66 Chapter 3 and preventive care professionals. This proposed improvement strategy corresponds with the need for additional training as also previously expressed by PCPs and described in our parallel paper (Snijder et al.,2021), and is recommended in several other publications (Fenikilé et al., 2015; Mazurek et al., 2020, Oosterling et al., 2010). The second barrier faced by parents in the early identification process of ASD emphasized the importance of professionals attending to parental needs. Several parents felt that their concerns were dismissed and marginalized by first line healthcare professionals. Unfortunately, this ‘wait-and-see’ approach is a well-known phenomenon. This approach where healthcare professionals show reassuring responses to initial parental concerns often result in a delayed referral for further assessment (Crais et al., 2020; Johnson et al., 2020; Oswald et al., 2015; SmithYoung et al., 2020; Zuckerman et al., 2015). The current study shows that a dismissive response often does not have a reassuring effect on parents, but instead seems to increase parents’ level of insecurity. Thus, instead of adapting a ‘wait-and-see’ approach, healthcare professionals should take parental concerns very seriously, monitor closely and refer to adequate care as quickly as possible when it comes to developmental concerns and/or suspicions of ASD. On the other hand, in clinical practice, there is another group of parents who don’t express first concerns regarding their child’s development, but where a healthcare professional is the first person to express concerns (Snijder et al., 2021). For this group of parents, an accelerated process in referring to adequate care might not be desirable and appropriate since parents need more time to process that their child’s development might be divergent. ASD in young children is complex and the timing and developmental course of early ASD symptoms vary amongst children (Zwaigenbaum et al., 2015). Still, it is highly recommended that first line healthcare workers let go of their “wait-and-see approach” and adopt a more family-centered care approach (Boshoff et al., 2018; Crais et al. 2020; Kuo et al., 2012; Locke et al., 2020). Familycentered care emphasizes the importance of a beneficial partnership between families and health care professionals with shared decision making as an important principle (Kuo et al., 2012; Locke et al., 2020). To establish shared decision making, an active role for parents during the decision making process is strongly encouraged (Crais et al., 2020). Examples on how to promote an active role for parents are the use of parent reports and specific screeners, such as the M-CHAT-RF (Modified-Checklist for Autism in Toddlers Revised and Follow Up; Robins et al., 2014) or the CoSoS (Communication and Social development Signs, previously known as ESAT; Dietz et al., 2006) or to let parents observe their child during daily routines, in order to reach consensus about developmental concerns and ease parent-professional conversations about the suspicions of ASD. The last barrier that parents were challenged with in the process of early identification is related to the field of System & Organization. Parents often faced an inflexible and fragmented system with long waiting lists, that can be difficult to navigate. According to parents, this
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