Global Developmental Delay: assessment, monitoring and changes from early detection to 8 years of life

Intellectual Disability (ID) is a neurodevelopmental disorder (NDD) characterized by 3 features:

1) Deficits in cognition (reasoning, problem solving, planning, abstract thinking, judgment, academic learning) confirmed by clinical assessment and individualized with psychometric tests

2) Deficits in the adaptive function

3) Appearance during the development period.

The definition of TND is a broad concept that refers to "a group of heterogeneous conditions characterized by a delay or impairment in the acquisition of skills in a variety of developmental domains including motor, social, language, and cognition."

Executive Summary
The concepts of RGD and DI are usually considered as complementary entities in one continuum chronological However, from an evolutionary perspective, the symptoms of the same TND change with age and, especially during the first years of life, similar symptoms may be expressing different disorders, so early differential diagnosis may mean , many times, a challenge. In Spain, patients under the age of 6 are followed up in early care centers (CDIAT) and in our service we offer follow-up in Ambulatory Care (AA) from this age, upon discharge from the CDIAT.

Context and Justification
Early intervention in all children at risk of TND is crucial, as it modifies the prognosis and improves the quality of life of the child and their caregivers. In Spain, this intervention is carried out in public centers that have a multidisciplinary team: the Child Development and Early Care Centers (CDIAT), which carry out diagnostic assessments, therapies and prevention tasks from birth to 6 years old, with an approach centered on the family and its environment, and integrated with the Health, Education and Social Rights services.

General Objective
Analyze the percentage of diagnostic change between the CDIAT and the AA.
Analyze changes within each diagnostic category.

Specific Objectives
Describe the frequency of comorbidities of other TNDs at the time of the current review.
Analyze possible associations between etiological and clinical diagnosis.
Analyze possible associations between diagnoses and activation of resources in the child's environment.

Standardized and age-appropriate psychometric tests were also administered in the CDIAT when possible.

In Ambulatory Care (AA) a neuropsychological assessment was carried out in all cases with the administration of standardized psychometric tests, and with a multidisciplinary team made up of neuropediatricians, clinical psychologists, speech therapists, and occupational therapists. Therapies were targeted using a global and interdisciplinary approach centered on the family and the natural environment.

The diagnosis in the CDIAT followed the ODAT classification, adaptation to Catalonia of CI 0-3. At AA we use the international classification CIE 10.

To be able to analyze the changes when comparing the output diagnosis of CDIAT with that of CCEE, we determine correspondences between these two classification systems, and group the ODAT and CIE 10 diagnoses into common categories.

A change in the diagnostic orientation entails a readjustment of the therapeutic approach and the vision of the focus of the difficulties at the professional, family, school level and of the entire community assistance network. Given the high emotional impact of the diagnosis on caregivers, a change in the diagnosis can also involve added stress, a possible conflict with and between professionals, the health professional and is often a factor of confusion for families who it can give rise to discrepant perspectives between the child's affective referents.