan, Shaw and Doherty2022). The RCPsych Autism Champion agreed that the College should support neurodivergent colleagues (Davidson Reference Davidson, Carpenter and Mohan2022) and thus an RCPsych working group was established. Outputs to date include online educational supervisor training, an eLearning CPD module under construction, reasonable adjustments guidance (Heaps Reference Heaps and Da Silva2024) and the option to request reasonable adjustments for RCPsych examinations (RCPsych 2025) (we will return to the RCPsych’s specific guidance below).

The reluctance to proactively disclose a diagnosis at work is also an issue for employees with ADHD. McIntosh et al (Reference McIntosh, Hyde and Bell2023) found that ensuring psychological safety and a low-stigma culture improved the chances of proactive disclosure and consequently the ability to thrive at work. Local initiatives include the NHS England-funded Neurodiversity Ally project in the West Midlands, which offers training on neurodiversity allyship to volunteer allies and is yet to publish its outputs (further information available from C.H.).

It is important that psychiatrists consider their own neurotype and how this positionality may affect their approach to both trainees and patients (Doherty Reference Doherty, Chown and Martin2024).

Reasonable adjustments

In the UK, disability is a protected characteristic under the Equality Act 2010 and neurodivergent individuals often meet legal criteria for disability. Employers have a legal responsibility to provide reasonable adjustments in the workplace to combat any disadvantage resulting from disability. This does not require a formal diagnosis and instead is needs-based (Government Equalities Office 2013). Good practice would be to offer reasonable adjustments to all doctors who identify as neurodivergent and are requesting support, being mindful of the rates of burnout and suicidality in this group. It is evident that most of these adjustments do not have significant financial cost, but rather require education, a change of mindset and small achievable changes to work practices. However, in the survey of autistic doctors (Shaw Reference Shaw, Fossi and Carravallah2023a), only 46% of respondents had requested reasonable adjustments at work and of those requests, half were not implemented.

More substantial adjustments can be supported via both the employer’s occupational health service, which can write a report specifically focused on which adjustments it recommends, and Access to Work (www.gov.uk/access-to-work), a UK-wide government scheme to provide funding to enable people to remain in work. Access to Work funds support such as technology, coaching, furniture, travel and Personal Assistants where there is sufficient evidence of need. Deanery support services (Professional Support and Wellbeing Units in England, the Trainee Development and Wellbeing Service in Scotland, Professional Support Unit in Wales and Professional Support and Wellbeing Team in Northern Ireland) can provide coaching to neurodivergent individuals and their teams, alongside therapy and learning skills support (NHS England 2024). Local NHS trusts may also have neurodiversity champions, mentoring, ally development projects or peer support groups.

A step further is to consider designing a neuroinclusive workplace – setting up a workplace or training scheme to be accessible to all, reducing the need for specific adjustments for those with disabilities and allowing all employees to reach their potential (Thompson Reference Thompson and Miller2024). For example, all trust buildings could have bookable silent work rooms, dimmable non-fluorescent lighting and soundproofing. There could be sensory-friendly uniform policies, flexible working available as standard, team and manager neurodiversity training aiming to change culture, enhanced induction programmes, dyslexia-friendly written resources and training on neuroinclusive feedback methods. The use of electronic text chat for discussion in meetings and apps to support organisation and scheduling, and a range of options to work collaboratively, could be normalised. Inclusive design may be particularly helpful for doctors who feel unable to disclose support needs at work.

In the remainder of this section, we will discuss some common examples of reasonable adjustments in the psychiatric workplace (summarised in Box 2), using the Autistic SPACE framework (Doherty Reference Doherty, McCowan and Shaw2023b) and drawing on the Institution of Engineering and Technology’s (2024) report Understanding Neurodivergence at Work.

The Autistic SPACE framework

The Autistic SPACE framework (Fig. 1) was developed to facilitate equitable access to healthcare for autistic patients. This has more recently been applied to supporting and providing reasonable adjustments for a range of neurodivergent people in medical education (Shaw Reference Shaw, Doherty and Anderson2023b). It is a framework for considering the various categories of need using the acronym SPACE – sensory, predictability, acceptance, communication and empathy. It also considers physical, processing and emotional space. We now consider these in turn, looking specifically at psychiatrists and at both individual adjustments and options for neuroinclusive design.

FIG 1

The Autistic SPACE framework (Doherty Reference Doherty, McCowan and Shaw2023b).

Sensory

For many neurodivergent people, the sensory environment is the fundamental determinant of performance and therefore is the first area to consider, as described in the framework. Background noises can be difficult to filter out and can make focused deep work impossible – thus the importance of a silent workspace and the avoidance of hot-desking. This can be implemented via a quiet-room booking system, setting up a shared silent workspace or alternatively supporting some non-clinical hours working from home. Handovers and key clinical conversations should take place in a quiet space wherever possible and noise cancelling ear buds accepted as routine. Lighting adjustments, avoidance of casual touch, sensory-friendly dress codes and minimising smells are all important for some doctors. Sensory overload can usually be managed with regular short sensory breaks if the doctor has a good understanding of early signs of overload developing and this can be particularly helpful during long ward rounds or in overstimulating hospital wards during a liaison post.

On the contrary, some neurodivergent doctors may need increased sensory input in a specific modality, for example background music or proprioceptive input, in order to support their ability to focus.

Predictability

Predictability is key for the many autistic people who thrive on routine, structure and minimal change. For some, the urgent and unpredictable nature of both crisis team and liaison work may be tricky to manage in comparison with the clearer expectations of a ward or slower pace of a well-managed community mental health team. Adjustments to support this include enhanced induction (including name badges, maps, timetables, clear expectations), providing information and warning ahead of any changes and enabling the doctor to adhere to their job plan. Rotational training schemes can be problematic, but minimising moves between different trusts can help mitigate this.

Managing their own diary for out-patient bookings and meetings can enhance predictability and avoid the stress of unexpected urgent extras being added in without time to process the change. Some doctors with ADHD and AuDHD may need to think carefully about how to balance a need for both predictability and novelty in their job plans in order to maximise their productivity.

Many neurodivergent people find that adjusting their working pattern to best suit their energy levels and productivity pattern is the most useful adjustment. This also allows processing space (see below). Such an adjusted work pattern may involve ‘less than full time’ (LTFT) working, compressed hours with a recovery day midweek, five short days, shifting hours away from peak commuting times, or planning intense clinical work in the mornings when medication doses peak. Clinical supervisors or line managers are well placed to approve these adjustments with support from local trust policies on flexible/home working, particularly for community-based posts. Most doctors now have access to an LTFT champion and/or an LTFT training programme director (TPD) for further advice. However, working LTFT is not the solution for everyone and absolutely does not negate the need for other reasonable adjustments to be considered.

Acceptance

All doctors benefit from a team that is understanding and accepting of individual differences, rather than imposing assimilation into the majority culture. Neurodivergent people should not be expected to squeeze into an unsuitable environment designed for the neurotypical majority. Rather, it should become normalised to ask people what kind of adjustments might maximise their productivity and well-being. Special interests and monotropism (single focus of attention) related to these can be embraced and included in job plans to maximise hyperfocus and joy in work. Indeed, higher trainees have a ‘special interest day’, which can be used for this purpose. A fully inclusive team may support unmasking and open self-regulation and stimming in front of colleagues. Social events could occur in a neurodivergent-friendly environment and attendance could be optional. Evidence also suggests that workers with ADHD may benefit from work-related coaching to support their strengths and improve their career success (Crook Reference Crook and McDowall2024).

Communication

It is important to consider a neurodivergent doctor’s communication preferences, which may be via email or messaging rather than face-to-face or telephone. Video call chat functions may allow some doctors to participate in online meetings where they might otherwise stay silent. For some, there may be a mismatch between their intended verbal communication and their non-verbal body language and expression, which may remain neutral. For many, communication occurs best in a quiet area, free from interruptions, which should be considered regarding clinical care, handovers and meetings. It can be helpful for staff to write doctor’s tasks down in a book to prevent verbal interruptions if they are permitted within local trust policies. Also bear in mind that someone usually articulate can lose their speech when struggling with overload or anxiety and colleagues can be educated in handling this in a supportive manner.

Conflicts involving autistic doctors may start with a miscommunication, where a request might be too vague for an autistic person who needs accurate literal and direct communication. This may then activate their need for things to be correct and a heightened sense of justice, which is misunderstood or dismissed by neurotypical colleagues. The autistic person may then become rigid and stuck about the issue, resulting in the situation escalating. This might have been prevented entirely if their need for accurate literal and direct language was understood.

Feedback may also need to be unambiguous, literal and direct to avoid misunderstandings. Some neurodivergent doctors, however, are sensitive to rejection so it is important to check the style of feedback a doctor would like to receive at the start of the placement. Low-key regular positive feedback focusing on outcome above process can be helpful. Focusing on specific examples rather than vague concepts can help clarify issues and a high level of detail in this may be requested and found helpful. Multisource feedback (MSF) from the team can highlight communication differences and it is important that teams have received training on neurodivergent communication styles before completing any MSF forms, so that responses can be helpful rather that broad negative statements.

Dyslexic doctors may benefit from a number of specific literacy adjustments, including dyslexia-friendly text. This includes using sans serif fonts in a larger point size (12–14 point), evenly spaced words, and without italics or bold. The use of bullet points, key point boxes, illustrations and diagrams help to break up long chunks of prose. Antiglare screen filters and pastel backgrounds may all help, alongside printer access to read longer documents in paper format. Access to Work may fund specialised speech-to-text software, although standard speech-to-text and screen reading tools such as those built into Windows 11 may be sufficient for many (Shaw Reference Shaw and Anderson2017b). Microsoft’s Immersive Reader is a free adaptive technology to better support on-screen reading for dyslexic and visually impaired people. Enco-Jáuregui et al (Reference Enco-Jáuregui, Meneses-Claudio and Auccacusi-Kanahuire2023) published a systematic review of various technological solutions to improve internet accessibility for dyslexic people.

Empathy

It is important to appreciate that it may be difficult for neurotypical colleagues to understand the experiences and perspectives of neurodivergent colleagues, and particular efforts are required to achieve this. Traditionally, for example, when communication difficulties involved autistic people, the default approach was to assume the ‘deficit’ was on the part of the autistic person. However, research shows that communication and empathy challenges between autistic and non-autistic people are bidirectional and that autistic people communicate as effectively with other autistic people as non-autistic people do (Crompton Reference Crompton, Ropar and Evans-Williams2020). As already discussed, moves to break down the stigma surrounding neurodivergent doctors by enabling disclosure and role modelling by senior neurodivergent doctors, and supporting others to act as active bystanders, are key. Whole team training using a neurodiversity-affirmative approach is used by many deanery support services. Many neurodivergent psychiatrists find that they are able to connect particularly well with neurodivergent patients and this skill could be maximised in job planning and allocation of clinical work (O’Connor Reference O’Connor2024).

Physical space

Practical considerations of the work environment include increased personal space and silent space for deep work or administrative tasks. As mentioned above, this may be achieved using room booking systems and creating a shared space for silent work only, in addition to a busier shared doctors office. Doctors with ADHD may benefit from regular movement breaks and well-structured organisation systems to support executive function. Dyslexic doctors may benefit from accessible technology, including antiglare screen filters and training on dyslexia-friendly accessibility features on their devices. Dyspraxic doctors may need particularly clear instructions on working any machinery, including electroconvulsive therapy (ECT) equipment, alongside ergonomic keyboards, an adapted mouse and training on keyboard shortcuts.

Processing space

Many neurodivergent doctors require additional processing time to consider questions, changes and decisions; rushing for an answer may delay the process. They can be particularly well suited to managing the clinical complexity and uncertainty often found in psychiatry if this need for processing time is respected. Meetings can be adjusted for by ensuring that pre-reads, agendas and expectations are sent well in advance. As mentioned above, The need for interruption-free silent time to focus on deep work is key for many and strategies to support this, including door signs and email muting, may be helpful. Doctors with ADHD may need clear strategies to support their executive function, including task lists, clear deadlines, reminder alarms, good secretarial support and use of one of the plethora of prioritisation and scheduling apps available. Dyspraxic doctors may need extra time to learn any new practical procedure and have complex physical tasks broken down into small chunks with detailed instructions and time to practise each stage.

Emotional space

Neurodivergent doctors may be alexithymic or require additional support in identifying and processing their emotions, which may be particularly relevant for Balint group attendees and psychodynamic therapy training. Team training may allow colleagues to support neurodivergent doctors with emotion processing, and may include strategies to ensure safety, minimise sensory input and avoid unnecessary verbal communication at times of distress. It is important to be mindful that many neurodivergent doctors may be sensitive to rejection and may respond catastrophically to perceived criticism. Given the statistics already discussed on rates of self-harm and suicide in this population, it is key to both create an emotionally safe space and refer onwards for further support when necessary.

Royal College of Psychiatrists’ specific guidance

Sources of support

Informal peer support is invaluable and there are several active social media groups. The Association of Neurodivergent Doctors has a membership of around 2700 doctors and the Doctors’ Inclusive Neurodivergent Group has over 900 members. Both have active Facebook pages and welcome new members across the spectrum of neurodivergent identities. Autistic Doctors International has over 1200 members and is open to all formally diagnosed and self-identifying autistic doctors, with both a Facebook group and several speciality- and topic-specific WhatsApp groups.

Many trusts are creating neurodiversity champion roles or have an accessibility TPD for both neurodivergent doctors and their supervisors or line managers to seek support and advice from.

Deanery support services experience some national variations but may provide screening for neurodivergent conditions, educational psychology reports to support exam adjustments, and mentoring and coaching for both the individual and their team.

NHS Practitioner Health (www.practitionerhealth.nhs.uk) is open to referrals of neurodivergent people with co-occurring mental health conditions or addictions and offers interventions tailored to the needs of doctors confidentially and distant from local workplaces.

Occupational health services require a supervisor or line manager referral, ideally with a specific question to address. They will provide a report outlining adjustments required for the workplace and training that gives human resources (HR) departments the required evidence to implement any larger adjustments.

Access to Work (www.gov.uk/access-to-work) accepts self-referrals and although there is often a significant wait, it may provide funding for larger items such as adapted technology, furniture, travel and for personal assistants.

A number of key considerations for organisational leads are outlined in Box 3.