CHAPTER ONE NEURODIVERSITY PRIMER

In 2020, in Aotearoa (New Zealand), a not-for-profit organization Te Pou launched an online dictionary of Te Reo Hāpai—the “language of enrichment” in Māori.1 This project of creating a nonstigmatizing language for neurodiversity, mental health, and disability was funded by the Ministry of Health and the Māori Language Commission. For several years, linguists, clinicians, and, most importantly, community representatives worked to develop a positive, strengths-based language aligned with the community perspective and Māori culture. They replaced words evoking stigma and discrimination with words focused on humanity and dignity.

For example, the Te Reo Hāpai word for ADHD is aroreretini—“attention goes to many things.”2 Compare the meaning of “attention deficit hyperactivity disorder” with “attention goes to many things.” In many situations, such as when looking for food sources in the wild or working in a busy ER, attention to many things can be a benefit—not a deficit or disorder. This word is an example of both a more accurate and intentionally nonstigmatizing, nonjudgmental language.

Aroreretini may not be a perfect word—it is not possible to capture the many manifestations of ADHD and the unique forms it can take in every individual. But a nondeficit perspective is a major departure from the traditional medical approach.

Like any attempt at developing terminology, creating the Te Reo Hāpai involved negotiating alternative opinions and settling debates stemming from both the multiple dialects of Māori and differences in perspectives. For example, the Te Reo Hāpai word for autism is takiwātanga—“in his/her own time and space.”2 However, there is an alternative Māori term for autism—kura urupare, which is often translated as “treasure in around your head.”3, 4 This latter term has many interpretations, and there are likely to be shades of meaning only a native speaker would pick up on.

Still, I find these terms irresistibly beautiful. They are examples of looking at differences in human psychological functioning as just that—differences, rather than deficiencies or pathologies. And that is the very heart of the neurodiversity approach.

Neurodiversity-related terminology is still developing and there are disagreements regarding language within neurodivergent communities.5, 6 Here are some key neuro-terms as envisioned by those who developed them, which may help clarify often-encountered misunderstandings:

• Neurodiversity: A biological fact that there is a limitless variety in human neurodevelopment across the lifespan, with many neurotypes and individual differences.7, 8,9 Neurodiversity as a concept refers to the full range of variations in human cognition, emotion, and perception.
• Neurodiversity paradigm: A perspective on neurodiversity that sees it as an essential aspect of human diversity; a view that there is not one “correct” type of brain or mind, although some types of minds have been societally privileged and others have been shunned or disadvantaged.7, 8,10
• Neurodiversity movement: A social justice movement born in the 1990s to counteract the medical model of autism (also known as a deficit or pathology model) and soon expanded to include other developmental differences (e.g., ADHD, learning differences, Tourette Syndrome) and neurobiological variations. Its goal is to promote the interests of individuals and groups that have been disadvantaged and denied opportunities due to their neurobiology.7, 8
• Neurotypical: A person or people whose neurodevelopment falls within the range conventionally seen as typical by prevailing cultural standards and is enabled by their society for a given period.10, 11
• Allistic: A nonautistic person who may be either neurotypical or neuro-divergent (this more accurate term replaced the earlier/original use of “neurotypical”).12
• Neuronormative: A set of ideals, actions, and functions seen as “normal” by prevailing cultural and societal standards.13
• Neurodivergent: A person or people whose neurological development or functioning diverges from the range conventionally seen as typical (e.g., a dyslexic or dyspraxic person may refer to themselves as a neuro-divergent person; a group of ADHDers or people with a specific phobia are groups of “neurodivergent” people). Some use “neurodistinct,” “neurospicy,” and other creative variations of this term, while others prefer “neuroatypical.”7, 10 Many prefer identity-first language.6, 10
• Neurodiverse: A collective term for groups including mixed neurotypes (e.g., a group of dyspraxic, autistic, and neurotypical people is a “neuro-diverse” group).7,10,13 This term and the term “diverse” should not be applied to individuals.14
• A neurominority group: A population of neurodivergent people who (1) share a similar form of neurodivergence that is (2) largely innate and inseparable from who they are. These people also (3) experience some degree of prejudice from the neurotypical majority/larger society, are disadvantaged by societal norms and systems, or both.13

Heated arguments and misunderstandings often occur within neurodiver-gent communities and in communication between neurodivergent communities and larger societal cultures because neurodiversity as a fact, the neurodiversity paradigm, and the neurodiversity movement are all sometimes referred to as “neurodiversity.” Hence, it is important to clarify these distinctions.

Although some degree of neurodiversity is generally found in most organizations, people of some neurotypes (for example, those more sensitive to the environment or more inclined to focus on tasks rather than office politics) experience more barriers to workplace access and success. The movement for neuroinclusion in the workplace can be seen as a specific form of the neurodiversity movement and neurominority justice. Ensuring fair opportunities for those who have been excluded from and disadvantaged in traditional work environments can be accomplished by creating more flexible organizational systems that include and support a wider range of talent and productivity styles.

For example, the use of selection methods that have little or no relevance to essential job responsibilities and instead focus on neuronormative expression (such as maintaining eye contact or not fidgeting) adversely affects certain neurominority groups. Hence, one of the approaches to workplace neuroinclusion is identifying and correcting organizational practices that unfairly exclude or disadvantage neurodivergent individuals in pursuing work for which they are otherwise qualified.

Workplace improvements associated with neuroinclusion benefit individuals of many different neurotypes—including those who are neurotypical. A more accurate measurement of skills and work outcomes, along with increased flexibility and transparency, not only creates truly neurodiverse workplaces but also improves the overall work environment and strengthens organizations.

If you are wondering whether you need to identify with any specific form of neurodivergence to benefit from this book, the answer is absolutely not.

DEEP DIVE

There are some who believe that neurotypical does not exist—that everyone is in some way neurodivergent.15 However, according to an autistic psychologist and thought leader Nick Walker, this argument stems from the false assumption that “neurotypical is just a synonym for normal.”13 The belief in “normal” minds and brains is associated with the medical/pathology paradigm and does not make sense from the neurodiversity perspective. “Neurotypicality” is socially and culturally constructed. Dominant cultures operating within the “normal” versus “pathological” paradigm create cultural expectations of normativity: hence, children and adults are repeatedly told to “act normal” and not be “weird.”

The collective belief in “normal” creates an image to which people are expected to conform—or else. In my paraphrasing of Walker’s13 work, a neuro-typical person is (1) able to convincingly and reliably perform according to expectations of neuronormative functioning throughout one’s life, without unbearable suffering, and (2) chooses to maintain that performance and comply with the standards of the dominant culture. The reward for compliance with dominant standards, or neuronormativity, is the perception of “normality” and, consequently, neurotypical privilege.

For example, in many modern cultures, teenagers are expected to enjoy dance parties, and adults are expected to enjoy lively lunches with colleagues. Those are “things to do.” Both of these things are also stimulating. However, optimizing the functioning of some people’s nervous systems requires relaxation, not revving up. Research indicates that the brains of autistic youth at rest produce 42 percent more information than the average.16 This elevated resting state results in higher neurological excitation for autistic youths compared to allistics exposed to the same stimulation and likely triggers the need for protective withdrawal. Thus, some nervous systems are naturally more active and become more easily overwhelmed with additional external stimulation.16,17,18,19

There is nothing inherently wrong with having a nervous system that is more active at rest. There is also nothing inherently wrong with being highly responsive to environmental signals in the form of sounds, smells, and other sensations. Being highly attuned to sensory environments is likely an advantage in the wild, but it can be torture in revved-up human-built environments like bars or clubs.

HUMAN HAPPENINGS

As an undiagnosed autistic teenager, I tried to meet neuronormative expectations of enjoying dance parties—heavy music, flashing lights, and all. And every time, I would end up sobbing uncontrollably and feeling physically sick. I could not convincingly perform the socially sanctioned role of a “normal teenager,” which meant that I would never be particularly popular in high school.

It’s a good thing I did not care about popularity all that much.

But I did care about my career—a lot. Neuronormative work expectations, however, are often concerned with neuronormative performance more than with objective outcome performance. Most workplaces have an expectation of lunch-time socializing. For me, that usually meant a choice between experiencing the sensory overwhelm of lunch in a busy cafeteria and the resulting shutdown, or being able to do the “work work” in the afternoon. After trying for some time, I largely chose to work and take walks instead of socializing. The penalty was the loss of the neurotypical privilege of access to organizational power.

In traditional workplaces, neurotypical privilege often takes the form of rewards for neuronormative social performance, rather than for objectively measured work performance. Neuronormative social performance should not be confused with social skills. Regardless of social skills, this performance often occurs in environments that are overstimulating for people whose brains are naturally more active, taxing their neurological capacity. In effect, the socially constructed “neurotypicality norm” favors those who prefer, or at least can tolerate, the levels of stimulation preferred by those who are neurotypical. The “neurotypical brain” may not exist, but the neurotypical privilege of conforming to neuronormative expectations without making oneself sick certainly does.

BRIDGING SCIENCE AND PRACTICE

What kind of people would you rather hire?

1. A. People who behave ethically, regardless of whether they are observed or not, or
2. B. People who are likely to behave ethically when observed, but less ethically when not observed?

One may think that, at the very least, if people were doing the right thing when not observed, managers’ jobs would be much easier, right? Surveillance would not be needed, which would free up time and resources to focus on other aspects of work. If you were hiring a CFO, wouldn’t you want someone who is less corruptible?

During the decade leading up to 2020, researchers conducted experiments focused on moral choices. In many studies, participants had to decide whether to be charitable or greedy in two situations: when they thought they were observed and when they thought they had privacy. Researchers were interested in exploring differences between groups in how they behave publicly versus privately.

In 2020, an online-first publication appeared in the Journal of Neuroscience.20 It described an experimental study of moral behavior in which privacy manipulation was complemented by monitoring brain activity patterns in people from group A as compared to people from group B. The results illuminated the same between-group differences as were observed in earlier studies:

• People in group A financially supported a good cause (children’s education) and refused to support a bad cause (killing street animals) consistently, even if doing the right thing cost them some money, whether they were observed or not.
• People in group B acted ethically when they were observed. But, when not observed, and when helping a bad cause resulted in personal gain, people from group B were more likely to be self-serving. They were more willing to financially support killing the animals if that also meant more money in their own pockets.

As researchers predicted, noted differences in moral behavior were also accompanied by differences in brain activity detected with functional magnetic resonance imaging (fMRI). After analyzing the results, the research team proceeded to explain how dysfunction of the right temporoparietal junction (rTPJ) leads to higher concerns about ill-gotten gains and a lack of moral flexibility in group A individuals.

That’s right. The purpose of the study was to better understand the dysfunction and pathology in moral judgment in group A. You see, group A consisted of the “atypical”: autistic people or, in the language of the original article, “Autism Spectrum Disorder” patients. Their more consistent moral behavior was interpreted as a symptom of that disorder.

In contrast, group B was made up of “healthy controls.” The allistics—the “healthy controls”—tended to do the right thing when monitored. But they were more self-serving than autistics when left to their own devices. Following the tradition of prior studies, the researchers interpreted the more hypocritical behavior of people in group B as normal and explained it in terms of a healthy concern for their reputation. The lack of hypocrisy in autistic individuals was described as a deficit attributable to lower reputational concern.

By no means was this study particularly egregious or ill intended. It simply reflected the state of the discipline—the decades of teaching and mentoring steeped in assumptions about autistic “pathology.” Many other researchers studied the “lack of reputational concern” among autistic people in a similar way.

Back in 2011 prominent neuroscientists Uta and Chris Frith of the University College London pointed out that obliviousness to others and a lack of hypocrisy are not the same thing.21, 22 They deduced that autistic people demonstrate not a deficiency of reputational concern but a lack of hypocrisy—or, in other words, “transparent trustworthiness.” At that time, the Friths’ gentle correction was largely ignored, and studies continued to investigate autistic “deficits.”

However, as the neurodiversity movement strengthened, pathologizing interpretations of research results became increasingly likely to be called out by the public. The 2020 Journal of Neuroscience publication was met with an outcry from the autistic community, in the form of a Twitter campaign and letters to the journal editor, one of which was published along with the article when it appeared in print.23, 24 The authors quickly revised their work to address some of the concerns and remove stigmatizing language. It is difficult, however, to fully reinterpret a study stemming from a certain set of assumptions. And, unfortunately, assumptions behind a significant portion of autism studies to date have been influenced by a highly stigmatizing perspective on autism.

Research on psychological and developmental differences has been dominated by the deficit perspective for so long that this paradigm was the only way of thinking that entire generations of researchers and clinicians ever encountered. Consequently, a large part of autism research is based on the expectation that autistic reasoning and behavior are “inferior” and “deficient” by virtue of the label. For example, research findings have also been interpreted to mean that autistic people are abnormally logical, resistant to cognitive bias, and deficient in deception.25, 26

Monique Botha and Eilidh Cage from the University of Stirling described a pattern of ableist assumptions in autism research, including the use of dehumanizing language such as comparisons to apes.27, 28 They also found evidence of objectification: treating autistic people like objects whose presence within humanity must be justified by their usefulness to others. Assumptions that guide the design of studies, methodologies, and the interpretation of findings become a part of the self-perpetuating cycle of stigmatizing and pathologizing that is only starting to be challenged.28

Words used to frame human differences have consequences far beyond research. The choice to call one group of people “lacking in moral flexibility” and “disordered” rather than “morally principled” and “transparently trustworthy” creates very different consequences for this group’s well-being, position in society, and access to jobs. Likewise, the choice to call people from another group “healthy” and “morally flexible” rather than “hypocritical” creates very different opportunities for them. And there are consequences for the larger society as well. The wording and framing of research contribute to the cocreation of societal norms and the acceptability of honest versus dishonest behavior.

Let’s try the question from the introduction to this section again. Would you change your initial answer?

What kind of people would you rather hire?

1. A. The autism spectrum disorder patients, or
2. B. Healthy people?

Despite understanding the results of research on moral behavior, many would think twice about hiring “ASD patients.” Despite their best intentions and a desire to be inclusive. Despite the evidence of outstanding productivity, such as the JP Morgan findings that individuals in their autism hiring program learn much faster and are 140 percent more productive than the typical employee. In many people, the words “ASD patient” conjure visceral fears that are hard to override.29, 30 Until there is an internationally accepted nonstigmatizing language for differences associated with neurodivergence, workplace neuroinclusion advocacy remains very much an uphill battle against stigma and stereotypes.

DEEP DIVE

Deficit labeling is so powerful that people and organizations would pay to obtain certain neurodivergent advantages for themselves while simultaneously trying to cure neurodivergent people of the same characteristics. For example, there are leadership programs that help leaders be more honest. But would the same organizations that wish to increase honesty hire autistic people and promote them to leadership positions? Considering autistic unemployment rates and the thorny paths of autistic leaders, this does not seem to be the case.

However, there does exist research focused on finding the most effective ways to teach autistic children how to lie.31, 32,33

In response to the many instances of ethical failures, business ethicists call for increasing the ability of employees to see their responsibility for the outcomes of their actions and consider how their behavior, if scaled, would affect the world.34 This is, paradoxically, the very type of moral reasoning that researchers deemed dysfunctional in autistic people20—the most excluded group in the work-place.

As another example, in search of productivity advantages, many people seek focus gurus to help them get into a flow or hyperfocus.35 However, in autistics and ADHDers, hyperfocus is seen as a deficit and a symptom of the disorder in need of correction.36, 37 This is the essence of the medical model and its biasing impact on thinking. Without an “autism” or “ADHD” label, hyperfocus is framed as a highly desired state of flow, associated with people working on tasks that interest them with a level of challenge that is just right—stretching, yet within reach.38 With a label attached, however, the flow becomes a flaw—something to break rather than nurture.

The stigma associated with all types of neurodivergence is hard to override—dyslexic doctors find themselves stigmatized, bullied in medical school, and not heard by medical administrative bodies.39 Dyspraxic medical students are worried about the stigma.40 People in the ADHD community are stereotyped as deficient in character.41 People with depression and anxiety face a lack of acceptance and support in the workplace.42, 43 Media representations of neuro-divergence make us seem either scary or laughable.44 The widespread prejudice is reflected in the fact that half of surveyed UK managers stated that they do not want to hire neurodivergent people.45

If we want to live in a more just world and if we want more trust, less corruption, and higher productivity, we must override fears of the different and challenge negative assumptions. And that is the point of the neurodiversity movement.

NEURODIVERSITY NARRATIVES

The neurodiversity movement is a social justice movement challenging the traditional medical model’s view of neurodivergent individuals as disordered and in need of cure or “normalization.”46, 47 Instead, it seeks to recognize the value and diverse strengths of all neurotypes and advocates for equal rights and opportunities for neurodivergent people.

An influential forerunner of the neurodiversity movement was Michael (Mike) Oliver, a disabled British sociologist and a disability rights activist credited with developing the social model of disability in a 1983 book.48 Oliver strongly critiqued the positioning of disability within individuals and instead pointed out that people are disabled by unaccommodating environments. Rejecting the medical focus on “fixing” disabled people—regardless of how painful that “fixing” might be—Oliver emphasized the need for creating accessible environments.

Oliver’s social model of disability stresses the importance of removing barriers and creating an inclusive society that accommodates the needs of all individuals, regardless of their impairments. Or, in the case of neurodivergence, perceived impairments such as having strong ethical principles and the tendency to hyper-focus. Instead of prescribing the fixing of neurodivergent honesty and flow, the logic of the social model calls for creating environments where honesty is welcomed and productivity that comes from the flow is supported.

Oliver’s work was inspired by the disability rights movement of the 1970s and, in turn, inspired the early autism rights movement in the 1990s. Then, in 1993, Jim Sinclair published a “manifesto” of this emergent movement, now considered a classic of autism acceptance and possibly the first example of identity-first language as applied to autism.49 Sinclair also organized autistic gatherings, what he called “Autreats”—an important step in developing an autism acceptance community and Autistic culture.

Another important element in building a community was the internet. Autistic listservs and early web spaces of the 1990s allowed for unprecedented experience sharing along with cocreating the Autistic culture—and the early language of neurodiversity. The term “neurotypical” was born in Autistic culture in the early 1990s and made prominent, in a satirical context, by Laura Tisoncik, an autistic advocate. In 1998, Tisoncik launched a website named the “Institute for the Study of the Neurologically Typical” (ISNT). It was a parody exposing the biases and assumptions underlying research on autism and other neurodivergent conditions. The symptoms of “neurotypical syndrome” included preoccupation with social concerns, a lack of interest in trains, and “a denial that there’s something wrong with them.”50

Initially used to refer to nonautistic individuals, the term “neurotypical” caught on in online communities. It quickly became part of the vocabulary of both Autistic culture and the emerging neurodiversity movement used to highlight the social power and privilege differences that made neurotypicality a perceived “norm” and neurodivergence a “pathology.”

Today, “neurotypical” is meant to be a neutral and descriptive term. It acknowledges the diversity of human neurobiology and of social and cultural factors shaping the experiences of people with different neurological predispositions; for example, the much higher likelihood of harsh criticism, rejection, abuse and bullying faced by neurodivergent individuals, starting in early childhood.51, 52,53

The late 1990s were an eventful time for the neurodiversity movement. Judy Singer, an Australian researcher, wrote a sociology thesis that defined the term “neurodiversity” and contextualized it within a critique of the medical model and recognition of the diversity of human minds.8 Harvey Blume, an American journalist, published a widely read 1998 essay on positive aspects of neurodiversity in The Atlantic magazine.54 Judy Singer’s work was more extensive and academic, and although Blume’s essay was published first, Singer is credited with coining the term “neurodiversity.” Harvey Blume and Judy Singer also corresponded with each other and participated in autistic online spaces.8, 55 It is likely that both expressed the zeitgeist and the community’s desire for a cultural rather than medical framing of the autistic experience.

The late 1990s autism acceptance discussions—including both Singer’s and Blume’s work—were generally focused on Asperger’s Syndrome.8, 54 At the time, it was an accepted diagnosis that did not have negative associations with Hans Asperger’s Nazi ties or the “high functioning” superiority it acquired in the early 2000s.56, 57 However, neurodiversity thought leadership and terminology use continued to develop rapidly, leaving this narrow use behind.

In 2000, Kassiane Asasumasu, an autistic/multiply neurodivergent writer and activist, coined the terms “neurodivergent” and “neurodivergence,” which were meant to apply to a wide range of human neurological differences, from genetic to acquired.16 Soon after, in 2004, Nick Walker coined the term “neurominority” to refer more specifically to groups of people who share similar forms of innate developmental neurodivergence for which they might encounter discrimination (e.g., autistic or dyslexic people).

Damian Milton, an autistic British academic, led neurodiversity-r elated discussions in education and the workplace by advancing the concepts of the double empathy problem and of a “spiky profile” of abilities.58 The double empathy perspective counteracts the notion that autistic people are deficient in empathy and suggests that autistic and allistic people struggle to empathize and communicate with each other.59 A spiky profile signifies that neurodivergent people are more likely than the general population to have pronounced capabilities in some areas, such as math, reading, and creativity, and struggles in other areas like multitasking or task switching. Many people have since found this approach useful for explaining neurodiversity to those used to the relatively flat profile of abilities considered average or typical.

The neurodiversity movement is still young, and ideas and terminology are developing rapidly. Moreover, this movement is not represented by a single organization. Rather, it is a collection of thought leaders who take the core of the work done before them and push it forward based on new research, analysis, and their lived experience. The neurodiversity movement is a changing, or-ganic phenomenon.

DEEPER DIVE

The heterogeneous nature of the movement results in much debate and misunderstanding. One of the critical areas of contention is the relationship between the neurodiversity perspective and seeking help and treatment. Some believe the neurodiversity perspective is incompatible with seeking medical treatment or any form of therapy for distressing psychological symptoms, but the issue is more nuanced.

True, for a long time, society pathologized harmless or positive neurodiver-gent characteristics like left-handedness, strong emotions, or the lack of hypocrisy. Some earlier and even current treatments hurt more than the neurodivergent condition. Schools “treated” dyspraxic handwriting and other motor issues by humiliating students in gym class or beating someone’s hands (in my case, hand beating came from a music teacher). Relentless societal shaming of ADHD characteristics resulted in a range of negative psychological consequences.60 Electrical shock “treatments” for autistic children remain a focus of a debate between US legislatures and autistic advocates.61

The medical and educational establishment profoundly failed people like the nonspeaking autistic accessibility professional, Jordyn Zimmerman, who was not expected to be able to learn anything beyond repetitive tasks and was frequently restrained and secluded at school. But what she needed was a communication device and a bit of patience from people. With these, she went on to earn a master’s degree.62, 63

Some mistrust from the neurodivergent community toward the “cure and treatment” establishment is expected. But it is also true that it is important to address personal distress, self-harm, or harm to others, including addressing them medically. It is also true that people who need care or disability support should have access to that care and support. And while neurodivergent people may not wish to be “cured” of their ability to hyperfocus, we may need help in dealing with the consequences of lifelong bullying. Any good theoretical framework must be flexible enough to accommodate life’s complexity and compatible with common sense.

Addressing a person’s distress also does not preclude investigating whether the concerning behavior is, in part, a form of communication—and whether something in the environment might be the trigger. When it comes to adults, for example, feelings of unease in unsafe or unethical work environments are to be expected. Humans are complex, as discussed in the next chapter, and intellectual honesty requires consideration of multiple perspectives.

As I write this book, I do not claim that I will always be right. Moreover, I hope that my own understanding of neurodiversity in the workplace will further develop between the time of this writing and the time when this book will be published and in your hands.

What I can promise is my best effort to identify the most relevant and the least biased research and to provide honest and practical applications. I also promise to draw on my decades of experience and curate the most outstanding examples of inclusive organizations worldwide to inform this book.

More than anything, I will not pathologize normal human reactions to stress, overwork, and mistreatment as individual deficits. And I will aim to uphold the view of neuro-differences as kura urupare—“treasure in around your head.”4

KEY TAKEAWAYS

• The neurodiversity perspective was born in the 1990s from the desire to reframe differences in neurobiology and their psychological expression (e.g., dyslexic or ADHD thinking, autistic focus, sensory differences) as an essential aspect of human diversity rather than a pathology.
• It was informed by the disability rights movement and the social model of disability, focused on fixing the environment rather than the person.
• The dominance of the pathology perspective still affects the everyday experience of neurodivergent people, including work opportunities. It is reflected in the language used to describe neurodivergent experiences and people, which can sometimes be dehumanizing.
• The movement toward neuroinclusion in the workplace aims to create flexible organizational systems that can support a wide range of talent and productivity styles.

DEVELOPMENTAL QUESTIONS

• Did anything in this chapter surprise you?
• What does your surprise tell you about your own perspective and how it was formed?
• How can our choice of words affect the life outcomes of other individuals?
• How can you support marginalized and misunderstood populations by being more intentional in your word choices?
• What is your personal experience with neurodivergence? In what ways can it broaden or narrow your perspective on neuroinclusion?