Early detection of young children at risk of autism spectrum disorder at well-baby clinics in the Netherlands: Perspectives of preventive care physicians.
Dutch well-baby doctors skip the mandated ASD screen for six fixable reasons, not because the tool fails.
01Research in Context
What this study did
Snijder et al. (2021) asked Dutch well-baby doctors why they skip the ASD checklist.
The team ran focus groups and interviews.
Doctors said they doubt the tool, fear parent upset, and lack time.
What they found
Most physicians never use the formal ASD screen.
They watch for red flags but avoid the guideline step.
Knowledge, attitude, culture, and system blocks stop them.
How this fits with other research
van 't Hof et al. (2021) tried a fix: live online training.
Knowledge rose for six months, yet referrals stayed flat.
The training beat one barrier but left the rest untouched.
Shrestha et al. (2021) show a different path.
In Nepal, trained volunteers using the SACS checklist caught toddlers with near-perfect accuracy.
Lay workers followed the protocol better than Dutch doctors, showing the tool works when people use it.
Together the papers say: the screen is sound, the delivery system is not.
Why it matters
You can’t assume the checklist is flawed; assume the workflow is.
Pair any screen with quick parent handouts, short demo videos, and clear referral fax forms.
Schedule a five-minute warm hand-off with your local clinic so doctors see the next step is easy.
These small tweaks target the real barriers Ij et al. found and lift uptake without more lectures.
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02At a glance
03Original abstract
To improve early detection of autism spectrum disorder in preventive care, a Dutch guideline was developed 5 years ago. The guideline provides preventive care physicians at well-baby clinics action-oriented advice and describes a step-by-step approach for children identified at an increased risk for autism spectrum disorder during general healthcare surveillance. The present qualitative study evaluated adherence to the guideline and studied barriers regarding early detection of autism spectrum disorder at well-baby clinics. Interviews were undertaken with 12 preventive care physicians (one representative per province). It was found that the vast majority of participants did not follow-up general surveillance with an autism spectrum disorder -specific screener as prescribed by the guideline. Six barriers (limited knowledge about autism spectrum disorder symptoms in infant and toddlerhood, professional attitude toward early detection, problems in discussing initial worries with parents, limited use of screening instruments, perceptions toward cultural and language differences and constraints regarding availability of healthcare services) were found. The results of this study highlight the importance of an integrative approach, raising awareness of the benefits regarding early detection of autism spectrum disorder in preventive care, the need of continuous investment in easy and accessible training and active screening, and a closer collaboration between preventive care organizations and autism spectrum disorder experts.
Autism : the international journal of research and practice, 2021 · doi:10.1177/13623613211009345