156 Chapter 7 revealed an absence of significant treatment effects on child developmental outcomes. However, note that changes observed in joint engagement and in ASD symptoms are in the hypothesized direction without passing the significance threshold. Next, results revealed a positive treatment effect on the parent in terms of improved parental scaffolding and affect. Specifically for the scaffolding skills there was a significant increase at six months follow-up for the BEAR group. Looking at caregiver affect, a positive treatment effect occurred directly after treatment and was maintained six months later. Finally, a possible treatment effect on dyadic level (i.e. improved fluency and connectedness in the parent-child interaction) was found. However, definitive conclusions cannot be drawn, as sensitivity analyses showed significant improvements directly after treatment regarding parent-child interaction, while analyses on imputed data did not. The study described in this chapter suggests that the primary benefits of the intervention lie in enhancing parental skills rather than directly impacting the child and, through that, possible benefit the parent-child interaction. To draw more firm conclusions regarding the effects of BEAR, future research is recommended and this will be discussed in the General Discussion below. General discussion Early detection and screening of infants and toddlers at elevated likelihood for ASD The first part of this thesis (Chapters 2 and 3) focused on identifying barriers and strategies for improvement in the early detection of infants and toddlers at elevated likelihood for ASD amongst two stake holders: preventive care professionals and parents. ASD in young children is clinically rather heterogeneous, and the timing and developmental course of early ASD symptoms can also vary significantly among children (Zwaigenbaum et al., 2015). The findings from these two studies highlight the complexities involved in screening and early detection. Moreover, there is a risk that parents may feel their concerns about their child’s development are not adequately acknowledged by preventive and primary care professionals. This may stem from a “wait-and-see” approach adopted by these professionals, potentially because they have insufficient knowledge about early signs of ASD in young children, limited awareness of the benefits of early ASD detection in preventive care, and infrequent use of an active, two-step screening approach (Oosterling et al., 2010; richtlijn NCJ 2015). Additionally, on the other hand, professionals may find it challenging to discuss developmental concerns with parents during consultations, especially when the parents themselves do not have concerns, when there are language and/or cultural differences or when appropriate care options are lacking. For some parents, an accelerated referral process to (specialized) healthcare might not be desirable and appropriate since parents need more time to process that their child’s development might be “atypical”.
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