97 SCOPE study design 5 participants (children and parents) and the therapist know to which condition the participant is assigned through cluster randomization. However, for the primary outcome measure, our assessors rating parent-child interaction are unaware of group allocation (see Table 2). Participants Children at high likelihood of ASD and their families who meet inclusion criteria are recruited at participating well-baby clinics in the allocated cluster region surrounding Nijmegen, the Netherlands. If families outside of the region are interested in participating in the study, participants will be individually randomised in one of the two groups. Children and their parents are eligible to participate if the following criteria are met: a) a screen positive result (≥3) on the Communication and Social development Signals (CoSoS, formerly known as ESAT, [Dietz et al., 2006]) list, or with a screen negative result (<3) although with serious professional and/or parental concern regarding social-communicative development; b) age between 12-30 months; and c) at least one of the parents is able to understand and speak Dutch. Exclusion criteria are family issues that limit the likelihood to engage in an home based intervention, significant chronic illness of the child, severe parental psychopathology (such as depression, psychosis, substance use disorder), a severe intellectual disability of both child and parents, severe vision and hearing impairments and/or severe motor impairments. Procedures The study consists of two phases with several steps, as described below. Pre-study phase (T0) Step 1: Training of professionals. All preventive care physicians, nurses and other professionals working at the well-baby clinics in the target area first completed an e-learning in recognizing the early symptoms of ASD in infants and toddlers and were trained in administering the CoSoS in order to screen at risk children. Next, preventive care physicians participated in a live online educational program. This program raises physicians level of specific ASD knowledge, as well as their self-confidence in screening for ASD (van ‘t Hof et al., 2020). For their participation, both physicians and nurses were awarded with CME (Continuing Medical Education) points. During training, preventive care physicians and nurses were informed in which study condition their well-baby clinics was assigned to. They received strict instructions from the research team regarding recruitment. Step 2: Screening and inclusion As part of regular healthcare and screening procedures, the Van Wiechenscheme is conducted at all well-baby clinics to monitor developmental milestones for children from birth to 4 years of age (Laurent de Angulo et al., 2008). The surveillance tool holds eight signals, considered to be first behavioral red flags of ASD in infants and toddlers (Dietz et
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