Homeworking experiences of neuro-divergent workers: systematic review

Abstract

Background

Working from home (WFH) is becoming more common, but little is known about how it specifically affects neuro-divergent workers’ psychological and occupational well-being.

Aims

This review aimed to explore the experiences of neuro-divergent staff WFH, including the challenges they face; the potential benefits of homeworking for this specific population and the support systems they require.

Methods

We searched six electronic databases, as well as reference lists of included papers, one preprint server and Google, for literature on neuro-divergent workers’ experiences of WFH. Results were synthesized using thematic analysis.

Results

We reviewed 25 studies (mostly based on data collected during the coronavirus disease 2019 pandemic), finding very little research statistically analysing the impact of WFH on well-being or productivity, or comparing the impact of WFH across neuro-divergent and neuro-typical populations. The (mostly qualitative) findings showed that neuro-divergent participants described various benefits and challenges of the sensory environment at home; the reduction of commuting; increased flexibility and lack of routine when homeworking; the reduction of ‘masking’ behaviours; lack of in-person social contact and increased use of technology.

Conclusions

The findings emphasize the importance of not assuming a one-size-fits-all approach to homeworking and suggest managers should be mindful of workers’ individual preferences for working whilst ensuring that all employees are appropriately supported. The results can inform future research and provide insights for employers to help them create more inclusive work environments.

Introduction

‘Neurodivergence’ is an umbrella term for neuro-cognitive developmental conditions, including autism spectrum disorders (ASD), attention-deficit hyperactivity disorder (ADHD), dyslexia, dyspraxia, dysgraphia, dyscalculia, Tourette syndrome, tic disorder, apraxia and developmental coordination disorders [1]. Approximately 15–20% of the global population is believed to be neuro-divergent [2]. While conditions differ, they share common features, including challenges with executive functioning, communication and understanding social cues. All of which can affect work, productivity and relationships. Difficulties experienced by neuro-divergent workers can include time management, concentration, self-regulation, multi-tasking, organization, communication and slowed cognitive processing. These may benefit from workplace adjustments [2]. Neuro-divergent employees may also bring several positive qualities to the workplace, including creative/innovative thinking, hyper-focus, strong work ethics, reliability and entrepreneurialism [2,3]. Evidence suggests that teams including neuro-divergent employees are up to 30% more productive than those without [4].

There are ongoing concerns that neuro-divergent individuals are underemployed [5]. At a time when diversity and inclusion are key concerns of many workplaces, neurodivergence is recognized as a dimension of diversity [6]. Organizations increasingly recognize the need to address workplace systemic biases and discrimination for legal and moral reasons [7] as well as to gain a competitive edge in the work environment [6] through increased performance and profits [8]. While a number of high-profile organizations have targeted inclusion programmes, there remains little evidence as to their effectiveness, and little evidence-based guidance on supporting neuro-divergent employees [1,2]. Reviews of policies and practices designed to support neuro-divergent workers [9,10] report that flexible work arrangements, including homeworking, are among the most common practices to accommodate employees [10]. Research on neuro-divergent employees’ own workplace accommodation preferences has found that the ability to work remotely is commonly suggested due to its flexibility, reduced stress of inter-personal interactions and increased time to focus on individuals’ strengths [11]. In particular, employees with ASD, who may find ‘small talk’, reading body language and understanding social cues to be challenging, can prefer to work in settings outside of the traditional workplace [8].

It is unsurprising that the abrupt global shift to homeworking during the coronavirus disease 2019 (COVID-19) pandemic [12], inspired media articles claiming this would benefit neuro-divergent workers [13,14]. The shift in work practices was deemed to make work easier for people who struggled to adapt to office environments. Messaging platforms replacing in-person conversations were seen to remove a major obstacle for those struggling with social interaction [15]. Working from home (WFH) may also reduce the need for ‘masking’, i.e. the suppression of neuro-divergent traits and behaviours that may serve as a form of impression management [16] and can be exhausting and stressful [17]. It thus follows that WFH may allow neuro-divergent workers to flourish. However, there are numerous potential challenges, too: research has shown that autistic people may find video calling (in non-work contexts) stressful due to struggling with eye contact, distracting background noises, feeling self-conscious and concerns about misreading conversations due to missing non-verbal cues [18]. Additionally, the blurring of boundaries between home and work and subsequent loss of the home environment as a ‘safe space’ could negatively affect well-being [19].

A wealth of research on WFH since the COVID-19 pandemic indicates WFH has the potential to improve well-being, job satisfaction and productivity for some, but can also introduce challenges such as difficulties maintaining work–life balance [12,20]. These findings are based solely on neuro-typical populations [15]. There have been compelling arguments for why WFH might benefit neuro-divergent populations [15], but little is known about the lived experiences of neuro-divergent employees who homework. While the overall impact of the pandemic on neuro-divergent populations has been reviewed [21], little research focuses specifically on working practices. Two previous reviews explored the impact of COVID-19 and the associated change in working practices for neuro-divergent workers [22,23] but found little relevant primary data. One rapid review focussed mostly on news articles rather than research studies [22]. Szulc [23] reviewed academic literature but found only five studies; they developed recommendations including offering flexible hours of work and developing support groups to share strategies for WFH. This field has grown substantially as COVID-19-related studies continue to be published. A better understanding of how to support neuro-divergent employees WFH is still needed. This review explored the WFH experiences of neuro-divergent employees, including the challenges they face; the potential benefits of WFH for this specific population; the impacts of WFH on psychological (e.g. mental health, stress) and occupational well-being (e.g. productivity, job satisfaction) and the support systems required.

Methods

We conducted a systematic literature review. No protocol was prepared/registered. See File 1 (available as Supplementary data at Occupational Medicine online) for the PRISMA checklist. We specified a research question informed by the relevant populations, concepts and context. The population was defined as ‘adult neuro-divergent workers’, in any country, including workers in all sectors, with any neuro-divergent condition. Concepts of interest included lived experiences of neuro-divergent employees, specifically any impact of homeworking on psychological and occupational well-being and perceived benefits and challenges of WFH. The context of the review was, simply, WFH for any reason. The research question was identified as: How do neuro-divergent employees experience WFH?

We developed a search strategy to identify relevant literature (File 2, available as Supplementary data at Occupational Medicine online). The first author searched six electronic databases (Web of Science, Embase, Medline, PsycInfo, Global Health and Business Source Complete) from inception to 20 March 2024. Reference lists of included studies were hand-searched, as was the reference list of an existing review on the broad impacts of COVID-19 on neuro-diverse populations [21]. The preprint server PsyArXiv was searched using the term ‘WFH’ and the first 50 results of a Google search for ‘neuro-divergent WFH’ were screened. Eligibility criteria to select studies for inclusion are presented in Table 1.

While we included studies whose samples drew from both neuro-divergent and neuro-typical populations, or neuro-divergent populations and other stakeholders (e.g. employers of neuro-divergent people), we excluded studies which only included employers and colleagues of neuro-divergent people. This is because much of the research on employment of neuro-divergent people focuses on employers’ perspectives and neglects the voices of neuro-divergent people themselves. We felt it was important that neuro-divergent employees’ own perspectives were the focus of the review due to the ‘nothing about us without us’ campaign [24].

Studies were downloaded to EndNote (Version X9). Duplicates were removed, titles and abstracts were screened by two authors and any clearly not relevant to the research question were excluded. Full texts of remaining citations were downloaded and read by two authors; any not meeting all inclusion criteria were excluded. Reference lists of studies meeting all criteria were hand-searched for additional studies. There was an agreement rate of 99% between the two authors; the single disagreement was easily solved after a short discussion.

To chart the data, an extraction form was developed (File 3, available as Supplementary data at Occupational Medicine online). Extracted results were imported into NVivo (Version 12) software where principles of thematic analysis [25] were used to collate, summarize and analyse findings. First, the results of each paper were read multiple times to familiarise the author with the data. Next, initial codes were generated: for example, data relating to the use of technology (including emails, hybrid meetings and video calls) were all initially coded as ‘technology’. Similarities between codes were identified and the first author grouped codes into analytic themes (e.g. codes relating to the perceived impact of background noises, bright lights or unwanted physical contact were all included together within the sub-theme: ‘Control over the sensory environment’). All authors reviewed the themes to ensure they reflected the data corpus.

Quality was assessed using the AXIS tool [26] or the Critical Appraisal Skills Programme Qualitative Checklist [27] depending on the study design. Both tools had one or two questions modified slightly so that yes/no responses were possible. Based on the cut-offs used in a previous review [28] studies were rated ‘poor’ if they scored under 30%, ‘moderate’ if they scored 30–60%, ‘good’ if they scored 61–80% and ‘very high quality’ if they scored +81%.

Results

Database searches yielded 275 citations, of which 105 duplicates were removed. Following title screening, 111 citations were excluded and a further 42 were excluded based on the abstract. Full-text screening resulted in eight exclusions and nine inclusions. Studies excluded at the full-text stage [29–36] are described in Table 2. Hand-searching resulted in 10 additional studies being included, and screening of Google results identified 6 additional articles, leaving a total of 25 studies [37–61] included in the review. A PRISMA flow diagram is presented in Figure 1. Study characteristics are presented in File 4. Most studies (17/25) were rated as either ‘good’ or ‘very high’ quality; qualitative studies were generally higher in quality, although they tended to lose points for not adequately considering the relationship between researcher and participants. Quantitative studies most often lost points for not reporting response rates or not adequately discussing non-responders. Thematic analysis resulted in the identification of four main themes (see Table 3, available as Supplementary data at Occupational Medicine online).

Within Theme 1: Overall impact of WFH on mental health and occupational outcomes, only two studies carried out statistical analysis to examine the impact of WFH on neuro-divergent workers [42,46]. One examined how psychological and occupational well-being changed over time following the shift to homeworking at the start of the COVID-19 pandemic [42], finding that neuro-divergent participants still physically reporting to work showed no change in emotional distress whereas those WFH showed a marginally significant increase in distress. WFH was not associated with change in job satisfaction but was associated with a significant decline in satisfaction of psychological needs for competence (e.g. feeling capable) and autonomy (e.g. feeling that their choices were based on their interests and values). Conversely, another study [46] found that participants with ADHD who were hybrid working had significantly lower depressive symptoms than those working fully on-site. In this study, the location of work did not predict productivity or quality of life for participants with ADHD. However, for neuro-typical participants, hybrid and homeworking were associated with higher depressive symptoms, presenteeism, work impairment, activity impairment and lower quality of life.

One study [49] found that 34% of participants (‘n’ not reported) believed that WFH had helped their focus and increased their productivity, although 23% said WFH made them ‘more aware of the challenges they faced’. Qualitative findings showed that many participants believed WFH helped them to feel less anxious [60], less exhausted [48] and more relaxed [60] and improved their productivity and mental health [45].

Within sub-theme: ‘Work-life balance and blurred boundaries of work and home’, many participants (in primarily qualitative studies) described struggling with work–life balance when WFH, particularly when work needed to be balanced with childcare and home-schooling [50]. Working in the home meant there was no clear division between home and work environments, which made it difficult to maintain an appropriate balance [39,42,44,48,55,57,58]. Some participants described the lack of transition between work and home, making it difficult to unwind, describing how bringing work into a place that should be calm and secure could be emotionally harmful [42]. Needing to use the same space for work, hobbies and relaxing was difficult and participants who had to work from their bedrooms found this negatively affected their productivity and mental health [39]. Many participants, without the presence of managers to monitor their working hours, dedicated extreme hours to their work [42,43,55]. Additionally, some described confusion between home and work boundaries as negatively affecting self-identity, as they had different ‘work personas’ that they had to negotiate when WFH [60]. Conversely, some participants with ASD reported increased work–life balance because they could manage their time more freely and spend more time engaging in hobbies [42].

Participants in six studies spoke positively about the increased flexibility of WFH (sub-theme: ‘Reduced structure of the working day’). They could create working schedules suited to their own needs, rather than limited to the rigid hours of the workplace [61]. This meant they could choose to work during the hours they were most effective [57,59], taking breaks when needed [39,50], allowing them to feel they had greater autonomy [42,60]. However, while many praised homeworking for its flexibility, others struggled with a lack of structure. Homeworking was described as requiring good self-management skills [41] and some described struggles becoming motivated and managing their time [47]. For some, the lack of structure negatively impacted waking and sleeping hours [58] while for others it left time for self-deprecating thoughts and anxiety [42]. Some reported a loss of motivation for self-care and exercise routines, which was believed to contribute to stress and exhaustion [39].

Within Theme 2: Changes to physical environments was a Sub-theme: ‘Control over the sensory environment’. Participants in 11 primarily qualitative studies reported WFH afforded them increased control over their sensory environment. This was generally seen as a benefit of WFH and an improvement from the sensory overload often experienced in the workplace. For example, when in the workplace (rather than at home) participants often struggled with distracting background noises, overly bright lights, odours and unwanted physical contact, all of which caused substantial sensory distress [54, 58, 60] and could reduce focus, productivity [39] and cause fatigue [60], particularly for those with ASD. By contrast, at home participants could create comfortable, quiet, less overwhelming environments suited to their needs [39,47,54,55,57–59,61] with autonomy over temperature, lighting and noise [39,42,52,55,57]. This reduced sensory overload [38,55,57,58], helping employees focus [52]; preventing them from feeling drained [39]; increasing their tolerance of others [54]; improving perceived mental health [54] and reducing meltdowns [38]. Due to the absence of sensory triggers, spare time was not taken up with recovering from sensory overload and could instead be spent on other activities [60]. However, some participants expended considerable effort configuring home workspaces appropriately, and noise and interruptions from cohabiting family members or roommates could cause sensory overwhelm [39].

Ten studies discussed the fact that WFH removed the need for commuting (Sub-theme: ‘Lack of commuting’), which was generally, but not always, seen as positive. Many participants cited not needing to commute to work as a benefit of WFH [38,41,54], suggesting that not using public transport reduced their stress [47]; removed concerns about crowds and noise [57]; positively affected mental well-being [39]; was more convenient [57]; increased focus and productivity [39,41]; saved time and energy [39,57] and allowed more time for sleep [42] and learning new technological skills [60].

However, some described missing their commute routine [52] or felt that no longer having to get up early to commute to work had negatively affected their sleep cycle [54]. The exercise and alone time of commutes sometimes benefited mental health as well as acted as a boundary marker between work and home, helping to transition from one to the other [44]. Additionally, participants with ASD in one study [50] described worrying about returning to in-person work because they feared they would be exhausted from sensory overload on their commute due to being out of the habit.

Some participants described difficulties configuring accessible workspaces (Sub-theme: ‘Challenges of turning the home into a workspace’): this was difficult for those living in resource-constrained spaces [39] and others struggled with getting family members/housemates to acknowledge the use of the home as an office [48]. Participants in several studies described experiencing distractions while WFH [41,42,44,47,55,56,58,60]. People with young children at home struggled to focus on work due to noise and interruptions [44,47,60], and people with ADHD were concerned about distractions at home preventing them from working productively [56].

Participants in two qualitative studies acknowledged the benefits of learning new technological skills (sub-theme: ‘Increased use of technology’) [42,60]. However, for some, learning how to use the technology was difficult [60] and technological problems such as poor internet connection and sound issues on video calls were cited as challenges [42,60].

Participants in several studies described an increase in emails when WFH. For some, this was preferable to speaking in person because it did not require immediate response [44,57] and was thus empowering [59] and improved communication [48]. However, some described online interactions as difficult and exhausting due to needing to interpret and process the language used in emails [51], and others [49] described feeling overwhelmed by instant messaging. The increase in notifications from various applications due to the entire workforce homeworking could make it difficult to prioritize important messages [39]. Some participants with ASD preferred in-person communication because of the availability of visual cues to ensure they responded appropriately [60]; opportunities to ask questions instantly and directly, making it easier to receive immediate feedback [42] and ability to demonstrate to colleagues that they were being productive [47]. The collaborative editing interfaces common when WFH could also be cognitively overwhelming [56].

Some participants described the benefits of video meetings (sub-theme: ‘Increased use of video calls’), suggesting they were more efficient and less complicated than in-person meetings as less time was spent on social niceties [47,60]. Online meetings were perceived by some as less anxiety-inducing than in-person meetings [54] and beneficial from a sensory perspective [57,60].

Challenges were reported. Online meetings were often more frequent and longer than in-person meetings [39,60] leading to ‘Zoom fatigue’ [49], struggles prioritizing tasks and working after-hours, which could negatively affect mental health [39]. Scattering remote meetings throughout the day resulted in short gaps between meetings where it was difficult to get into the headspace for focussed work because the cognitive switch to different tasks required more time than it perhaps would for neuro-typical colleagues, leading to fatigue [39]. Some described difficulties concentrating in online meetings [47,49], often due to background noises [37,55]. Reliance on non-verbal cues could be difficult and distracting on video calls, which failed to adequately capture facial expressions and body language making it difficult to gauge the reactions of others [37,39,60]. As a result, the professional and social rules of remote meetings (e.g. knowing when to talk and when to listen) were unclear [37,39,44,60]. Participants who used dictation features, screen readers or text read-aloud features struggled to manage multiple streams of information [39]; needing to attend simultaneously to information on chat windows and presentations could be stressful [56].

Participants provided mixed views about video calls. Some participants with ASD found eye contact to be stressful and more intense in video calls than in person [44,60]. Participants with various neuro-diverse conditions opted to switch videos off, so they did not need to suppress tics or behaviours [55,56]. Many described how seeing others’ videos could be distracting [39] but others reported struggling if colleagues did not switch videos on, as they needed visual cues to ensure they communicated appropriately [39,55].

Within Theme 3: Changes to social environment, we identified sub-theme: ‘Abrupt changes to routine’. As nearly all included studies took place during the COVID-19 pandemic, most participants had experienced an abrupt shift to homeworking which was perceived to cause anxiety [41,44,60]. The sudden disintegration of everyday routine was particularly difficult for those who disliked change and led to feeling overwhelmed [44]. Employees then had to establish new routines, which could be difficult [38,55,60], worsen stress [53] and increase workload [39]. Inboxes could be overwhelmed due to policies and guidance on WFH and increased work-related communications, leaving participants working long hours to maintain productivity [42,44].

Within sub-theme: ‘Perceived freedom of not having to engage in impression management’, participants in two studies described appreciation for being able to wear comfortable clothes when WFH: this reduced physical discomfort [44] and was perceived to enhance productivity [60]. Participants in one study [38] described how WFH made them realize how much they ‘masked’ and ‘camouflaged’ at work and the relief of no longer having to do so. Six studies discussed the perceived freedom to follow rituals or ‘stimming’ (self-stimulatory sensory regulation activities), without worrying about being judged by colleagues. For example, when on-site participants had concerns over colleagues judging them for wearing noise-cancelling headphones [39], multi-tasking [37,39], repetitive hand movements [44], doodling [55] and pacing [44]. Participants tried to cover such activities to preserve workplace relationships, fearing colleagues may think they were unfocussed [39]. WFH, however, did not require such activities to be hidden (except on video calls) [39] and they could be less hyper-vigilant over socially acceptable’ behaviours [44,59]. While this was generally viewed positively, some described fears about having to return to in-person work: they were concerned that they may have forgotten how to hide their stimming [50].

We also identified sub-theme: ‘Reduced inter-personal contact’. In some studies, participants described missing incidental contact with co-workers and missing the ‘security’ of having others around them [38,42,47,51,55]. Some were daunted about returning to in-person work, fearing they would have lost their social skills and would experience sensory overload when interacting in person again [50]. Some suggested homeworking made it harder to find time with managers and hindered the scale at which personal feedback was delivered [55]. Others viewed reduced contact more positively, suggesting social events with colleagues were stressful before WFH [60]. Many reported that reductions in small talk lessened stress and mental strain [50,57,61] and allowed for more efficient working [40,41]. In some cases, relationships with colleagues improved as participants communicated more effectively online than in-person [43].

The final theme was ‘Theme 4: Overcoming Barriers to WFH’. Participants in four studies described difficulties raising concerns about challenges they faced when WFH [37,39,52,57]. Some described difficulties voicing access concerns during remote meetings: they felt uncomfortable asking people to repeat themselves or switch their videos on to access non-verbal cues [39]. This was perceived to be particularly difficult for junior members of staff [37,39] and those in meetings with complex power dynamics, who feared being seen as ‘calling out’ others for not being inclusive [37]. Additionally, even when support was requested, it was not always received or was sometimes forgotten about [37,39].

Participants across studies described how they had overcome some of the challenges. Some found that educational webinars on homeworking with reminders to exercise and prioritize well-being had inspired healthier habits, a routine and helped them decompress [38,39,44].

Suggestions for improving the homework environment included the use of noise-cancelling headphones [44], having a separate office space to establish time and space boundaries around work and home [44], hybrid working where appropriate [39,44], keeping a clock within peripheral vision to ensure awareness of time [39] and using fidget tools as an outlet to channel energy and maintain focus [39].

In terms of support from employers and colleagues, participants suggested regular, honest, constructive feedback, when homeworking, helped to avoid misunderstandings [48,55,57]. It was suggested that managers needed to remember the ‘invisible challenges’ of neuro-divergent employees when giving directions [55], and that clearly defined goals for productivity and performance assessment, were essential [42,48].

Regarding video meetings, suggestions included allowing workers to catch up via minutes rather than attend meetings [44], the use of smart cameras for hybrid meetings (i.e. cameras that detect and spotlight active speakers) to help homeworkers better understand social cues [37], and sharing of materials both in advance and post-meeting to help workers follow along with presentations, prepare talking points and process information post-meeting [39].

Discussion

This review of 25 studies found no robust statistical analyses of the impact of homeworking for neuro-divergent workers. One study found that homeworking was associated with increased distress and reduced satisfaction, but this was based on 23 employees in Israel and it is unclear whether the results are generalizable because of the relatively small, limited sample [42]. Another found that hybrid workers with ADHD experienced significantly less distress than those who worked fully on-site [46], but this study focussed only on undiagnosed workers in Japan. This was also the only study to compare outcomes for neuro-divergent and neuro-typical workers: however, neurodivergence was not clinically diagnosed and was instead based on scores on an ADHD measure, which is not necessarily an accurate reflection of whether individuals meet the criteria for diagnosis [62].

The most prominent finding was the importance of not assuming a one-size-fits-all approach to support neuro-divergent employees who homework, illustrated by the mixed and often contradictory findings within nearly every theme. We noted both positive and negative effects of WFH: this echoes research on COVID-19 experiences generally for neuro-divergent populations [21]. For many, homeworking beneficially limited sensory overload, but this depended on living arrangements. Lack of commuting was perceived as a benefit for some but a challenge for others who liked the routine and exercise; previous reviews on WFH in the general population have only noted the benefits of not commuting [12,20].

Previous research suggests neuro-divergent people feel pressure to ‘mask’ neuro-divergent traits and behaviours in the workplace, which can be exhausting [17]. WFH provided mixed blessings on this front: many participants felt free at home to engage in ‘stimming’ (self-stimulation, e.g. repetitive physical movements) without worrying about impression management, while others reported concerns about the return to on-site work overwhelming them due to forgetting how to mask behaviours.

Some participants appreciated that WFH allowed them more flexibility, while others struggled with a lack of structure. Reduced social contact benefited some, who felt more focussed and less anxious, but was a challenge for others who missed contact with colleagues and found it difficult to communicate remotely. Blurring of ‘work’ and ‘home’ boundaries often resulted in over-working. Similarly, mixed feelings about the increased use of technology saw participants highlight greater efficiency and reduced stress, alongside struggles with processing information, focus and turn-taking during virtual meetings. Similar challenges relating to online communication have been noted in the literature on neuro-divergent students’ experiences of home-schooling [63]. Our findings also supported previous research suggesting that neuro-divergent employees may struggle to request adjustments in the workplace [64].

Many of our findings echo studies of homeworking in the general population [12,20,65]. However, it is important not to minimize the difference in experiences between neuro-divergent and neuro-typical individuals [39]: the experiences may be similar, but the impacts may not be and the energy and effort required are also likely to differ [66]. Challenges may be magnified for neuro-divergent employees, and difficulties with WFH may be more likely to have a compounding effect. Previous research suggests that neuro-divergent employees are already at greater risk of over-commitment and effort-reward imbalance [67] and research with autistic employees suggests that general occupational demands have a greater impact on their well-being than they do for neuro-typical employees [33].

Taken together, the findings generate evidence-based suggestions for employers. First, we emphasize that a one-size-fits-all approach should not be taken and identify the need for flexibility in balancing employee needs and WFH choices based on what works best for the worker with the organization’s needs. Second, our recommendations are relevant to the entire workforce—not just neuro-divergent employees. Not all neuro-divergent people will want to disclose their condition to employers [68]. Neuro-divergent employees should not be ‘singled out’ as ‘different’, as many characteristics of neuro-divergent people are also found in neuro-typical populations [15]. Many neuro-divergent employees may not have a diagnosis due to unequal access to medical diagnoses [15] and long waiting lists for assessment [69]. Additionally, the experiences described in this review’s findings are likely to also apply to many neuro-typical people. Adapting work practices to support neuro-divergent employees will benefit neuro-typical employees too. As such, adjustments informed by neuro-divergent employees should be accessible to all employees to create more inclusive environments [52]. Potential interventions senior management could implement include considering neuro-divergent workers in the development of WFH guidance; allowing flexible hours; providing equipment to help control the sensory environment; encouraging inclusive remote meeting practices and providing neuro-diversity awareness training. Line managers should encourage regular breaks; clearly communicate expectations/feedback; send relevant materials before and after remote meetings and ‘check in’ with their employees. Table 4 summarizes recommendations. Additionally, Occupational Health and Human Resources could play a role in supporting neuro-divergent employees WFH, by ensuring that managers are provided with relevant training/guidance and ensuring that the organization’s support provision is suitable for neuro-divergent workers.

We note various limitations of the studies included in this review as well as of the review itself. Most studies we found were conducted during the COVID-19 pandemic when homeworking was not voluntary and participants would have been in a period of adaptation and under additional stress. Research suggests the pandemic and lockdowns negatively affected the mental health of neuro-divergent people [21], who often experienced greater psychological burden than neuro-typical individuals due to the loss of routines [50], and so WFH challenges may have been magnified by an overall decline in well-being. Additionally, the shift to WFH during the pandemic was abrupt, which may have been particularly difficult for individuals with difficulties adapting to change (a common feature of neuro-diverse conditions). Therefore, findings may not necessarily reflect WFH outside of a crisis. Most included studies were based on small, unrepresentative samples and findings cannot necessarily be generalized to wider neuro-divergent populations; however, we note that similar findings emerged from both small and large studies. Only four studies included participants from more than one country. Most studies focussed on employees with ASD or ADHD, so little can be established as to the experiences and needs of those with less common neuro-divergent conditions. We found no research looking at new starters homeworking; work relationships established before the transition to WFH may have been protective of employee well-being.

Regarding the review itself, findings are limited by the fact that we restricted our included studies to those published in English. Additionally, we did not carry out a systematic quality appraisal of the included studies. Additional databases or a greater number of search terms may reveal additional insights.

Overall, this review provides valuable insights into the nuances of WFH for neuro-divergent staff. Our findings highlight how individuals with the same neuro-diverse condition may have different preferences and needs: something which may advantage one neuro-divergent person could cause another to struggle (e.g. commuting causing sensory overload for some but a positive work/home buffer for others). Choice and flexibility appear to be key. It is important that, where possible, managers consider individuals’ preferred working arrangements and their specific needs just as they should for any worker to optimize working conditions and consequently performance.

Funding

National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between the UK Health Security Agency, King’s College London and the University of East Anglia (grant number NIHR200890). The views expressed are those of the author(s) and not necessarily those of the NIHR, UKHSA or the Department of Health and Social Care. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising. The funders had no involvement in study design; collection, analysis or interpretation of data; writing the report or the decision to submit the article for publication.

Competing interests

None declared.

Data Availability

The data underlying this article are available in the article and in its Supplementary Material, available as Supplementary data at Occupational Medicine online.

References