Epistemic Injury Checklist (EIC) as a Complement to ADOS-2: Supporting Differential Formulation and Triage in Autism and ADHD Assessment Pathways

Rising demand for autism and ADHD assessments has increased 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 note 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—disruptions in an individual’s capacity to safely express, test, and trust their own perceptions—which may contribute to behavioural convergence with autism or ADHD presentations across childhood and adulthood. The note clarifies the relationship between EIC and ADOS-2, outlines practical use cases across triage, developmental history-taking, multidisciplinary formulation, and support planning, and situates EIC within NICE-aligned pathways. It argues that an explicit epistemic-developmental formulation layer may improve differential assessment, support proportionate intervention, and inform service design under conditions of rising demand and constrained capacity.