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The study presented in this article tackles a crucial challenge in the field of infant health: relational withdrawal in infants aged 2 to 24 months. Relational withdrawal is an important warning signal in child development, associated with disorders such as autism, childhood depression, attachment disorders, and even malnutrition.

The lack of assessment tools for this phenomenon led to the creation of the Alarm Distress Baby (ADBB) scale, designed to assess sustained withdrawal reactions in infants. The study included 60 infants and examined various causes and manifestations of withdrawal, including responses to non-contingent relationships and the effects of maternal depression.

Reliability and Validity of the ADBB Scale

  1. Content Validity: According to the opinion of seven experts, the ADBB has good content validity. Each item corresponded to a postulated dimension, and each dimension was represented by several items.
  2. Criterion Validity: Criterion validity was examined in two ways. First, the ADBB was used to measure the intensity of the withdrawal reaction, with a good correlation between the scores of the expert, nurse, and pediatrician. Then, it was used as a screening tool to detect the child’s developmental risk, with optimal sensitivity and specificity for a threshold score of 5.
  3. Construct Validity: The scale showed good construct validity, with good convergent and discriminant validity.
  4. Reliability: The inter-rater reliability between the nurse and the pediatrician was very good (ICC = 0.84). The test-retest reliability also showed good stability over time (rs = 0.90 and 0.84 for two different evaluators). The internal consistency of the scale was satisfactory, with a Cronbach’s alpha of 0.80 for the first subscale, 0.79 for the second, and 0.83 for the overall scale.

My Opinion as an Expert

This study is a significant advancement in our understanding of relational withdrawal in infants. As an expert in the field of child mental health, I believe the ADBB scale offers a valuable tool for clinicians, pediatricians, and mental health professionals to assess and intervene early in the psychological suffering of babies and young children.

This work underscores the importance of recognizing and treating relational withdrawal as an indicator of potential developmental problems. It reminds us that child development is complex, and withdrawal signs may be the symptom of serious underlying problems in development or already present but difficult to diagnose. This study reinforces the need for a careful and holistic approach in assessing and supporting the healthy development of the child, and I consider it an essential contribution to our field.

Furthermore, it provides solid evidence of the reliability and validity of the ADBB scale. The demonstrated validity and reliability of this scale strengthen its relevance and utility in various clinical contexts. It can be used by nurses, psychologists, or doctors after a short training period, making it accessible and practical.