Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol

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The literature tells us that there is a close link between neurodivergence and mental health resulting in such individuals being more likely to attend a recovery college. However, there is a lack of data on how such recovery colleges can support neurodivergent individuals in learning about their mental health and wellbeing, leading to the question: can recovery colleges create neuro-inclusive environments conducive of supporting this community in acquiring the knowledge and skills needed to support their mental wellbeing? Methods and analysis To address this, an overarching project: The Neurodiversity In Recovery Education [N.I.R.E] Study was created. It consists of three work packages, each of which involves an iterative process where recovery college staff and students are interviewed in order to support the co-creation of specific guidelines. These guidelines will support these recovery colleges [both within the study sites and beyond] to harness an environment that is neuro-affirming whilst also representative of the wider recovery movement. Ethics and dissemination This study received ethical approval from UCC’s Social Research Ethics Committee [SREC] in November 2024. This protocol, and all data created as a result of this study is stored in OSF registries. Almost all outputs will be through publication in high impact peer reviewed journals. The exception of this will be the co-created guidelines which will be stored on a specific website and with the help of ImROC [an organisation in the UK well linked in with recovery colleges] will be circulated to all recovery education services in the UK and internationally. 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HRB Open Res 2025, 8 :8 ( https://doi.org/10.12688/hrbopenres.14046.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol [version 1; peer review: 1 approved with reservations, 1 not approved] Michael John Norton https://orcid.org/0000-0002-7420-9339 1,2 , William Gallini-Poole https://orcid.org/0009-0007-4094-9180 3,4 , Lydia Little https://orcid.org/0009-0003-7196-2311 5 , Olga Zilberberg 6,7 Michael John Norton https://orcid.org/0000-0002-7420-9339 1,2 , William Gallini-Poole https://orcid.org/0009-0007-4094-9180 3,4 , Lydia Little https://orcid.org/0009-0003-7196-2311 5 , Olga Zilberberg 6,7 PUBLISHED 23 Jan 2025 Author details Author details 1 Adult Continuing Education, University College Cork, Cork, County Cork, Ireland 2 Office of Mental Health Engagement and Recovery, Health Service Executive, County Dublin, County Dublin, Ireland 3 Dorset Mental Health Forum, 29 Dungate Street, Dorchester, Dorset, UK 4 ImROC, Nottingham, Nottinghamshire, NG146UZ, UK 5 FearFree Oak House, Epsom Square, White Horse Business Park, Trowbridge, Wiltshire, BA140XG, UK 6 The Missing Link, 187 Kidmore Road, Reading, RG47NW, UK 7 Recovery College Facilitator, Devon, Wokingham, Reading, Bracknell, UK Michael John Norton Roles: Conceptualization, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing William Gallini-Poole Roles: Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Lydia Little Roles: Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Olga Zilberberg Roles: Conceptualization, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Introduction Neurodiversity is considered to be an umbrella term, used to demonstrate a variation in brain functioning which can impact a person’s thinking and information processing. The literature tells us that there is a close link between neurodivergence and mental health resulting in such individuals being more likely to attend a recovery college. However, there is a lack of data on how such recovery colleges can support neurodivergent individuals in learning about their mental health and wellbeing, leading to the question: can recovery colleges create neuro-inclusive environments conducive of supporting this community in acquiring the knowledge and skills needed to support their mental wellbeing? Methods and analysis To address this, an overarching project: The N eurodiversity I n R ecovery E ducation [N.I.R.E] Study was created. It consists of three work packages, each of which involves an iterative process where recovery college staff and students are interviewed in order to support the co-creation of specific guidelines. These guidelines will support these recovery colleges [both within the study sites and beyond] to harness an environment that is neuro-affirming whilst also representative of the wider recovery movement. Ethics and dissemination This study received ethical approval from UCC’s Social Research Ethics Committee [SREC] in November 2024. This protocol, and all data created as a result of this study is stored in OSF registries. Almost all outputs will be through publication in high impact peer reviewed journals. The exception of this will be the co-created guidelines which will be stored on a specific website and with the help of ImROC [an organisation in the UK well linked in with recovery colleges] will be circulated to all recovery education services in the UK and internationally. Registration ID https://doi.org/10.17605/OSF.IO/R93WM READ ALL READ LESS Keywords Guidelines, Mental Health, Neurodiversity, Protocol, Recovery Corresponding Author(s) Michael John Norton ( [email protected] ) Close Corresponding author: Michael John Norton Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Norton MJ et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Norton MJ, Gallini-Poole W, Little L and Zilberberg O. Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol [version 1; peer review: 1 approved with reservations, 1 not approved] . HRB Open Res 2025, 8 :8 ( https://doi.org/10.12688/hrbopenres.14046.1 ) First published: 23 Jan 2025, 8 :8 ( https://doi.org/10.12688/hrbopenres.14046.1 ) Latest published: 23 Jan 2025, 8 :8 ( https://doi.org/10.12688/hrbopenres.14046.1 ) Introduction Neurodiversity is an umbrella term that is not easy to define and has several meanings ( Dwyer, 2022 ; Stenning & Rosqvist, 2021 ). However, for the purposes of this study protocol, the National LGBT Health Education Center (2020) definition will be utilised. Here, neurodiversity is described as a variation in brain functioning which causes individuals to think and process information differently than others in society ( NHS Cambridge University Hospital, n.d ; National LGBT Health Education Center, 2020 ). The term was first coined by Judy Singer, an autism rights activist, who developed the term for those with autism who did not want to be defined by a disability label but instead be seen as neurologically different ( Armstrong, 2015 ; Dalton, 2013 ). The term is inclusive of a range of disorders that can be typically found within diagnostic manuals such as the International Classification for Diseases 11 (ICD-11) and the Diagnostic and Statistical Manual for Mental Disorders fifth edition Text Revision (DSM5-TR). Such disorders include dyspraxia, dyslexia, attention deficit hyperactivity disorder (ADHD), dyscalculia, autism and Tourette’s syndrome ( Clouder et al ., 2020 ). Although these are widely observed as mental disorders or intellectual disabilities, the neurodiversity movement challenges this assumption by suggesting that these minority cognitive styles form part of a range of cognitive behaviours that are deemed to be within normal limits in society ( Chapman, 2021 ). In other words, these are not a set of diseases but instead a range of normal cognitive processes, which do not fit into one marginalised identity Botha and Gillespie-Lynch, 2022 ). Understanding neurodiversity is becoming ever more important for psychiatry and other mental health professionals ( Shah et al. , 2022 ). Neurodiversity and mental health are intrinsically linked as neurodiversity itself sits on a spectrum between normal and pathological behaviours ( Glannon, 2007 ). In particular, those who define themselves as neurodivergent may meet the diagnostic criteria for such disorders as ADHD, autism, and some other neurodevelopmental conditions ( Kirby, 2021 . In 2021, Curnow and colleagues found that 33% of Scottish people with autism had a co-occurring mental health challenge ( Curnow et al ., 2021 ). Additionally, more recent literature indicates that the prevalence of anxiety and depression in the neurodiverse youth population has increased by tenfold to that of the prevalence within the non-neurodiverse adolescent population ( Accardo et al. , 2024 ). This percentage of mental health challenges in autism and other neurodiverse experiences reflects observations that are often witnessed within outpatient psychiatry ( Shaw et al ., 2022 ). This is particularly true for autism, where the presence of a co-occurring mental health challenge is most likely ( Lai et al ., 2019 ). However, this dual diagnosis can often be overshadowed by the person’s other mental health difficulties which can lead to diagnostic overshadowing ( Nyrenius et al ., 2022 ). As a result of the possible overshadowing of diagnosis and because of the higher prevalence of mental health challenges in those who identify as neurodivergent, they are more likely to encounter a recovery college and attend recovery education courses during their recovery from such challenges. Recovery education is a process of exploration, assimilation, and creation of knowledge required to support the recovery of service users and their family members/carers/supporters ( Health Service Executive, 2020b ). This process is achieved through the ethos of adult education which relies on the principles of active, challenging learning which supports reliance, self-agency, and self-directedness ( Health Service Executive, 2020a ). In the UK, recovery education is centred around a hub, known as a recovery college. Recovery colleges are a relatively new initiative in statutory mental health services ( Hayes et al. , 2022 ), built based on the values of co-production, andragogical learning, peer support and self-management ( Ebrahim et al ., 2018 ). For individuals dissatisfied by traditional psychiatry, recovery colleges can offer a different approach to mental health support - one based on the idea of community, and supporting individuals to develop a sense of agency around mental health owing to the culture of self-management present within these hubs. Recovery education is also unique in their application of intentional use of lived experience within its delivery. This aims to foster a sense of community and understanding within any support offered to service users. The first recovery college emerged in the United States in the 1990s ( Whitley et al. , 2019 ). Since then, the initiaitve has spread rapidly across several westernised countries including Ireland and the United Kingdom. In the UK specifically, the first recovery college was piloted in Southwest London and since this time, in 2024, there is now in excess of 75 recovery colleges nationwide ( Meddings et al. , 2019 ). Rationale for the N.I.R.E study Currently, there is a diverse amount of literature available into neurodiversity in the traditional educational space ( Clouder et al. , 2020 ; Rodgers Behavioural Health, 2021 ; Smagorinsky, 2020 ). In addition, within the recovery college space, a quick internet search documents multiple examples of recovery colleges already offering specific courses on aspects of neurodiversity – such as autism ( Online Recovery College, 2023 ; Sussex Recovery College, 2022 ) and ADHD ( Sussex Recovery College, 2022 ). Consequently, some third level colleges that offer Peer Support Worker training, like Atlantic Technological University in the Republic of Ireland, have also offered specific modules to this cohort of students in order to build a cohort of peers that are specialised in neurodiversity ( Atlantic Technological University, 2022 ). However, despite the above advances in the field, there is a paucity of evidence examining recovery college staff and students’ observations, perspectives, and experiences of recovery education and neurodiversity. With the increase in neurodiversity specific courses and lack of evidence base on how to best facilitate these courses and support neurodivergent students, there is a palpable sense of anxiety within the historically purely mental health focused recovery college space to address this growing need. Aim and objectives As such, the overall aim of this proposed study is to explore whether recovery colleges and those who work within them are suitably equipped to support neurodivergent students receiving recovery education for their mental health and well-being. To meet this aim, the proposed study has a number of objectives including: 1. To perform a scoping exercise to identify and analyse the peer reviewed and grey literature relating to neurodiversity in mental health. 2. To gather the observations, perspectives, opinions, and views of recovery college staff into their ability to support neurodivergent students receiving recovery education for their mental health and well-being. 3. To gather the observations, perspectives, opinions and views of recovery college students who identify as neurodivergent regarding recovery colleges staff’s ability to adequately support their needs. 4. To identify the role recovery college staff and neurodiverse students play in the creation of neuro-inclusive environment within recovery college settings. 5. To make recommendations and guidance to support the future development of neuro-inclusive environments within recovery college settings in the United Kingdom. Methods The first step in this study was to configure a group of individuals with an interest in recovery education and neurodiversity from the United Kingdom. This group would serve as the research advisory group [RAG] for this project. Their responsibility is to review all the work co-created before submission into journals and other publishers as required. In this way, the process described here will be iterative, thereby ensuring that the material created remains current and truly reflects the needs of those who engage in recovery education in the United Kingdom. Additionally, due to the co-productive nature of recovery education and the lead author’s [MJN] way of working, individuals involved in the RAG will also be given the opportunity to support the work of the lead researcher in his work within this project. Finally, to address the aims and subsequent objectives of this project, the study will consist of three main work packages. Each of which will be guided by a scoping review of the available literature – which will act as the first activity of this project. The results of this scoping review, along with the three work packages will ultimately support the creation of a set of guidelines to support the creation of a neuro-inclusive environment within recovery college spaces. Scoping review As noted earlier, the first activity of this project is to scope out the literature base as it relates to neurodiversity in recovery education. To do this, a scoping review which examines peer reviewed and grey literature on the subject of neurodiversity within recovery education will occur. This is necessary in order to confirm the paucity of literature we suspect is there currently on this aspect of recovery education/mental health. In order to support rigour, this scoping review will adhere to the methodological framework described by Arksey and O’Malley in their seminal 2005 work. Additionally, this scoping review will also adhere with the associated Preferred Reporting Items for Systematic Reviews and Meta-Analysis amendments for scoping reviews [PRISMA-ScR] as described by Tricco et al . (2018) . In addition, a scoping review protocol has been registered with Opens Science Framework [OSF] repository on the 27 th June 2024 and has been assigned the following registration doi: https://doi.org/10.17605/OSF.IO/853K2 . This protocol is currently under consideration by BMJ Open for publication. As such, for more information pertaining to the scoping review, please click on the registration doi link above. Work package one Work package one comprises of a qualitative investigation into recovery college staff observations and experiences of neurodiversity within recovery college environments of four nominated colleges which one of the authors of this protocol [OZ] is affiliated with. As described above, the sample of this work package comprises of recovery education staff within one of the four chosen recovery colleges [Compass Recovery College, Devon Recovery Learning Community, Wokingham Recovery College and Stepping Stones Recovery College]. To determine sample size, a process of information power will be utilised. Information power is a principle which basically suggests that the more a sample knows about a particular phenomenon under investigation, the lower the number of participants one needs within a study ( Malterud et al ., 2016 ). Therefore determining the final sample size will not be possible at this phase of the study. Additionally, to narrow down the sample somewhat, an inclusion/exclusion criteria has been created. For a staff member to be considered for inclusion in this work package, they need to meet the following criteria The staff member is a member of staff and works for one of the chosen four recovery colleges. The staff member has at least six months work experience at the particular college The staff member is proficient in the use of the English Language. The staff member is over the age of 18 years at time of interview. The staff member has experience within the co-production process of liaising with those who identify as neurodivergent. Recruitment. Once ethical approval is achieved, the researcher will contact each of the four chosen recovery colleges to ask for permission to access the research site. To support this, a research proposal will be supplied to these gatekeepers along with a confirmation note from University College Cork’s Social Research Ethics Committee [SREC] confirming ethical approval has been granted. To gain access to staff of these recovery colleges, a poster will be circulated to them via the staff interweb. Additionally, the poster will also be shared on the designated N.I.R.E. study social media platform on LinkedIN. Once a potential participant contacts the researcher, the researcher will discuss the details of the study with them and provide them with an information leaflet and informed consent form for them to review. The participant is then given time, at least seven days, to consider whether or not they wish to partake in the study. If the participant wishes to partake in the study, they will be invited to an interview on a University College Cork licenced MS Teams platform. Data collection. Data will be collected from participants through a semi-structured interview process. Semi-structured interviews are in-depth interviews that require participants to answer open ended questions documented in an interview topic guide ( Jamshed, 2014 ). However, the semi-structured nature of the interview means that the interview topic guide is not followed rigidly, but instead serves as a guide to steer the discussion. Data analysis. Qualitative data from the semi-structured interviews will be transcribed verbatim and analysed using the computer software programme NVivo Version 14 for MacBook, with copyright for the use of same being held by the lead author’s [MJN] institutional affiliation – University College Cork. The mechanism of analysis is Braun and Clarke’s ( 2006 ; 2019 ; 2022 ; 2024 ) reflexive thematic analysis. This process involves the researcher becoming familiar with the data gathered through multiple readings of the transcripts ( Norton et al ., 2023 ). From which, initial codes will be generated and enhanced to become themes which are then revised, adjusted and refined by the researcher through NVivo. The process also allows the researcher to reflect on their own subjectivities and pre-conceived ideas surrounding the research topic. Work package two Like work package one, work package two also consists of a qualitative investigation. However, this time, the focus is shifted so that the observations and experiences of recovery education from recovery college students who self-identify as neurodivergent is of primary interest. This work package will occur in tandem with work package one as it focuses on the four particular colleges that one of the author’s [OZ] is associated with. Sample size is once again determined by the process of information power. To support the narrowing of participants, the sample must comply with the following inclusion/exclusion criteria: The student is either currently or has in the past attended one of the four recovery colleges to receive recovery education for their own mental wellbeing. The student is proficient in the use of the English language. The student is over the age of 18 years at time of interview. The student has experience within the recovery college’s co-production process. The student self-identifies as neurodivergent. Recruitment. Once ethical approval is achieved, the researcher will contact each of the four chosen recovery colleges to ask for permission to access the research site. This will be done as per the mechanism employed in work package one above. To gain access to the students who identify as neurodivergent, the researcher will ask these recovery colleges to circulate a poster amongst their networks. This will also be shared on the specific recovery college’s social media as well as the N.I.R.E study’s own social media LinkedIN page. Once a potential participant contacts the researcher, the details of the study will be discussed with these students and they will be provided with an information leaflet and an informed consent form for them to review. The participant is then given time, at least seven days, to decide if they wish to partake in the study. If the participant wishes to partake in the study, they will be invited to an interview on a University College Cork licenced MS Teams platform. Data collection. Data collection for this work package mirrors that discussed in work package one. Data analysis. Data analysis for this work package mirrors that discussed in work package one. Work package three The final work package mirrors that of work packages one and two. However, this time, the study will broaden its focus so that recovery college staff and students’ observations and experiences of neurodiversity are captured within recovery education settings across the United Kingdom [England, Scotland, Wales and Northern Ireland]. The sample size will once again be determined by the principle of information power. The process of narrowing the sample will also include an inclusion/exclusion criteria which mirrors that of work package one and two, but with one caveat: The staff member/student must be associated with a recovery college that is situated within the geographical area of the United Kingdom – which for this study is consistent of England, Wales, Scotland and Northern Ireland. Recruitment. Once work packages one and two are completed, the researcher will identify and contact the recovery colleges within each of the study sites within the United Kingdom to ask for permission to access these sites. This will be done as stipulated in work package one and two above. To gain access to staff of these recovery colleges, a poster will be circulated via the staff interweb. Additionally, the poster will also be shared on the N.I.R.E study LinkedIN social media page. To gain access to students who identify as neurodivergent, the researcher will ask these recovery colleges to circulate a poster amongst their networks. This will also be shared on the recovery college’s and the N.I.R.E study’s social media accounts. Once a potential participant contacts the researcher, the researcher will discuss the details of the study with them and provide them with an information leaflet and an informed consent form for them to review. The participant is then given time, at least seven days, to consider whether or not they wish to partake in the study. If the participant wishes to partake they will be invited to an interview on a University College Cork licenced MS Teams platform. Data collection. Data collection for this work package mirrors that discussed in work packages one and two above. Data analysis. Data analysis for this work package mirrors that discussed in work packages one and two above. Guideline development To further support this work and to ensure that the information found by the N.I.R.E study is implemented into practice across the UK and elsewhere, this study also plans to produce two guidelines – the first after work packages one and two are complete, the second after work package three is completed. The need to develop guidelines to support neurodivergent individuals in recovery colleges is further spurred on from the increasing prevalence of neurodiversity among those with mental health challenges. In developing such guidelines, it is hoped that recovery colleges can foster neuro-inclusive environments, by enhancing staff preparedness, and ensuring recovery outcomes are improved for neurodivergent students by addressing their needs holistically. Once again, due to the co-productive nature of the working environment in which this study is situated, these guidelines will be co-produced and co-authored by those who work/use recovery colleges and identify as neurodivergent. This will ensure that all information written in both set of guidelines will be an accurate reflection of as many neurodivergent voices as possible, and as a result, are best able to serve and support this population. In the creation of this protocol, it was noted that the R eporting Items for practice G uidelines in H eal T hcare [RIGHT] statement was deemed the most appropriate statement to follow as our guidelines are to support the creation of a neuro-affirming environment and not to develop guidelines relating to for example a particular drug’s use for a particular condition and so on ( Chen et al ., 2016 ). However, the RIGHT statement has yet to develop a protocol statement to support researchers in preparing a protocol for same. This is despite the fact that Luo et al. (2022) have suggested that there is one in development. As such, as part of the wider N.I.R.E study, we have utilised aspects of Chen and colleagues original RIGHT guidelines, in order to make a protocol for the creation of both sets of these guidelines. This protocol has been created and is currently under consideration for publication by BMJ Open. Ethics and dissemination As this study proposes to inform human subjects, ethical approval was sought from the lead author’s [MJN] home institution – University College Cork. Ethical approval was subsequently granted [Case Number: 2024-215] on November 26 th 2024. To support transparency, any information pertaining to this study will be stored in the OSF registry, where such information is freely available to interested parties. Most information created as a result of this study will be distributed through high impact peer reviewed journals in the subject area. The exception to this are the guidelines, which will be distributed through a designated website that will be set up for the N.I.R.E study by the lead author. In addition, the guidelines co-created as a result of this study will also be distributed through the support of ImROC who supports this overall study, but do not own the intellectual property for same. Patient and Public Involvement This proposed study has been co-designed with public and patient involvement [PPI] representation. Equally, the proposed study itself will also be co-produced with these same PPI representatives. Some of whom [WGP, LL, OZ] are co-authors of this paper. The study will also be overseen by a wider research advisory group. This research advisory group also consists of these PPI representatives and also others who work in the recovery education system within the UK. As part of their work, the research advisory group reviewed this study protocol prior to its registration with OSF repositories, submission to the journal and eventual publication. Strengths and limitations to the N.I.R.E study The proposed study demonstrates several strengths. It adopts a qualitative methodology which is well-suited for exploring complex experiences and perspectives that cannot be captured through quantitative means. The study's approach, encompassing staff and student perspectives across multiple recovery colleges, thereby ensuring an in depth comprehensive understanding of neurodiversity within these settings. The study aims to address a significant research gap by exploring neurodiversity within recovery colleges, which will inform the future development of neuro-inclusive practices and policies in these settings. It is the first study of its kind that is conducted that addresses the pressing matter of accessibility of content and inclusion in adult educational settings. Despite this, the proposed study also has a number of potential weaknesses. For example, the lack of research and work that has been carried out to date on the topic. As such it is difficult to benchmark what the findings will provide us with and how useful they will be to inform our guidelines to support recovery colleges in being more neuro-inclusive. Additionally, the reliance on self-reported data from participants introduces the risk of bias, as individuals may provide socially desirable responses or struggle to articulate their experiences fully. The study's scope, while valuable, may face challenges in capturing the full diversity of neurodivergent experiences due to the complexity and variability of neurodivergence itself. Furthermore, the interpretation of data through reflexive thematic analysis, though robust, depends heavily on the researcher's subjective lens of the data collected, which may inadvertently influence the results despite efforts to maintain reflexivity and rigour. These factors could limit the broader applicability and replicability of the study's conclusions. However, despite this, the need for this research to be carried out outweights the potential limitations noted above and as such, the research has been approved to commence in January 2025. Ethics and consent Ethical approval was sought and awarded by University College Cork’s Social Research Ethics Committee [REC No. 2024–215]. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committee on human experimentation with the Helsinki Declaration of 1975, as revised in 2008. Both written and oral informed consent will be obtained before any data collection commences in this study. The ethics committee in which approval was sought are aware of this and have provided approval based on both written and verbal consent being obtained for all study activity involving participants. Data availability Underlying data No data are associated with this article. Software availability The software noted for data analysis in this paper can also be carried out manually through downloading the transcripts and manually creating themes and sub-themes using paper and pen. Contribution statement MJN and OZ conceptualised the study. MJN, WG-P, LL and OZ all wrote aspects of the protocol. The N.I.R.E Research Advisory Group and MJN both reviewed the protocol prior to submission. 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PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 23 Jan 2025 ADD YOUR COMMENT Comment Author details Author details 1 Adult Continuing Education, University College Cork, Cork, County Cork, Ireland 2 Office of Mental Health Engagement and Recovery, Health Service Executive, County Dublin, County Dublin, Ireland 3 Dorset Mental Health Forum, 29 Dungate Street, Dorchester, Dorset, UK 4 ImROC, Nottingham, Nottinghamshire, NG146UZ, UK 5 FearFree Oak House, Epsom Square, White Horse Business Park, Trowbridge, Wiltshire, BA140XG, UK 6 The Missing Link, 187 Kidmore Road, Reading, RG47NW, UK 7 Recovery College Facilitator, Devon, Wokingham, Reading, Bracknell, UK Michael John Norton Roles: Conceptualization, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing William Gallini-Poole Roles: Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Lydia Little Roles: Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Olga Zilberberg Roles: Conceptualization, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 23 Jan 2025, 8:8 https://doi.org/10.12688/hrbopenres.14046.1 Copyright © 2025 Norton MJ et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Norton MJ, Gallini-Poole W, Little L and Zilberberg O. Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol [version 1; peer review: 1 approved with reservations, 1 not approved] . HRB Open Res 2025, 8 :8 ( https://doi.org/10.12688/hrbopenres.14046.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 23 Jan 2025 Views 0 Cite How to cite this report: Soklaridis S and Harris H. Reviewer Report For: Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol [version 1; peer review: 1 approved with reservations, 1 not approved] . HRB Open Res 2025, 8 :8 ( https://doi.org/10.21956/hrbopenres.15423.r45211 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-8/v1#referee-response-45211 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 11 Mar 2025 Sophie Soklaridis , Centre for Addiction and Mental Health (CAMH), Toronto, Canada Holly Harris , Education, Centre for Addiction and Mental Health (Ringgold ID: 7978), Toronto, Ontario, Canada Not Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15423.r45211 Thank you for the opportunity to review the study protocol, Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol. The study explores the intersection of neurodiversity and mental health, focusing on how recovery ... Continue reading READ ALL Thank you for the opportunity to review the study protocol, Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol. The study explores the intersection of neurodiversity and mental health, focusing on how recovery colleges can support individuals who identify as neurodivergent in learning about their mental health and wellbeing. It highlights the lack of data on creating neuro-inclusive environments in these colleges, posing the question of how such settings can help individuals who identify as neurodivergent acquire essential knowledge and skills for mental wellbeing. The project, called the Neurodiversity in Recovery Education (N.I.R.E) Study, consists of three work packages involving interviews with recovery college staff and students to co-create recommendations to support the future development of neuro-affirming environments. This is such important work and recovery college research is growing. After careful review, it appears that the manuscript has several significant gaps in its content and lacks the necessary methodological rigour for acceptance in its current form. Unfortunately, We are unable to recommend it for indexing at this time. Please see below some general comments, which will hopefully be helpful to the authors, should they decide to pursue a re-write. While neurodiversity is initially framed outside the illness/disorder paradigms, the language used in the introduction is inconsistent. Judy Singer’s original work coining the term "neurodiversity" was not cited. There are inaccuracies in the recounting of the origins of the Recovery College model, and several foundational texts are not cited (e.g., Recovery Colleges: An Overview ). Recovery colleges are an alternative or complement, they are not only for those who are dissatisfied with psychiatry. It is also unclear what is meant by traditional psychiatry. When discussing the co-occurrence of mental health challenges and neurodiversity, it would have been important to highlight the tensions between dominant biomedical/pathological understandings of mental health challenges and the neurodiversity paradigm (which recognizes human diversity). More details about the approach to co-production would have been helpful to maintain the integrity of the term. Methodologically there would need to be more description of the scoping review methodology and the interviews, why these methods were chosen and the research questions attached to each phase of the project. The authors need to explain what a work package is as this is not a common term used. It was difficult to understand the purpose of work package three. The authors describe the process of guideline development near the end of the manuscript which was described differently in the beginning (more like recommendations, guidance). Guideline development has its own methodology and would need to be fully described. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? No Are sufficient details of the methods provided to allow replication by others? No Are the datasets clearly presented in a useable and accessible format? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: recovery college research, coproduction, equity health research We confirm that we have read this submission and believe that we have an appropriate level of expertise to state that we do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Soklaridis S and Harris H. Reviewer Report For: Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol [version 1; peer review: 1 approved with reservations, 1 not approved] . HRB Open Res 2025, 8 :8 ( https://doi.org/10.21956/hrbopenres.15423.r45211 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-8/v1#referee-response-45211 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: McCormack Z. Reviewer Report For: Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol [version 1; peer review: 1 approved with reservations, 1 not approved] . HRB Open Res 2025, 8 :8 ( https://doi.org/10.21956/hrbopenres.15423.r44997 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-8/v1#referee-response-44997 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 Feb 2025 Zoe McCormack , Royal College of Surgeons in Ireland, Dublin, Ireland Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15423.r44997 Really important study which will no doubt provide really important guidelines for recovery colleges. Some comments: Ethical approval from UCC, but study seems to focus on UK? Why not include Ireland based RC's in the study? Are ... Continue reading READ ALL Really important study which will no doubt provide really important guidelines for recovery colleges. Some comments: Ethical approval from UCC, but study seems to focus on UK? Why not include Ireland based RC's in the study? Are staff members/participants from these recovery colleges going to be invited to the PPI advisory group or be involved in guideline development? When inviting neurodivergent students to be involved in the study, will the information be provided in a way that is understandable for them? i.e. - visual guide or video. Will they be enabled to bring a support person with them to interview? If you could specify your process for supporting neurodivergent participants involvement please. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Mental health education, autism. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT McCormack Z. Reviewer Report For: Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol [version 1; peer review: 1 approved with reservations, 1 not approved] . HRB Open Res 2025, 8 :8 ( https://doi.org/10.21956/hrbopenres.15423.r44997 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-8/v1#referee-response-44997 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 23 Jan 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 23 Jan 25 read read Zoe McCormack , Royal College of Surgeons in Ireland, Dublin, Ireland Sophie Soklaridis , Centre for Addiction and Mental Health (CAMH), Toronto, Canada Holly Harris , Centre for Addiction and Mental Health (Ringgold ID: 7978), Toronto, Canada Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Soklaridis S et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 11 Mar 2025 | for Version 1 Sophie Soklaridis , Centre for Addiction and Mental Health (CAMH), Toronto, Canada Holly Harris , Education, Centre for Addiction and Mental Health (Ringgold ID: 7978), Toronto, Ontario, Canada 0 Views copyright © 2025 Soklaridis S et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review the study protocol, Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol. The study explores the intersection of neurodiversity and mental health, focusing on how recovery colleges can support individuals who identify as neurodivergent in learning about their mental health and wellbeing. It highlights the lack of data on creating neuro-inclusive environments in these colleges, posing the question of how such settings can help individuals who identify as neurodivergent acquire essential knowledge and skills for mental wellbeing. The project, called the Neurodiversity in Recovery Education (N.I.R.E) Study, consists of three work packages involving interviews with recovery college staff and students to co-create recommendations to support the future development of neuro-affirming environments. This is such important work and recovery college research is growing. After careful review, it appears that the manuscript has several significant gaps in its content and lacks the necessary methodological rigour for acceptance in its current form. Unfortunately, We are unable to recommend it for indexing at this time. Please see below some general comments, which will hopefully be helpful to the authors, should they decide to pursue a re-write. While neurodiversity is initially framed outside the illness/disorder paradigms, the language used in the introduction is inconsistent. Judy Singer’s original work coining the term "neurodiversity" was not cited. There are inaccuracies in the recounting of the origins of the Recovery College model, and several foundational texts are not cited (e.g., Recovery Colleges: An Overview ). Recovery colleges are an alternative or complement, they are not only for those who are dissatisfied with psychiatry. It is also unclear what is meant by traditional psychiatry. When discussing the co-occurrence of mental health challenges and neurodiversity, it would have been important to highlight the tensions between dominant biomedical/pathological understandings of mental health challenges and the neurodiversity paradigm (which recognizes human diversity). More details about the approach to co-production would have been helpful to maintain the integrity of the term. Methodologically there would need to be more description of the scoping review methodology and the interviews, why these methods were chosen and the research questions attached to each phase of the project. The authors need to explain what a work package is as this is not a common term used. It was difficult to understand the purpose of work package three. The authors describe the process of guideline development near the end of the manuscript which was described differently in the beginning (more like recommendations, guidance). Guideline development has its own methodology and would need to be fully described. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? No Are sufficient details of the methods provided to allow replication by others? No Are the datasets clearly presented in a useable and accessible format? No Competing Interests No competing interests were disclosed. Reviewer Expertise recovery college research, coproduction, equity health research We confirm that we have read this submission and believe that we have an appropriate level of expertise to state that we do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Soklaridis S and Harris H. Peer Review Report For: Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol [version 1; peer review: 1 approved with reservations, 1 not approved] . HRB Open Res 2025, 8 :8 ( https://doi.org/10.21956/hrbopenres.15423.r45211) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-8/v1#referee-response-45211 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 McCormack Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 Feb 2025 | for Version 1 Zoe McCormack , Royal College of Surgeons in Ireland, Dublin, Ireland 0 Views copyright © 2025 McCormack Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Really important study which will no doubt provide really important guidelines for recovery colleges. Some comments: Ethical approval from UCC, but study seems to focus on UK? Why not include Ireland based RC's in the study? Are staff members/participants from these recovery colleges going to be invited to the PPI advisory group or be involved in guideline development? When inviting neurodivergent students to be involved in the study, will the information be provided in a way that is understandable for them? i.e. - visual guide or video. Will they be enabled to bring a support person with them to interview? If you could specify your process for supporting neurodivergent participants involvement please. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Mental health education, autism. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) McCormack Z. Peer Review Report For: Observations and experiences of neurodiversity in recovery colleges in the United Kingdom: The N.I.R.E study protocol [version 1; peer review: 1 approved with reservations, 1 not approved] . HRB Open Res 2025, 8 :8 ( https://doi.org/10.21956/hrbopenres.15423.r44997) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-8/v1#referee-response-44997 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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