While the topic of disabilities often brings to mind visible markers — wheelchairs, guide dogs, sign language — many health conditions aren’t as readily apparent. It’s especially difficult to detect the barriers that prevent neurodivergent adults — those with attention deficit, autism, dyslexia or other neurological differences — from accessing fulfilling full-time employment.

The Centers for Disease Control and Prevention estimates that 2.2 percent of adults are on the autism spectrum, although the condition often goes undiagnosed, particularly in women. Joseph Riddle, director of Neurodiversity in the Workplace, estimates that “fewer than 1 in 6 neurodivergent job seekers are employed full-time at the level they should be.”

When people do land full-time jobs, they often encounter internal barriers that make it difficult to keep those jobs. “Every workplace has what’s called a ‘hidden curriculum,’” says Riddle — an implicit set of assumptions and expectations about how people behave and communicate that can be difficult for neurodivergent thinkers to navigate.

I recently received a letter from one such person who is on the verge of being fired from an employer where he has worked for 16 years. For almost a decade, Alex — whose identity is being withheld to protect his privacy and avoid causing further conflict with his employer — was a high performer, receiving excellent reviews, awards and press coverage and working with VIPs.

Then, after he asked management for help resolving a situation in which he was bullied, Alex was transferred to another department doing different work. He was unable to learn the new job quickly enough, and was transferred again. He ended up being assigned to five different supervisors in seven years.

After years of seeking medical care and therapy, Alex was diagnosed with autism.

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“Having to quickly learn a new job, then face drastic changes … can lead to anxiety for anyone,” Anthony Pacilio, a vice president at CAI Neurodiverse Solutions, said in an email. “But for a neurodivergent employee, it can be insurmountably triggering and overwhelming.”

For Alex, the earlier career success hurts his credibility when he struggles with other challenges that seem basic to neurotypical thinkers. “I have done public speaking all over the world. However, I could not do a job interview,” he said in an email. “When I can’t do something, it is … perceived as insubordination.”

“To the employer it just looks like he’s just choosing to be a problem,” says Annie Crowe, a neurodiversity and disability consultant and autism activist in Australia. However, “our experience is so fluid, and our capacity varies depending on our health and our safety,” she said.

After his diagnosis, Alex requested the accommodation of an autism advocate to help mediate his interactions at work, “the same way a person who can’t hear needs an interpreter.” Unfortunately, his request was granted only after the removal process had begun, and the outside advocate service declined to serve him until he finds a mental health provider to confirm he is “ready for coaching,” according to an email he shared.

Since his diagnosis, Alex has struggled to find doctors and therapists for continuing care. He consulted a lawyer who seemed to think he might have a valid ADA claim — but after learning he had autism, he said the lawyer “abruptly ended the call saying, ‘I’m not touching a psych case.’”

Such struggles are common, Crowe says. Autism is often viewed through a “pathologizing lens or the medical model of disability,” which treats autism as a medical condition to be cured or fixed. Crowe notes that a growing number of the autistic community prefer the social model of disability, which focuses on the environment and the systemic barriers it contains.

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While characterizing autism as a disability may be more effective in accessing accommodations under the Americans With Disabilities Act, some employers are beginning to embrace the social model, working with consultants to refine their hiring processes and offer coaching to help build and retain neurodiverse workforces.

Riddle notes that coaching to help people navigate executive functioning, sensory processing differences and social communication issues in the workplace fills the same employee development and retention function as executive coaching for business leaders and other “soft skills” training many employers already offer. It’s not an accommodation so much as a performance-enhancing benefit.

So what happens now to the employee who is seeking accommodations and support, but keeps running up against barriers?

Unfortunately, Alex’s work history at his current employer is stacked against him. Meanwhile, the stress of his pending job loss has pushed him into a state of burnout, further hurting his chances of keeping his job. “My previous success … relied on the benefits of my autistic traits being combined with an ability to ‘pass’ and ‘mask.’ When the ability to mask went away, my respect and credibility went away,” he said. “I am simply being treated as a ‘problem employee’ that needs to be pushed out.”

“I have interacted with a mix of people who never had the time or never believed me, and people who wanted to help, didn’t know how, and eventually gave up,” he said in another email. “I also think everyone involved … doesn’t like me and is sick of my [problems]. I don’t blame them, and I’m sick of this too.”