161 Summary and general discussion 7 focus on reducing ASD related symptoms, we now even more advocate for a more holistic approach with a focus on supporting parents and strengthening the parent-child interaction and through that maximizing the child’s developmental opportunities. Within this context, we are also aware of the importance of using inclusive language and terminology. Experts and people with lived experience recommend terms such as “elevated likelihood,” “neurodevelopmental vulnerability,” or “social-communicative vulnerability” instead of “increased risk of ASD” to promote non-stigmatizing language. The researchers endorse this perspective, which is reflected in the shift in terminology observed in this thesis, particularly when comparing the earlier chapters to the later ones. Strengths and limitations A strength of this thesis is the integration of both qualitative and quantitative studies that provides a comprehensive understanding of the challenges of early detection and pathways to appropriate and accessible care. By including and combining perspectives of parents and preventive care physicians, these studies gained an in-depth exploration of their views and provides an integrated perspective on the (difficulties of) early detection and intervention. Also, this thesis explores the effects of the BEAR intervention in a heterogeneous and clinically complex population, enhancing the relevance of study results. Next, a significant strength is the inclusion of a moderately large cluster RCT with blinded primary outcome measures. Overall, the combination of these approaches strengthens the thesis, offering valuable insights and contributing to the field of early detection and preemptive interventions while also paving the way for future developments. There are several limitations to be considered as well. First, the cluster RCT study was limited by insufficient statistical power and a relatively high percentage of missing data, particularly in the questionnaires. This missing data likely stemmed from the diversity of the sample, which included parents from different cultural backgrounds and related problems in completing the questionnaires. While this diversity is a strength, as most studies focus on homogeneous populations (Hampton & Rodriguez, 2022), it also posed challenges in collecting follow-up data due to unanticipated language and cultural barriers. We attempted to address this by imputing missing data and conducting sensitivity analyses on complete cases to verify our findings. It is highly recommended that future research addresses these cultural and language barriers by collaborating with organizations specialized in these areas and ensuring that study materials are available in translated versions. Second, there was an uneven sample size between the BEAR and CAU conditions, with significantly more participants allocated to the BEAR group. This difference in participant allocation might be attributed to the open-label nature of the study with no active control group. This possibly created an additional barrier for preventive care professionals to screen
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