| Summary: | Aims. The objective of this thesis was to test surveillance procedures for early detection of autistic children. The specific aims were: (1) to describe the characteristics of children diagnosed with autism before and after the age of 6 years, and to identify factors that influence the age of diagnosis; (2) to study the implementation of a screening program for autism within the well-child care in primary health care centers (PHCs); (3) to validate the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) on a population sample of 30-month-old children; and (4) to evaluate the rate of autism in a group invited to a screening program in comparison with the rates in two groups who received usual care. Materials and methods. Study I was a cohort study. We studied all children in Iceland born 1992 to 1995 who had been diagnosed as autistic (N = 99) according to a nationwide database kept at the State Diagnostic and Counseling Center (SDCC). Children diagnosed before and after the age of 6 years were compared, and parents answered a questionnaire about their first developmental concerns. Studies II, III, and IV dealt with a prospective program on the early detection of autism. The program included a two-stage screening for autism and a course on autism for the well-child care clinicians. The population eligible for screening included all children in Iceland registered for their 30-month well-child visit at a PHC from March 1, 2016, to October 31, 2017. The capital area of Reykjavik was chosen for implementation of the screening, and cluster randomization was used with the PHCs as the units of randomization. Nine PHCs were randomly selected for the screening, while eight PHCs were assigned to control group 1. PHCs outside the capital area were not randomized and were assigned to control group 2. The well-child care clinicians completed a questionnaire on their pre- and post-course knowledge of autism, and contact persons at the PHCs answered a survey about their experience and attitudes ...
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