Care for Rare – A Guideline Review Towards Inclusive Work Environments for Neurodiverse Workers

Twenty-four guidelines were quality assessed. Findings suggest that guidelines provide conceptually coherent and practice-oriented recommendations but exhibit limited methodological maturity. The results indicate strong convergence in recommended adjustments. AGREE II ratings showed high scores for scope and purpose and clarity of presentation, but consistently low scores for stakeholder involvement, rigour of development, applicability and editorial independence.

Most guidelines relied predominantly on heuristic or anecdotal evidence, with a small subset supported by empirical research. Evidence of adjustments’ effectiveness is not provided. Neurodivergence specific adjustments fall short. Guidelines mainly target employers, managers, HR professionals, union representatives, commissioners, or organisational leaders, opposed to designers, architects, built-environment professionals or specialized users such as rehabilitation professionals, policy makers or employees themselves.

Conclusions

Few guidelines have been developed with sufficient rigor. More development is needed in applicability of findings (e.g. risk management, concrete solutions and examples). Systematic stakeholder involvement across neurodivergence types and intervention-level empirical evaluation are required to support effective and equitable workplace implementation.

Objectives

A range of guidelines on the physical work environment have been developed to prevent work-related performance and health problems in neurodivergent workers, but little is known about the quality of such guidelines. We systematically reviewed the content and quality of workplace adjustment guidelines aiming to prevent, detect, and/or manage work-related performance and health problems.

Methods

We conducted systematic online and database searches (Swisscovery, Scopus, PubMed, JSTOR, ABI/Inform, Wiso-net, non-profit organisations, charities, trade unions, professional associations, private companies, design consultancies, architecture firms, academic and research institutions, government organisations, public services, EU agencies and national standards bodies) to identify guidelines. Eligibility criteria were defined in accordance with the CIMO framework.

Nine reviewers independently assessed the quality of each guideline three times using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Guideline quality was classified as high (≥80%), moderate (65–79%), low (50–64%), or poor (<50%) based on total scores.

In addition to the project team listed below, the following individuals contributed to the project as ZHAW student assistants:

• Helen Urban
• Dr. Kirsty Lauder
• Danqing Xie
• Dr. Alessandro Morganti
• Dr. Theresa Wheele
• Richard Zemp
• Dominik Robin