30 Chapter 2 detection and screening of ASD. It describes that the development of all children should be monitored by using a general tool for health surveillance, called the Van Wiechen Scheme (Laurent de Angelo et al., 2008). The Van Wiechen Scheme provides a template to monitor developmental milestones for children from birth to four years of age. The surveillance tool holds eight signals, considered to be first behavioral red flags of ASD in infants and toddlers (Dietz et al., 2006). When one or more behavioral red flags are identified during general surveillance with the Van Wiechen Scheme, the Dutch guideline urges PCPs to use an ASDspecific screener (CoSoS). Figure 1 provides a schematic representation of the guideline, as developed by van Berckealer-Onnes et al. (2015). In the Netherlands, there is a general rule that national guidelines must be implemented in preventive healthcare organizations within two years after its introduction. To realize this, the organization that oversees guideline implementation carries out a standard protocol (Dunnink et al., 2016). Although it has been five years since the guideline was introduced and implemented by standard methods, until now, the current state of guideline adherence has not been investigated. Developmental worries expressed by parents, school, kindergarten, and/or healthcare professionals Developmental worries during general healthcare surveillance (missed items on the Van Wiechen Scheme) Likelihood of ASD CoSoS/ESAT Specific anamnesis AND / OR Positive screen? Continue to monitor child development. Follow-up assessment if needed Referral for diagnostic assessment and early intervention YES NO Start other healthcare trajectory (i.e. referral to audiologic centre) YES NO Other causes? Figure 1. Representation of the Dutch national guideline on autism spectrum disorders by van Berckelaer-Onnes et al. (2015, translated). Previous studies show that clinical screening guidelines are often not fully applied (Arunyanart et al., 2012; Fischer et al., 2016; Wallis et al., 2020). A systematic review that proposes a model to improve guideline implementation and adherence (Knowledge-
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