A validity and reliability study of assessment and screening for sustainedwithdrawal reaction in infancy: The alarm distress baby scale

Sustained withdrawal behavior in infancy is an important alarm signal to dr aw attention to both organic and relationship disorders. A withdrawal scale , the Alarm Distress Baby scale (ADBB), for infants between 2 and 24 months of age was built. This article describes the construction of the scale and the assessment of its psychometric properties. The ADBB has good content v alidity, based on the advice of seven experts. The scale has good criterion validity: first, as a measure of the infant's withdrawal reaction, with a very good cot-relation between nurse and pediatrician on the ADBB (r(s) = 0 .84), and second, as a screening procedure for detecting the developmental risk of the infant. The cutoff score of 5 with a sensitivity of 0.82 and a specificity of 0.78 was determined to be optimal for screening purposes. Th e scale has good construct validity, with good convergent validity with bot h the Spitz (1951) and the Herzog & Rathbun (1982) lists of symptoms of inf ant depression (r(s) = 0.61 and 0.60, respectively). Exploratory factor ana lysis showed two different factors, consistent with the scale's construct. Reliability was satisfactory with good internal consistency for both subsca les (the Cronbach alpha = 0.80 for the first subscale and 0.79 for the seco nd) and for the global scale (alpha = 0.83). The test-retest procedure show ed good stability over time (r(s)= 0.90 and 0.84 for the two different rate rs). The scale could be used in different clinical settings, provided a suf ficient level of social stimulation is given to the infant in asettings, su fficient level of social stimulation is given to the infant in a This study would not have been possible without the support of Marcelle Detour, M.D., Head of medical services. Protection Matermelle et Infantile de Paris. Jan ine Charon, M.D. (Head of PMI, 14th district of Paris), Franqois Roge, M.D. , pediatrician (PML IPP). Malika Benjellal-Zamoun, puericultrice de jeunes enfants (PMI, IPP), Annie GauvainPiquard. M.D. (IGR. Viltejuif), Martine Ve rmillard, nurse (PML IPP), Caroline Dumont (psychologist), Hoisc Courtier ( psychologist), and Edith Thoueille, director (PML IPP) have directly partic ipated in the study. Rachael Henry, Ph.D. (Wollongong. Australia), R. Kumar , Ph.D. M.D. (Maudsley, London), and Campbell Paul, M.D. (Royal Children's Hospital, Melbourne) have kindly provided expert advice at different points of the study. Frederic Alger, M.D. (Institut Mutualiste Monsouris, Paris) has been very helpful in the use of the statistical software. Annie Nataf-C ooper Ruscom, M.D., Marianne Kumar, Gisi le Danon, M.D., and Denise Parise made translations and back-translations of the scale from French to English . Kaija Purra, M.D. (Tampere University. Finland), Priti Patel, M.D., Dilys Daws (Tavistock Clinic, London), and Stephen Matthey (South Western Sydney Area Health Service, Australia) have kindly provided editing help. The stu dy has benefited from the financial help of the Nestle Corporation. Direct correspondence to: Dr. Antoine Guedeney, Hopital Bichat-Claude Bernard, pol iclinique Ney, 124 blvd Ney, 75018 Paris, France; email: guedency (C), bch. ap-hop-paris.fr,