42 Chapter 2 and language difficulties. Especially early on in their career, PCPs seem to have a limited knowledge about ASD symptoms in infant-and toddlerhood, are not aware of the importance of early identification (and subsequently the benefits of early intervention) and experience feelings of incompetence. This finding is often cited as a barrier in early detection of ASD in previous research, and is frequently recommended to target by offering additional training (Bright et al., 2019; Fenikilé et al., 2015; Mazurek et al., 2020; Pinto-Martin et al., 2005). Based on the Knowledge-Attitude-Behavior Framework, knowledge influences personal attitudes and attitudes will subsequently influence behavior (Fischer et al., 2016). Therefore, improving knowledge about ASD symptoms (as the first personal barrier) in infant-and toddlerhood can be considered as a fundamental target in improving early detection of ASD, which in turn can influence professional attitude (as the second personal barrier) towards early detection. The third personal barrier covers the field of discussing initial worries with parents. PCPs find it difficult to discuss the possibility of the child having ASD when parents do not express any concerns. Furthermore, PCPs describe that parents find it difficult to recognize and accept that their child’s development is compromised. Since early interventions are being advised to start as quickly as possible (Zwaigenbaum et al., 2015), there is an increased possibility that parents are being confronted with their child’s disability even before they share concerns on their own initiatives. However, the statement made by PCPs in the current study (that parents find it difficult to recognize and accept that their child’s development is different) is noteworthy. Previous studies conducted amongst parents of children with ASD suggest that parents are often the first ones to express concerns. They often start having concerns about their child’s development during the first 2 years of life (Landa et al, 2008; Zwaigenbaum et al., 2015). Despite initial worries expressed by parents, they are often met with a ‘wait and see’ approach (Crane et al., 2016; Chao et al., 2017). So as from the professional perspective discussing initial worries might be difficult, whereas from a parent perspective, initial concerns are often dismissed by a PCP. However, who first raises concerns is not the main question. Instead, we must focus on how to ease parent-professional conversations regarding the early identification of ASD. Strategies to narrow the gap between parents’ and professionals’ perspectives could be additional training for PCPs in motivational interviewing and active listening strategies (Locke et al., 2020), and making use of a specific screening tool (as prescribed by the guideline, and further discussed below). However, in order to better understand and ease PCP-parent conversations, additional research is needed that investigates parents experiences with the early identification process and integrates their perspective with PCP’s point of view. The last personal barrier is related to perceptions regarding cultural and language differences. According to PCPs, having a different cultural background and speaking a different language can make it more difficult for parents to discuss initial concerns with a professional. Additionally, PCPs might experience more difficulties in discussing initial concerns of ASD. This barrier is
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