Elna Saah, MD, MS, is a pediatric hematologist at Children’s Healthcare of Atlanta’s Aflac Cancer and Blood Disorders Center and an associate professor of pediatrics at Emory University.
Many of us have had casual conversations that shift our ways of being and thus our ways of approaching science, research, and clinical practice. I had one such conversation recently with the director of a large cancer center in the Southeast region of the U.S. He mentioned a piece written by the current editor-in-chief of the journal Science, Holden Thorp, PhD, titled “Science Needs Neurodiversity.”1
Dr. Thorp explained how an “evaluator” suggested in one of his encounters that he had Asperger syndrome (AS); formal evaluation then confirmed Dr. Thorp’s diagnosis. Rear-view mirror, seemingly off-handed, spot diagnoses or presumptions like this are made by people who observe us and interact with us in different settings. Because these diagnoses are not by formal evaluation, I refer to this phenomenon of presumptuous diagnoses as a “palette” of neurodiversity, rather than using the medically succinct term “spectrum” that has criteria per the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5).
What Is Neurodiversity?
Neurodiversity is an all-encompassing term that highlights the inherent variability between human minds. It includes autism spectrum disorders (ASD) — such as AS — attention-deficit/hyperactivity disorder (ADHD), attention-deficit disorder (ADD), dyslexia, and dyspraxia.
Autism is classified in the DSM-5 as ASD. Proponents for the declassification of autism as a disorder propose that the ASD brain is not abnormal or deviant in function from the neurotypical brain but has differences. These differences are inherent in the human fabric and represent individual variability seen within the population. The neurodiversity model proposes a framework that recognizes all variables in individual brain function: aptitude toward speech, numbers, specific areas of interest, focus, memory, and spatial and pattern recognition. They prefer to refer to the subgroup as autism or autism spectrum condition.2,3
ADHD and its more subliminal counterpart, ADD, are characterized by increased activity, inattention, and poor focus in some areas, while being able to hyperfocus in areas of interest and perform task switching but having poor impulse control. These traits seem to be deterrents to pursuing a medical degree, and self-reports among medical students and physicians appear lower than those in the general population.4 Despite these data, we can anecdotally recall colleagues we thought had nervous energy or were full of energy, who breezed through night calls or ER rotations seemingly with ease.
Potential Benefits of Having Diverse Brains
A provocative study, published in 2023 in the journal Autism, hypothesized that people experiencing “high rapport” or “strong social connection” were more likely to copy each other’s ideas.5 The study compared neurotype-matched to neurotype-mismatched pairs in completing a creative task of building towers. The results showed that towers built by the neurodiverse pairs had the least similarity, contrasting towers built by non-neurodiverse pairs. The researchers’ observation proposed that pairing neurotype-mismatched people fosters creativity. This would be considered advantageous in a clinical and research team.
Increasing Recognition of Neurodiversity Within Our Ranks
In our daily interactions with colleagues, teammates, and learners, we observe this “palette” of variability. It adds color and interest to our lives. How do we explain individual areas of interest or the career choices we make? Barring serendipitous encounters with mentors or patients who shape our careers, why do some choose hemostasis and thrombosis and others multiple myeloma? Pediatric hematology versus geriatric hematology? At some level, we can detect the differences; we know colleagues who deal with difficult patients and clinical situations the best, those who like outcomes research versus the folks in quality improvement, statisticians who can sniff out an erroneous conclusion. The list goes on...
Anecdotal reports of doctors diagnosed with autism or AS are steadily rising in the literature, with most of the diagnoses happening after medical school or much later in life. Some consider the diagnosis to be a double-edged sword that provides introspection into the self while creating vulnerability to prejudice and discrimination. Proponents advocate for both recognition of differences and support for learners and practitioners.6-8 Autistic Doctors International (autisticdoctorsinternational.com) was founded in 2019 in the U.K. by Mary Doherty, MBBCh BAO, an anesthesiologist diagnosed with autism as an adult. The group has more than 1,000 members, and their vision is to support, advocate for, and perform research centered on physicians and medical students with autism and educate the medical community and regulatory boards. As medical school educators, we also need to be more aware of these differences in the learners we encounter.
Expand Our Purview to Include Neurodiversity
Temple Grandin, an advocate who recognized neurodiversity as a natural phenomenon, reminds us, “The world needs all kinds of minds.”9 Because hematologists, scientists, and our collaborators are a subset of humanity, hematology needs all kinds of minds!
Clinical psychologist Simon Baron-Cohen, MPhil, PhD, a proponent of the neurodiversity movement, has demonstrated that science has more neurodiversity than other fields as the result of the self-selection of people with a high aptitude for pattern recognition, a feature of neurodiversity.1 To promote inclusion of neurodiversity in our ranks and grow from its benefits, we need to foster a safe and inclusive work environment for all “kinds of minds.” Hematology could facilitate this through screening and strengths-based coaching, career counseling, and mentoring starting in medical school, through the residency, fellowship, and junior faculty stages. We have to learn, appreciate, and maximize the palettes of differences in our ranks. As more attention is brought to the neurodiversity among us, expanding tenets of diversity, equity, and inclusion to include neurodiversity is a goal worth striving for.
Elna Saah, MD, MS
Associate Editor
References
- Thorp HH. Science needs neurodiversity. Science. 2024;384(6694):
- Baron-Cohen S. Editorial perspective: neurodiversity - a revolutionary concept for autism and psychiatry. J Child Psychol Psychiatry. 2017;58(6):744-747.
- Taylor G. Embracing neurodiversity in medicine. Aust J Gen Pract. 2021;50(3):101.
- Im DS, Tamarelli CM. Attention deficit hyperactivity disorder in medical learners and physicians and a potentially helpful educational tool. Adv Med Educ Pract. 2023;14:435-442.
- Axbey H, Beckmann N, Fletcher-Watson S, et al. Innovation through neurodiversity: diversity is beneficial. Autism. 2023;27(7):2193-2198.
- Price S, Lusznat R, Mann R, et al. Doctors with Asperger's: the impact of a diagnosis. Clin Teach. 2019;16(1):19-22.
- Duong D, Vogel L. Untapped potential: embracing neurodiversity in medicine. CMAJ. 2022;194:e951-e952.
- Moore S, Kinnear M, Freeman L. Autistic doctors: overlooked assets to medicine. Lancet Psychiatry. 2020;7(4):306-307.
- Tommy G. Thompson Center on Public Leadership. The world needs all kinds of minds. December 3, 2019. Accessed August 16, 2024. https://www.thompsoncenter.wisc.edu/the-world-needs-all-kinds-of-minds/.
The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.
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