How can we support neurodivergent paediatricians? Three trainees share experiences

This week - 18-22 March - is Neurodiversity Celebration week, and we're sharing stories about how neurodiversity has impacted the journeys of three paediatric trainees. Plus how we as a College is working to support a working environment that is inclusive for everybody.
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Neurodiversity celebration week is about reframing perceptions of neurodiversity and talking about the unique approach to working that neurodivergent individuals can bring. While doing this we want to start conversations about how we can support neurodivergent paediatricians. 

Member stories

We asked some members to tell us their experiences as neurodivergent paediatricians - their challenges and what has helped them.

"I have been particularly able to reassure neurodivergent children because of shared experience"

I’m Natalie, an autistic ST1. My autism went undiagnosed for a long time because I’m bubbly and friendly, but I struggle a lot with rejection sensitivity dysphoria and autistic burnout. This means that I get really anxious about feedback from colleagues; if it is critical, then I catastrophise and if it is positive, then I diminish it.

I mask a lot at work, which empowers me to do my job well, but then I struggle to organise my life on days off as I need a lot of extra rest to recover. I also need a lot more sleep than neurotypical people, which makes nights hard! Despite these challenges, I can connect with children and young people in different ways and have been particularly able to reassure neurodivergent children because of shared experience. I also have a great head for facts, which is helpful at exam time! 

To overcome the difficulties, I adhere to strict planning of my life outside work. I rely on supermarket deliveries and apps to manage household tasks. Minimising the burden of outside life enables me to thrive at work. I’ve also been open with my supervisors and colleagues about being autistic, which helps them to understand better about how I communicate. I’m looking at going less-than-full-time to support getting good rest between on calls.

I’d recommend other neurodivergent trainees to be open about their neurodiversity, particularly with senior colleagues who can offer support with particular challenges. My supervisor helped me to adapt existing techniques to be suitable to the ward. I’ve been privileged to have had warm understanding from colleagues and I believe openness about individual struggles reduces stigma.

"I have learnt to value and celebrate the autistic characteristics...that contribute to me being a good doctor"

My path through paediatric training wasn’t the most straightforward as I had periods of both sick leave and out of programme career break (OOPC) due to depression and anxiety. It’s only more recently that I have recognised autistic traits in myself and reflected on how these contributed to my mental health difficulties. 

The regular changes of placement really knocked my confidence. I had only just got comfortable with one group of colleagues before I had to start over with a whole new set! 

I struggled with alexithymia (difficulty identifying, describing, and expressing emotions) and as a result I didn’t see my mental health symptoms coming and didn’t communicate what I was experiencing to my supervisors until it was too late. 

The sensory aspect (particularly sounds) of an open plan working environment made it hard for me to concentrate. Something I adapted to using headphones. 

In the later stages of training, I was able to spend a longer time in one placement where I had a very supportive team, and I was able to thrive. Through counselling and using mindfulness I have learnt to regularly check in with my emotions.  

Knowing what I now know about myself has helped me to make sensible decisions and plan appropriately for transitions in my career. I have learnt to value and celebrate the autistic characteristics, attention to detail, pattern recognition, and a conscientious work ethic that contribute to me being a good doctor.

"We need to get better at... understanding that neurodiversity is just another flavour of the human condition"

Katie (Kit), ST4 Paediatrics, Pronouns they/them

It was not until my final year of medical school that I was diagnosed with ADHD and more recently I have realised I am also autistic. We are seeing more and more adult diagnoses of both conditions simply because people who did not fit the typical stereotypes of both conditions (based on typically male presentations) were missed.

Looking through some old school reports recently, there was a wealth of comments like ‘needs to concentrate more’, ‘enthusiastic but sometimes unfocused’ and ‘if they applied themselves they would do better’. However, because I was bright and always did well in exams, it was never flagged that something else was going on. 

It was during my Foundation Doctor 2 year that I made the reluctant decision to start medication for my ADHD. This was a real game changer; suddenly I could focus on tasks that didn’t interest me! It also helped at home as I became better at developing good habits and doing things I hated like household chores.

I am very open about my neurodivergence at work and it is generally well received, however, though I have experienced thoughtless comments from colleagues such as, “well, clearly ADHD is a pathology as you take medication” or “oh, you can’t possibly have autism, you’re too good at communicating”. We need to get better at thinking outside a medical model and understanding that neurodiversity is just another flavour of the human condition and can be a positive thing.

Both diagnoses have been a real lightbulb moment for me and have given me a really helpful lens in terms of reflecting on life, work as well as my strengths and weaknesses. Diagnosis and medication was the right decision for me but may not be for everyone.

There is a wealth of great resources out there, I would particularly recommend Unmasked by Ellie Middleton as a starting point and there is a Facebook group Doctors’ Inclusive Neurodivergent Group (DING).

What the College is doing

In November 2023, we set up a task and finish group of volunteers on supporting neurodivergent trainees. This group and our EDI team have been talking about what we can do to support neurodivergent paediatric trainees: how we can remove barriers they may face and create a working environment where everyone can show up as their best. 

One of the first steps to support anyone facing barriers is to listen and ask what helps them. The task and finish group has been pivotal in providing insights into the challenges the paediatric trainee journey poses and the additional support the College can provide to neurodivergent trainees. Later this year we hope to release guidance with tips, useful resources and available support using the group's expertise. 

If this is an area you are interested in and are joining us RCPCH Conference 2024, look out for a session on Tuesday 26 March on neurodiversity and inclusion: how to create a supportive educational environment for learners with neurodiversity.