New study reveals the 'missing middle' undermining workplace neuroinclusion

Brain in Hand's report, Neuroinclusion in Practice: Neurodivergent Employees, Line Managers and the Missing Middle, combines a six-month diary study with 18 neurodivergent employees, 20 in-depth employer interviews, and a survey of 995 senior HR professionals. Across all three, the same disconnect shows up: organisations consistently believe they are doing better than neurodivergent employees say they are.

Within the employer survey, 41% of senior HR professionals rated their organisation's support for neurodivergent employees as fully sufficient. Separate research with over 1,000 neurodivergent employees found only 31% agreed. The report states that this 10-point gap means organisations systematically overestimate their own provision. Such discord signals a wellbeing issue as much as a workplace culture one.

This aligns with other stark figures cited in the report: 91% of employed autistic and ADHD respondents to an independent evaluation reported low or very low wellbeing on the WHO-5 scale, and 84% of HR professionals agreed some neurodivergent staff choose not to disclose for fear of judgement or a lack of confidence that support will follow.

Brain in Hand calls this space between organisational intent and lived experience "the missing middle": the practical implementation layer that most current approaches simply don't reach. Awareness has grown substantially, and it is not that businesses do not care. However, awareness and operational capability are not the same thing.

The line manager paradox

If there's one figure in this research likely to reorganise how HR teams prioritise their neuroinclusion budgets, it is this: a third of diary study participants ranked a supportive line manager as the single most important factor in a neuroinclusive workplace, and 44% placed it in their top three. Yet manager training remains among the least commonly adopted neuroinclusion practices, with only 15% of employers naming it their top priority going forward: well behind general awareness campaigns.

As one disability manager at a very large charity put it in the report: 'Your manager dictates what your experience is like.'

Again, managers are not necessarily unwilling. Employer interviews show managers wanting to do right by their team, but not knowing how. 'A lot of them are scared — scared of doing the wrong thing or saying the wrong thing,' one charity CEO told researchers. Another interviewee, a neurodiversity inclusion specialist, described managers who 'feel completely lost in those moments' of wanting to help but not knowing what to say.

The report identifies what is needed: practical help with the real-time question of what to do in the moment. For example, how to respond to a disclosure, or how to support a colleague who is visibly struggling. Neuroinclusion awareness campaigns remain the most common intervention organisations reach for. But awareness in isolation does not equip anyone for that moment.

Disclosure: the moment nobody's ready for

Disclosure comes up repeatedly in the research as the point where good intentions most often collide with practical unpreparedness. It is a moment of real vulnerability for the employee and one that demands confidence and follow-through from the manager. The research suggests many managers simply are not equipped for it.

Structured tools were highlighted as one way to bridge this: wellbeing passports, for instance, described by one head of equality, diversity and inclusion as 'a really nice way of having a conversation with your manager — "this is who I am, this is what I have, these are my triggers, this is the support I need in place."' Diary study participants echoed how much this mattered in practice. One described a previous manager as 'great at this' while their current one had 'no clue how to approach it,' leaving them, in their words, to deal with it largely alone.

Crucially, the report cites prior research suggesting disclosure alone does not reliably improve wellbeing. It only helps when it's followed by effective support. Policies that encourage disclosure without ensuring that follow-through, in other words, may be asking something of employees without delivering much in return.

Three organisations, three different routes to closing the gap

The report's most useful section for anyone trying to move from diagnosis to action is its trio of case studies: organisations that, despite very different sectors and sizes, converged on similar principles.

Kent and Medway Mental Health NHS Trust tackled the problem structurally. Recognising that support varied wildly depending on which manager an employee had, and how confident (or how well-resourced) that manager happened to be, the Trust introduced a central reasonable adjustments budget, letting employees request adjustments directly rather than relying on individual managers to interpret and fund them locally.

'We would never know [someone needed support] until they were almost out the door,' said Yasmin Damree-Ralph, the Trust's head of equality, diversity and inclusion. Since the change, support requests have moved from a slow, inconsistent process to something faster and far less dependent on manager discretion.

British Heart Foundation took a similar structural approach but focused heavily on embedding it into everyday systems rather than treating it as a standalone initiative. Disability manager Rae Nowicki built a cross-functional Support Needs Working Group, a new adjustments policy and proactive planning before new starters even begin their roles. Requests that once took months are now typically resolved within days. As Nowicki put it: 'I've worked with our L&D team on how to create neuroinclusive training... not just make it a separate thing.'

Lane Clark & Peacock (LCP), the actuarial and consulting firm, focused more on culture and psychological safety, aiming for an environment where staff could ask for support without needing to justify or label it. Neurodiversity lead Paul Meredith described the approach: 'Every bit we put out, we deliberately put: "here are five things you can do to support your colleagues"... So actually, how do you just make life easier for everyone?'

Senior leaders sharing their own personal experiences — during Carer's Week, for instance — helped normalise the wider conversation. 'If you have senior people demonstrating that it's OK to talk about these things,' Meredith said, 'that's how you get cultural change.'

The common theme with these three examples is: direct support for the employee; practical capability for the manager; and structural systems at the organisational level that do not rely on any one person's goodwill.

10 recommendations, three levels

The report closes with 10 practical recommendations, organised around its three-level model:

For neurodivergent employees: give people practical, portable tools (wellbeing passports, 'Working With Me' documents) to communicate their needs without repeated re-explanation; and provide direct, in-the-moment support alongside formal adjustments, not instead of them.

For line managers: move training from general awareness to scenario-based, practical capability; prepare managers specifically for disclosure conversations, since a conversation that goes nowhere can do more damage than no conversation at all; give managers ongoing, reachable support rather than a single training session; and build neuroinclusive behaviours into management standards and appraisals.

At the organisational level: centralise reasonable adjustments so they don't stall on a manager's local budget or confidence; build genuine cross-functional accountability rather than leaving neuroinclusion siloed in HR; integrate it into existing processes (onboarding, appraisals, L&D) rather than running it as a bolt-on initiative; and track neurodivergent employee experience as its own workforce metric, since — as the perception gap shows — organisations cannot be trusted to self-assess accurately.

One principle runs underneath all 10: design for everyone, and reduce the need for disclosure in the first place.

The gap is closing capability, not commitment

The report's framing, in the end, is hopeful. The evidence shows that organisations do care — 92% of senior HR professionals reported at least basic levels of neuroinclusion training, and only 14% said neuroinclusion wasn't currently an organisational priority at all. The problem the research identifies is capacity, confidence and systems.

As the report's authors put it: the question now is whether organisations can move fast enough and specifically enough to effectively implement neuroinclusive practice, in a way that is tangible for neurodivergent employees.

Neuroinclusion in Practice: Neurodivergent Employees, Line Managers and the Missing Middle was published by Brain in Hand in June 2026. Access the report here.