18 Chapter 1 DIANE project led to the development of the Dutch national guideline “Autism Spectrum Disorders” by van Berckelaer-Onnes et al. in 2015 (Nederlands Centrum Jeugdgezondheid, 2015). A summary of the guideline is presented in Figure 1.2. For a schematic representation of the guideline, please see Chapter 2. The Dutch guideline “Autism Spectrum Disorders” offers action-oriented advice to 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 4 years. The surveillance tool holds the eight “red flags” of Dietz et al. (2007, see Box 1.3.). Should one or more behavioral red flags be identified during general surveillance with the Van Wiechen Scheme, the Dutch guideline encourages PCPs to employ the CoSoS screening questionnaire. In the Netherlands, there are high standards of primary and preventive healthcare and an extensive scientific and clinical knowledge about the importance of early detection and intervention of ASD. However, signals from the clinical field gave the impression that the Dutch ASD guideline was not applied in PCPs daily work, a few years after its introduction (2018/2019). This perhaps contributed to a later than preferred detection and receiving later than desired healthcare of children at elevated likelihood of ASD. However, research on this “gut feeling” was limited. Therefore, one of the goals of this thesis was to explore possible barriers experienced amongst PCPs regarding early detection and to offer possible solutions to alleviate these identified barriers (see Chapter 2). The professional and/or parent is concerned. There is a suspicion of ASD. The professional completes a screening questionnaire based on their own observations, information from other sources (such as daycare/school), and input from the parent(s)/caregiver(s) If the score on the screening questionnaire indicates the need, and the parents have a request for support, the child can be referred for diagnostic assessment and treatment. “Gut feeling” Screening questionnaire Referral for diagnostic assessment Figure 1.2. Summary of the Dutch guideline “Autism Spectrum Disorders” (van Berckelaer-Onnes et al., 2015).
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