Early identification of infants at risk of poor development The suitability of the Alarm Distress Baby Scale as a screening tool in the child health centre: Psychometric properties and professionals’ perspectives

Infancy is a particularly important time in life characterized by rapid brain development and heightened sensitivity to environmental influences. This makes it important to identify signs of developmental or psychosocial challenges early while also providing a window of opportunity to support healthy growth. Mental health difficulties are as prevalent in infants as in older children, often manifesting as regulation difficulties such as problems with sleep and feeding, excessive crying, uneasiness and social withdrawal. While brief social withdrawal during interaction, such as looking away or turning the head, is a normal and healthy regulation behaviour, sustained social withdrawal is considered an alarm signal that may indicate underlying organic or relational difficulties.

The aim of the present thesis was to explore the suitability of the Alarm Distress Baby (ADBB) Scale as a screening tool for early identification of infants at risk of poor development. The ADBB scale is an observer-rated screening tool targeting social withdrawal behaviour in infants 2-24 months, designed to fit a child health care setting. While the use of screening tools has increased as part of evidence-based practice in modern healthcare, questions remain about their quality, practical application and the professional considerations that shape their use.

To address the overarching aim of this thesis, we conducted a systematic review and meta-analysis of the psychometric evidence for the ADBB scale and qualitative studies conducted before and after ADBB training and certification. Pre-training, we explored public health nurses’ (PHNs) acceptance of assessment tools like the ADBB scale and how using such tools align with their professional role and practices. After training and certification, we explored their experiences using the ADBB scale and how professional values are negotiated, and potential conflicts are addressed and resolved.

The psychometric properties of the ADBB scale are promising, with good internal consistency, inter-rater reliability, and evidence supporting construct validity, such as detecting expected group differences. The evidence for criterion-related validity is, however, limited, as it is based on a small number of studies with varying criterion measures. The small number of studies on the modified version of the-ADBB scale renders results inconclusive. Additionally, the ADBB scale's use in research often differs from its intended clinical application, where scoring is based on immediate observations during examinations and a follow-up reassessment after two weeks in cases of elevated scores are recommended. Scoring based on video-taped assessment and the lack of reassessment in research studies may limit the generalizability of findings. […]