A validity and reliability study of assessment and screening for sustained withdrawal reaction in infancy: The Alarm Distress Baby scale


  • This study would not have been possible without the support of Marcelle Delour, M.D., Head of medical services, Protection Maternelle et Infantile de Paris. Janine Charon, M.D. (Head of PMI, 14th district of Paris), François Rogé, M.D., pediatrician (PMI, IPP), Malika Benjellal-Zamoun, puéricultrice de jeunes enfants (PMI, IPP), Annie Gauvain-Piquard, M.D. (IGR, Villejuif), Martine Vermillard, nurse (PMI, IPP), Caroline Dumont (psychologist), Héloise Courtier (psychologist), and Edith Thoueille, director (PMI, IPP) have directly participated 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. Frédéric Atger, M.D. (Institut Mutualiste Monsouris, Paris) has been very helpful in the use of the statistical software. Annie Nataf-Cooper Rusconi, M.D., Marianne Kumar, Gisèle 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 study has benefited from the financial help of the Nestlé Corporation. Direct correspondence to: Dr. Antoine Guedeney, Hôpital Bichat-Claude Bernard, policlinique Ney, 124 blvd Ney, 75018 Paris, France; e-mail: guedeney@bch.ap-hop-paris.fr.


Sustained withdrawal behavior in infancy is an important alarm signal to draw 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 validity, 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 correlation between nurse and pediatrician on the ADBB (rs = 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. The scale has good construct validity, with good convergent validity with both the Spitz (1951) and the Herzog & Rathbun (1982) lists of symptoms of infant depression (rs = 0.61 and 0.60, respectively). Exploratory factor analysis showed two different factors, consistent with the scale's construct. Reliability was satisfactory with good internal consistency for both subscales (the Cronbach α = 0.80 for the first subscale and 0.79 for the second) and for the global scale (α = 0.83). The test-retest procedure showed good stability over time (rs = 0.90 and 0.84 for the two different raters). The scale could be used in different clinical settings, provided a sufficient level of social stimulation is given to the infant in a relatively brief period of time. The scale can be used by nurses and psychologists or by medical doctors after a short period of training.  © 2001 Michigan Association for Infant Mental Health.