Alarm Distress Baby Scale (ADBB) in Assessing Social Withdrawal in Infants with an Underlying Organic Illness – Congenital Heart Disease, Prader Willi Syndrome, Cleft Lip and/or Palate – An Overview

Carla Pérez-Martínez, Samuel Menahem, Sylvie Viaux-Savelon, Antoine Guedeney, Antoine Guedeney



Infant social withdrawal, recognizable from two months onwards as assessed by the Alarm Distress Baby Scale (ADBB), provides a further measure of infant well-being. It has been widely used studying normal infants and those subjected to major adverse psychosocial environments. An overview is presented together with its use to evaluate infants with underlying organic illness and to understand the importance of the psychosocial well-being of the parents.



The theoretical basis for the ADBB is followed by a description of the observations and interactions that constitute the scale and how they are measured. Normative values are provided together with the prevalence and risk factors of infant withdrawal. Three papers are reviewed where the ADBB was scored in infants subjected to cardiac surgery, who were born with Prader-Willi Syndrome, or who had a cleft lip.



Half of the infants with severe congenital heart disease (CHD) requiring cardiac surgery had elevated ADBB scores. That correlated not with the severity of the CHD or the surgery required but more to the maternal distress, anxiety, and depression. Almost two-thirds of infants with Prader-Willi syndrome exhibited social withdrawal. Intranasal oxytocin which improved the infants’ sucking and interactions dropped the incidence down to one-fifth with improvement in parental sensitivity and dyadic reciprocity. Infants with a cleft lip ± a cleft palate had by 12 months decreased their ADBB scores to normative values. A high incidence of depression was noted in both parents which dropped following early repair of the cleft lip. The maternal well-being was found to be of greater importance than the nature of the abnormality and/or the surgery required.



Infant social withdrawal found in infants subjected to adverse psychosocial environments was also observed in infants born with significant organic abnormalities.  The interrelationship to parental, especially maternal, well-being provides multiple avenues for potential interventions.

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