Hidden disabilities – are you paying attention?


hands holding up jigsaw pieces representing hidden disabilitiesHow we can all help facilitate a safe, supportive and efficient working environment

Principal UX and Ergonomics Consultant, Helen Cheetham exposes some of the unseen problems that employees with hidden disabilities battle every day. Her article highlights how easily they can be overlooked, and explores ways managers and colleagues can help to facilitate a safe, supportive and efficient working environment for everyone.

Helen Cheetham has a background in occupational therapy and a decade’s experience completing ergonomics and accessibility workplace assessments for people with a multitude of long and short term impairments and hidden disabilities. The people she assesses often confide in her that colleagues frequently forget or find it difficult to understand certain conditions they have; especially if there are no obvious symptoms or causes. Similarly, they say managers often overlook simple measures that would make their working life much easier.

Mental health issues

fragmented head image representing mental healthOne in six people experience a common mental health problem (such as anxiety, depression, bipolar disorder, schizophrenia or stress) in any given week; leading to 12.7% of all sickness absence days in the UK (Mental Health Foundation, 2016). While once a taboo subject, mental health issues are now in the public eye and are finally being given the attention they require.

Quick wins

Here are some quick wins for supporting people with mental health issues in the workforce.

  • Flexible working. Encourage employees to make use of flexible working options to better balance their work and personal lives. Flexibility over working locations and hours helps lower stress levels, providing those unable to handle an office environment on a given day with a way of completing their work in a calm and non-daunting place.
  • Workplace support interventions. Offer interventions including employee screening and basic care management, such as counselling and/or cognitive behavioural therapy. Studies have found that a small, short-term investment pays dividends in the long-term.
  • Promoting wellbeing at work (for example via tailored advice; a stress survey; risk-assessment questionnaire; seminars; workshops and information sheets; etc) is proven to deliver significant cost savings from reduced presenteeism (lost productivity due to an employee working while ill) and absenteeism (missing work due to ill health).
  • Open communication channels and regular catch ups between employees and their line managers make it easier for staff to voice concerns, difficulties and requests for change. This helps dispel anxieties and creates a more supportive working atmosphere.

Chronic pain/fatigue issues

Most of us would take the day off sick if we were experiencing acute or severe pain, or would at least ask others to make allowances for our reduced productivity. However, two in five people live with chronic pain lasting for three or more months (British Pain Society, 2016).

Like mental health issues, there can be a reluctance to talk about chronic pain because hidden disabilities aren’t as evident as other conditions. Exercise and continuing with work and other daily activities are key to chronic pain management (and the negative spiral that isolation from a familiar routine can lead to), so here we suggest some ways to support sufferers in the workplace:

  • Chronic pain/fatigue sufferers will doubtlessly have good days and bad. So offering them flexibility in their work tasks, pattern and location will facilitate them working to the best of their ability; being more active on good days, and working from home with more regular rest breaks on bad days. Flexibility also enables employees to manage their energy levels and conduct their prescribed exercises/stretches that may be required to help manage their condition.
  • Budgeting energy reserves and activity levels is essential for people with chronic fatigue/pain. Therefore, delegate tasks and locate people/meetings wisely to ensure people with limited energy/activity levels avoid ‘wasting energy’ on trivial things like getting to their desk (at the far end of the office, up two flights of stairs) or helping to unload deliveries. Whilst they are physically capable of doing such activities, their energy would be better spent elsewhere.
  • Comfortable ergonomic equipment (especially seating) that promotes a supported and neutral posture can really help people with chronic fatigue to work more productively. A fully supported position promotes better concentration on the task at hand, while avoiding excess energy expenditure. Free-float chair mechanisms and rocking footrests, that promote gentle movement as people sit, can also help to prevent the build-up of static postural tension to significantly reduce chronic joint pain and stiffness. Allowing people to stand or sit to work can also drastically increase productivity if a person is unable to comfortably tolerate prolonged periods of sitting.


Around 10% of the UK population (6.3 million people) have dyslexia (Gov.UK, 2017). This can include difficulties with written and verbal communication, time and work planning, and/or general day-to-day tasks such as working with numbers, directions or short-term memory.

It’s important to determine the nature of someone’s dyslexia (from their diagnostic assessment) to identify how the working environment or practices may impact their performance, and what training or reasonable adjustments are necessary to mitigate hidden disabilities like this.

Top tips for helping someone with dyslexia in the workplace.

  • Specialist dyslexia software and hardware can make a drastic difference to a dyslexic person’s work quality and productivity; such as text to speech and speech to text software, digital recorders, mind-mapping software, a calculator, coloured paper or overlays.
  • Supportive working practices also play a vital part; such as providing information ahead of time and in concise and customisable written and verbal formats, highlighting key points, avoiding prolonged computer use, proof-reading important outputs and facilitating a quiet working space that’s free from distractions.
  • Most dyslexics are diagnosed in education, but performance issues or stress at work can uncover undiagnosed dyslexic difficulties. Ensure that appropriate support is given to these people, such as a referral to an occupational health and workplace needs assessor.
  • Lastly, despite dyslexia being a recognised disability, many dyslexic people have above-average skills in big-picture thinking, lateral thinking, problem solving, visual strengths and an intuitive understanding of how things work. Focus on individuals’ strengths and make the most of their talents within your business.

profile standing out from otheres representing hidden disabilitiesAutism / Asperger’s Syndrome

Approximately 700,000 people in the UK have Autism (that’s 1 in 100 people), but many people overlook or misunderstand the invisible condition. Autism is a spectrum condition that affects people differently. Asperger’s Syndrome is a form of Autism associated with intelligence and difficulties understanding and processing language. With the right support, people with autism can thrive to become valued team members with fulfilling careers.

  • People with autism often struggle with verbal and non-verbal social communication and interactions because they have a literal understanding of language, and difficulty expressing their own emotions and ‘reading’ facial expressions or tones of voice. Colleagues may mistake this for rudeness, insensitivity or unfriendliness so misunderstandings should be addressed, and time out offered when a person with autism becomes overwhelmed. Short, frequent one-to-one line management meetings offer someone with autism a place to discuss issues and how to resolve them. Speaking in a clear, consistent, concise and specific way, with time for processing and repeating information helps to ensure a mutual understanding for someone with autism.
  • Autistic people often rely on routines, are very punctual and have repetitive behaviour. A timetable or structure can therefore be useful and additional time should be given to help people with hidden disabilities like autism to prepare for and adapt to change.
  • It is common for people with autism to have sensory issues, such as over- or under-sensitivity to sounds, touch, tastes, smells, light, colours, temperatures or pain. The person’s environment should take account of their sensory needs, as sensitivities can be unbearably distracting and cause significant anxiety, or even pain. For example, a screen around their desk or noise-cancelling headphones may block out visual or auditory sensitivities.
  • Many people with Asperger’s Syndrome have very good attention to detail, are meticulous and have highly-focused interests that are fundamental to their wellbeing and happiness. Channelling these things in a positive way is imperative and may lead someone to work in their specialist interest area – leading to a very dedicated and focused employee.

Migraines and light sensitivity

It has been estimated that 6 million people in the UK (NICE, 2011) suffer from migraines, with 190,000 migraine attacks each day in England alone. Beyond throbbing head pain, symptoms can include nausea/vomiting, hypersensitivity to light, sound and other sensory stimuli, and sensory disturbances (aura).

grid of 4 people suffering from migraineMigraine sufferers have differing triggers, but common causes are stress, sleep pattern disturbances, overtiredness, dehydration, alcohol or caffeine consumption, certain environmental conditions and use of visual display units. Many sufferers will take time off work during an attack, but others may have chronic symptoms that create the need to continue ‘normal’ daily activities (including work). The focus for employers in both cases should be to create the most comfortable working environment for that person and eliminate any known migraine triggers (examples outlined below).

  • Facilitate regular breaks from screen work and a comfortable sitting posture that minimises back and shoulder tension. If screens are a problem, consider adjusting brightness and contrast settings, and/or providing anti-glare filters and/or orange-coloured screen overlays (to reduce the amount of blue light emitted from the screen).
  • Investigate and remove any visual triggers, such as bright or flickering lighting, reflective or white surfaces. Consider providing spectacle lenses designed for people with light sensitivity migraines (and worn over prescription glasses).
  • Address any other sensory triggers, such as work temperature or noise.
  • Help employees stay hydrated by providing adequate drinks facilities and comfort breaks.
  • Explore potential work stressors or sources of sleep disturbances, then strive to reduce them. For example, by setting realistic expectations or adjusting shift work patterns or times.

Hearing issues

One in six people in the UK have some level of hearing loss, while one in ten UK adults have tinnitus (Action on Hearing Loss, 2018). Even mild hearing difficulties can cause people to feel or become isolated at work, and can prevent them from realising their full potential. The increased concentration required by people with hearing difficulties to communicate effectively demands more energy, which can affect their mood and work efficiency.

Here are some simple steps to support people with hearing difficulties and encourage others to improve their communication style for people who have a hearing impairment.

  • Offer alternatives to auditory information. Consider training videos, emergency evacuation alarms etc. and ensure that policies are adapted as needed (for example, phoning in sick may not be possible for someone who is deaf).
  • Bear in mind that noises become painful and/or excessively loud at the same level for people, regardless of hearing loss – so shouting is inappropriate. Speaking clearly, patiently and at a constant loud sound level is ideal, while good lighting and a clear view of the speaker’s mouth can help with lip reading.
  • People with mild to moderate hearing loss or hearing-aid wearers are often embarrassed to tell people of their difficulties hearing during meetings, in noisy environments and/or on phone/conference calls. An informal meeting in a busy restaurant may be counterintuitive. Good positioning within a quiet room with good acoustics and soft furnishings (including carpet) to reduce noise reverberation often makes a world of difference. Hearing aid wearers may also rely on a remote microphone system.
  • Many tinnitus sufferers use gentle background sound or white noise to make their tinnitus symptoms less noticeable, so wearing earphones while they work may improve their productivity.

Hidden disabilities: your duty

Under the Equality Act, 2010, employers have a duty to make reasonable adjustments to ensure their employees are never put at a substantial disadvantage compared with anyone else because of visible or hidden disabilities they have. Studies have shown that any extra effort to accommodate a person’s needs are usually rewarded by increased effort by that employee; as they feel supported and happy, so therefore work more productively.

If you’d like to know what support your employees may need, get in touch with us to discuss our disability management services. We carry out individual assessments to identify what support can be provided to help your staff be comfortable and effective at work.

We provide Nationwide with workplace adjustments services. Read our case study here.

Speech bubbleHow we can help with hidden disabilities

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