20 Chapter 1 c) strong collaboration between first line (executer) and specialized mental healthcare (supervisor). Without the need of an ASD diagnosis, BEAR is presumably more acceptable and better-received by parents who have relatively minor concerns, or who are somewhat ambivalent about getting help or those who dread diagnostic assessment. Additionally, it is seen as a suitable healthcare option for children who exhibit unclear clinical signals/ “red flags”. Chapter 5 and 6 will provide a more detailed description of the BEAR intervention, including its development and results. Aims and outline of the thesis This thesis aims to investigate ways in which early detection can be improved, and, most importantly, to facilitate timely access to early interventions for infants and toddlers (along with their families) at elevated likelihood for ASD. The three specific aims of this thesis are: 1. To identify barriers in the early detection and screening of infants and toddlers at high likelihood for ASD and to offer improvement strategies for the clinical practice; 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. The data described within this thesis have been collected from three study samples. Samples are collected in the “real world”, consisting of preventive care physicians, parents, and young children. See Box 1.4. for more details on the study samples. To address the concerns regarding late detection and intervention of infants and toddlers at an elevated likelihood for ASD, we explored the experienced barriers in early detection and access to (early) interventions and gathered perspectives on improvement strategies from two key stakeholders: preventive care physicians (Chapter 2) and parents (Chapter 3). We summarize these two perspectives in the discussion of Chapter 3 and present a chart that may be helpful in thinking of solutions for improving early detection and intervention of ASD. As one of these solutions, we propose an innovative intervention named BEAR. In Chapter 4, the BEAR intervention and SCOPE study protocol are tested in a pilot study to assess the feasibility of the research design and address any potential research challenges. After pilot testing, adjustments to the protocol were made. The final study protocol is presented in Chapter 5. In Chapter 6 the short-term and six month results of the BEAR intervention are presented. Finally, the general discussion in Chapter 7 presents a summary and analysis of the major findings, discusses limitations of the conducted research, explores directions for future research and concludes with implications for clinical practice.
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