From screening to dynamic assessment.

The Alarm Distress Baby Scale (ADBB) is a tool for detecting and assessing chronic relational withdrawal. Initially designed as a screening tool, it can be used in a long-term clinical setting as part of a dynamic assessment process to understand the baby’s experience of the relational environment.

Dynamic assessment is a concept that comes from psychology and especially from the field of learning. It is a methodology that consists in evaluating the processes implemented by the subject rather than taking a snapshot of the person’s functioning at a given time.

It is a measure of the individual’s learning potential.

In our context, that of babies whose relational experience and level of stress we are trying to understand, it is a matter of evaluating the processes/strategies that the baby will implement to protect himself. At the same time, it is also a question of being able to identify the baby’s resources, those that persist despite the sometimes complex conditions of care, we are talking here about the baby’s capacity for relational engagement, which will be the basis of learning during the very first years of life.

Reactive versus chronic withdrawal: from normal under stress to pathological.

Relational withdrawal, before being chronic, is reactionary. This is what Ed Tronick’s work on still face experiment has shown.

The still face experiment is a laboratory setting whose effectiveness lies in the fact that we voluntarily control the disruption of the dyadic synchrony expected by the baby during an interaction with his or her parent (usually the mother, but it also works with the father) and thus observe the effects on the baby and his or her behaviors independently of other factors.

An initial phase of protest is then observed, then the baby will quickly turn away, disengage. In normal developing babies , this dysynchrony, if it persists, will lead to a phase of disorganization of the baby’s behaviour (crying, agitation).

The ADBB, when the concept of relational withdrawal and the tool are sufficiently well mastered, also makes it possible to catch and observe relational reactive withdrawal, i.e., this coping strategy that the baby implements to deal with a situation that generates interactional stress for him.

A coping strategy is defined as the set of cognitive and behavioral efforts intended to control, reduce or tolerate specific internal and/or external demands, experienced by the subject as threatening, exhausting or exceeding his or her resources (R. Lazarus and R. Saunier, 1978). 

A signal that comes from the baby.

The ADBB can, in test-retest, make it possible to highlight the baby’s point of view with the help of a signal that comes from the baby and therefore has all its relevance for the early clinic.

An example of this type of use is the ” keeping the connection ” protocol used in child protection to understand the effect of parental visits on babies placed in a residential nursery.

A pilot study was able to show that the ADBB used in a test-retest setting allowed for the observation of different reaction trajectories in babies receiving parental visits in a residential nursery. These observations can then help child protection professionals to make decisions in the best interest of the child based on signals coming from the baby, which research has shown to be very relevant.(

In test-retest, the ADBB will also allow monitoring the quality of care of babies in nurseries. This was shown in a study by Mascaró, Dupuis-Gauthier-Jardri, & Delion, in 2012.

A group of 32 babies placed for their protection in a nursery was evaluated using the ADBB, but also other tools on the evolution of their relational behavior at two times: T0, at the time of their arrival in the nursery, T1: 4 months after their care in the nursery; the results showed a significant improvement of the relational withdrawal behavior of the babies during the care.(

Another study shows that relational withdrawal as assessed by the ADBB is a valid construct for assessing the effect of institutionalization and the presence or absence of a reference person on infants’ social-emotional development. (SOCIAL WITHDRAWAL BEHAVIOR IN INSTITUTIONALIZED TODDLERS: INDIVIDUAL, EARLY FAMILY AND INSTITUTIONAL DETERMINANTS)

Finally, it is also possible to monitor the functioning of the nursing groups: Regularly evaluating with the help of the ADBB (once a month for example) the relational withdrawal behavior of all the babies in a nursery nursing group will allow :

–      To identify at an early stage the child who is not doing well despite the care received and therefore to take the necessary decisions, such as increasing the time with the reference person, planning a neuro-paediatric check-up, considering foster care, etc.

–      To identify if a relational or organizational factor impacts the dynamics of the group’s functioning: too many changes in the personnel around the babies, personnel in particular difficulty (burn out, depression), in these cases, it is often the majority of the babies in the living group who will present a drop in their average relational withdrawal score.

As we can see, the clinical applications of the ADBB are multiple, especially in the complex clinic (child protection). Its semiological value is very important to understand the experience from the baby’s point of view and its flexibility of use makes it an inexpensive and reliable tool. ADBB training is available online or in person. The use of the ADBB scale does not require any particular equipment and can be repeated as many times as necessary.