What should you do if you suspect you might be neurodivergent? What’s the difference between neurodivergence and neurodiversity? And how can we support everyone to play to their strengths without feeling like we’re making allowances?

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Chances are you are working with someone who's neurodivergent in some way.

Maybe they've got ADHD or autism or dyslexia.

Maybe you identify as neurodivergent or you think you might be.

Either way, people working in teams represent a whole

spectrum of neurodiversity.

And while we tend to diagnose disorders to identify so-called

deficiencies, there are also incredible strengths that we can access.

And sometimes one symptom masks another one.

So one person's extroverted behavior might be another person's

autistic special interest in people.

This week.

I'm really pleased to welcome neurodiversity specialist Matthew

Bellinger back onto the podcast to talk about how we can embrace

people with a whole spectrum of neurodiversity, and how we can support

ourselves and other people to play to their strengths, rather than

alienating them when they struggle.

This is not just about making allowances or lowering the bar, but

making sure that the whole team can benefit from the unique abilities

that every member can bring.

Like every conversation with Matthew.

I found this interview to be really insightful.

It helped me understand some things that I never knew about

and was a real eye-opener.

You're in for a treat.

If you're in a high stress, high stakes, still blank medicine, and you're feeling

stressed or overwhelmed, burning out or getting out are not your only options.

I'm Dr. Rachel Morris, and welcome to You Are Not a Frog

I'm Matthew Bellinger.

I'm a neurodiversity and innovation specialist.

Lovely to have you back on the podcast.

Matthew.

Matthew was on a while back

It was a while

think it was a while back, and we've since repeated the episode

because it's been so popular.

It's reached all the different ends of the world.

We hear it's very popular in Australia and lots of other places.

Um, because I think what Matthew doesn't really know about neurodiversity

probably isn't, isn't worth knowing.

You made it sort of real specialism.

And added to that, we are both neurodivergent ourselves, aren't we?

Um, Matthew, how would you describe yourself?

Well, I'm, I'm an autistic, dyslexic ADHDer, so I've kind

of got all of the things.

Interestingly, last time we spoke, I didn't have the autism diagnosis.

I very strongly suspected, I was pretty clear, but I hadn't

actually got the diagnosis yet.

So, uh, there's a, there's a really interesting kind of, I

suppose, arc of self-discovery going on with this stuff as well.

And I think it's, it's quite a common theme for people as well

to get one and then be like, uh.

Yeah.

And we, we, I mean, I know last time you described yourself as autistic, so

that's been interest, that's interesting that you've only just been diagnosed.

We are gonna talk about diagnosis in a minute.

It's always good to have you on Matthew, because I think the

healthcare community, we are a group of very neurodivergent individuals.

Um, I'm sure people will know I was diagnosed with A, ADHD,

a few only a few years ago.

Um, and that diagnosis has made a massive difference to me in my life

and how I manage myself and my time and everything else about my life.

But I think it can be a blessing and a curse, can't it?

We've, we've already, we've already talked about that before.

But just before we started the podcast, you were talking to me about actually

how profound neurodiversity is, just as a, a whole concept and as an idea.

I think this is one of the things that kind of gets overlooked with

the whole, with, we are thinking about neurodivergent conditions

and thinking of, of them as these kind of separate things.

You've got these, this group of people who are essentially

neurotypical and then a group of people who are essentially, who

are neurodivergent and have a, a condition associated with that.

And fundamentally, what neurodiversity says is there is this huge, almost

infinite variation in neurology and the experiences that come

about as a result of neurology across the whole population.

And that, that's actually, that's, that's just simple biological fact,

and probably an evolutionary advantage in many cases as well, because it's

persisted, persisted for so long.

But that fundamental idea, everyone is experiencing the

world somewhat differently.

Everyone is thinking differently, feeling differently in the world,

whether or not they have a diagnosis.

And even within those diagnostic categories is really quite a profound

thing to engage with and I, I think it fundamentally shifts the way

you see and engage with people.

And certainly thinking from a, you know, more as a psychologist, it really

changes the way we think about how we do psychology, how we say things about what

people are experiencing and feeling, and how much we can say and we realize that

we are talking about averages rather than any one individual's experience.

Yeah, 'cause we often use the phrase, well that's not normal, is it?

Or, you know, I'd have thought, you know, that they would've

interpreted that like that.

That's really weird that they'd done it like that.

But what does normal actually mean, I guess for anybody?

Normal means their own experience really.

A few months ago, I remember I was talking to my other half about

something someone had said to me.

And, um, I'd interpreted it one way and when I said it, he was

like, Ooh, like, he's interpreted it a completely different way.

Just that, exactly the same sentence.

But in his mind it definitely meant that in my mind it

definitely meant something else.

And neither of us were right or wrong.

It was purely an interpretation.

We wouldn't have known unless we actually asked that person what

they'd, what they'd meant by it.

Yeah, I mean, I, I think it, and sometimes I find if you ask that third

person, that they'll, they'll have their own perspective and it'll be

different to, to both of the, both of the other interpretations as well.

Um, I actually recently did some work for an organization

around instructional design.

Um, they were concerned about the accessibility of some of their exams,

and, uh, they wanted to make sure that they were neuro accessible, so

they wanted to make sure that the language they were using was as clear

in its interpretation as possible.

And actually got me thinking, you know, this isn't, this isn't

something we speak about very much in terms of how we're, we assume

that what we ask people to do.

They understand what we mean very often.

And that can be a huge gap.

And really digging into it and all of the different kind of conditions, and

also cultural background and, you know, the, this stuff spreads so far beyond

just kind of neurology is, it's like what we hear as a result of what people

tell us is, is not as clear as all that.

And, and you are right.

It is based in our, our own experience.

And I think this is, this is one of the things that's been emerging for

me in the work around supporting neurodivergent people is actually

the self-awareness of everyone.

Again, if we assume everyone is having their own unique experience,

we all need to be able to situate ourselves in our experience to be

able to really robustly work out what other people are experiencing

and convey that to other people.

It's really important to be able to reflect on our own position.

And I think this, this is a particularly difficult one, and

so many people who are um, late discovery, late diagnosis, find

that they just assumed that everyone experienced the world as they do.

Everyone found it this difficult, they were just getting on with

it, is very often the way.

And what's interesting is actually if we also experience a difficulty

in that direction, we can reinforce that message for people.

So say that you were, you know, if, uh, if I'd been working with someone

before I knew I was ADHD, I had ADHD, I might have said to someone who came

to me and said this is difficult, I because they had something related to

a DH adhd, I might have said to them, well, everyone finds it that difficult

because I found it that difficult.

Whereas that's not necessarily the case.

And I think that understanding that, you know, of, of, of how we

experience the world differently is really, really important, because it

actually helps us connect with others as well around their experience.

I guess it takes a look the judgment away as well, doesn't it?

Because I did a podcast a few months ago about the judgment you

put on things, whether things are right or whether they're wrong, and

actually you could change that to whether it's helpful or unhelpful.

And actually even that's quite judgmental and just actually changing

it to behavior that works or behavior that doesn't work, now that is

the, that is really unjudgmental.

And if you apply that to neurodiversity, we often think people who are

neurodivergent, they've got it wrong, the rest of us are right or whatever.

Actually, that's not helpful either.

It's like, have I used language that is clear or not?

But there's no judgment that is clear, whatever interpretation you have,

whatever way you see the world clear for someone who considers themselves

neurotypical or autistic or uh, ADHD, it's just, is it clear or not?

'Cause there's so many, so much nuance in everything that we say.

Let's take the judgment out.

I think that's the main problem is that there is a, a body of people

who perceive them to be normal and then everything else is abnormal.

Actually, what you are saying is everyone's just different, there's

no normal abnormal, and what we need to do is just find that,

that common ground where everyone can understand things the same?

Yeah, it's that meeting point, that intersection between our understanding.

It is one of the things that actually just improving this stuff

for people who are a long way to the edge of a battle curve tends to

improve things for almost everyone.

It's, it's better design.

You know, your, if you, if you improve the language, you make

the language simpler and clearer, you improve it for everyone.

If people are in a stressful situation, they have less cognitive resources to

be able to understand and, um, engage with the language that you are using.

So, making it more straightforward, making it easier to interpret is gonna

help them as well, regardless of whether they're neurotypical or neurodivergent.

A lot of this is actually just generally good design, it's

not for one group of people.

That makes sense.

I've got a, a friend who's head of, um, SEN at a local college and when

she does sort of teaching observations and, and helps teachers with stuff,

she's like, well, actually, if you make this clear or if you look for

this, if you help this particular learner or you develop this resources

for someone who's dyslexic or these resources for someone who might be

autistic, actually those resources will be better all over, better in

the end for everybody, absolutely.

And I, I love that analogy that that really helps.

So we talk about good design, we talk about getting clarity on, on

what we mean and being curious about how other people see the world.

One thing you talked about is something you've been looking at a lot recently

is non stereotypical presentations.

And I'm really interested in that because I think when it comes

to healthcare professionals, often there are some very

non-stereotypical presentations.

For example, a an old cliche is, Well, I'm a doctor, I can talk to

people, therefore I can't be autistic.

I mean, talk about, you know, a ridiculous belief that

act absolutely isn't true.

I think it's, it's really important to note that, um, the majority

of research on neurodevelopmental conditions, so, you know, ADHD,

autism, dyslexia, dyspraxia, Tourettes, that kind of cluster has

been done on cisgendered white boys from a middle class background,

largely in anglophone countries.

So once you, you know, once you move them further, you move outside of that

group, the less likely the stereotypes we hold with the way that the conditions

present are likely to be true.

And that, that, that has all sorts of kind of knock on problems.

And one of the interesting things is, um, this even affects medication

and medication effectiveness.

So one of the big challenges is like all of the research into

medication and effectiveness, or almost all of it has been done on

young men for a variety of reasons.

But that means that we actually don't understand the

efficacy as much for women.

And we, neither do we understand the efficacy of, um, of talking

therapy interventions or like this, this whole range, we, we

just don't have this understanding.

We also don't have the understanding of how these conditions are

understood and present from people from different cultural backgrounds.

So they can show up quite differently.

And the way that people might display them can be different.

You know, one of the classic autistic traits of differences in eye contact,

not making the direct eye contact, that's also a cultural difference.

It's only the, like Europe and the US, um, and nor, uh, north

America where people actually make that kind of pervasive

eye contact culturally, mostly.

A lot of other countries don't have that level of intense eye contact.

So that trait, you could misidentify that trait as autistic

in someone who was just from a different cultural background.

But that trait wouldn't, it just wouldn't be an indicator.

So all of these different things can make it actually very, very

hard to tease apart when we are looking at these external factors.

I think it's being able to reflect on this inner experience is, is, is

a much more helpful guide, but that itself is challenging because we're

so trained to look for external markers and there's these kind of in

inverted commas, objective markers.

Whereas a lot of this is really phenomenological.

So.

In terms of presentations that you might see in sort of really high functioning

people, thinking, you know, doctors, nurses, healthcare professionals, what

do do you see showing up and where do we commonly think to ourselves,

oh, I, I can't possibly be near neuro divergent because actually

I'm good at this and I can do this?

I, I think this is, well there's a couple of different things.

So the first of these is, um, this intersection with twice exceptionality,

which is, uh, to be, and I, I, I think this whole area is somewhat problematic

'cause of the way it understands people.

But this idea of being intellectually gifted as well as

neurodivergent in another way, because to be intellectually

gifted is to be neurodivergent.

You know, you're, you're enough of an outlier and, and comes with its own

set of problems that are very common.

You know, even people who are, who don't fit any of the other criteria

for neurodivergence, but are intellectually gifted, often have a

lot of similar experiences in common to other neurodivergent people.

And I, I think it's an interesting challenge to our ideas of like,

what's a, it's like this, the word gifted is a strange word in a way.

If it comes with all of these struggles, it comes with social

isolation, it comes with a whole load of different difficulties.

So it, it really challenges our idea of what's a disability?

You know, what's a deficit and what's a strength?

And I think that is the core thing to really understand about, you know, when,

when we're, when we're neurodivergent our strengths and relative

weaknesses constellate differently.

So we might be extremely strong in one area and relatively weak in another.

And the difficulty is interacting with the wider world is we expect

certain abilities to vary together.

So what, so you'd expect somebody who was very intellectually fit, Very

intellectual, very, very clever to have very, very good social skills as well?

Even, simpler than that, like to someone who was, uh, someone who's

very bright to be able to communicate very clearly verbally, whereas you

can have non-speaking or almost non-speaking people who are, you know,

who would ace an IQ test, but just don't use spoken language that way.

So it can be that, that strong as a difference for some people.

And I think those, yeah, those, those ideas of what, what, a successful

whatever looks like, you know, what, what is a successful doctor?

You know, and how are they doing that?

This is one of the really big problems is we have these stereotyped ways

of achieving certain things as well.

So say, you know, you've got a task in front of you, but there are

multiple ways of achieving that, and you might do that differently

to one of your colleagues.

And if we get too hung up on how we achieve that, we can miss the,

the multiple ways that we are all achieving this, uh, you know, ultimately

achieving a goal, but, but doing it in very different ways that play to our

strengths or not in, in some cases.

It's interesting.

Matthew, I've got, this is gonna come from a bit from left Phil, but I think.

One thing I've noticed, one thing I'm doing a lot of talks

on at the moment is this sort of superhero mentality of doctors.

You know, we are absolutely capable of doing anything and everything.

And, and often they are, they're not capable of doing everything though

because they haven't got time.

But then there's this over responsibility.

And so I'm gonna work really, really hard, like as hard as I

possibly can, and I'm responsible for everybody and everything.

And the thought of letting other people down or dumping on

colleagues is just almost painful.

In fact, we were running a, a day yesterday and one of the, the

doctors said I can't live with other people thinking I'm shirking.

Like literally I can't live with it.

Now I'm beginning to think I is, is that over responsibility and

this desperation to, to always be the hero for other people?

Is that a neurodivergent trait?

I, it certainly can be.

There's a couple of reasons it can be particularly.

And again, it can be particularly related to this high, being able to

perform highly in a certain domain and being rewarded for it, and then really

finding that it's unsafe to ever fail.

It's unsafe to back off.

You have to be present.

You have to be there.

And that can get even worse for those of us who perceive things

differently and perceive therefore perceive things others don't.

And this can be a real challenge because very often if we're neurodivergent, we

just see different aspects of the world.

It's, it's not that we, we don't have necessarily like more acute

perception, 'cause we don't see things other people do, but we're

just seeing from a different angle.

But when we see from a different angle and that angle is relatively rare, it's

very easy to then take responsibility for everything that we perceive, because

we are the only one perceiving it.

This often crosses over with these kind of hyper adapted skills and these, these

skills that people have have developed.

You know, the classic one of these is if people have developed hyper empathy as a

skill for, you know, for connecting with people is if you're hyper empathetic,

you are likely to be doing emotional processing faster than other people.

And this is quite common in, in, in a ADHDers and um, autistic

people and anyone with emotional intensity might be better stated

as quick emotional processing.

But if you are processing faster than anyone else, you

tend to end up doing all of the emotional labor in a situation.

So whatever you are perceiving, whatever you are ahead of people on,

it's very, very easy to fall into that pattern of I'm the only one seeing

this, therefore I'm responsible for it.

And I think when you add that to the fact that, you know, our identity

is really tied up in helping people and always being there, if

you then add to it that actually you might genuinely be perceiving

more than other people, perceiving more need, having more empathy.

That's just like a double whammy of feeling responsible

for everybody, everything.

No wonder everyone's freaking burning out.

Yeah.

And you add that to the expectations that will have

carried on from childhood.

There are very few people that make it to medical professions

who weren't successful at school to some significant degree and

will have had reward from that.

You know, for, for a lot of people, this is one of the, this is one

of the big challenges of, um, being brighter in a non-adaptive

environment is you basically can go through school, college, university,

sometimes, without ever really hitting something that challenges you fully.

And so you can kind of cruise, but that means that you never develop

the, the tools and techniques for engaging with something.

So when you do hit the difficulty, if you think about, you know, most

people have been on a, on a gradually increasing difficulty curve, so, so

the next inflection point is a small change for that, whereas you hit the,

the curve when it's nearly vertical.

Yeah.

Oh, that happens to me.

I was, you know, A Levels fine, university, yeah, mildly

hard work, but it's fine.

And it wasn't till I got onto the wards as a junior doctor that I hit that oh

my goodness, I am absolutely exhausted.

I now have to organize myself.

And this one particular nurse was a complete cow to me, and I

did not know how to handle it.

I just was not used to that type of emotional abuse or some, someone

just being so intransigent and, and awful, and we hadn't been trained

in the emotional side of things.

We've been trained in the intellectual problem solving side of things, and

I was completely unprepared for it.

And I, I feel like there's also, this is almost like the flip side of,

um, the expectations that we might place on ourselves is that those

can often come from other people.

You know that, that expectation that because you are very good in one

area and because very often because you've had the resources given to

you to develop that skills in those areas, that it becomes almost like

a moral failing or an expectation if you have needs anywhere else.

In healthcare and medicine, we are observing that, and people tell me that

they're probably a higher proportion of people who are neurodivergent

from the neurotypical people.

And I'm presuming, because neurodiversity actually helps

us in a lot of those roles.

How, how is it helping us?

I think it's definitely helpful to think on strengths, and

that can be a really good cue.

One of the, one of the problems with our current diagnostic criteria is

they're all deficit based, and that can lead to mistakes in diagnosis because

deficits are only half of the picture.

So it's definitely worth thinking on particular strengths and the strengths

associated with particular conditions.

Particularly, you know, autism is associated in, in a, probably in a

medical context with someone who is capable of synthesizing a lot of detail

and coming to a singular conclusion and ADHD has a bunch of skills that

are really good with coping with chaotic and unpredictable environments.

So anyone who works in emergency medicine, I'd expect to be like

to, to maybe have ADHD traits.

And to some degree also, uh, in general practice because of the variety of

different experiences that come in.

You know, you don't know what's going to walk through the door next, and

that's a really difficult situation for some people, but for others,

it's actually a source of interest.

It, it keeps the engagement.

You know, and you see, you see that, that, that, that really high level,

some people need that level of stimulus and le level of novelty, and others

find it completely overwhelming.

And the same with details.

So it's, I think it, again, it comes down to understanding where

your particular strengths are, and for me, where they are supported

and where they're unsupported.

As very often these strengths and what we see as strengths and weaknesses

are really two sides of the same coin.

I like the model of sensitivities to understand this.

We're sensitive to a certain thing and that means that we can work

with it to a really high degree, but it also means we are susceptible

to overwhelm in that area.

A classic example of this is someone who is auditory sensitive might

be a really good audio engineer.

You know, they might be a great music producer, but they're not

gonna be able to cope in a really noisy environment, like a really

noisy train station, that's, that's likely to be overwhelming for them.

So the sensitivities and the strengths are actually really closely related

and making sure that we are taking care of our sensitivities and so we are

not pushing ourselves into overwhelm is really, really important area.

And that can be really hard when we've learned to rely on them.

You know, it's that reflexive thing.

As soon as you get close to overwhelm, you end up in somewhere difficult.

We tend to rely on the things that we are strongest at.

It's a very natural response.

It's our normal response, but that means that we can do too much of a good thing.

You know, we can have too much of a good thing and we can burn through

the resources that we do have.

I'd never thought of it like that before and I'd just been writing down.

So if you are someone who, who has autism, um, so you can synthesize

all that detail, come up with a single DI diagnostic criteria,

which is brilliant for medicine.

But then dealing with uncertainty, something that you, you can't deal,

you know, that there, there is no answer to, that's really, really hard.

Potentially yes, though, you know, again, we don't wanna stereotype

too much 'cause I'm sure there are people with, but, but in general, the

skills are often in that direction.

And for me, I'm an autistic ADHDer, so I have this, you know, some, the,

the, this is one of the weird things.

It's like I, I am a coherent person, but the way that we think about both

of those conditions, both in terms of strengths and weaknesses to some

degree, kind of contradict each other.

I was just thinking that actually, yeah, they're like opposites.

So like you are two opposites in, in one person, so that must be quite a jumble.

But lots, lots of people are, aren't they?

Yeah.

And I, I, I think this is, this is, this gets to the, the uniqueness of it and

the fact that we are all a cluster of different things, strengths, weaknesses,

and we are all embodied differently.

We all have different physiological things.

You know, this, this, this gets to something really around

co-occurrence and, you know, when we have co-occurrence things.

That can really fundamentally change how different things present, how different

things are experienced, whether they're experienced as a problem or whether

they're experienced as a, as a benefit.

And there's, there's this whole space that we, we really need to,

you know, think, again, going back to the neurodiversity idea and that

the generally the idea of population diversity is if, if you have one

thing, the way that another thing is going to present might be profoundly

different because of that one thing.

And that's, you know, autism, ADHD is quite a good example, is part

of the reason I'm late discovery is because I was always, I, I went out

too much, I had too many friends.

I'm too interested, like too, too out, like to be autistic.

I'm also much too careful and much too like precise to be, ADHD.

So I didn't fit the stereotypes on either side.

And I think there, there, there's also a more subtle way that

we stereotype and that's how people, how we experience people.

There is a significant degree that we are associate, we, we are kind of

assigning people to categories on vibes.

And and there is a level of validity in that.

But if our understanding of a condition is very narrow in terms of how it

presents, then it's not going to.

Give us a really good steer on what happens.

And again, I have another confounding issue for both

autism and ADHD is that one of my passionate interests is people.

I'm fascinated by people.

I've studied people academically and always been really interested.

And that means that I engage differently to someone whose passionate

interest might not be people.

So people hold my attention, but that means that if you interact with me, you

might not notice that I have some of the traits, even though I do because I'm

interested in you because I'm interested in people, rather than because I'm

relating to you in the way that perhaps a neurotypical person might.

From that then, is there any point in a diagnosis?

If everybody is so different and it all interacts so differently and you can't

infer anything from one thing, you can't say, well, if you've got ADHD, you're

like this, or autism are like this, what's the point in diagnosis at all?

It's a good question.

Diagnosis does have quite a lot of value according to research.

So the sooner someone is diagnosed with autism or ADHD,

the better their life outcomes.

Late diagnosis, an untreated ADHD is associated with really significant,

uh, lifespan impact, actually.

There was some research published relatively recently in the UK that put

it at seven to nine years for ADHD.

Um, I've seen up to 12 years for ADHD and autism.

So they're really significant in terms of lifespan and quality of

life, and we know that life outcomes are improved with sooner diagnosis.

So there is something going on that's helpful.

What appears to be helpful is it's useful to differentiate between

explanatory value and predictive value.

So a lot of diagnosis has a huge degree of explanatory value.

You can look at past experiences and go, oh, that's why.

That's why that worked, that's why that happened, that's why that didn't work.

And that is really useful, but they can have much less predictive value.

So being able to work out what is going to work is not

so strong as a, as a value.

It can to some degree, but because of all of these other intersectional

things that we've mentioned, we don't actually have the data to know.

I want, I think if we, if we did enough research, if we threw enough at it,

we could probably get better at that, but we don't at the moment, and we,

we don't have that level of, we just don't conduct studies on that level.

We don't collect data on that level.

We just, we just don't have that model yet.

But what it can do is it can narrow the search space, or it can at least

create a more, more likely area of things that are going to work.

And from what you've said, everybody's very individual anyway,

with all the intersectionality of everything that you've got.

So to be able to say, well, this is what you need to do in every really

way anyway, you've got to just try it.

But like, I love the way you said, well, it will narrow the search space.

You say, well, these are the sorts of things if you have ADHD,

this sort of thing can work.

Start here.

Start here.

Yeah.

Try this first.

Try that.

This may or may not help.

Likewise with autism, this may or may not help, but yeah, there's definitely

not a one one size fits all approach.

No, and I, I, I think it's, it's, it's really working with that and being,

being comfortable with that experimental approach and being able to say it's,

it, it's going to be about how it integrates, how any, any support, how

it integrates with the rest of your life and what you're trying to do.

I know that there are a lot of sort doctors that roll their eyes when it

comes to, you know, neurodivergence.

Um, I've seen threads on Facebook and stuff like that.

Like there's, oh, I'm fed up of everyone wanting to get diagnosed with this,

wanting to get diagnosed with that.

Honestly, everyone's gonna have diagnosis these days, lots and lots

of eye rolling and stuff like that.

I can see their point 'cause I think everyone, every man and his

dog is now identifying like that.

But I think that probably just means that actually it's just so common and

it's so helpful, and maybe the eye rolling is because people see diagnosis

as either an excuse for them or a, well, I think gen people are genuinely

looking for that, um, explanations, that explanations of what's been going

on all their life, so they're looking for it, but they're also looking for

perhaps a bit of a quick fix that if I'm diagnosed, someone can fix

me and it's all gonna be all right.

And that in my experience, very rarely happens.

Yeah, and I, I, I think this is, you know, there's a, there is an element

of this being a diagnostic pathway.

And part of a diagnostic pathway is eliminating the most likely thing first.

And we do know that ADHD is dramatically underdiagnosed.

I think, if I remember rightly, it's about a quarter of a million

people who are medicated for ADHD, but ADHD is probably about two and

a half percent of the population.

So that means that it, we are under medic.

It only about one in 10 are actually taking medication for ADHD, whether or

not that's desirable, you know, but, but so there, there are significant

underdiagnosis and particularly in populations where this hasn't been,

fitted the stereotype, and there's a real risk here of simply not listening

to people from marginalized and minoritized groups about their lived

experience, which is, is unfortunately a failure mode that we have seen

in, in, in medicine for a long time.

And, and again, you can have two sides of this.

It's either someone that shares none of your lived experience

and you really don't understand what they're struggling with.

But it can also be that you are undiagnosed and that you are

struggling and you just assume this is normal and it isn't.

This is one of the things I often, I often say to people is, if everyone

around you is getting diagnosed, you should look into whether you

have that condition yourself,

Yes.

'cause you sort of flock together, don't you?

because every, like the wider population, everyone and everyone

is not getting diagnosed.

There's a significant sample bias going on if that's your experience.

I'm just wondering maybe just the, the problem is actually the word diagnosed.

Because I think what doctors don't like is the fact that everyone's walking

around thinking there's something wrong with them, that they've got

an ill, they've got an illness, and the minute you tell someone they're

ill or they've got a, an illness, they then take an ill role or a sick

role or, you know, or that's our perception that that's what happens.

So the idea that you have to be diagnosed with a disorder, so then

you've suddenly got like 10% of the population or whatever having

a, a disorder, when actually what we wanna be doing is promoting

health and proposing promoting healthy behavior and healthy living.

So.

I don't know.

Is there, is there a different way of saying, rather than we are

gonna diagnose you with, with a neurodivergent problem or condition?

It's actually we're, what we're doing is recognizing the way

that your brain works and.

Well, I, I tend to use condition because it is more neutral than disorder.

It is a condition in, in the scientific sense, in, in the way

that like an experimental condition is a different condition, it's

a different set of, of things.

And you might have noticed I say discovery as well as diagnosis,

and discovery is, is more on that identity and personal identity side.

And what's interesting for me is when we discover, you know, when we

are seeing a situation where, where waiting lists for things like ADHD

are, are absolutely huge at the moment.

You know, adult ADHD, I think the average in this country is

something like eight years now.

The waiting list for eight years,

Yes.

Mental health services has always been underfunded and under-resourced.

And this, and now a lot of people are realizing they might have ADHD,

they are significantly under, you know, so it's, it's, it's, it's

become it really, really big issue.

And if we think about the life scale impact of that, we are

not supporting people in the way that we could support people.

And what interesting for me is how much we can do before diagnosis.

And actually, you know, in terms of things like stimulant

medication, that needs diagnosis, that needs careful management,

that can have really big downsides.

They can be habit forming, they can be abused.

They have all sorts of different problems, so most ADHD people

find it hilarious that people talk about them addictive because they

forget to take them very often.

But that there's this, this challenge around like, what can we do about it?

And it's really about how you can be supported better.

One of the other flip sides of that is we, you know, as a culture,

we need an explanation if someone needs accommodation or support, and

this is around work, is like, why do we not just listen to people's

reported experience about what they think is better for them?

If we had more flexible services and more flexible support and more

flexible work where people just got their support needs met and we met

a wider range of support needs, by default, we'd have less need for

identifying people who then need to justify their support because that's

where a lot of this comes from.

Essentially it's saying, and I'm just thinking they're the same for mums,

you have to justify the reason why you can't work eight till six in the way

that a white male can who has a wife at home looking after all their kids

in, in a British, you know, exactly.

It's all set up for that step, that person, and then there's no flex around

it unless you have something that's maybe, yeah, enshrined in law now you

have to legislate to get any protection.

But it's mad, isn't it?

Just like if you gave working conditions actually worked best for the person.

Yeah.

If we move to a more person-centered position, that's it.

It becomes much easier.

And I accept that, you know, doing things in a person-centered way can seem

quite resource intensive, but I feel, I mean, it increases efficacy so much

that it's worth it, and it also just means involving the person, the groups

of people that you're working with in the way that we understand the thing

and the way that we work with the thing.

Unfortunately, psychiatry in particular has a history of

making other people comfortable.

Not the person who has the condition but the people around them.

It's the distress in others that interventions, medication have really

been primarily about, rather than the the experience of the individual.

And so I think when we move to this, actually, what is

good for you as an individual?

How do we understand this?

Me?

Isn't it like you as an individual and us collectively?

That's a much more useful question and it changes the whole complexion

of how we are looking at this.

And again, this comes back to this fundamental idea of neurodiversity.

We are not trying to make people normal.

There are, there are, there's a middle of the bell curve,

but there isn't an ideal.

There isn't a perfect, it's, it's about a range of different, you know,

it, it, it's that range of difference that's actually the feature that's

that what we want out outta society.

So, so trying to normalize can be actually the problem here.

And that can also lead to normalization for normalization's sake, you know,

so it is this, this mitigation thing where if there's a perceived

deficit is we spend a lot of effort addressing that deficit so that someone

can achieve a kind of mediocrity.

We are moving people back to a very flat skill, you know, but instead we'd

be better focusing on the strength.

So for me, whilst deficits do matter and can really get in the way, they

only get in the way when they get in the way of things that we want to achieve,

And there's that old adages isn't there?

Yeah, if you play your strength, if you invest money in developing

your strengths, you'll get a much better bang for your buck

than if you just like, yeah.

Like you said, focused on trying to make something that you

find really difficult doing it.

When we talk about that, we often mean for quite a narrow range of strengths.

That being the difficulty and, and, and this, this experience of having

really extraordinary strengths can be very common for, for neurodivergent

people and particularly for, you know, if, if there're a neuro people

listening in, in the audience of this particular podcast, when, when we

talk about masking, we often seem to think about it as a, as as weakness.

You know, it is like papering over the cracks, but very often

for high performing people, it's it's strengths that you mask.

You don't say the thing that you are seeing because you know that

other people get uncomfortable when you point that out.

You know, you were, you were a junior and you weren't supposed

to see the thing that the person teaching you missed.

That's not socially acceptable, so you learn not to say it.

Those are the kind of things that we often cover up.

So I think that ability to fully locate in our strengths does require

a supportive environment, and requires a degree of emotional capability in

those around us to be able to cope with the idea that there are people

seeing things that they are not seeing.

I think there's a flip side though, Matthew.

I think there is, and I'm gonna bring up the elephant in the room, that, you

know, I was talking to someone the other day who, they have a, a junior doctor

who is not capable of doing the job.

She, I don't think she's neurodiverse, so there's some other reason, but she's

just sort of keep, keeping on going, keeping demanding this, that, the

other thing, you know, making everyone run around, make her, you know, and

actually she's just not doing the job.

And there are some jobs that you actually have to be

capable in certain areas to do.

And I think people sort of, of of my age, I'm nearing 50 now, um, we are, we

are Gen X, we've got these millennials coming up below, and the, there's a big

culture clash between Gen X, they've just worked so hard working their arses

off, had this over responsibility, feel they should do everything and just

work harder and harder, there's the millennials that realize how important

it's to protect their work life balance and put more boundaries around.

But then sometimes we see people that genuinely need adaptions in

their work asking for them, but thinking, well actually, if you

can't do that bit of your job and you're asking for this, well, who's

gonna do the rest of rest of it?

And how flexible can we be if someone is genuinely because of

their exceptionality in a role that they can't fulfill, how much,

how much contortion can we do to make that okay for that person?

Yeah, I mean, I, I, I think there's a, there's a number of different

ways to approach this having, but starting with there are fundamen

fundamental capability baselines.

We want to make sure that people are capable of doing what we want them

to do and what we need them to do.

But what we do need to be careful about is whether they are actually

supported in doing those things, how they are doing those things and

whether they might use a different method because we want an outcome.

We need to be more flexible about the method.

So that can be, that can be a real problem, is if your, you know, if

your strengths lie in a certain direction, you might approach a problem

differently to someone else, but that's still valid in terms of outcome.

The other thing we need to look at is whether the roles, when we

think of an overall job role, is whether that actually that cluster

of skills go together for everyone.

Is there a set of really valuable things that person could be doing, but

that just don't cluster together in the same way as we expect them to do?

Which becomes more of a bureaucratic challenge.

And again, there are bureaucratic limits and we do have to do some of this.

But that idea, that skills all cluster together in a certain way is related

to what I was talking about earlier.

And, and, and you can, you know, if you've got skills that cross

over different domains, if you can find a role that fits, that can

be an incredibly valuable role.

Often see people, and particularly with ADHD traits actually, because of

the, the kind of connected thinking and the, the, the, the difference

in like the wanting to follow different areas is end up in a kind

of go-between role where you are translating from one domain to another

domain, which is incredibly value valuable because we need those links.

So if someone has a set of skills where you can link up two different domains,

but you're not using them 'cause you've got people in this box or that box, then

that can be a real missed opportunity.

Yeah, we do, as doctors expect ourselves to feel, fulfill an incredibly

diverse role within, within one role.

So I'm thinking, you know, maybe a, a physician, you've got an

on-call rotor that you've got to do, you've then got to your clinics

and your diagnosis, you've got to do your research and stuff.

Um, and then, you know, in order to get out the on-call rotor, you

have to have a doctor's note or something saying you can't, and it

makes the people who have to carry on with the on-call rotor incredibly

frustrated and resentful actually.

'Cause they're like, well, well, how can we have to, but this person is

shirking their response, we can't do it.

But actually, if we had a, a load of different roles within that

department saying actually there's a clinic role, there's an on-call role.

There's this, you can choose what's gonna suit you

. I had a, another person who was on one of our courses and she said, she

said, I would love, she was a GP.

I would love just to do everyone's admin for them.

I would love to do all the results and all the letters and everything and,

and half the people the course were going I would love you to do that.

I love doing the emergency clinic, but I role, we don't create roles like that.

So it's about, I guess it's, it's creativity, isn't it, in the workplace.

Yeah.

And I, I, I think that idea of being able to play to strengths

and preferences, you know, we have, unfortunately, and this is kind

of a, a British cultural thing, that work is kind of a struggle

quite a lot of the time that we have essentially paid to suffer.

That is so true.

and it's not a healthy way to approach high performance.

It comes from, you know, like working in Victorian mills, I think.

Um, and, and we, it, it's just not a healthy way for us to approach you.

And when we're talking about we want, we'd be better thinking about

professions, learning from things like sport, like high performing sports.

We want our, we want doctors to be high

You stick to the javelin, you do the high jump.

Stop.

Stop trying to jump over that when you're supposed to be

Exactly, exactly that.

Oh that, you know, it's such a different way of thinking, isn't it?

But I think you're right.

It's the way our systems are set up.

But the problem is what happens is that then pits people against each

other because then people get upset and then, well, I've got to do that,

why don't they have to do that?

But actually if, okay, well we'll pay to do that, that bit, that bit over there.

If you don't do that bit, you get paid differently, you get paid

to do this bit or whatever, then everyone starts working as a team

rather than gets resentful about, well how come you get off on that?

And are you using your neurodiversity as a neurodiversity, as an excuse,

or why should I be inconvenienced?

That's the problem I think.

I think a lot of people think, why should I be inconvenienced 'cause we

are having to make a allowances for you.

And that's the problem.

It just shouldn't be like that, should it?

Everyone should be, we, we should always be adapting this

way, one way or the other.

You know, it's like everyone.

It's, it's not about making allowances.

It's about accepting that everyone's different and has

different strengths and interests.

And if we support those and let people use those, we get more out of them.

Which is why we circled back to what we first started talking about, that

everybody is neurodiverse, so we need to be thinking, even if we don't feel

that we have a, a different condition, actually how do I, how do I work best

within this environment that I'm in?

Even if you don't have autism or ADHD or dyslexia or anything else, you'll

still have strengths and weaknesses and things that you want to, you need

to actually develop and work to and other things that you really hate.

So just don't do that anymore.

You are allowed.

I, I think it is this, this, this association between having a, having

a diagnosis and being allowed to be a human with, with specific needs

and experiences and preferences.

That feels like the, the, the problem here to some degree.

And we are implicitly chasing this kind of idealized person when

we do this, we are, we are, you know, as you mentioned, it's, it's

the straight white, neurotypical label, bodied middle class man.

But it's even, even then, it's an idealized version of that person

who almost no one is going to com, you know, be, be that like anyway.

And it, it is this kind of Superman figure and it's not helpful for anyone.

You know, we, we we have to accept humanity, limitation, and the way

that humans are, and design systems and services that reflect that.

It's the systems and services that are the problem.

If they're not, you know, it's, it, it's, it's a design problem

on some very fundamental level.

If we are pushing people to the limit or over their limits in a system

that's supposed to deliver something, that's a problem, that's a, you

know, that's, that's not a necessary function of deli of the outcome.

That's a probably implicit decision that was made in how we meet that outcome.

What tips would you give to people who are working in this really

complex system that really needs to change and should change and ought

to change, but we are not in control of that, so we are only in control

of what we can do and there are things that we can do individually.

What would your sort of three top tips be for actually, what can you do

to make things better for yourself?

Yeah, I, I, I think the most important thing about any of this change

stuff is start with what you have.

Don't get too hung up on an idealized, potential future.

Look at what you know, what you have, how it all hangs together and what

you want to do, what the context is.

And without having to take a huge leap, without having to build

a huge amount of stuff, move in the direction you want to do.

You'll find that, you know, you can push an edge, you can move towards

an edge in that direction, almost certainly with what you have already.

And actually that's a significant degree how systems change.

There's a lot of how, you know, things like a, a large organization

changes is it's constructed in the individual behaviors of a

whole load of different people.

There isn't, like on some level, organizations are a fiction.

They're just a bunch of people doing stuff.

And, and so if you can change.

What everyone does, then you fundamentally change how

the organization functions.

It's really about running small experiments, running small tests to see,

you know, what can you do differently?

And in fact, if you are exploring neurodivergence as a

possibility, this is a really a good way of, of exploring that.

Because if you, if you have a high, you have a hypothesis, say I've listened

to this and maybe I have a DH adhd, or I think I resonate with a lot of

this, I, I wonder if I have ADHD.

One of the ways you can explore that is to go on a very long

waiting list, you know, and, and try and get support that way.

But another way is to go, is to think, well what, what helps?

What has helped a lot of people with ADHD?

Where are my experiences coinciding with that and what can I do about it?

And use that as an experiment.

Just a very small intervention.

If that works, that supports the hypothesis that you have ADHD.

Because if the things that help ADHDers help you, there's a

good chance that you'll share some of that lived experience.

And so the more you do that, the clearer you get on where you are.

So it's, it's really iterating towards that understanding instead of making

it that categorical thing of like ADHD, and it means this not ADHD.

And it means that.

And that gives you the nuance as well.

'cause you run these experiments over time.

So it's like, oh, in these circumstances, yeah, this is true.

But in those circumstances, it's not.

It's building up that overall picture through kind of small

experiments of yourself and the relationship to the world.

And if you are in charge of organizations, this is also a

very effective way of developing organizational capabilities is to

do this in this small, repeated way rather than trying to kind of

understand and solve everything and act.

So you are letting, you're letting the world give you feedback.

You're letting the world think for you to some degree, instead of having to

kind of take this incredible, complex, overwhelming amount of information

and come to a decision about it.

And you're gonna have to do that anyway, aren't you?

'cause even if a psychiatrist says, yes, you have ADHD, or yes, you, you have

autism and this is what you should do, well you're gonna then have to try that.

And you're not just going to swallow it hook, line, and sinker, 'cause you're

still gonna go, well that doesn't work.

So you might sort of done that already.

What does this mean, you know, to me?

And I think, you know, we do, at the moment, we do diagnose people,

particularly if you're an adult and it's broadly like, great, here's this.

Maybe if, if you're in one of the more, um, resourced services, you might get

a couple of leaflets and an invite to a, um, a support group, maybe, uh, uh,

like a facilitator group that meets a few times and has a cup of coffee.

That's the absolute most I've ever seen.

So making sense of this stuff, making sense of what it means

to you in your context is a huge amount of stuff that's left to you.

And yeah, like you say, you can do that.

It, you can do the sense making first and allow that to go with the label,

rather than going I need the label before I can start making sense of

this experience, using that as a potential lens, and understanding when

it is a useful lens and when it isn't.

'Cause even once you have a diagnosis, it's not the only thing about you

as a person, so you need to be able to discern when it's a relevant

explanation and when it isn't.

And I was just thinking actually you play to your straight to that.

Like if you've got ADHD, you could think of like 20 different ADHD things

you could try and try them like I was, and I thought, oh, that's very,

that would really appeal to my ADHD.

Yeah, I think your difficulty with ADHD will be doing it more than once.

Yeah, that's true.

Like, oh, that worked.

Well, let's just go into the next thing.

But honestly, when I realized I had ADHD was when I had listened

to someone talk about it, I was like, oh, that's interesting.

I never thought in before.

And then I just listened to a podcast and he's like, these are the top

seven strategies to someone with ADHD and I was like, yep, yep, yep.

I was like, oh my God.

I do, I, I know from experiment, I need to do all of those, and

maybe that's why I've got into all this sort of self-help stuff.

But absolutely just try stuff.

Try stuff now you even suspect you've got ADHD or your autistic.

Try it.

Try it straight away.

and I think actually going back to where we started to some degree, particularly

if you were a high performer at school and you've got this reputa, you've

kind of internalized this idea to seek permission for everything, and

I think we need to be very careful about whether what we are really doing

is just seeking permission instead of being able to take on something and

say, yeah, this is, you know, taking it on for ourselves and saying, actually

this is something I can just do and I don't need to ask someone else's

permission, to explore how I experience the world, what it means to be me.

And not just permission, I think it's about some external validation as well.

Do we, do we need external validation of this stuff?

I think it's useful.

We, we, we only understand ourselves in the context of

other people really identity, you know, we think about identity as

something located in, in ourselves.

It isn't really, it's located in our relationships, in

that web of relationships.

What we need to be careful about is, is any one relationship, you know,

and, and, and being like, putting it all on, on one aspect of identity.

So we, we do understand our experience in relation to others, and there's

value in sharing our experience with others, particularly when they

share our, when, when, when, when we experience things in similar ways,

because you all have solved things that I haven't solved, and I'll

have solved things that you haven't.

So being able to share and develop, this is actually a really, really

important way of improving and being able to not have to do

everything from scratch ourselves.

Because that's the, that's the key with this, is how, how can

we meet our own needs as a unique individual, but without having to

do everything from first principles?

And we are so lucky there's so many podcasts out there

about, about these things.

There's so many YouTube videos, so many books.

So just find the book, find the podcast, go really deep into it, which, you

know, our special skills probably mean that we can do that, right?

Yeah.

And, and I think follow you, follow your interest in this.

Is, is, is if it has energy for you, what aspects of it have energy for you?

What needs aren't being met right now?

You know, it is like, is this a professional thing?

Is it that you are bored?

Is it that you are creatively unsatisfied?

What is it that's missing?

And again, you don't need permission to meet that need.

You can go and look for it yourself, and that's okay.

Even if it's not, what other people who you know, fit some of

your other identities would do.

Matthew, what resources would you recommend if someone is wandering

and wants to explore that?

Are there any good books or particularly good things for

starting to look at any of this?

I think in general, I would suggest look to resources created by people who have

that lived experience and see how much you resonate with those experiences.

There's a real element that which we kind of know our own, whether or not,

you know, we, we can kind of sense it in other people without necessarily

consciously being aware, but we can kind of, I I, I sometimes heard it

described as neurodivergent peer review.

is, is, is you just kind of know someone's experiencing

the world like you.

If someone describes an experience that resonates for you, follow

it up and have a look and go with whatever form works for you as well.

You don't have to do this a specific way.

If you like podcasts, find some podcasts about it.

You like videos, go to YouTube.

If you like books, you know, it, it, you get the picture.

It's like, and if you like, if you're primarily interacting and talking

to people, find a group of people and be open about your situation.

Say, I'm exploring this.

People are usually very, very happy to share their experience with someone

else they think who, who thinks they might have that going with humility

and, and like, I'm, I'm learning and understanding, people will share a

huge amount, very generously usually.

So I think just explore, follow the thread and don't be worried

if that thread then goes nowhere.

You can always pick up another thread, but follow the

thread that comes up for you.

Well, Matthew, we've, we've, we could talk on and on forever, couldn't we?

We'll have to get you back another time.

Um, if people want to hear more about you and your work,

how can they find out more?

Yeah.

So you can find pretty much everything I do at matthewringer.com.

You can also find me on LinkedIn where I post quite a lot and I've

also just started on Bluesky, so hopefully that'll carry on.

I dunno whether that will stick but started.

So yeah, that, those are the main areas people can find all of my

different work, um, and information about working with me one-to-one as

an organization and the community I run called Curious Being as well.

So there's, there's a whole load of different ways

that, that you can interact.

Um, and I'm always happy just to chat to people if you've got any

kind of questions or anything that that's come up for you, always happy

to, you know, talk to someone, point you in the right direction, share

specific resources if you are, you know, if you do want a pointer.

That's wonderful.

And Matthew, I think you're coming to be one of our speakers

hopefully at our, um, Work Well Live conference on the 21st of May.

That's for any senior healthcare professionals, leaders, managers,

coaches, mentors, anyone in healthcare who manages, leads, people, and, and

wants to really look at how we help people work happier and beat burnouts,

but without burning out yourself.

'Cause as a leader we can do that.

So you might feel like you might be neuro reverse yourself.

You might think that there's some, um, neurodivergent people in your team.

There probably are.

FYI, there almost certainly are in your team.

So come along, talk to Matthew and, um, yeah, come, come along to that

event, it's gonna be really interesting and we're gonna be think about a,

a really, really different way of fostering wellbeing and resilience.

So Matthew, thank you so much for being on the podcast and we'll, we'll

speak to you again soon, hopefully.

Yeah.

Super.

Thank you very much.

Thanks for listening.

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