Australia National Standard for Health Assessment of Rail Safety Workers 2024 4.9: Neurodevelopmental disorders: assess ADHD, autism spectrum disorder, disorders of intellectual development and traits at the extreme of neurodiversity for their effect on attention, behaviour, communication, cognition, perception and response to unexpected change, including comorbid conditions and the effect of treatment such as stimulant medication, individually and in relation to the task, and apply the criteria in Table 18

What does 4.9 require?

Neurodevelopmental disorders, principally attention deficit hyperactivity disorder and autism spectrum disorder, together with disorders of intellectual development and traits at the extreme of the neurodiversity spectrum that may impair safety critical functioning, are treated separately from psychiatric and neurological conditions because they are non-episodic, typically arise in childhood though they may be diagnosed in adulthood, and need their own approach. They may disturb attention, behaviour, language, social communication, cognition and perception and the response to unexpected change, so they can affect Safety Critical Work, including the shared understanding of nuance, tone and expression that group responses to emergencies rely on; ADHD's inattention, hyperactivity and impulsivity bear on emergency response, ADHD and ASD can coexist, and comorbid psychiatric and sleep conditions are common. Assessment is individualised, considers the pattern and severity of symptoms, the demands of the task, comorbidities and the effect of treatment including stimulant medication (which rarely impairs unless misused but will show on drug testing), and draws on specialist and psychological input where needed; the fitness criteria in Table 18 set when a worker is not Fit for Duty Unconditional and the conditions for Fit for Duty Subject to Review for Category 1 and Category 2 work.