37 Perspectives of preventive care physicians on early detection of autism spectrum disorder 2 Table 1. Continued Selective codes Axial codes Illustrative quotes 6. Availability of healthcare services “Audiologic centers have long waiting lists, they can’t handle the number of referrals. Experts often say: we see them [children with ASD] too late! You should identify them earlier! But when we do screen earlier and identify more children, the system gets clogged.” - Participant 8 “I believe it is really important that we should have a clean and easy gateway to the child and adolescent psychiatry. They are difficult to reach with those long waiting lists.” – Participant 10 “In our region, we don’t have any infant teams anymore. They have been closed down by municipalities, four or five years ago. It was a thing about finance. But that makes it so difficult. When you want to refer parents and their child to the specialized mental healthcare, the doctor or the parents have to be really sure that it is something. So, in our region, I miss the ability to offer easy and accessible care.” – Participant 12 1. Knowledge about autism spectrum disorder Limited knowledge of ASD in infants and toddlers was the first theme constructed. There seems to be a variation amongst PCPs’ knowledge of the early signs of ASD. PCPs with less work experience express their difficulties and insecurities in recognizing the early red flags of ASD, and seem often not to be aware of the fact that symptoms can already be evident in infants and toddlers. More experienced PCPs often report a higher degree of confidence in their knowledge in recognizing early risk signals of ASD. The majority of them mention their ‘professional intuition’ when it comes to early detection of ASD. 2. Professional attitude The second theme was PCPs’ professional attitude which covered a) feelings of competence, and b) beliefs about the importance of early detection. 2a. Feelings of competence Some PCPs feel that they are not capable enough to recognize signs of ASD, due to their educational background and/or due to the limited time they have to examine a child. PCPs with less work experience and knowledge of the subject seem to be less confident in signaling high risk children than PCPs with more experience and knowledge. One PCP suggested a need for peer feedback.
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