Epistemic Injury Checklist (EIC) as a Complement to ADOS-2: Supporting Differential Formulation and Triage in Autism and ADHD Assessment Pathways
Year: 2025
Type: article
Abstract: Increasing demand for autism and ADHD assessments has led to growing reliance on standardised behavioural instruments such as ADOS-2 within NHS and private diagnostic pathways. While these tools are essential and NICE-aligned, they are not designed to distinguish neurodevelopmental conditions from behaviour patterns arising from relational inhibition, trauma adaptation, masking, or disrupted epistemic environments. This policy and clinical discussion paper introduces the Epistemic Injury Checklist (EIC) as a supplementary formulation and triage aid intended to complement, not replace, existing diagnostic instruments. The EIC focuses on identifying markers of epistemic injury—developmental disruptions in an individual’s capacity to safely express, test, and trust their own perceptions—which may produce behavioural convergence with autism or ADHD presentations across childhood and adulthood. The paper clarifies the conceptual relationship between EIC and ADOS-2, outlines practical use cases across referral triage, developmental history-taking, multidisciplinary formulation, and post-assessment support planning, and situates EIC within NICE-aligned pathways. It argues that incorporating an explicit epistemic–developmental formulation layer may improve differential assessment, reduce diagnostic ambiguity, support proportionate intervention, and inform service design under conditions of rising demand and constrained capacity.
Author: Kahl, Peter
Language: English
Subfield: Cognitive Neuroscience
Field: Neuroscience
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W7117539689
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