Adapting the ECLECTIC framework for intellectual disability assessment: an ethical and cross-cultural approach

Child and Adolescent Mental Health Services (CAMHS) clinicians increasingly conduct cognitive assessments with culturally and linguistically diverse children and young people, often using tools and diagnostic pathways developed within narrow cultural, linguistic, and educational contexts. In intellectual disability (ID) assessment, this can generate interpretive and ethical uncertainty, particularly when differences in language exposure, schooling histories, migration experiences, and interpreter-mediated assessment complicate the interpretation of standardized cognitive scores. This study examined the adaptation and implementation of Fujii's ECLECTIC framework within CAMHS cognitive assessments for possible ID, and its integration with the ETHICA-4P ethical reasoning framework, to support structured, developmentally informed, and ethically grounded clinical reasoning. Using a qualitative-dominant mixed-methods design, semi-structured interviews were conducted with 14 clinicians reflecting on their use of the adapted frameworks across 36 assessments involving culturally and linguistically diverse children and young people. Brief descriptive self-report ratings were collected to contextualize qualitative findings. Clinicians described the adapted ECLECTIC framework as supporting more explicit integration of contextual, cultural, linguistic, and developmental information into cognitive interpretation and formulation. Diagnostic certainty was consistently framed as calibrated confidence rather than maximal decisiveness, with explicit articulation of uncertainty regarded as clinically appropriate and ethically defensible, particularly in complex or interpreter-mediated assessments. Integration of ETHICA-4P supported clearer ethical reflection on the limits of interpretation and the potential consequences of diagnostic conclusions. Overall, the findings suggest that cross-cultural and ethical frameworks may function most effectively as decision-support tools, enhancing transparency and proportionality in clinical reasoning rather than producing definitive diagnostic answers.