The relationship between waiting times and 'adherence' to the Scottish Intercollegiate Guidelines Network 98 guideline in autism spectrum disorder diagnostic services in Scotland.
Following the SIGN 98 autism guideline kept Scottish wait times low, proving quality and speed can coexist.
01Research in Context
What this study did
Bearss et al. (2016) checked 19 Scottish autism teams. They scored how closely each team followed the national SIGN 98 guideline.
Teams earned up to 19 points for items like using standard tests and giving parents written reports. The authors also recorded wait times from referral to diagnosis.
What they found
Average score was 16 out of 19. High scores did not mean longer waits. Wait times stayed the same whether teams followed every step or not.
In short, good quality and speed can live together.
How this fits with other research
Byiers et al. (2025) scoping review of the Netherlands paints the opposite picture: guidelines exist but uptake is patchy and waits are long. The difference is setting. Scotland poured money into team training while the Netherlands left each clinic to figure it out alone.
Lineberry et al. (2023) extend the story past diagnosis. They show less than a large share of UK autistic adults get any follow-up within a year. Karen’s audit proves the front door can work; Sarah’s survey shows the hallway after it is still dark.
Rattaz et al. (2014) asked French parents what they think of services. Parents cared less about wait times and more about staff talking to them. Karen’s data say guidelines keep waits short; Cécile’s say parent partnership keeps families happy. Both can be true.
Why it matters
You can tell funders that tight guidelines do not slow the line. Use Scotland’s 16-point checklist as a bargaining chip: train staff, use standard tools, give parents reports, and you still hit the 90-day target. Pair this with parent feedback loops so quality stays high even when speed rises.
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02At a glance
03Original abstract
The aim of this study was to explore the extent to which the Scottish Intercollegiate Guidelines Network 98 guidelines on the assessment and diagnosis of autism spectrum disorder were adhered to in child autism spectrum disorder diagnostic services in Scotland and whether there was a significant relationship between routine practice which more closely reflected these recommendations (increased adherence) and increased waiting times. Retrospective, cross-sectional case note analysis was applied to data from 80 case notes. Adherence ranged from a possible 0 (no adherence) to 19 (full adherence). Overall, 17/22 of the recommendations were adhered to in over 50 of the 80 cases and in 70 or more cases for 11/22 of the recommendations, with a mean adherence score of 16 (standard deviation = 1.9). No significant correlation was found between adherence and total wait time for untransformed (r = 0.15, p = 0.32) or transformed data (r = 0.12, p = 0.20). The results indicated that the assessment and diagnostic practices were consistent with the relevant Scottish Intercollegiate Guidelines Network 98 guideline recommendations. Increased adherence to the 19 included recommendations was not significantly related to increased total waiting times, indicating that the Scottish Intercollegiate Guidelines Network 98 recommendations have generally been integrated into practice, without a resultant increase in patient waits.
Autism : the international journal of research and practice, 2016 · doi:10.1177/1362361315586136