Comparable need, unequal access: why workplace support should not depend on a diagnosis
About the research
Autistic and ADHD employees are entitled to workplace support based on what they need, not on whether they hold a clinical diagnosis. Under the Equality Act 2010, the duty to make reasonable adjustments rests on an employee’s needs and the disadvantage they face. In practice, though, a diagnosis is widely felt to make support easier to ask for and easier to secure – while diagnostic waiting lists in the UK run to hundreds of thousands of people, often for well over a year.
That raises a question that has not been tested directly: does a diagnosis track how much difficulty someone is actually experiencing, or does it act as an informal gateway to support?
This longitudinal study followed 280 employed autistic and/or ADHD adults – 203 with a clinical diagnosis and 77 without – over six months while they used Brain in Hand (BiH), a hybrid support tool combining a self-management app with personalised coaching and on-demand human support. Participants completed validated measures of wellbeing, anxiety, stress, and everyday functioning at baseline, three months, and six months. Workplace disclosure and formal adjustments were recorded at baseline, before anyone started using BiH.
Key findings
1. The two groups arrived with comparable levels of difficulty
Levels of strain were high across the whole sample. Around 70% of participants in both groups reported moderate or severe anxiety, and around 91% in both groups reported low or very low wellbeing. Average stress scores were well above general population norms.
For wellbeing, anxiety, and stress, the analysis positively supported equivalence between the diagnosed and non-diagnosed groups – a stronger test than simply failing to find a difference. Everyday functioning was the exception: the non-diagnosed group reported somewhat fewer functional difficulties, but the evidence here was inconclusive rather than establishing a real difference.
2. Despite this, access to workplace support differed sharply
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48.8% of diagnosed employees held formal workplace adjustments, compared with 28.6% of those without a diagnosis – more than double the odds.
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89.7% of diagnosed employees had disclosed their neurodivergence to a manager or HR, compared with 62.3% of those without a diagnosis.
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18.2% of those without a diagnosis had told no one at work, compared with 2.5% of diagnosed employees.
Because the groups were comparable on the measured indicators, this gap is unlikely to reflect the non-diagnosed group needing less support.
3. Both groups engaged with and improved alongside support to a similar degree
App use was near-identical across the two groups, and coaching session counts were similar. Over the six months, wellbeing, anxiety, stress, and functioning all improved significantly across the sample, with no reliable difference between groups in how much they changed.
In other words: the factors that shaped who reached support did not shape who benefited from it once they had it.
4. Disclosure explains part of the access gap – but not all of it
Disclosing to a manager or HR was associated with holding adjustments in both groups, but more strongly among diagnosed employees. Looking only at people who had disclosed narrowed the gap in adjustments from roughly 20 percentage points to roughly 15 – it did not close it. This residual difference was exploratory, did not reach significance, and rests on a small number of non-diagnosed employees who had disclosed, so it should be read as a suggestive trend rather than an established finding.
Notably, only around half of diagnosed employees who had disclosed held formal adjustments – so disclosure not reliably leading to support is not a problem confined to those without a diagnosis.
Why this matters
Among employees with comparable measured profiles, access to workplace adjustments tracked clinical diagnosis rather than the difficulties those employees reported. Diagnosis, in this sample, shaped who reached support – but not who needed it, and not who benefited from it.
This points to a disadvantage that is structural rather than clinical. Employees who are undiagnosed or waiting for assessment arrive with comparable challenges and the same capacity to benefit, yet are considerably less likely to hold the adjustments that would help them.
For employers, this suggests two practical directions: organising support around demonstrated need rather than diagnostic status, and lowering the perceived and actual costs of disclosure for those who choose to disclose. Where support depends on a manager or HR representative recognising and validating a disclosure, it is more exposed to this credentialing effect. Approaches that let employees engage with support directly – without that intermediary step – offer one route that does not hinge on a diagnostic label. Such tools are not a substitute for organisational change, and work best alongside employer training and buy-in.
A note on interpretation
This was an observational study without a comparison group, so improvement over time was observed alongside support but cannot be attributed to it. All measures were self-reported, participants received a complimentary licence for the tool, and the sample was self-selected, predominantly white and predominantly women, and limited to those working at least 25 hours a week. The baseline access gap was recorded before anyone used the tool, so it is unaffected by the incentive.
Read the full article
This paper is currently a preprint and is still undergoing peer review.
The preprint can be accessed here: https://osf.io/preprints/psyarxiv/8ruza_v1