115 Short-term outcomes and six-month follow-up of BEAR 6 Similar to the iBasis-VIPP approach, BEAR uses video feedback techniques and furthermore builds upon well-studied principles that assume that, a) high synchrony between parent and child is expected to be related to reduced autism symptoms and that b) improved joint attention and joint engagement skills are related to better communicative abilities (Kaale et al., 2012; Kasari et al., 2012; Murza et al., 2016). The aims of the current study are to investigate the short-term and six-month follow-up effects of the novel pre-emptive BEAR intervention The primary hypothesis of this study is that the BEAR intervention leads to improved joint engagement in parent–child interactions. Secondary hypothesis include improved socialcommunicative development of children at elevated likelihood of ASD, enhanced parental skills such as scaffolding, highlighting symbols, following the child’s interest, caregiver affect, lower parental stress, improve parental well-being and overall improvement of parent-child interactions. Methods Study setting In the Netherlands, all infants and toddlers receive regular check-ups at well-baby clinics (WBCs, also known as Child Health Care centers)from birth onward until the age of four. The frequency of these visits may vary slightly between different clinics. In the Nijmegen area, where this study was conducted, approximately around 13 visits are scheduled, beginning at one month of age and finishing at three years and nine months of age. The WBCs were trained in following the Dutch Autism Spectrum Disorders-guideline (Van Berckelaer-Onnes et al., 2015). This guideline offers action-oriented advice to preventive care professionals (PCPs) regarding early detection and screening of ASD. It advocates the use of a general health surveillance tool known as the Van Wiechen Scheme (Laurent de Angulo et al., 2008) to monitor the development of all children from birth to four years. The surveillance tool holds eight behavioral signs, considered to be high likelihood behavior characteristics in infants and toddlers (Dietz et al., 2006). When one or more behaviors are identified during general surveillance with the Van Wiechen Scheme the guideline recommends specific screening using the Communication and Social development Signals (CoSoS1) screening questionnaire as a second step. The CoSoS consists of 14-items to be answered dichotomously as ‘yes’ or ‘no’. A score equal or higher than three indicates a positive screen, meaning the child is at an elevated likelihood for ASD (Dietz et al., 2006). Before start of the study, all PCPs (i.e. physicians and nurses) were trained to enhance their knowledge and ability to recognize early indicators of high-risk behavior associated with ASD, as well as in administering the CoSoS. Training 1 Previously known as ESAT
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