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Long term medical conditions: career prospects
B J Bateman, F Finlay
Arch Dis Child 2002;87:291-292
The purpose of this study was to gain employers' views on
employment restrictions for young people with four
medical conditions - asthma, epilepsy, attention deficit
hyperactivity disorder (ADHD), and insulin dependent
diabetes mellitus (IDDM).
A questionnaire was sent to Directors of Occupational Health
and Personnel of 15 national companies and recruitment
offices of the Royal Navy, RAF, Army, and the police. Respondents
were asked for details of policies for applicants with
asthma, epilepsy,ADHD, and IDDM and potentially unsuitable
Response rate was 75%. Specific conditions will be considered
The Armed Forces had clear policies-asthma is generally
incompatible with service requirements. Exceptions may be
considered for those: (a) who have been asymptomatic during
the previous four years; and (b) whose earlier symptoms did
not require long term/maintenance therapy with theophyllines,
nebulisers, or steroids, unless associated with a proven
Only two companies had policies. Free text comments
included: "our policy originally excluded asthmatics from soldering,
but now asthmatics are not 'screened out' as proper
extraction systems are in place"; "isocyanate spraying jobs are
The Armed Forces have clear guidelines-those with epilepsy
or those who have had more than one seizure after the age of
5 are unfit for enlistment. Those who have had a single seizure
more than four years before entry, and are off treatment, may
gain entry to a restricted number of trades, provided that there
is no evidence of predisposition to epilepsy. Those who had
febrile convulsions at less than 5 years of age, without subsequent
seizures, may be enlisted in all trades.
Four companies had specific policies. Comments included:
"certain jobs are excluded by law or 'common sense', e.g.
heavy goods vehicle driver, work involving fast moving
unguarded machinery"; "for jobs involving 'safety critical'
work the risk of fits would have to be very low".
The Armed Forces stated that candidates with hyperactivity,
uncomplicated by violence or criminality, absent for more than
two years without treatment, may be fit for enlistment.
Respondents from the police forces were unaware of
candidates declaring ADHD, but stated that "psychiatric/
developmental history is important in considering police
Although no company had an ADHD policy, several made
comments: "I'm not sure how many would declare this";
"employment may depend on medication side effects".
Individuals with IDDM are excluded from the Armed Forces
and police. Only two companies had policies. Comments
included: "some jobs are precluded by law, e.g. pilot, HGV
driver, all other cases will be considered on their merits";
"consideration would be given to difficulties arising out of
Some medical conditions restrict employment choices; early
advice may help career planning.1 This is the rationale behind
colour vision screening, but even this may not be done
adequately. One respondent said: "one common preemployment
problem is colour blindness; in severe cases certain
jobs are unsafe, e.g. electrician, or inappropriate, e.g.
accurate colour matching-sadly a significant number are not
advised that their choice of career may be restricted, so it may
be a severe blow to be rejected".
Companies varied in their individual policies.Many referred
to the Disability Discrimination Act (DDA)2: "the Disability
Discrimination Act makes it legally necessary to consider all
candidates, bearing in mind that most can be accommodated
by making reasonable adjustment to the job". Exceptions
quoted were asthmatics working with chemicals, or those
with epilepsy working at heights.
Many respondents referred to the DVLA guidelines in relation
to driving or jobs working with machinery.3 These guidelines
produced for medical practitioners are sent to all doctors
except paediatricians; they are not thought to need this information.
Many paediatricians are unaware of regulations
regarding group 2 vehicle licences-those with IDDM are
excluded as are those with epilepsy until fit free for more than
10 years off treatment.
The Armed Forces have strict guidance for enlistment.4
Recruits must be fit to serve anywhere in the world, in all
environments where medical care and drug supply may be
limited. Their physicians encourage interested young people to
personally contact them when making career decisions.
The police distinguish between employment of officers and
support staff. There was variation between forces in policies.
One excluded candidates using any inhalers, while others
specified only steroid inhalers.
Respondents appeared currently unaware of potential
employees declaring ADHD; as this condition is diagnosed
more frequently, inevitably it will need to be addressed.
Approximately half of the young people diagnosed with
ADHD will continue to have significant problems with
concentration, impulsivity, and social interaction which may
lead to work difficulties.5 There appears to be little guidance-
ADHD is not indexed in the Royal College of Physicians, Faculty
of Occupational Medicine textbook.6
As this study was in progress, "Connexions" was launched.
This national government funded service (for 13-19 year olds)
aims to identify barriers to progress in education and employment.
Connexions personal advisors can make contact with
employers who have specific enquiries, acting as advocates for
young people (www.connexions.gov.uk).
The DDA2 has made most civilian jobs accessible, but there
remain significant restrictions in the Armed Forces and police.
Paediatricians need training to fulfil two potential roles: as
advocates nationally, lobbying to ensure that restrictions are
based on evidence; and secondly to actively discuss career
decisions with our patients. "Connexions" may be useful for
this second role.
B J Bateman, F Finlay, Bath & North East Somerset Primary Care Trust,
Correpondence to: Dr B J Bateman, Child Health Department, Bath NHS
House, Bath BA1 3QE, UK; email@example.com
Accepted 8 May 2002
1 Hall DMB. Health for all children, 3rd edn. Oxford: Oxford Unversity
2 Disability Discrimination Act 1995 (c. 50). London: The Stationery Office,
3 Drivers Medical Group. "At a glance". Guide to the current medical
standards of fitness to drive. Swansea: DVLA, 2002.
4 Finnegan TP. Fifty years of PULHHEEMS-the British Army's system of
medical classification. Ann Acad Med2001;30:556-7.
5 Hechtman L. Predictors of outcome in children with ADHD. Pediatr Clin
6 Cox R, Edwards F, Palmer K. Fitness for work. Oxford: Oxford University
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