38 Chapter 2 2b. Beliefs about the importance of early detection. A couple of PCPs wondered whether or not it is important to identify children with possible ASD before the age of four. PCPs who are aware of the benefits of early detection and intervention seem more likely to screen children early and discuss concerns with parents. However, some PCPs are unaware of the importance of early detection and only screen when problems have accumulated. 3. Discussing initial worries with parents Discussing initial worries with parents can be divided into: a) discrepancies in worries between PCPs and parents, and b) parental recognition and perspective on diagnosis and healthcare. 3a. Discrepancies in worries between PCPs and parents Almost all PCPs noted that they find it difficult to express their concerns regarding ASD and motivate parents for diagnostic assessment when there are discrepancies in worries between PCPs and parents. Since parents are essential partners when proceeding referral, PCPs often choose a different strategy: they choose to express their worries about the child’s delayed language development and refer for an audiology assessment, instead of discussing their concerns about ASD and refer to a specialized mental healthcare service. 3b. Parental recognition and perspective on diagnosis and healthcare PCPs often describe that parents find it difficult to recognize and accept that their child’s development is compromised. Furthermore, PCPs mention parental perspective on diagnosis and healthcare: parents sometimes do not want a diagnosis for their child at such a young age, because of stigma. 4. Screening instruments Notably, a minority of PCPs used an ASD-specific screener (CoSoS) when developmental worries occurred based during general surveillance. This theme covers obstacles mentioned by PCPs in the use of an ASD-specific screener. 4a. Unfamiliarity with ASD specific screening tools The majority of the PCPs is unfamiliar with the CoSoS. First, PCPs mentioned that they are often unaware that an ASD-specific screener is recommended (as in the guideline) when concerns are raised during general surveillance. Second, PCPs mentioned that they find the purpose of the CoSoS unclear, and that they do not know how and when to use it. For example, one PCP (mistakenly) thought that the CoSoS was part of diagnostic assessment.
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