153 Summary and general discussion 7 Summary and general discussion The overall aim of this thesis was to study improvement strategies regarding early detection of infants and toddlers at elevated likelihood for autism spectrum disorders (ASD) and - most importantly - to facilitate timely access to early interventions. More specifically, this thesis addressed its overall aim through the following three objectives: 1. To examine barriers and improvement strategies in the early detection and screening of infants and toddlers at elevated likelihood for ASD, as experienced by preventive care physicians and parents. 2. To develop and pilot test a new, innovative early intervention named BEAR (Blended E-health for children at eArly Risk). 3. To study short-term and six-month effects of the BEAR intervention. This chapter includes a summary and general discussion of the studies presented in this thesis. Key findings are summarized and discussed, as well as strengths and limitations of the conducted research. Furthermore, clinical recommendations and directions for future research will be discussed. This chapter closes with an overall conclusion. Summary of main findings Although early identification of children at elevated likelihood for ASD and referral to appropriate care is vital, this process can be lengthy and challenging. Therefore, this thesis seeks to contribute to facilitate timely access to healthcare for infants and toddlers (along with their families) with a social-communicative vulnerability. First, experienced barriers in early detection and access to (early) interventions as well as perspectives on improvement strategies from two key stakeholders (preventive care physicians and parents) were investigated in qualitative and mixed-method studies (Chapters 2 and 3). Second, a pilot study and cluster randomized controlled trial were conducted on the effects of a new pre-emptive intervention called BEAR (Chapters 4, 5 and 6). Below, a summary per chapter is provided. Chapter 2 presents a qualitative study that used in-depth interviews to investigate barriers and suggestions for improving early detection and access to early interventions for autism spectrum disorder (ASD) as experienced by preventive-care physicians. In 2015, the Dutch ASD guideline was established in to enhance early detection in preventive care by advising a two-step screen approach for children at elevated likelihood during general health surveillance at well-baby clinics. This study assessed adherence to the guideline, identified barriers to early ASD detection and explored improvement strategies through semi-structured interviews with 12 preventive care physicians (one representative per province). Qualitative analysis using
RkJQdWJsaXNoZXIy MjY0ODMw