Assessment, Neonatal Behavioral Assessment Scale

The widespread use of the Neonatal Behavioral Assessment Scale (NBAS) by both researchers and practitioners across a variety of disciplines speaks to the universal and applied nature of this newbornassessment tool. By tapping the neonate's natural mode of communication, that is, an elaborate vocabulary of body movements, cries, and explicit responses, the NBAS reveals its sensitivity to the unique language of infant behavior and corresponding developmental agenda. Moreover, the NBAS captures and communicates each infant's individual developmental timetable by identifying strengths and examining breadth of individuality. By transforming theories of neonatal development into empirical evidence that, in turn, informs policy and future practice, the NBAS epitomizes the objectives of applied developmental science.

From the moment of its inception in 1973, the NBAS has revolutionized Western perceptions of the neonate through its broad use in research and clinical settings (Brazelton, 1973, 1984; Brazelton & Nugent, 1995). The NBAS is based on the belief that the newborn is an active and competent participant in what can be conceived of as a system of mutualistic reciprocity whereby the caregiver enhances the infant's behavioral organization and, in turn, the infant enhances the caregiver's (Als, 1978). Once considered a passive recipient of environmental stimuli, the newborn is now recognized for his or her organized behavioral repertoire and impressive capacities for social interaction. Having documented the behavioral organization of the newborn, the NBAS has permeated and irrevocably changed the research and application of disciplines such as neonatology, nursing, and applied child development.

The primary goal of the NBAS is to systematically capture the extensive behavioral repertoire with which the neonate is endowed at birth. Furthermore, it seeks to identify and describe individual differences in newborn behavior so that clinicians can communicate the unique personality of the infant to his or her caregiver in an effort to facilitate their relationship. Thus, the scale comprises behavioral, reflexive, and supplementary items (Brazelton & Nugent, 1995). Infant behavior is assessed via 28 behavioral items, each of which is scored on a 9-point scale. The status of the infant's neurological system is considered through 18 reflex items, each of which is scored on a 4-point scale. Rather than a single score, it is the combination of these items that produces a profile of neonatal functioning across the following four systems: autonomic, motor, state, and social interaction.

Four developmental tasks, autonomic, motor, state, and social interaction, are most vital to growth during the period between 36 weeks gestational age and 2 months postterm (Brazelton & Nugent, 1995). The most basic challenge first confronting newborns is the task of regulating their autonomic systems. Before infants can tend to other developmental agenda, they must first succeed in regulating such things as breathing and temperature. Second, infants devote energy toward stabilizing their motor systems. Once newborns are able to inhibit random movements and control activity levels, they are better suited to channel their energy into mastering other developmental tasks. Infants who are capable of managing their motor behavior will be better able to move to the third developmental agendum: state regulation. The extent to which newborns are able to regulate their state is perhaps the best indication of central nervous system function (Brazelton & Nugent, 1995). Infants who move quickly from state to state tend to reflect the existence of an immature nervous system. These infants have more difficulty processing and responding to environmental information. The behavioral newborn state has a tremendous impact on the extent to which infants are able to interact with their caregiving environments. The infant who is able to maintain various states, such as alert and sleep, is in a better position to process and respond to stimulation from his or her surrounding environment. These infants are ready to engage in the ultimate developmental task of the neonatal period, the task of social interaction. Once newborns have achieved equilibrium in their autonomic, motor, and state systems, [Page 112]they are better able to entertain the social environment. In fact, it is the degree to which they have mastered other developmental agenda that dictates their capacities for exploration and social interaction (Brazelton & Nugent, 1995).

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