POSH, plus nonvisible disabilities too

To the idea broached in the focal article that industrial-organizational psychology has focused to date on Gloss et al.’s (Reference Gloss, Carr, Reichman, Abdul-Nasiru and Oestereich2017) conceptualization of the POSH, “…Professionals who hold Official jobs in a formal economy and who enjoy relative Safety from discrimination while also living in High-income countries” (p. 329), we agree and add the concept of nonvisible disabilities. These disabilities are those not immediately apparent, or not apparent at all, and yet impair an individual’s ability to engage in daily activities and include conditions such as chronic illnesses and neurodiversity. Approximately 96% of chronic medical conditions are not visible (Disabled World, 2023) with 88% of disabled employees saying that their condition is not visible or not always visible to coworkers (Sherbin et al., Reference Sherbin, Kennedy, Jain-Link and Ihnzie2017). Overall, an estimated 10% of people in the US have a nonvisible disability (Disabled World, 2023).

To date, our field has focused overwhelmingly on non-disabled, neurotypical workers, largely ignoring the 15% worldwide who have some type of disability (WHO, 2011) and the 15–20% of the world estimated to be neurodivergent (Doyle, Reference Doyle2020). Many nonvisible disabilities are neurological in nature, particularly given that presence of a chronic medical condition increases likelihood of having or developing a mental health condition (NIMH, 2021). The term neurodiversity has become an umbrella term encapsulating those nonvisible disabilities with a neurological component. Those who are neurotypical think, learn, and behave the way most people do, with the neurotypical brain functioning as society expects. Neurodivergent individuals, on the other hand, perceive the world differently due to neurological differences such as autism, ADHD, Tourette, dyslexia, and, included more recently, mental illnesses.

Ethically, we cannot continue to ignore those of us who differ from the majority whether that difference is visible or not. Economically, the world cannot continue to ignore us. Coupled with a decreasing or stagnating population growth rate in western countries (Roser et al., Reference Roser, Ritchie, Ortiz-Ospina and Rodés-Guirao2013) is an increasing incidence of neurodiversity and other chronic conditions. The Centers for Disease Control and Prevention (CDC) reported the prevalence of autism in the United States had again increased to 1 in 36 (Maenner et al., Reference Maenner, Warren, Williams, Bilder, Durkin, Esler, Furnier, Hallas, Hall-Lande, Hudson, Hughes, Patrick, Pierce, Poynter, Salinas, Shenouda, Vehorn, Warren, Constantino and Cogswell2023) from 1 in 200 in 2000 (CDC, 2023), and this is only one type of neurodiversity. Chronic medical conditions, in general, are becoming more common (WHO, 2011). Long COVID, a new chronic condition, affects as many as one in five US adults, according to the CDC (2022) with a recent meta-analysis finding a higher global pooled prevalence of long COVID of .43 (Chen et al., Reference Chen, Haupert, Zimmermann, Shi, Fritsche and Mukherjee2022) and increased rates of depression (Perlis et al., Reference Perlis, Ognyanova, Santillana, Baum, Lazer, Druckman and Della Volpe2021).

The world, as we psychologists know, is built for those who are normal, or average. Society requires that those of us who have a nonvisible disability fit into a world (or workplace) not designed with us in mind. Those of us who do not meet society’s definition of normal pretend, by masking who we truly are. Masking allows us to keep our disability hidden, and ourselves safe from discrimination. Sherbin et al. (Reference Sherbin, Kennedy, Jain-Link and Ihnzie2017) found only 3.2% of employees self-identify to their employer. This lack of disclosure and resultant masking is not without cost. A person with an autoimmune disease might be as productive as others at work yet collapse into bed once they are home, exhausted from the additional effort required to appear healthy. A day at a typical busy, noisy office means a person with sensory processing disorder comes home weary from being over-stimulated all day. Masking occurs because of a lack, or perceived lack, of inclusion.

Per the United Nations (UN), social inclusion is one of three core elements required for sustainable development. Industrial-organizational psychologists and those with similar backgrounds are uniquely qualified to ensure the core element of inclusion is met. Workplaces lacking inclusivity and a sense of belonging are a barrier to good health and well-being, the third sustainable development goal of the UN, and also undermine Goal 8—“productive employment and decent work for all” (United Nations, n.d.).

We can be a meaningful part of the UN’s sustainable development goals by changing our mindset and broadening our focus beyond the POSH focus on the “typical” employee. Most, if not all, of us are guilty of at least occasionally falling into the trap of designing one-size-fits-all solutions that turn out to be one-size-fits-some instead. Rather than aiming for solutions that will “fit all,” explore how designing for a specialized group might improve inclusivity for all employees. Below, we use one nonvisible disability, neurodiversity, as an example of how this might be done.

Neurodiversity, which is the natural variation in the neurology of humans, is necessary. Deviation from normative strengths and challenges exist because without those deviations, our world would not flourish. The natural directness with which someone who is autistic might approach an issue can be off-putting and yet that same ability to speak up where others hesitate can lead to new insights and a more innovative product (Austin & Pisano, Reference Austin and Pisano2017) and could help avoid potentially catastrophic groupthink situations such as the Bay of Pigs (Janis, Reference Janis1983). There has been other research, enough to determine unequivocally that neurodivergent workers are worth having on the payroll. Just two examples, teams with autistic professionals are 30–40% more productive (DXC, n.d.) and individuals with ADHD take a more entrepreneurial approach (Lerner et al., Reference Lerner, Verheul and Thurik2018). Regarding inclusivity in general, employees in inclusive teams are more satisfied, less likely to leave, experience less discrimination, engage in more self-care, and have greater self-regulation (Cox et al., Reference Cox, Davis, Rock, Inge, Grant, Sip, Grey and Rock2016; O’Leary & D’Almada-Remedios, Reference O’Leary and D’Almada-Remedios2019).

Despite the benefits we bring to the workplace, living and working in a world built for the average person means that neurodivergent adults are much more likely to be unemployed or underemployed because we just do not fit what is expected of the typical employee. The unemployment rate for employable autistic adults is approximately 85% (Mahto et al., Reference Mahto, Hogan, Hatfield and Sniderman2022) with unemployment across all types of neurodiversity estimated to be 30–40% (University of Connecticut, n.d.). Compare those shockingly high numbers to the unemployment rate in the United States for June 2023 of 3.6% and the worldwide unemployment rate for 2022 of 5.8% (U.S. Bureau of Labor, 2023; International Labour Organization, 2023).

As IO psychologists, we can and should be making a difference in this space. We are beginning to demonstrate more interest in neurodiversity, for example, with eight sessions at the 2023 SIOP conference mentioned neurodiversity, autism, or ADHD in their titles compared to six in 2022, and one in 2021 (SIOP, 2023). Yet we need to do more. We can learn from the programs targeting autistic potential employees that pioneers started (e.g., Capital One in 2009, SAP in 2013, Willis Towers Watson in 2014, and JP Morgan Chase in 2015) and go further. Instead of a special program focused only on autism, we can explore how we can include a broader range of workers. We can use the concept of universal design first coined by architect Ronald Mace in 1997 (Simmons, Reference Simmons2020) to improve the learning of everyone regardless of how their brains, or bodies, operate. We can offer accommodations (modifications to a person’s environment) to all employees. We can develop processes that support employees without requiring them to first disclose. Not requiring disclosure would reach so many more people given that 88% of employees with a nonvisible disability do not tell their employer (Tillotson et al., Reference Tillotson, Laker, Pereira and Bhatnagar2023). We can change the culture of organizations through education, top-down acceptance of neurodiversity, and grassroots advocacy. More often now, we see marginalized workers starting their own employee support groups and employee resource groups (Doyle, Reference Doyle2022). We have started to see, near the bottom of some job postings, a notice that the person reading should apply even if they do not meet all criteria. This is a great step forward but this messaging needs be included at the top of these postings and made more visible and explicit. Someone who is neurodivergent tends to stop reading as soon as they hit a task for which they do not consider themselves expert. We encourage you to help make the suggestions above reality by using the expertise you already have in house (because some of us already work for you, we just have not felt safe enough to tell you).

We also call for those in research to become more involved. For those already investigating diversity, equity, and inclusivity (DEI) topics, add neurodiversity and other nonvisible disabilities to the list of those subject to discrimination, if you have not already. Find more reasons we can use to show management why those with nonvisible disabilities should be valued at work. Identify ways to increase success on the job through application of countermeasures. Does having a neurodivergent buddy work better for someone who is neurodivergent than having a neurotypical one? How effective is education at destigmatizing autism, other nonvisible conditions, and even visible ones, such as obesity? Weight stigma is one of the most pervasive prejudices worldwide (World Obesity, 2022). Does knowledge that a coworker has a nonvisible disability increase tolerance of that coworker? What accommodations significantly unlock performance potential across all workers, and offer organizations greatest return for implementing them?

Now is the time to act. In the United States, we workers with decades of experience grew up being taught that the United States is a melting pot and that we should change ourselves to fit the existing culture. Forty years ago, immigrant parents did not teach their children to speak their language because that would differentiate their children instead of helping them blend in. Today, however, equality through individualization is promoted. We hear about identity, diversity, and inclusivity. Those of us just entering the workplace today demonstrate our commitment by being 75% less likely to apply to work at a company that does not have satisfactory inclusivity and diversity programs in place (Fredman, Reference Fredman2022). We have the opportunity, even the obligation, to reframe the narrative of nonvisible disability in the workplace from one of a lack, a weakness, and a problem to one of strength, creativity, and perseverance.

Get started in your organization, or in your clients’ organizations, by selling the value of neurodiversity to top management using evidence such as increased productivity and innovation and decreased turnover. Find individuals with nonvisible disabilities in your organization by inviting their participation in sculpting a universally designed workplace. Ensure everyone at every level in the organization knows what neurodiversity and other nonvisible disabilities are. After forming your inclusive teams, determine your organization’s priorities. You might want to start with implementing an accommodations selection and management practice as part of onboarding for all employees. Or, start by empowering managers to delegate and collaborate on how the job is designed and accommodated while also encouraging employees to self-advocate and self-accommodate. See the Table 1 for a few ideas of how systems designed for a particular group can become more inclusive at all phases of the employee work experience.

Table 1. Redesigning Diagnosis-Specific Programs to Be More Universal: Neurodiversity as an Example

ND = neurodiversity.

* Neurodiversity programs currently focus on autism as the primary diagnosis.

Whether you work top-down through formal organizational channels or take a bottom-up approach through a grassroots effort, one critical piece of advice we can give you is to include people who have nonvisible disabilities, who are considered different in some way, in the process. Follow the dictum, “nothing about us without us” and you will find yourself further along the path of inclusivity and sustainable development than you could have expected.

To continue, cultivate the UN core element of inclusivity by designing solutions using a variety of lenses, such as ethnicity, gender, and nonvisible disability. Where possible, promote choice by putting more control in the hands of the employees. Our neurodiversity example demonstrates how meeting the needs of one group can also improve inclusion for the “typical” employee when we create solutions where individual customization is available and one size does not have to fit all.