The evaluation of withdrawal behavior in infants during pediatric examinations using the Alarm Distress Scale (ADBB)

Withdrawal behavior in infancy, whether it be of organic, relational or mix ed origin, is an important signal of alarm which can appear in numerous cir cumstances and yet there exists no specific tool to measure it. A scale to detect and evaluate withdrawal behavior of the young child (The Alarm Distress Scale ADBB) was constructed and tested in a clinical context with a population of children between the ages of 2 and 24 months, consult ing regularly at the PMI (Maternal-Infant Protection Center). This article describes the construction of the scale and the evaluation of its propertie s. The ADBB has good content validity based on the opinion of several exper ts. A good correlation (0.84) was observed between the pediatrician and the nursery nurse measuring the level of withdrawal with the scale both togeth er and independantly. The threshhold score of 5 obtained the best sensitivi ty (0.82) and the best specificity (0.78) when used for detection. The scal e has good construct validity and high internal consistancy (Cronbach alpha = 0.83). Test-retest on videotaped documents displayed good judgement stab ility with the scale over time. The scale could contribute to an earlier di agnosis of withdrawal in diverse infantile pathologies and improve communic ation between professionals with the aim of providing the most expediant pr eventive and curative action. Use of the scale is thus possible in a variet y of clinical situations and research (postnatal depression, mother-child u nits, troubles in parenting, prematurity, handicaps) and its mastery is rel atively simple.