This article explores the role of health screening generally, its applications in pre-employment and during employment, and delves into emerging questions about occupational neurodiversity screening.

The Role of Health Screening in Employment

Health screening serves multiple purposes: it helps identify conditions that might affect an employee’s ability to perform their job safely, detects early signs of work-related illnesses, and ensures that workers are not at increased risk of harm from workplace exposures.

Pre-Employment Medical Screening

Pre-employment medicals are a crucial part of the recruitment process for many roles, particularly those high-risk occupations in industries such as transport, healthcare, emergency services, construction, military to name a few. These medicals assess a candidate’s ability to perform job tasks without risk to themselves or others and also establish the baseline of a prospective workers’ health status at pre-employment so that changes in this baseline that may be caused or contributed to by work-related hazards can be monitored and managed. Common pre-employment screening tests include:

• Noise-Induced Hearing Loss (NIHL) – Audiometric tests identify hearing loss caused by prolonged exposure to loud noise, ensuring workers can safely work in noisy environments.
• Lung Function Tests – These tests detect respiratory issues that could be exacerbated by exposure to dust, fumes, or other airborne contaminants.
• Colour Blindness – Screening for colour vision deficiency is important for roles requiring colour discrimination, such as electricians or pilots.
• General Medical Conditions – Conditions like diabetes, hypertension, or epilepsy are screened to manage any risks associated with these conditions in the workplace.

Health monitoring during employment

Ongoing health surveillance and monitoring helps in the early detection of occupational diseases and ensures continued fitness for duty. This can include regular hearing tests for workers where noise levels are above the minimum acceptable threshold and lung function tests for those exposed to respiratory hazards as well as general health check-ups.

Lawful vs. Unlawful Discrimination

It is important to distinguish between lawful and unlawful discrimination during occupational health screening both at pre-employment and during employment.

Lawful discrimination on health and safety grounds is permissible, and even required under the Work Health and Safety (WHS) legislation as a reasonable risk management strategy when an individual’s medical condition or vulnerability places them or others at unacceptable risk of injury. For example, excluding a worker with asthma from a job involving exposure to dust, or from industrial SCUBA diving is 

justifiable, so too is excluding people with colour-blindness from work that requires accurate colour recognition such as train drivers and pilots.

However, discrimination based on personal characteristics such as age, gender, ethnicity etc. is protected under the Anti-Discrimination Acts (ADA).

Disability discrimination is a tricky issue. Under the Disability Discrimination Act (DDA) employer cannot exclude a person from employment because of a disability, where the person’s ability to perform the work safely is not affected by their disability, or where with reasonable adjustments the person would be able to perform work safely.

For example, a software developer with severe visual impairment can effectively contribute to a team by using assistive technologies such as screen readers and Braille displays. They can handle coding, testing, code reviews, and team collaboration through accessible tools. With reasonable adjustments, they can excel in high-risk, detail-oriented work environments, demonstrating that disabilities do not preclude individuals from performing intellectually demanding roles. Excluding visually impaired individuals from such positions could therefore be considered discriminatory and unlawful.

However, there are other roles where even with reasonable adjustments individuals with certain disabilities would not be able to safely perform the work safely and so excluding them from employment in that role is necessary and lawful. For example, a person with uncontrolled epilepsy will usually be precluded from work as pilots or commercial drivers, at least until their epilepsy is controlled and stable because of the risks to both personal and public safety were the worker to experience a seizure whilst operating the vehicle.

Such determinations are complex, they require skill and experience, a deep understanding of the risks involved, the ability to accurately identify and assess the risks and identify risk mitigations that may reasonably be applied.  It is often not a black and white decision. There are many shades of grey.

Neurodiversity sits firmly within the grey-zone.

Understanding Neurodiversity

Neurodiversity refers to the natural variation in the human brain that leads to differences in how all humans think and function. It is the umbrella term that refers to all of us. The human species has diversity in gender, language, ethnicity, sexual orientation and so too there is diversity in neurological functioning. Humans are a neurodiverse species, and we have neurodiverse workforces, customers, clients, suppliers and contractors, whether we know it or not.

It is estimated that whilst 80-85% of the global population has the more typical (or generalist) type of neurological functioning (“neurotypical”) and between 15 – 20% of the global population has one or more specialist (or “neurodivergent”) thinking skill (Doyle, 2020). 65% of these are of working age.

Neurodivergence encompasses traits such as autism, ADHD, dyslexia, and more. These differences can affect cognitive and executive functioning, communication, and sensory processing, influencing how individuals perceive and respond to risk, regulate attention and emotion and experience the physical environment.

Current Management of Neurodiversity at Work

Neurodivergence is usually viewed through a disability discrimination lens by employers. Workers who disclose their neurodivergence can request reasonable adjustments under the DDA. Employers are obliged to provide these adjustments if deemed “reasonable.”

Often the first step in considering a request is for the employer to ask the worker to provide a medical certificate or letter from their doctor to demonstrate that the adjustments are required on genuine disability grounds.

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There are several problems with this approach:

1. Absence of a Diagnosis – Many neurodivergent adults have never been diagnosed and may not even be aware of their neurodivergence. For those who suspect they are neurodivergent, a diagnosis may be inaccessible given the costs involved and a shortage of practitioners qualified to undertake the extensive diagnostic processes. A request by an employer that the worker provide evidence of their neurodivergence can be an inherently discriminatory practice, when such evidence may have been unattainable by the worker. The same evidence would not be required of a new mother returning to the workforce and requesting flexible work arrangements so that she may continue to breastfeed. Likewise, an LGBTQ worker would not be required to provide proof of their sexual orientation in order for leave to be granted for them to care for their same sex partner.

2. Stigma and Fear of Discrimination – Those who suspect they are neurodivergent may avoid diagnosis due to a fear of stigma or discrimination if they disclose to their employer and what this will mean for their ongoing employment. Or they may have been diagnosed and choose not to disclose for the same reason.

3. Self-Perception – Some neurodivergent individuals do not identify as “disabled” despite their challenges and would not consider requesting reasonable adjustments.

Given the estimated global prevalence of neurodivergence, it is reasonable to estimate that roughly 10% of the workforce is neurodivergent. Many (50%) experience co-morbid mental health conditions, complicating both diagnosis and management.

The fact is that MOST neurodivergent workers will never disclose it to their employer.

But if workers do not know about their neurodivergence, or do not disclose it, how is the employer able to manage the inherent risks of the work that may affect the neurodivergent worker differently.

Consider for example an autistic worker with sensory processing differences who experiences emotional distress when required to wear a full facemask for respiratory protection. This distress can lead to reduced compliance and increase the risk of exposure to the respiratory hazard as well as an increased risk of psychological injury. The employer cannot manage this risk if they are not aware of what is at the root of the worker’s non-compliance.

Is there a role for occupational neurodiversity screening?

This is a question I’m often asked, and my answer is usually “it depends on the reason for doing it”.

First let’s look at the difference between screening and profiling.

Screening is typically used to identify conditions or vulnerabilities that may impact an individual’s ability to perform their job safely, like the Ishihara test to screen workers for colour-blindness or lung-function tests to screen for respiratory disorders.

Profiling on the other hand is used to understand an individuals’ unique personality or cognitive profile, strengths, and challenge to promoting a strengths-based approach to workforce management. Insightful workforce profiling such as Myers-Briggs or DiSC assessments can provides insights into employees’ unique personality and cognitive profiles, and help employers build balanced teams and optimise talent deployment.

Neurodiversity Screening – If neurodiversity screening is used to exclude individuals from employment based only on their label (e.g. autistic, ADHD, dyslexic etc) without an accompanying assessment of functioning against the inherent requirements of the job, it may be a discriminatory practice. Unlike other medical conditions, neurodivergence is a natural variation in the human brain that accounts for 15 – 20% of the population. It is not in itself reasonable grounds for a person to be routinely screened out of employment, as we would a prospective colour-blind pilot or train driver or aspirational industrial SCUBA diver with asthma.

Neurodiversity Profiling like other profiling tools commonly used in employment (e.g. Myers-Briggs), neurodiversity profiling can help employers understand the neurodiverse composition of their workforce, assess and identify neurodivergent strengths and talents in individuals, deploy them to teams where they can balance and optimise team performance and make informed decisions about universal design features to benefit all workers. It can also promote safety and foster inclusion.

Developed by Do-IT Profiler in the UK and now available in Australia through the Neurodiverse Safe Work Initiative, the Neurodiversity Workplace Profiler is unique in this space.

When utilised within organisational teams or work groups it can help employers identify and deploy neurodivergent talent and design balanced neurodiverse teams for optimal performance.

The Neurodiversity Workplace Profiler includes within its assessment modules a Neurodiversity Screener which is designed to map the individual’s neurodivergent profile and provide an indication of whether they have traits of autism, ADHD, dyslexia etc. Whilst this is not a diagnostic tool and cannot be used to screen neurodivergent candidates or workers out of employment, it can help bridge the current knowledge gap and remove subjectivity from the process of identifying reasonable adjustments, where a formal diagnosis may not have been accessible to the worker.

Importance of Neurodiversity Awareness Training

Neurodiversity awareness training is essential for employers, recruiters, occupational health professionals, and medical examiners to correct much of the current misinformation, assumptions and unconscious biases, based on out-dated or non-evidence-based information that leads to ill-informed decisions, negatively impacting not only neurodivergent workers, but also employers by increasing risks or the concealment of unmanaged risks and depriving the employer of the strategic advantages of neurodivergent talent.

The Neurodiverse Safe Work Initiative is about to launch our new course – Neurodiverse Safe Work for HR Professionals that compliments both our accredited and non-accredited Neurodiverse Safe Work Foundations Courses.

These neurodiversity awareness training courses offer learners a deep understanding of neurodivergence at work and draws on a strong and contemporary evidence-base to give learners both the knowledge and tools to consciously design and implement neuroinclusive systems and practices.

Neurodiversity screening and profiling offers significant benefits for creating inclusive and effective workplaces. However, these must be used responsibly and with care to avoid discrimination. Neurodiversity awareness training and tools such as the ND Workplace Profiler can provide employers with the knowledge they need to be able to make informed decisions, supporting both neurodivergent workers and organisational goals.

By embracing neurodiversity, employers can harness the full potential of their workforce, fostering innovation and inclusivity in the workplace.