60 Chapter 3 score was 3.49 (SD=1.46). Overall, this score implies that parents are rather satisfied with the early identification process of ASD, but that there is still room for improvement. The experiences of parents with early identification and initial care are further explored in the focus group, along with proposed improvement strategies. Barriers and improvement strategies in early identification of ASD This section covers the themes extracted from the focus group data. Based on their experiences, parents shared their struggles and proposed ideas for improvement, further referred to as ‘barriers and improvement strategies’ in the process of early identification of ASD. A description of three themes that were constructed from the focus group data is given below. Additional quotes are presented in Table 2. Although the emphasis was on the early identification process of ASD in primary and preventive care, parents additionally shared their experiences of the diagnostic process and treatment. As we consider this information beyond the scope of the current study but as additional interest, these findings are presented in the Supplementary Materials. 1. Knowledge & Expertise Knowledge & Expertise was the first theme constructed from the data. Parents expressed their concerns about the lack of knowledge and expertise regarding early signs of ASD when consulting preventive care professionals and general practitioners. Some parents felt that preventive care physicians and nurses only focused on the average developmental milestones (e.g., growth, speech, motor skills) instead of acknowledging parents’ concerns of ASD and did not identify the behavioral red flags of ASD. However, two parents expressed to have positive experience regarding early identification of ASD at the general practitioner’s office, where a specialized healthcare professional (i.e., a psychologist or a child psychiatrist) was available to provide consultation and address their concerns. Therefore, as an improvement strategy, parents recommended additional training in recognizing the early symptoms of ASD in infancy and toddlerhood for primary and preventive care professionals. 2. Attention to parental needs Attention to parental needs was the second theme and was divided into the barriers regarding: a) acknowledgement of parental concerns, and b) risk of social isolation, prejudice and stigma. 2a. Acknowledgement of parental concerns Parents experienced their concerns to be easily dismissed and marginalized by preventive care professionals and general practitioners. When parents discussed their initial worries of ASD, they mentioned that preventive care professionals (physicians and nurses) and general practitioners often would first try to comfort the parent, ensuring
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