Neonatal behavioral assessment scale (NBAS)

Transcription

1 Neonatal behavioral assessment scale (NBAS) I. Descriptive Information A. Title, Edition, Dates of Publication and Revision* Neonatal Behavioral Assessment Scale Current: 3 rd edition 1973, 1985, 1995 B. Author (s) Heidelise Als, M.D., Edward Tronick, M.D., Barry M. Lester, M.D. and T. Berry Brazelton, M.D. J.K. Nugent C. Source (publisher or distributor, address) Mac Keith Press 526/529 High Holborn House High Holborn, London WC1V 6RL D. Costs (booklets, forms, kit)* $68.95 for Booklet $1000 per training session and recertification at the Brazelton Institute E. Purpose* It is used to evaluate an infant's responses to negative and positive environmental stimuli. 1 It evaluates 20 different reflexes and records the newborn's responses to 26 stimuli and situations including lights, the sound of a rattle, and cuddling. F. Type of Test (eg, screening, evaluative; interview, observation checklist or inventory)* Direct, descriptive, inventory tool G. Target Population and Ages* Checked initially at day two or three, again at days seven to fourteen, and at one month. 1 H. Time Requirements - Administration and Scoring* minutes The NBAS assesses 28 behavioral items, on a nine point scale. Also, assesses 18 reflex items based on a four point scale for gross neurological abnormalities. See Table 2.1 on the items assessed during NBAS administration. 2

2 II. Test Administration A. Administration The administrator assesses the patient responses to specific stimuli, and relates the findings to the subject s state of consciousness. 2 B. Scoring Attractiveness and need for stimulation are measured and then correlated to a nine point scale for behavioral characteristics. 1 Most optimal scores are at the midpoint, and all scores are based on the best activity by the infant. Four dimensions exist to organize responses by the infant. 3 (1) Dimension I-Interactive Processes: the capacity to attend to and process simple and complex environmental events (2) Dimension II-Motor Processes: the ability to control motor behavior and to perform integrated motor activities (3) Dimension III-Organizational Processes: the ability to maintain a calm, alert state despite increased stimulation

3 (4) Dimension IV-Organizational Processes- Physiological Response to Stressors: physiological demands of immaturity, the ability to inhibit startles, tremulousness interfering movements with increasing arousal, and the vulnerability to the environment. Further categorization of the BNBAS dimensions are listed below: 3 Each dimension is scaled according to specific criteria from behavioral items scored along three points: 1 =superior, 2 =average, 3 = deficient. Thus at the end of the examination each infant is assigned a four point profile identifying relative quality of functioning along the four dimensions: a very well-organized infant can end up with a 1,1,1,1 profile. A sample scoring sheet is provided for review below. 3

4 C. Type of information, resulting from testing (e.g. standard scores, percentile ranks) Values ranked a nine indicate high activity, and values ranked a one indicate low activity. These values are transcribed. 1 With consolability, scores are based on the number of movements necessary to soothe the child. 1 A score of one indicates that no movements soothe the child, and a score of nine indicates that the assessors face soothes the child. These items reflect the infant s capacity to (1) organize states of consciousness; (2) habituate reactions to disturbing events; (3) attend to and process simple and complex environmental events (4) control motor tone and activity while attending to these events; (5) perform integrated motor acts; and (6) appropriately respond to parents and caregivers. 2 Standard scores are developed based on the information gathered, however summative scores cannot be formed from this data to make a significant measurements. 3 D. Environment for Testing Midway between feedings, in a quiet semi-darkened room at a temperature between F 1 E. Equipment and Materials Needed Required testing equipment include: bell, rattle, light, pin, animate and inanimate objects. 1 F. Examiner Qualifications Examiners should be knowledgeable about infantile responses and behaviors prior to use. 1 Proficient administers the assessment while carefully noting responses. Training and experience are required to effectively administer this evaluative tool. 1

5 III. Psychometric Characteristics* A. Standardization/normative data The tool is not based on norms, it is based on observations of reflex responses to stimuli considered normal for median responses for the nine point scale. 3 B. Evidence of Reliability Test retest reliability has been poor, in multiple studies. 3 Test-retest reliability of Brazelton dimensions has shown values ranging between 0.31 to Interrater reliability has been listed to C. Evidence of Validity Good validity for long term differentiation of poor responses to activity and prolonged poor outcomes. 1 IV. Summary Comments* A. Strengths A thorough evaluation tool assessing the newborn s abilities, specifically reflexes, awareness level, and response to stimuli. Helps parents understand the responses of the infant relative to different stimuli. 1 Many items can be observed through a normal physician examination. B. Weaknesses It is a poor indicator of early adolescence development or neurological functioning. 4 C. Clinical Applications The resource is clinically applicable as an assessment of newborn behavior in long term hospital stays or for research purposes. 5 References 1. Brazelton TB, Nugent JK, eds. Neonatal behavioral assessment scale. MacKeith Press; 1995: Als H, Tronick E, Lester BM, Brazelton TB. The Brazelton Neonatal Behavioral Assessment Scale (BNBAS). J Abnorm Child Psychol. 1977;5(3): Jacobson JL, Fein GG, Jacobson SW, Schwartz PM. Factors and clusters for the Brazelton Scale: An investigation of the dimensions of neonatal behavior. Dev Psychol. 4. Als H. Assessing an Assessment: Conceptual Considerations, Methodological Issues, and a Perspective on the Future of the Neonatal Behavioral Assessment Scale. 43(5/6): Sewell J, Tsitsikas H, Bax M. Comparison of the Brazelton NBAS with Health Visitors' Assessments of the Nursing Couple. Developmental Medicine & Child Neurology. 2008;24(6):