35 Perspectives of preventive care physicians on early detection of autism spectrum disorder 2 Table 1. Themes (selective codes) and categories (axial codes) representing barriers, accompanied by illustrative quotes Selective codes Axial codes Illustrative quotes 1. Knowledge “What could we possibly have seen at the well-baby clinic? In order to diagnose this girl with ASD? At elementary school I can imagine, but I wonder, which signs could we have seen at the well-baby clinic?” – Participant 1 “We have physicians who just started and we have physicians who are more experienced. You develop some kind of intuition that will improve by the years.” – Participant 6 2. Professional attitude 2a. Feelings of competence “In the beginning, I had a lot of insecurities regarding this subject. However, since I have to do everything by myself, the insecurity has disappeared a bit. But nobody tells me that I am doing it [screening for ASD] right.” – Participant 4 2b. Beliefs about the importance of early detection. “Possibly, parents experience no problems with their child’s development at that age. I wonder, if the child is doing okay and parent don’t express any worries, is it necessary to further investigate the child and refer for treatment at a young age?” –Participant 1 “I thought it [early detection] was only important when problems have accumulated. But the specialized mental healthcare center told me: if we had seen this child earlier, we could have taught parents different strategies on how to cope with this behavior. So, I don’t know if all of my colleagues are aware of the urgency of early detection and referral.” – Participant 12 3. Discussing initial concerns with parents 3a. Discrepancies in concerns between PCPs and parents “Parents had no idea that there was “something different” with their child. She was the first and only child in the family. I first referred for an audiology assessment to test their hearing. There they said: ‘Her hearing is fine! But we believe that there should be additional diagnostic assessment. Then I referred to a specialized mental healthcare center”. – Participant 11
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