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www.elsevier.com/locate/braindev
Brain & Development 35 (2013) 79–80
Book review
The neonatal behavioral assessment scale, T. Berry
Brazelton, J. Kevin Nugent (Eds.), MacKeith Press,
London (2011).
This is the latest update of the Neonatal BehavioralAssessment Scale (NBAS) manual, the previous (3rd)edition of which was published in 1995. The NBAS hasbeen widely used for almost four decades internationallyas a standard tool for research into the behavior of termand preterm infants. The scale has also enabled academicand clinical professionals to demonstrate to parents theremarkable abilities of newborns to communicate behav-iorally and has helped researchers and clinicians objec-tively describe the neurobehavioral characteristics ofnewborns.
Like the previous edition, the new release contains amanual for scoring NBAS items and also offers an im-proved section on the standard administration of theNBAS, including new guidelines and refinements toadministration methods. The fourth edition also contin-ues to recommend initial supervised training and peri-odic refreshers in the use of the tool for research andclinical purposes. Each examination item on the scaleis categorized under one of four technical packages –habituation, reflex & motor, social interaction, or con-soling maneuvers – in order to assess four domains ofneurobehavioral functioning, (1) autonomic/physiologi-cal regulation, (2) motor organization, (3) state organi-zation & regulation, and (4) attention/social interaction.
The authors also provide a new series of selected top-ics of research conducted since 1995 which employ theNBAS in fields such as psychological preparation forparenthood, emotional communication among exam-iner, infant and parent, newborn infant risk factors,postpartum depression, and effects of breastfeeding onparenthood. Particularly useful new sections comparethe NBAS and other neurobehavioral assessment meth-ods such as Prechtl’s Assessment of General Movements(GMs), Milani Comparetti’s examination, and the Phys-ical and Behavioral Newborn Examination (PEBE).These methods each have functional features in commonwith the NBAS, indicating how widely the NBAS hasstimulated researchers and clinicians to try to under-stand the neuromotor development of infants and makethem seek for the most suitable assessment scale for theirown research and clinical needs.
doi:10.1016/j.braindev.2012.01.006
The NBAS is no longer the only the instrument avail-able for evaluating the neurobehavioral characteristicsof newborns. During the past 40 years, particularly inthe field of neuromotor assessment for preterm infants,several neonatal examination tools, such as theDubowitz Neurological Assessment of the Preterm andFull-term Infant (Dubowitz), the Assessment of PretermInfants’ Behavior (APIB), the Neonatal Intensive CareUnit Network Neurobehavioral Scale (NNNS), theTest of Infant Motor Performance (TIMP), Prechtl’sAssessment of General Movements (GMs), theNeurobehavioral Assessment of the Preterm Infant(NAPI), and the Neuromotor Behavioral Assessment(NMBA) have all been developed. All these neonatalassessments, however, have been strongly influencedby the early work of Brazelton and Prechtl, with respectto scoring of neurobehavior, spontaneous movementsand arousal levels (“behavioral states”).
Moreover, due to the refinement of brain imagingtechniques using ultrasound, CT, and MRI, we nowrarely perform neurological evaluation of young infantsjust using traditional neurobehavioral assessment scales.Instead we know that a combination of clinical neurobe-havioral assessments and brain imaging at appropriatestages (for instance, MRI imaging at term and at around18 gestational months of age) is considered more reliablefor predicting the developmental outcome of infants.
Nevertheless, the NBAS has made a tremendous im-pact on the approaches of research and on medicalexamination methods. One of the reasons for this is thatthe scale sets out to examine the interactive and emo-tional capabilities of newborns. This concept quite dif-fers from Prechtl’s approach, which avoids anyinterpretation of psychological factors, instead requiringexaminers to systematically evaluate the various neuro-logical responses of neonates by objectively document-ing any deviations in these responses. In contrast, theNBAS assumes that the newborn is a social organism,predisposed to interact with her caregiver from thebeginning and able to elicit the kind of care giving nec-essary for her species-specific survival and adaptation.The philosophy of the NBAS is to observe and empha-size the positive aspects of the infant’s behavior. A seriesof studies have shown that, using the NBAS, profession-als and parents learn how to observe, assess, and inter-pret infant behavior in order to enhance interaction
80 Book review / Brain & Development 35 (2013) 79–80
between the infant and family and also to improve out-comes in the areas of infant behavioral, emotional, andcognitive development.
Brazelton’s view has been of interest to people in awide range of fields such as psychology, education, nurs-ing, physical therapy and medicine, who are interested inthe effects of infants’ temperament and medical interven-tion on the physical and psychological development ofinfants. Due to the recent high level of interest in theearly diagnosis of ASD and ADHD to enable possibleearly intervention, it is likely that once again people inthe field of developmental disorders will come to closelyexamine Brazelton’s views to better understand the ef-fects of social interaction at early developmental stagesof infancy.
As a result, the NBAS, with its wide ranging neuro-logical and psychological examination paradigm, willcontinue to be a powerful tool for both academic andclinical professionals to clinically assess the neurobehav-
ioral development of newborns and be an importantbasis for understanding the parent-infant relationshipduring early infancy.
Hidenobu OhtaDivision of Diagnostic Research, Department of
Developmental Disorders, National Institute of Mental
Health, National Center of Neurology and Psychiatry,
Kodaira, Tokyo, Japan.
Fax: +81 42 346 2158
E-mail address: [email protected]
Shohei OhgiDivision of Physical Therapy, School of Rehabilitation
Sciences, Seirei Christopher University, Hamamatsu,
Shizuoka, Japan.
Fax: +81 53 439 1406
E-mail address: [email protected]
