How Can Managers Spot When An Employee Is Struggling Without Diagnosing Them?
Short answer
Managers should look for changes in an employee’s work, behaviour, communication or attendance rather than trying to identify a condition. Notice the pattern, describe what you have observed and ask an open question privately. Focus on workplace barriers and practical support. It is not a manager’s job to diagnose someone.
Something seems different.
A previously reliable employee has missed two deadlines. Someone who usually contributes in meetings has become quiet. A team member is working longer hours but producing less. Another has started reacting defensively to routine feedback.
A manager notices the change and begins wondering what it means.
Are they overwhelmed? Burnt out? Experiencing anxiety? Could they have ADHD? Are they autistic? Is something happening outside work? Have they simply stopped trying?
Here’s the bit managers often get stuck on: you do not need to know the diagnosis to begin a useful conversation.
In fact, trying to work it out can get in the way.
The same visible behaviour can have many possible causes. Missed deadlines could relate to an unclear workload, caring responsibilities, poor sleep, workplace conflict, ill health, neurodivergence, difficult personal circumstances or a straightforward performance issue.
The manager’s role is not to choose the most convincing explanation.
It is to notice what has changed, understand what is affecting the employee’s work and respond appropriately.
That is not diagnosing. It is managing well.
What does “struggling at work” actually look like?
There is no single sign that proves an employee is struggling.
What matters is usually a change, pattern or combination of changes.
The Health and Safety Executive advises managers to pay attention when employees begin acting differently. Possible signs of work-related stress can include increased absence, lateness, nervousness, withdrawal, reduced motivation, loss of confidence, mood changes or stronger emotional reactions. The HSE also warns that these signs can have other causes, which is why they should prompt a conversation rather than a conclusion.
Managers might notice changes in several areas.
Changes in work and performance
These could include:
missed or repeatedly extended deadlines
more errors than usual
difficulty beginning or completing tasks
work being completed in the wrong order
a noticeable drop in output or quality
repeated misunderstandings about instructions
difficulty adjusting when priorities change
spending much longer than expected on routine work
avoiding particular tasks, meetings or responsibilities
working excessive hours to maintain previous output
These signs do not automatically indicate a health condition or neurodivergence.
They tell you that something may need to be discussed.
Changes in communication
An employee may:
become unusually quiet or withdrawn
stop asking questions
contribute less in meetings
appear confused by information they previously managed
become more abrupt or defensive
interrupt more frequently
send messages late at night
apologise repeatedly
struggle to explain what is going wrong
avoid their manager
Again, none of these behaviours gives a manager enough information to diagnose anything.
The practical question is whether the employee’s communication has changed and whether it is affecting them, their work or the team.
Changes in attendance and working patterns
A manager might notice:
more short-term absence
frequent lateness
difficulty returning after breaks
repeated requests to work from home at short notice
missed meetings
reduced availability
working very early or very late
not taking breaks or annual leave
Attendance changes may have many explanations. The purpose of noticing them is to understand what support or management response is needed, not to speculate about someone’s personal life.
Changes in mood or behaviour
Possible changes include:
appearing more anxious or restless
being unusually tearful
becoming irritable or easily frustrated
reacting strongly to small changes
seeming less confident
looking exhausted
becoming unusually perfectionistic
withdrawing from colleagues
appearing overwhelmed by decisions
expressing hopelessness or feeling unable to cope
Managers should not turn these observations into amateur clinical assessments.
They should treat them as reasons to check in.
Changes across the team
Sometimes the problem is not located within one employee.
The HSE identifies team-level warning signs such as more arguments, increased sickness absence, declining performance, higher staff turnover, complaints and grievances. These patterns should prompt leaders to consider whether workload, relationships, role clarity or another workplace factor is contributing.
If several people are struggling with the same process, the process may be the problem.
Why should managers look for changes rather than “symptoms”?
Searching for symptoms encourages managers to match an employee’s behaviour to a condition.
That is risky for several reasons.
First, people experience neurodivergence, stress and mental health difficulties differently. There is no reliable workplace checklist that allows a line manager to identify what condition someone has.
Second, visible behaviour is open to interpretation.
An employee who avoids eye contact might be anxious, concentrating, culturally uncomfortable with eye contact or simply tired. Someone who misses details might be overloaded, distracted by office noise, unclear about the task or dealing with something outside work.
Third, stereotypes can distort management decisions.
Once a manager decides that an employee “looks autistic” or “probably has ADHD”, they may start interpreting every action through that assumption.
A better approach is:
Notice the change. Describe the impact. Ask what is happening. Discuss what might help.
This keeps the conversation grounded in evidence.
What should a manager avoid saying?
Managers should not confront an employee with a suspected diagnosis.
ACAS advises that when an employer suspects someone may be neurodivergent, they should not ask directly about that suspicion. Instead, the employer should discuss what they have noticed and focus positively on support or reasonable adjustments.
Avoid questions such as:
“Do you think you might be autistic?”
“Have you ever been assessed for ADHD?”
“Are you depressed?”
“Is this because of your anxiety?”
“What is wrong with you?”
“You seem mentally unwell.”
“Everyone thinks you are struggling.”
“You clearly cannot cope with this role.”
These statements make assumptions, invite defensiveness and may make the employee feel scrutinised rather than supported.
They also move the conversation away from what the manager genuinely knows.
What can a manager say instead?
Start with a specific, neutral observation.
For example:
“I’ve noticed that three deadlines have moved during the past month, which is different from your usual pattern. I wanted to check how things are going and whether anything at work is making it harder to complete them.”
Or:
“You’ve seemed quieter than usual in our team meetings, and you left yesterday’s meeting before it finished. I’m not making assumptions, but I wanted to check in.”
Or:
“The last two sets of instructions have needed several follow-up conversations. I’d like to understand whether the way the information is being shared is working for you.”
These openings do three useful things:
They describe something observable.
They avoid assigning a cause.
They create space for the employee to explain.
The employee may disclose a diagnosis or personal situation. They may say the workload is unrealistic. They may identify a conflict with a colleague. They may say nothing is wrong.
The manager’s job is to listen, clarify and agree what happens next.
How should a manager prepare for the conversation?
A supportive conversation does not need to be heavily scripted, but preparation helps.
Separate facts from assumptions
Write down what you have actually observed.
For example:
Fact: The employee missed two agreed deadlines.
Assumption: They have lost interest in the role.
Fact: The employee has stopped contributing in meetings.
Assumption: They are experiencing anxiety.
Fact: The employee reacted sharply to feedback.
Assumption: They cannot manage pressure.
Only the facts belong in the opening conversation.
Choose an appropriate setting
Speak privately and allow enough time.
Do not raise a sensitive concern:
in front of colleagues
while walking into another meeting
in a rushed five-minute gap
through a public team message
during a performance meeting without warning, unless the concern is directly relevant
ACAS recommends speaking privately, being flexible about when and where the conversation happens, and approaching it positively and supportively.
Be clear about your purpose
The purpose is to understand what is happening and whether support is needed.
It is not to extract personal medical information.
A useful opening might be:
“I wanted to have this conversation because I’ve noticed a change and I do not want to make assumptions. I’d like to understand whether something at work is getting in the way and what we can do next.”
What questions should managers ask?
Use open questions that focus on work and support.
Useful questions include:
“How are things going for you at the moment?”
“How manageable is your current workload?”
“Is anything at work making your role more difficult?”
“Which parts of the work are creating the most pressure?”
“Are the priorities and deadlines clear?”
“Is the way I’m communicating tasks working for you?”
“What would help you work more effectively?”
“Is there anything you would like us to change or explore?”
“Would you like some time to think before answering?”
“Shall we agree a follow-up conversation?”
A better question is often:
“What is making this task difficult?”
rather than:
“Why can’t you do this?”
The first invites information. The second sounds like an accusation.
What if the employee does not want to talk?
Employees do not have to disclose that they are neurodivergent. ACAS advises employers to offer support regardless of whether someone has a diagnosis and to create workplaces where employees can access support without having to share a label.
An employee may not feel ready to talk because they:
do not know what is happening themselves
are worried about being judged
have had a poor experience with a previous manager
fear that disclosure will affect progression
are waiting for an assessment
want to keep a personal matter private
need time to process the question
Do not force the conversation.
You can say:
“You do not need to tell me anything personal that you do not want to share. I do need to discuss the work issues I’ve noticed, and I want you to know that we can explore support if something is making the role harder.”
Then arrange an appropriate follow-up.
ACAS recommends letting employees know they can talk at another time and holding follow-up conversations when concerns continue.
Respecting someone’s privacy does not mean ignoring an ongoing work problem.
Can managers discuss performance and support at the same time?
Yes.
A supportive conversation should not become so vague that the employee leaves without knowing there is a performance concern.
Equally, a performance conversation should not assume that the employee is unwilling or incapable before possible barriers have been explored.
You can say:
“The required standard is for customer enquiries to receive a response within two working days. That has not happened consistently over the past month. I want us to understand what is contributing to that and agree both the support and the improvement needed.”
This approach keeps two things clear:
the employee is accountable for agreed work
the employer is responsible for considering barriers and appropriate support
ACAS advises employers to make sure they have done all they reasonably can to support an employee before beginning a formal performance, conduct or capability process. Starting a formal process without first exploring support can waste time, cost money and fail to address the underlying issue.
This does not mean lowering standards.
It means establishing whether the employee has a fair and workable opportunity to meet them.
What practical support can managers explore?
The right support depends on the person, the role and the barrier.
A manager does not need to wait for a diagnosis before improving basic working practices. ACAS states that an employee does not need a diagnosis to be considered disabled under the Equality Act 2010 and recommends offering support whether or not a diagnosis exists. The legal position will still depend on the individual circumstances and the effect of the condition.
Possible changes might include:
clarifying priorities
confirming instructions in writing
dividing a large project into smaller stages
agreeing more frequent check-ins
reducing unnecessary interruptions
changing the timing or format of meetings
allowing focused work in a quieter area
reviewing workload or conflicting deadlines
providing extra preparation time
agreeing how feedback will be delivered
using a visual planner or task-management system
involving occupational health
discussing a formal reasonable-adjustment request
These are examples, not a standard package.
Ask what would help rather than prescribing support based on a suspected condition.
What if the employee discloses that they are neurodivergent?
Listen without immediately jumping to a solution.
The employee may have spent considerable time deciding whether it feels safe to tell you.
A useful response is:
“Thank you for telling me. What would you like me to understand about how this affects you at work?”
You can then ask:
“What is currently working well?”
“What creates difficulty?”
“Have you had useful support in a previous role?”
“Are there adjustments you would like us to consider?”
“Who are you comfortable involving?”
“How would you like this information recorded?”
Do not assume that knowing the diagnosis tells you what the person needs.
Two employees with the same diagnosis may experience work completely differently.
Language preferences also vary. Some people use identity-first language, some prefer person-first or diagnosis-specific language, and some do not identify with broader labels at all. Matching the employee’s preferred language is usually more respectful than insisting on a supposedly correct term.
What if they disclose a mental health difficulty?
Stay calm and listen.
You do not need to become a counsellor. You do need to respond as a manager.
ACAS recommends listening carefully, using open questions, considering workplace support and explaining confidentiality. Managers should thank the employee for speaking openly and give them time rather than rushing into immediate decisions.
You might say:
“Thank you for telling me. You do not need to explain more than you are comfortable sharing. Let’s look at what is affecting work and what support might help.”
Possible next steps could include:
agreeing immediate workload changes
signposting an employee assistance programme
involving HR
seeking occupational-health advice
discussing reasonable adjustments
agreeing how and when you will check in
encouraging the employee to contact their GP where appropriate
Managers should not provide medical advice or promise complete confidentiality before understanding whether there is an immediate safety concern.
How should confidentiality be handled?
Information about an employee’s health, diagnosis or personal circumstances should be treated carefully and shared only where there is a legitimate reason.
ACAS advises managers to reassure employees that information will not be shared without permission unless there is a good reason. Where information must be shared, the manager should explain who needs it and why.
Ask:
“Who are you comfortable with me involving?”
“What information are you happy for me to share?”
“Would you prefer to speak with HR directly?”
“What should we say to colleagues if a working arrangement changes?”
Colleagues do not normally need to know someone’s diagnosis.
They may only need to know the practical arrangement, such as:
“Alex will be using the quieter workspace on agreed afternoons.”
They do not need:
“Alex is using the quiet room because they have ADHD and anxiety.”
When should HR become involved?
HR involvement may be helpful when:
the employee requests a formal reasonable adjustment
the situation involves repeated absence
occupational-health advice may be useful
a performance or capability process is being considered
there are concerns about bullying, harassment or discrimination
the manager is unsure about confidentiality
a significant role or working-hours change is proposed
the employee raises a grievance
there may be a health and safety issue
the manager needs support to handle the conversation fairly
HR should help the manager respond consistently, not take over every human conversation.
Employees usually experience inclusion through their line manager. Sending every concern directly to HR can make support feel formal and distant before it needs to be.
When does the manager need to act urgently?
Most conversations about someone struggling at work are not emergencies.
However, immediate action is needed if an employee says or indicates that they may harm themselves or someone else, or if there is another serious and immediate danger.
ACAS advises encouraging the employee to seek urgent help and involving appropriate services. If someone is in immediate danger, call 999. A manager may also need to involve a trusted contact, GP, occupational health, an employee assistance programme or a crisis-support service, depending on the situation.
Do not leave an immediate safety concern to a future check-in.
Follow the organisation’s emergency and safeguarding procedures, explain what you are doing where possible, and record the actions taken.
What mistakes do managers commonly make?
Waiting for the employee to disclose
Some employees will ask directly for help. Others will not.
They may fear stigma, be unsure what support exists or not have a diagnosis to disclose.
Managers should not wait until someone reaches crisis point before discussing visible changes in work.
Trying to solve the diagnosis
The manager becomes focused on whether the employee has ADHD, autism, depression, anxiety or burnout.
Meanwhile, the workload remains unclear and the deadlines remain unrealistic.
Address the workplace barrier you can see.
Being too vague
“Let me know if you need anything” sounds supportive but places all responsibility on the struggling employee.
A more useful approach is:
“Would it help if we reviewed your priorities together and agreed which deadline can move?”
Avoiding performance feedback
A manager may worry that giving feedback will make the situation worse.
The result is often that concerns build silently until they become serious.
Specific, timely and respectful feedback is kinder than allowing an employee to believe everything is fine.
Making the conversation about the manager
Statements such as “I’m terrified of saying the wrong thing” ask the employee to manage the manager’s discomfort.
You do not need perfect words.
You need respect, curiosity and a willingness to adjust when you get something wrong.
Assuming support means permanent exemption
An adjustment should address a barrier and be reviewed.
It is not necessarily permanent, and it does not automatically remove every difficult or less-preferred part of a role.
What should managers do next?
Use this five-step approach:
1. Notice
Look for a change or repeated pattern rather than one isolated incident.
2. Check
Separate what you observed from what you have assumed.
3. Ask
Have a private conversation using neutral, open questions.
4. Act
Agree practical support, clear expectations and who will do what.
5. Review
Set a date to check whether the support is working and whether performance has improved.
Document agreed actions appropriately, but do not record a diagnosis the employee has not disclosed.
A simple follow-up note might say:
“We agreed that weekly priorities will be confirmed in writing each Monday, with a ten-minute review on Thursday. We will review this arrangement in four weeks.”
That is clearer and more useful than:
“Employee appears to have ADHD traits.”
How can HR make these conversations easier?
HR teams can help by giving managers a clear framework rather than expecting them to improvise.
Useful organisational support includes:
practical conversation guides
training based on realistic scenarios
a straightforward adjustments process
clear routes to occupational health
guidance on confidentiality
templates for recording and reviewing adjustments
support with fair performance management
escalation procedures for urgent concerns
visible senior-leadership support
An ACAS survey of line managers published in January 2025 found that 39% reported difficulty having conversations about reasonable adjustments with neurodivergent employees. This suggests the barrier is not always unwillingness. Managers may understand that support matters but lack the confidence or language to begin.
Telling managers to “have an open conversation” is not enough.
They need to know what that sounds like.
The goal is not to diagnose people at work
Managers will sometimes notice behaviours that resemble things they have read about ADHD, autism, anxiety, depression or burnout.
That does not make the interpretation correct.
The same person may be dealing with a difficult workload, an inaccessible process, a health condition, family circumstances, workplace conflict or several things at once.
You do not need the label before you can:
clarify expectations
review workload
improve communication
ask what support would help
address performance fairly
involve appropriate professional support
Neuroinclusive management is not about turning managers into clinicians.
It is about helping them notice problems earlier, ask better questions and respond without judgement.
When someone is struggling, the most useful starting point is rarely:
“What condition do they have?”
A better question is:
“What has changed, what is getting in the way and what do we need to do next?”
How NeuroConfetti Can Help
Managers are often told to support wellbeing, consider adjustments and manage performance fairly, but they are rarely given enough practice in how to combine those responsibilities.
NeuroInclusion Unlocked is designed for that gap.
It gives managers practical confidence with conversations, adjustments, performance and everyday support. The goal is not to make managers diagnose people. It is to help them recognise when a conversation is needed and know what to say next.
For organisations that need to review wider processes, policies or management consistency, NeuroInclusion Unleashed provides consultancy and advisory support.
Because “my door is always open” only helps when employees believe it is safe to walk through it.
FAQs
Can a manager ask whether an employee has ADHD or autism?
A manager should not confront an employee with a suspected diagnosis. ACAS recommends discussing the workplace difficulty that has been observed and focusing on possible support. An employee does not have to disclose that they are neurodivergent.
What are the signs that an employee is struggling at work?
Possible signs include changes in performance, attendance, communication, confidence, mood or behaviour. However, these signs can have many causes. Managers should look for changes from the person’s usual pattern and start a conversation rather than reaching a conclusion.
What should I say to an employee who seems overwhelmed?
Describe what you have noticed and ask an open question. For example: “I’ve noticed that your workload has been harder to complete over the past few weeks. How are things going, and is anything at work making the role more difficult?”
Can I address poor performance if an employee is struggling?
Yes. Be clear about the required standard while exploring whether unclear expectations, workplace barriers, ill health or missing adjustments are contributing. ACAS recommends exploring appropriate support before starting a formal performance process.
Does an employee need a diagnosis before adjustments can be considered?
No. ACAS advises employers to offer support whether or not an employee has a diagnosis. A diagnosis is not required for someone to be considered disabled under the Equality Act 2010, although whether the Act applies depends on the individual circumstances.
What should I do if an employee says they are not safe?
Take the concern seriously and act immediately. Follow your organisation’s emergency procedures and encourage urgent professional help. Call 999 if there is immediate danger. Do not leave an urgent safety concern for a later meeting.