In my years as a hiring manager, I interviewed hundreds of candidates and oversaw the hiring of thousands. Before the accident that left me a quadriplegic, it rarely occurred to me that a candidate who appeared sluggish or unmotivated might be living with a serious health condition. I now realize that my own judgments – sometimes harsh, often uninformed – may have dismissed people coping with degenerative illnesses.
Degenerative neurological conditions like Parkinson’s disease, multiple sclerosis (MS), ALS, and early-onset dementia are often assumed to affect only the elderly – people considered to be in “old age”. But millions of younger adults – many under the age of 60 – live with these diagnoses. MS alone affects over a million people in the U.S. under 50. Unless someone is a celebrity like Michael J. Fox or Lady Gaga, their illness often goes unnoticed.
People with these conditions face a range of barriers in the workplace that affect their ability to obtain, retain, or advance in employment. These include:
- Functional Challenges
Cognitive issues such as memory loss, slower processing, or difficulty concentrating (common in early-onset dementia or MS) can affect task performance and productivity. Motor symptoms like tremors, weakness, or poor coordination (seen in Parkinson’s and ALS) can make physical tasks challenging. Fatigue, especially in MS and ALS, can be unpredictable and disabling.
- Stigma and Disclosure
Fear of being treated differently may lead individuals to hide their diagnosis – a survey found that 88% of people with an invisible disability had negative views of disclosing their disability to employers. This can lead colleagues and supervisors to misunderstand the conditions or assume incompetence. These conditions may cause career instability because the progression of symptoms can lead to frequent absences, demotions, or forced leaves of absence. There’s a cascade effect – people have difficulty in finding new employment due to bias during interviews or concerns about longevity in the role.
- Workplace Systems and Policies
Many employers lack ergonomic tools, assistive technology, or even basic awareness of ADA-compliant accommodations. Few companies have inclusive policies that address progressive or invisible disabilities. Remote or flexible work options – which can be game-changers – are often discouraged.
- Lack of Organizational Support
Most companies don’t have disability-inclusive policies that specifically address invisible or progressive disabilities. HR departments frequently lack training in how to support employees with neurodegenerative conditions. Employees may lack access to peer support or mental health resources to help manage the emotional toll of working with a chronic illness.
Accommodations
Some companies have made an effort to hire and be inclusive of people with degenerative conditions. A few of these are:
- Microsoft: Microsoft has participated in initiatives like the ms&work campaign, aiming to address the needs of people with MS in the workplace.
- IBM: IBM’s Neurodiversity at Work programme supports neurodivergent individuals through customised onboarding, mentorship, and ongoing career development opportunities. The company also runs dedicated recruitment campaigns aimed at attracting neurodivergent talent.
- BP: BP emphasizes early support and reducing stigma associated with neurological conditions in the workplace.
- Quill Pinpoint (UK): Provides accommodations such as ergonomic equipment and flexible scheduling to employees with MS.
Supporting Neurodivergent Employees
- Adapt the hiring process
Traditional interviews can be stressful for neurodivergent people. Consider alternatives like working interviews or multiple-day assessments to give neurodivergent individuals a better chance to shine. - Offer workplace accommodations
Reasonable adjustments like flexible working hours can significantly reduce stress and improve productivity for employees with degenerative conditions. - Educate employees
Encourage training programmes that teach employees and managers how to better understand and support their neurodivergent colleagues.
The Costs of Accommodation
Hiring people with degenerative conditions is often straightforward – but supporting them well may require thoughtful accommodations. These changes aren’t always cheap or easy, especially for small businesses. But the long-term return on investment – in the form of loyalty, reduced turnover, and increased productivity – can be substantial.
- Lower turnover
Employees with degenerative conditions are more likely to stay with companies that understand and support their needs. That can significantly lower hiring costs. - Increased employee engagement
Research has demonstrated that teams that include neurodivergent individuals can have higher levels of employee engagement, and be as much as 30% more productive than those that don’t. This is especially true when the teams are focused on tasks requiring attention to detail, creativity, and innovation.
What I failed to see in those early interviews may have unfairly cost some candidates their chance. I can’t undo those decisions, but I can speak openly about the biases I held. If sharing my experience helps another hiring manager pause, reconsider, and recognize the barriers that people with invisible disabilities face – then maybe something good can come from my past mistakes.