The Neonatal Behavioral Assessment Scale (Revised)

The research faculty at the Brazelton Institute at Children's Hospital, Boston, recently developed the revised version of the Neonatal Behavioral Assessment Scale (1973, 1984,1995), the NBAS-R (2000).

The NBAS-R is a more objective standardized version of the NBAS. The goal of the NBAS-R is to identify individual differences in newborn behavior from birth to two months post-conceptual age. The impetus to design the NBAS-R was to address the questions raised in past research about the apparent lack of objectivity in the administration of items in the NBAS. The faculty at the Brazelton Institute standardized the administration of scale items, leaving less chance for human variation in presentation and, therefore, providing a more objective set of observations of newborn behavior. In addition, the administration of all the items in the NBAS-R take only 12 to 15 minutes compared to 20 to 30 minutes for the classic scale.

The NBAS-R consists of 26 behavioral and 14 reflex items. The reflex items are included to identify gross neurological abnormalities through deviant scores or patterns of scores. A number of behavioral and reflex items have been omitted from the original NBAS. One new item, Spontaneous Activity (consisting of a 30-second observation of the infant's motor activity while placed supine in the bassinet) has been added as an addition to the general activity score. The NBAS-R describes the current status of the individual infant's autonomic, motor, state and attentional systems as they become integrated during the postnatal period. The scale records the number of startles and tremors, the lability of skin color, assesses the quality of tone, motor maturity, activity levels, alertness, and assesses the quality of visual and auditory processing. The infant's state is observed by examining the quality of the infant's sleep and alert states, the amount of crying and consolability, and threshold for stimulation. The examiner scores the assessment immediately following its completion. All behavioral items are scored on a nine-point scale. The neurological items are scored on a four-point scale and asymmetries are also to be recorded.

The NBAS-R is presently in use in a collaborative research project between the Brazelton Institute and Psychology Department at Harvard University. The aim of this research project is to investigate the relationship between neonatal behavioral categories, as measured by the NBAS-R, and temperament at four months. It is believed that a more objective, standardized version of the NBAS will enhance the scale's predictive capabilities. The NBAS has never been standardized and this is the first time that performance norms for healthy full-term infants in the first two months of life will be examined with a large population of healthy neonates.