The modified ADBB (m-ADBB

Assessing for infant withdrawal during
routine examinations
Dr. Stephen Matthey1, Dr. Rudi Črnčec2,3, Prof. Antoine Guedeney4

Sydney South West Area Health Service; 2/3. The University of Western Sydney / Karitane, Caring for families;
4. Hôpital Bichat Claude Bernard, Paris.

• Infant social withdrawal can be an
indicator of both physical and
emotional difficulties in the infant.
ƒ The Full ADBB (Guedeney &
Fermanian, 2001) enables clinicians
to assess for such withdrawal during
routine clinical examinations.
ƒ Infants scoring as withdrawn on this
Full ADBB have been found to have
mothers reporting they were
depressed or sad since the birth
(Matthey et al., 2005).

Modification to the Full ADBB
ƒ In Australia many nurses routinely
assess infant development using
ratings of ‘Satisfactory’, ‘Possible
Problem’, or ‘Definite Problem’ for
each item.
ƒ We thus undertook to modify the Full
ADBB to utilise this same rating

ƒ The m-ADBB consists of 5 items,
easily remembered by the acronym
‘FEVAR’ (i.e., like ‘Fever’, but slightly
mispelt !):

ƒ Training in the use of the m-ADBB
may be conducted face-to-face
(1 day), or via distance education.
The training package contains:
ƒ Relevant literature.


1. Facial Expression
2. Eye contact

ƒ Discussion on the differences
between the Full ADBB and the mADBB.

3. Vocalisation

ƒ 4 ‘to-view’ video clips, with scores.

4. Activity

ƒ 3 practice video clips, to be rated.

5. Relationship (with the clinician or
ƒ Each item is rated as either:
- Satisfactory
- Possible Problem
- Definite Problem

ƒ Within our Australian context, it
appears that reducing the scoring
format from 8 to 5 items will also
increase inter-rater reliability, without
sacrificing validity.

ƒ 6 reliability clips, to be rated.
ƒ Detailed feedback is given initially for
the practice clips. Once the user is
confident on these clips, he/she then
rates the reliability clips.
ƒ Rating the 6 reliability clips to a
required level of accuracy provides
accreditation for the user for 12
ƒ A further set of video clips will need
to be rated at 12 months, to ensure
maintenance of the required
reliability level.

ƒ This resulted in our reducing the mADBB to 5 items.

ƒ It is anticipated that the m-ADDB will
- screening for infant withdrawal in
- high inter-rater reliability.

University of Western Sydney GWS
Postdoctoral Research Fellowship

Contact details
For more information on the m-ADBB

Upcoming research
ƒ We will shortly be conducting a
project where we explore the
psychometric properties of the mADBB, including the stability (testretest reliability) of infant withdrawal

Dr. Stephen Matthey (Australia)


tel: +61 2 9616 4262

Guedeney, A., & Fermanian, J. (2001). A validity
and reliability study of assessment and screening
for sustained withdrawal reaction in infancy: the
Alarm Distress Baby Scale. Infant Mental Health
Journal, 22, 559-575.

Or for more information on training
on the Full ADBB
Prof. Antoine Guedeney (France)

Matthey, S., Guedeney, A., Starakis, N., & Barnett,
B. (2005). Assessing the social behaviour of infants:
Use of the ADBB scale and relationship to mother's
mood. Infant Mental Health Journal, 26(5), 442-458.

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