The importance of early detection and intervention to promote development
Emotional well-being and social competence during the first years of life are the foundations of human development. These skills arise from the continuous and close interaction of the baby with its parents. The infant seeks interaction through looks, gestures, babbling and facial expressions. However, there are many factors that can negatively influence the social and emotional development of children such as prematurity, environments with little stimulation or disturbance, genetic factors, etc.
For this reason, during this first stage from 0 to 24 months, we understand alarm signals as a set of biological, emotional or social elements that indicate developmental impairment (Busquets et al, 2018). These signals may or may not end up consolidating into a neurodevelopmental disorder.
Withdrawal behavior is considered a defense mechanism and not a problem in itself. It is a normal regulatory mechanism when it occurs on a small scale, for a few seconds. On the other hand, withdrawal sustained over time is an adaptation of the baby to a situation that is being problematic. Withdrawal in these cases is associated with repeated mismatches in parent-baby synchrony. It is an important alarm signal in early childhood that can compromise the child's motor, cognitive, affective and social development. Withdrawal is found in the clinic of many early childhood disorders, such as: attachment disorders, autism spectrum disorders, depression, post-traumatic syndromes, anxiety disorders and developmental delays.
Relational withdrawal is not a diagnosis, it is a sign of risk in development with causes to be investigated. Likewise, an early diagnosis allows for timely intervention, key to a good prognosis of evolution. Recent studies indicate that thanks to the improvement in the observation of alarm signals, the age at which certain diagnoses, such as ASD, are detected has been advanced by several years. (Tizón, JL , 2016)
Early care is a fundamental approach to child development that seeks to identify and address the needs of children from birth to six years of age. At the Aspace Catalonia Foundation, in the CDIAP Aspace early care service, we diagnose children based on interviews with parents and clinical observation. When we believe it is necessary, we complement the exploration with the use of tests or scales such as the Alarm Distress Baby Scale (ADBB). The CDIAP Aspace has a multidisciplinary team of physiotherapists, psychologists, neuropediatricians and speech therapists trained in this scale.
What is the ADBB scale?
The ADBB scale (Alarm Distress Baby Scale) is a tool used in the Cdiap (Centre for Child Development and Early Care) and in pediatric services, which allows us to evaluate these warning signs and initiate early intervention. It is a screening scale that proposes a systematized way of observing babies between 2 and 24 months of age.
The author of the scale, Antoine Guedeney, is the Head of the Department of Child Psychiatry at the Claude Bernard Hospital in Paris and Head of the Department of Psychiatry at the Xavier Bichat Faculty. Guedeney was also the president of the World Association for Infant Mental Health (WAIMH).
Its validation was carried out in hospital centers in countries such as France, Portugal, Finland, Australia, Brazil and Norway. In Spain, the scale has not yet been validated, but it has cross-cultural validity, since it has been validated in Spanish-speaking countries such as Argentina, so its use in research has been permitted since 2011. The scale has a sensitivity of 82% and a specificity of 78%, as well as good internal consistency (Cronbach 0.83),
The scale focuses on observing the baby's reactions to stimulation (smile, voice, gesture, touch, etc.) in different situations, which provides valuable information about their emotional state.
What does the ADBB Scale assess?
The ADBB consists of eight items that assess different aspects of the baby's social behavior. Each item is rated from 0 to 4, with total scores ranging from 0 to 32. Low scores of 0 to 5 indicate no withdrawal, 6 to 10 mild withdrawal, and 11 to 32 severe withdrawal. The items rated are as follows:
- Facial expression. Decreased facial expressiveness.
- Eye contact. Reduction of eye contact.
- Physical activity. Reduction in the mobility of the head, torso and limbs, without taking into account the activity of the hands and fingers.
- Self-stimulation gestures. The child focuses on his body (fingers, hands, hair, thumb sucking, repetitive rubbing) in an automatic way, without pleasure, and seemingly separate from the rest of his activity.
- Vocalizations. Decrease in vocalizations of pleasure (chattering, laughing, babbling, babbling, high-pitched cries of pleasure) but also of displeasure, anxiety or pain (screams, moans and cries).
- Liveliness of reaction to stimulationDecrease in the speed and liveliness of the reaction to stimulation during the examination (smile, voice, touch).
- Relationship. Decreased ability of the baby to relate to the observer, the examiner or any person present in the room, except the one who usually takes care of him. The relationship is assessed by behavior, eye contact, reaction to stimuli.
- Attraction. Attention effort necessary to remain in contact with the child, feeling of pleasure or restlessness that contact with the child transmits, and the subjective feeling of the duration of the examination.
In conclusion, we can affirm that the experience in using the scale in the CDIAP Aspace is valued as a valuable tool for several reasons:
– Early detection: allows us to identify emotional development problems in early stages, which facilitates timely and appropriate intervention.
– Guidance for caregivers : provides parents and caregivers with information about their baby's development , helping us to better understand their needs and behaviors.
– Intervention planning: the results of the ADBB guide professionals in creating personalized intervention plans that address the child's specific needs.
Bibliographic references
1. Guedeney, A. and Fermanian, JA (2001). Validity and Reliability Study of Assessment and Screening for Sustained Withdrawal Reaction in Infancy: The Alarm Distress Baby Scale. Child Mental Health Journal, 22.
2. Busquets et al., (2019). Early detection of ASD in the pediatric consultation: a pilot project in the public network. psychopathology health mind 33.
- Tizón, J.L. (2016) Autistic spectrum disorders and generalized developmental disorders: for a relational perspective of their understanding and care. EIPEA Magazine Number 1.
