Adherence to Clinical Standards and Guidelines for ASD Diagnosis in Child and Adult Services in Scotland

Background: There is universal recognition of the importance of ensuring that the diagnostic process for ASD is robust and of high quality. This can be operationalised through the application of evidence based clinical standards and guidelines. A number of guidelines have been developed for use in the UK, including the SIGN guideline on ASD in children and young people (Scottish Intercollegiate Guidelines Network guideline 98; 2007) and the NICE guideline on ASD in adults (2012).  In addition, The Scottish Government has produced its own Quality Diagnostic Standard (QDS) from expert consensus.

Objectives: To explore the extent to which ASD diagnostic services in Scotland adhered to the SIGN 98 and NICE Adult guidelines and the Quality Diagnostic Standard (QDS).

Methods: A mixed methodology was used: 16 representative ASD diagnostic services from across Scotland were randomly sampled, resulting in an audit of 150 case notes; focus groups were then conducted with the same services. Clinical practice as evidenced within the case notes was mapped against the relevant standards and guidelines.

Results: Overall, child services were found to adhere to over 70% of SIGN 98 and the QDS.  The adult services were found to adhere to over 50% of the NICE (Adult) guideline and the QDS. No significant relationship was found between adherence to either of the evidence based guidelines or the QDS and duration of the assessment process. The focus group participants identified ways to increase adherence to the guidelines and the QDS in the context of their local service, provided feedback and identified areas for future review.

Conclusions: There is variability within and between child and adult services across Scotland in adherence to the current clinical guidelines and QDS for the diagnosis of ASD.  The outcomes of this study were used to help services improve the quality and robustness of their diagnostic procedures, and could also be used to inform future review of clinical guidelines and diagnostic standards.