Evaluating the baby’s point of view in the nursery

Limoges Residential Nursery
source photo : unknown
credits : D.R.

The Distress Alarm BabyScale is a tool for detecting and evaluating chronic relational withdrawal. Initially designed as a screening tool, it can be used in long-term clinical settings in a dynamic assessment process to understand the baby’s experience of the relational environment.

Dynamic assessment is a concept derived from psychology and especially from the field of learning. It is a methodology that consists in further evaluating the processes implemented by the subject rather than making an inventory of the functioning of the person. It is about measuring the individual’s learning potential.

In our context, that of babies whose relational experience and stress level we are trying to understand, it is for us to evaluate the processes / strategies that the baby will develop to protect himself. At the same time, it is also a question of being able to identify In our context, that of babies whose relational experience and stress level we are trying to understand, it is for us to evaluate the processes / strategies that the baby will develop to protect himself. At the same time, it is also a question of being able to identify the baby’s resources, those which persist despite sometimes complex care conditions, 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.


Relational withdrawal, before being chronic, is reactive. This is what Edward Tronick’s work on the experience of the still face has shown.

The still face experiment is a laboratory setting whose effectiveness lies in the fact that one voluntarily controls the rupture of the dyadic synchrony expected by the baby during an interaction with his parent (usually the mother but this also works with the father) and thus to observe the effects on the baby and his behaviours independently of other factors.

We then observe a first phase of protest, then quickly the baby will turn away, disengage. In 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 the relational reactive withdrawal, i.e. this coping strategy that the baby implements to face a situation source for him an internal stress.

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

The ADBB can, in test -retest, make it possible to highlight the point of view of the baby using a signal which comes from the baby and thus has all its relevance for the early clinic.

An example of this type of use is the “maintaining relationship” protocol used in child welfare to understand the effect of parental visits on infants placed in nurseries.

A pilot study   was able to show that the ADBB used in retest test made it possible to observe different reaction trajectories in babies receiving parental visits in residential nurseries. These observations then help child welfare professionals make decisions in the best interests of the child based on signals from the baby that research has shown to be relevant.

In test-retest, the ADBB will also make it possible to monitor the quality of baby care in nurseries. This is what a research of Mascaró, Dupuis-GauthierJardri, & Delion, en 2012. A group of 32 babies placed for protection in nurseries was evaluated using the ADBB at two times: T0, at the time of their arrival at the nursery, T1: 4 months after their admission to the nursery; the results showed a significant improvement in the babies’ relational withdrawal behaviour during the period of admission.

An other study  shows that relational withdrawal as assessed at the ADBB is a valid concept for assessing the effect of institutionalization and the presence or absence of a reference person on babies’ socio-emotional development.

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

  • Early identification of the baby who is not well despite the care received and therefore making the necessary decisions, such as increasing the time with the reference person, planning a paediatric neuro check-up, considering foster care, etc.
  • To detect if a relational or organizational factor impacting the dynamics of the group’s functioning: too many changes in the staff around the babies, a staff in particular difficulty (burn out, depression), in these cases, it is often the majority of the babies in the life group who will present a drop in their average relational withdrawal score.

As we can see, the clinical applications of ADBB are numerous, especially in the complex clinic (child protection). Its semiological value is very important for understanding the experience from the baby’s point of view and its flexibility of use makes it an inexpensive and reliable tool. ADBB is manageable after 4 days of training, it does not require any special equipment and can be repeated as many times as necessary, finally it signals the difficulty of the baby well before the appearance of more serious symptoms (developmental delay).


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