93 SCOPE study design 5 The importance of early detection and intervention of autism spectrum disorder (ASD) is widely recognized (French & Kennedy, 2018). Since greater plasticity of the brain during preschool years facilitate learning opportunities, early interventions starting at this crucial period have the best chance of altering neural connectivity (Dawson et al., 2012). Early intervention during the first three years of life is expected to decrease core autism symptoms (Estes et al., 2015), enhance social communication between parent and child (Green et al., 2017) and improve cognitive and adaptive behavior (Dawson, 2010). Unfortunately, varying time gaps of 1.5 to 3.5 years exist between first raised concerns and an ASD diagnosis (Crais et al., 2014; Crane et al.,2016; Snijder et al., 2021). So, despite an increased awareness of the importance of early detection and intervention, infants and toddlers at high likelihood for ASD generally receive access to appropriate intervention later than preferred. Difficulties in early identification and access to early interventions are multifaceted, with barriers related to child, parent, professional and organizational levels (Daniels & Mandell, 2014; Pijl & Servatius - Oosterling, 2021). Focusing on child characteristics, children with milder symptoms of ASD and (above) average IQ are often not recognized at an early age (Oosterling, 2010), whereas children with more severe ASD and cognitive impairments are identified sooner (Daniels & Mandell, 2014). Also, girls and children from ethnic minorities are at risk of late identification (Mandell et al., 2009; Rutherford et al., 2016). From parents perspective, it is sometimes difficult for a parent to acknowledge and accept that their child might develop differently, and therefore parents might be reticent to be referred to specialized mental healthcare when their child is still very young (Boshoff et al., 2018). On the professional level (especially for preventive care professionals), limited knowledge about ASD symptoms in infant- and toddlerhood and limited use of screening instruments are main components in late identification, as well as unfamiliarity with the opportunities and advantages of early intervention (Crais et al., 2014; Pinto-Martin et al., 2005; Snijder et al., 2021). Lastly, on organizational level, long waiting lists and limited service capacity make it difficult to access early interventions (Crais et al., 2014; Dosreis et al., 2004; Snijder et al., 2021). The lack of accessible early interventions raises the ethical question of why healthcare professional should screen for ASD, if there are no suitable referral options. Furthermore, insufficient compensation (i.e. time and money constraints) for healthcare professionals lead to the absence of investment in additional training (i.e. therefore the lack of knowledge regarding early signs of ASD) and adherence to screening guidelines (Pijl et al., 2018; Snijder et al., 2021). So, in order to improve early identification and access to early interventions, integrated improvement strategies targeting both child, parent, professional and organizational levels are highly required. The SCOPE (Social COmmunication Program supported by E-health) project aims to improve early detection and access to intervention by introducing three components that are developed to overcome aforementioned barriers and will be discussed below (see also
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