Across Australian workplaces, the concept of neurodiversity is gaining momentum not only as a matter of inclusion but as a practical consideration for health, safety, and workforce sustainability.
Neurodiversity refers to natural variations in brain function and development, encompassing traits such as Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), Developmental Coordination Disorder (DCD), dyslexia, dyspraxia, and Tourette Syndrome. These affect not only cognition and communication but also motor coordination, sensory integration, fatigue, and physiological regulation.
For professionals working in Human Resources (HR), Occupational Health and Safety (OHS), workers’ compensation, rehabilitation, and occupational medicine, understanding these physical dimensions is important in order to effectively manage risk. Neurodivergent traits may influence injury risk, symptom reporting, recovery timelines, and the effectiveness of return-to-work interventions. Yet, these factors are often overlooked in conventional safety systems, injury management frameworks, and workplace health policies.
This article highlights the physical health and safety implications of neurodivergence, maps their interaction with workplace hazards, and provides practical strategies to support both risk mitigation and inclusive employment. It also showcases the distinctive strengths neurodivergent workers bring to diverse roles and industries arguing for a proactive, person-centred approach that improves not only compliance but culture, engagement, and performance.
The Overlooked Physical Dimensions of Neurodiversity
For many organisations, workplace neurodiversity strategies have primarily focused on cognitive traits adapting workflows, improving communication, or reducing sensory overload. However, neurodivergence often includes less visible but equally significant physical health factors that directly impact occupational safety, injury risk, and return-to-work outcomes.
These physical traits may include impaired motor coordination, reduced proprioception, joint instability, gastrointestinal sensitivity, autonomic dysfunction, and impulse regulation challenges. While not always visible, these features can affect how an individual interacts with tools, navigates physical spaces, sustains attention during physical exertion, and maintains postural safety in demanding environments.
For professionals in OHS, HR, injury management, and occupational medicine, recognising these risk factors is critical to designing inclusive, effective, and compliant health and safety systems.
Developmental Coordination Disorder (DCD)
Developmental Coordination Disorder (DCD), also known as dyspraxia, is a neurodevelopmental trait affecting motor planning, coordination, balance, and spatial awareness. Adults with DCD may struggle with tasks requiring fine motor precision, quick spatial judgment, or postural control challenges that persist beyond childhood and can be exacerbated in dynamic or cluttered work settings.
In high-risk roles such as construction, logistics, education, or healthcare, individuals with DCD are at greater risk for slips, trips, falls, and equipment-handling incidents. Navigating uneven surfaces, climbing ladders, or operating manual tools can become hazardous without appropriate adjustments or controls (Kirby et al., 2024). These risks are often underestimated, particularly in injury investigations or return-to-work planning that overlooks coordination-based impairments.
Ehlers-Danlos Syndrome (EDS) and Joint Hypermobility
There is growing recognition of the overlap between neurodivergence especially autism and ADHD and connective tissue disorders like Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorders. These conditions are characterised by joint laxity, musculoskeletal pain, frequent subluxations or dislocations, and symptoms of autonomic dysfunction, including orthostatic intolerance, fatigue, and heat dysregulation (Baeza-Velasco et al., 2025).
From a WHS and clinical perspective, these traits may significantly affect lifting capacity, movement stability, stamina, and safe postural endurance. In industries such as aged care, hospitality, warehousing, and manufacturing where static postures, repetitive lifting, or long shifts are common workers with EDS are at heightened risk of strain injuries, near misses, and re-injury if return-to-work accommodations are inadequate (Clark et al., 2023).
Tailored ergonomic design and modified task allocation are essential not only for prevention, but also for ensuring sustainable work participation post-injury.
Gastrointestinal, Orthostatic, and Autonomic Challenges
Neurodivergent individuals are more likely to experience comorbid gastrointestinal and autonomic nervous system conditions. Chronic gastrointestinal distress, postural hypotension, and temperature intolerance are often reported by those with autism, ADHD, or anxiety-related profiles.
These conditions can impair concentration, endurance, hydration, and cardiovascular regulation resulting in symptoms such as nausea, dizziness, blurred vision, or fainting during physically demanding or heat-exposed tasks. The risk is particularly acute in shift-based industries like transport, retail, healthcare, and emergency services, where access to food, hydration, and rest breaks may be restricted.
Without proactive support, these workers may face increased presenteeism, unreported fatigue, or safety lapses that elevate the risk of accidents, absenteeism, or prolonged recovery timelines (Casanova et al., 2020; Thomson et al., 2023).
Impulsivity and Clumsiness in ADHD
ADHD is widely recognised for its cognitive and attentional traits, but it also includes motor impulsivity, poor hazard anticipation, and reduced self-monitoring all of which carry WHS implications. Adults with ADHD may move quickly without checking their surroundings, interrupt task sequences, or overlook environmental hazards, particularly under time pressure or boredom.
In high-paced or hazard-dense settings such as kitchens, laboratories, first response, or logistics these tendencies can contribute to increased incidents involving cuts, burns, equipment misuse, or procedural deviations. Far from being reckless, these behaviours stem from ADHD’s neurological profile, which prioritises fast action and external stimulation over risk scanning and procedural compliance (Barkley, 2014; Malloy-Diniz et al., 2007).
This has implications for task design, incident analysis, and supervisor training, especially where performance issues are misunderstood as behavioural rather than neurocognitive in origin.
The Worker is not the Hazard – Misapplying Risk in Neurodiversity Management
In safety-critical industries such as rail, aviation, mining, emergency services, and transport, the obligation to ensure public safety is both valid and paramount. However, this responsibility is sometimes misapplied when neurodivergent individuals are treated as inherent risks, rather than workers with unique profiles that can and should be evaluated on the basis of functional capacity and task compatibility.
This can result in a misuse of the hierarchy of control, where organisations bypass the accurate identification and assessment of risk and jump straight to the highest level in the hierarchy of control, elimination. In effect, this removes the person, not the risk.
This Looks Like in Practice
This flawed approach typically manifests in the following ways –
- Over-reliance on outdated or excessively conservative medical standards during pre-employment or fitness-for-duty processes;
- Automatic disqualification based on diagnosis alone (e.g., ADHD, autism spectrum disorder, developmental coordination disorder), with no exploration of actual work-related impairment, functional capacity or genuine risk;
- Failure to consult with the candidate, treating clinicians, or occupational physicians to accurately quantify risk and determine an appropriate and effective method or methods of control aligned with the inherent requirements of the role.
This is not only poor risk management, but also legally risky and may breach obligations under the Disability Discrimination Act 1992 (Cth) and WHS laws.
Worse than that, such approaches are counterproductive and arguably increasing overall risk by acting as a compelling disincentive for affected workers from seeking diagnosis, treatment and support thus driving the risk underground, concealing the risk rather than allowing the Person Conducting the Business or Undertaking, who owns the Primary Duty of Care, to actually manage the risk.
In Annovazzi v State of New South Wales – Sydney Trains (2023) the Federal Circuit and Family Court found that Sydney Trains unlawfully discriminated against a trainee train driver, Renee Annovazzi, after removing her from the training program and ultimately terminating her employment. The sole reason? Her disclosure of ADHD and Asperger’s Syndrome (Level 1 Autism), despite having passed all required assessments and performing competently.
Sydney Trains claimed the decision was due to a failure to disclose her diagnosis during her pre-employment medical screening. However, the Court found no evidence of dishonesty. The Appellant had verbally disclosed her diagnoses to the examining medical officer even though these were not explicitly disclosed on the Pre-Employment Health Questionnaire.
It ruled that, but for the Appellant’s disabilities (ADHD and Autism) the employer would not have argued that her conduct was dishonest, and they had terminated her employment on the grounds of her diagnoses alone, rather than any demonstrated risk created by her neurodivergent functioning. This amounted to direct disability discrimination for which the employer was liable.
The key takeaway for OHS and HR is that employers must focus on the individual’s functioning not their diagnosis. Where no evidence of impairment or risk is present, exclusionary action is unlikely to be legally defensible.
In Nam v Civil Aviation Safety Authority [2023] AATA 3574, the Administrative Appeals Tribunal reviewed CASA’s refusal to grant a Class 1 or Class 2 medical certificate to a licensed pilot with inattentive-type ADHD, managed with methylphenidate (Ritalin). CASA’s rejection was based on generalised concerns about medication and neurodevelopmental risk.
However, the Tribunal found no evidence of functional incapacity, safety risk, or performance impairment and held that the applicant met the required medical standards. The matter was remitted to CASA, with clear instructions, a diagnosis alone is not justification for disqualification.
The implication for occupational physicians and regulators is that fitness for duty assessments and pre-employment medicals must be individualised, evidence-based, and tailored to the actual task demands not diagnosis-driven or pre-emptively exclusionary.
A more complex picture emerges in the follow-up decision of Nam and Civil Aviation Safety Authority [2025] AATA 596. After the Tribunal initially remitted CASA’s refusal to issue a medical certificate, CASA conducted a second, more structured review, this time drawing on a formal panel of aviation medical experts. While the applicant’s clinicians maintained that his ADHD was well-managed and posed no safety concern, CASA’s expert panel highlighted the unresolved risks of stimulant medication in aviation contexts and the potential for executive function deficits to impact safety.
The Tribunal ultimately upheld CASA’s decision, distinguishing it from the earlier case on the basis that the refusal was now supported by specialised, task-specific evidence rather than a generalised reliance on diagnosis. This outcome illustrates how regulatory agencies can lawfully deny certification where they demonstrate a defensible, evidence-based risk assessment, but also shows how that bar must be met. The contrast between the two Nam rulings signals a shift. It is not the diagnosis itself, but the quality and specificity of the regulator’s reasoning, that determines legality.
Together, the Annovazzi and Nam decisions illuminate a critical tension in safety-critical employment, the need to uphold public safety while avoiding discriminatory exclusion of neurodivergent individuals. Both cases reinforce that medical certification and employment decisions must be rooted in individualised, evidence-based assessments rather than assumptions tied to diagnostic labels. For regulators and employers, the message is clear, rigid or diagnosis-driven exclusions will not survive legal scrutiny unless supported by a transparent, task-specific risk analysis.
For policymakers, these cases suggest the need for clearer national guidance on how neurodivergence should be assessed in high-risk sectors, balancing safety with the rights of workers to fair, inclusive participation. The future of work in safety-sensitive environments depends not on eliminating difference, but on intelligently managing it.
Why Functional, Inclusive Risk Assessments Matter
These cases reinforce a critical principle for all professionals involved in employment, safety, or medical certification decisions, the presence of a diagnosis does not equal incapacity or unfitness.
Treating neurodivergent workers as blanket risks without individualised, job-specific assessment:
- Violates anti-discrimination legislation;
- Undermines the effectiveness of WHS systems;
- Discourages disclosure and leads to unmanaged or hidden risks;
- Erodes trust in organisational safety culture and legal compliance.
Instead, organisations should adopt inclusive risk management practices that:
- Focus on functional impact, not diagnostic label;
- Involve consultative planning with the worker and medical advisors;
- Use risk control strategies aligned with ISO 45001/45003 and Safe Work Australia codes.
When Workers Become the ‘Hazard’
Rather than assessing how specific neurodivergent traits interact with task demands and work environments, some employers default to viewing the individual themselves as the risk. This leads to a misuse of the hierarchy of controls, jumping straight to the highest level, elimination, without undertaking appropriate individualised risk assessment.
In practice, this presents as –
- Overly broad or outdated medical standards used in pre-employment or fitness-for-duty assessments;
- Blanket exclusion of candidates based on diagnoses such as ADHD, autism, or DCD, regardless of actual impairment or job relevance;
- Refusal to engage in consultation about risk mitigation or consider reasonable adjustments.
This approach is not only ethically questionable it is also strategically flawed.
The Consequences of Overreach
This elimination-first mindset drives neurodivergent candidates to avoid formal diagnosis for fear of disqualification, and therefore miss the opportunity to better understand, manage and treat their neurodivergence; or withhold the medical information, creating blind spots in workplace risk systems.
Ultimately, these actions undermine WHS outcomes. An employer cannot manage a risk it does not know exists and undiagnosed or undisclosed neurodivergence remains invisible to the system.
A Risk-Based Alternative – Function, Not Diagnosis
Instead of defaulting to diagnostic labels, function-based, context-sensitive assessments should guide decisions about safety suitability. Here’s how neurodiversity-informed risk assessments can support better outcomes:
Role: Emergency Services – Task: Rapid Response Driving (ADHD)
Poor Practice: Exclusion based on ADHD diagnosis alone
Good Practice (Risk Phrase):
“Workers with impulsivity traits may benefit from additional hazard scanning training and reduced fatigue exposure during response shifts.”
Control Measures:
- Structured rest rosters
- Enhanced pre-shift briefings
- Visual traffic hazard maps
Role: Construction – Task: Ladder Work (DCD)
Poor Practice: Automatic exclusion due to dyspraxia label
Good Practice (Risk Phrase):
“Workers with motor coordination challenges may be at higher risk during ladder use; task allocation or team-based work may reduce exposure.”
Control Measures:
- Assigning alternative ground-based tasks
- Training in safe ascent/descent technique
- Visual hazard cues on worksites
Role: Nursing – Task: Manual Handling (EDS)
Poor Practice: Failure to consider adjustment requests
Good Practice (Risk Phrase):
“Workers with hypermobility-related joint instability may require reduced manual lifting or use of mechanical aids to prevent re-injury.”
Control Measures:
- Team lifting protocols
- Rotating shifts with low-lift patients
- Early physiotherapy reviews post-injury
A Safer, More Inclusive Approach
Employers, occupational physicians, and injury managers must evolve from exclusionary practices toward evidence-based, context-aware risk assessments that balance legal duties, practical job demands, and employee dignity. This includes:
- Separating medical diagnosis from job suitability
- Documenting task-specific risks, not person-based fears
- Using consultation, not gatekeeping, as the first response
Beyond the Challenges – Neurodivergent Strengths in the Workplace
However, employers who adopt a strength-based approach to neurodiversity report significant benefits in innovation, teamwork, and resilience.
Neurodivergent workers often demonstrate:
- Exceptional pattern recognition and problem-solving, especially among autistic individuals working in analytics, quality assurance, or engineering.
- Creative ideation and adaptive thinking, common in ADHD profiles, which can drive product development, marketing strategy, and rapid decision-making under pressure.
- Empathy, tenacity, and people-centred insight, frequently observed in individuals with dyslexia or dyspraxia, especially in roles involving counselling, aged care, and community engagement.
- Unusual resilience, developed through managing chronic physical or sensory issues, which translates into strong stress tolerance and adaptability in high-change environments.
Rather than framing neurodivergent profiles purely in terms of limitation, OHS practitioners and managers are encouraged to view them as untapped assets. Job redesign, universal design principles, and inclusive leadership can unlock this potential.
Mitigation Strategies – From Risk to Resilience
Workplace safety systems can and should evolve to reflect a neurodiversity-informed approach. This includes both universal design measures and individual accommodations made through a consultative risk assessment process.
1. Job and Task Matching
Align roles with the natural strengths and needs of each employee. For example:
- Assign analytical or repetitive precision tasks to autistic workers who thrive in structured environments.
- Limit physically repetitive tasks for staff with EDS or joint hypermobility.
- Allow ADHD employees to switch between tasks to maintain focus and reduce fatigue.
2. Environmental and Engineering Controls
Modify the physical workspace to support sensory, postural, and motor needs. Examples include:
- Ergonomic workstations with adjustable desks and chairs
- Anti-fatigue flooring or mats in standing roles
- Provision of left-handed or adapted tools
- Use of clear, visual safety instructions and zoning cues
- Break spaces with low sensory stimulation
3. Administrative Controls and Training
Update administrative protocols to reflect inclusive practice:
- Incorporate neuroinclusive language and graphics in safety briefings
- Provide rest breaks aligned with autonomic regulation needs
- Introduce fatigue management policies for neurodivergent shift workers
- Schedule physically intensive tasks when support is available
- Use peer-support systems to review safety practices without stigma
4. Supportive Workplace Culture
Culture change is the cornerstone of safety and inclusion:
- Encourage safe disclosure of disability or neurodivergent traits without fear of discrimination
- Train supervisors in neurodiversity awareness, including hidden physical challenges
- Empower employees to propose and trial reasonable adjustments
- Recognise and reward inclusive safety innovation
Risk Assessment Tools for Neurodiversity
Standard risk assessments often overlook the interaction between neurodivergent traits and task hazards.
Custom-developed framework draws on Safe Work Australia’s Code of Practice (2011) and ISO 45001:2018 to bridge this gap.
This neurodiversity-informed tool incorporates variables such as:
- Physical symptom fluctuation (e.g., fatigue, pain)
- Sensory integration and motor control
- Communication and hazard interpretation
- Environmental stimuli sensitivity
Trial case studies demonstrate its application in identifying overlooked hazards—for instance, delayed hazard perception in ADHD kitchen staff, or joint strain during morning lifts in EDS-affected aged care workers.
Conclusion
Incorporating neurodiversity into WHS policy and practice is not only a matter of fairness and inclusion it is increasingly a regulatory and strategic imperative. Under the Disability Discrimination Act 1992 (Cth) and contemporary expectations of psychosocial and physical risk management, workplaces that fail to consider the full spectrum of neurodivergent needs may face legal and reputational risks.
More importantly, by understanding both the physical risks and exceptional strengths neurodivergent individuals bring to the workplace, Australian organisations can build safer, smarter, and more responsive workplaces.