Determinants of maternal self-esteem in the neonatal period

The purpose of this study was to determine whether maternal perceptions of infant health and behavior made a unique contribution in understanding maternal self-esteem beyond what could be achieved from objective measures. The Perception of Infant Health (POIH) questionnaire and the Bates ICQ captured the perception of infant health and temperament. Standard medical variables including the Hobel Medical Risk Summary measured the objective aspect of infant health. The Brazelton Neonatal Behavioral Assessment (NBAS) measured objective infant behavior. The Maternal Self-Report Inventory measured self-esteem. Eighty mother-infant dyads, which included healthy, middle socioeconomic class mothers of both full-term, neurologically normal and preterm infants with a range of medical problems were studied. Negative maternal perceptions of infant health and behavior as well as poorer objective health status were associated with decreased maternal self-esteem. Perceptual variables of temperament and health made a unique contribution to maternal self-esteem scores. Regression analysis indicated fussy/difficult, POIH, and NBAS autonomic scores explained a significant amount of variance in maternal self-esteem.     

Studies of a Child. I

The authors examined the relationship between newborn neurobehavioral profiles and the characteristics of early mother-infant interaction in Nagasaki, Japan. The authors administered the Brazelton Neonatal Behavioral Assessment Scale (NBAS; T. B. Brazelton &; J. K. Nugent, 1995) in the newborn period and the Nursing Child Assessment Teaching Scale at 1 month (NCATS; G. Sumner &; A. Spietz, 1994). They administered the Perceived Stress Scale (S. Cohen, T. Kamarck, &; R. Mermelstein, 1983) as an index of maternal stress experienced over the past month. Lower irritability, higher stability in skin coloration, and lower tremulousness in the neonatal period were correlated with higher levels of maternal nurturing behaviors at 1 month. Birth weight and 2 NBAS range-of-state items (peak of excitement, irritability) predicted 31% of the variance in NCATS caregiver subscale score. The NBAS autonomic stability items (tremulousness, startles, lability of skin color) predicted 31% of the variance in the NCATS child subscale score. Perceived stress and maternal sociodemographic variables (education, income, age, parity) were not associated with child, caregiver, and total scores on the NCATS. The results suggested that lack of autonomic stability in Japanese neonates might serve as an early indicator of infant frailty, negative behavioral cues, and decreased maternal responsiveness.     

Neurobehaviors of Japanese newborns in relation to the characteristics of early mother-infant interaction

The authors examined the relationship between newborn neurobehavioral profiles and the characteristics of early mother-infant interaction in Nagasaki, Japan. The authors administered the Brazelton Neonatal Behavioral Assessment Scale (NBAS; T. B. Brazelton & J. K. Nugent, 1995) in the newborn period and the Nursing Child Assessment Teaching Scale at 1 month (NCATS; G. Sumner & A. Spietz, 1994). They administered the Perceived Stress Scale (S. Cohen, T. Kamarck, & R. Mermelstein, 1983) as an index of maternal stress experienced over the past month. Lower irritability, higher stability in skin coloration, and lower tremulousness in the neonatal period were correlated with higher levels of maternal nurturing behaviors at 1 month. Birth weight and 2 NBAS range-of-state items (peak of excitement, irritability) predicted 31% of the variance in NCATS caregiver subscale score. The NBAS autonomic stability items (tremulousness, startles, lability of skin color) predicted 31% of the variance in the NCATS child subscale score. Perceived stress and maternal sociodemographic variables (education, income, age, parity) were not associated with child, caregiver, and total scores on the NCATS. The results suggested that lack of autonomic stability in Japanese neonates might serve as an early indicator of infant frailty, negative behavioral cues, and decreased maternal responsiveness.     

Newborns of depressed mothers who received moderate versus light pressure massage during pregnancy

Sixty-four neonates (M age=6.8 days) of depressed mothers who received moderate pressure massage versus light pressure massage therapy during pregnancy (month 5 through month 8) were compared on their behaviors during 15-min observations and on their performance on the Brazelton Neonatal Behavior Assessment Scale. The group of neonates whose mothers received moderate pressure massage spent a greater percent of the observation time smiling and vocalizing, and they received better scores on the orientation, motor, excitability, and depression clusters of the Brazelton scale.     

Family administered neonatal activities: An exploratory method for the integration of parental perceptions and newborn behavior

This article presents the theoretical basis, clinical model, and case illustrations of the Family Administered Neonatal Activities (FANA), a specialized application of the Neonatal Behavioral Assessment Scale (Brazelton, 1973), in which parents are guided in eliciting behaviors from their infant within the context of a specific clinical protocol that integrates the practices of short-term, psychotherapeutic interviewing with principles of an empowerment model. The protocol is designed to elicit from parents their initial perceptions of their newborn and then to use the behavior of the baby as the vehicle through which parents can affirm or challenge their initial perceptions. Case examples illustrate the use of the FANA for three purposes: family support, intervention, and assessment.     

Prenatal dopamine and neonatal behavior and biochemistry

Depressed pregnant women (N=126) were divided into high and low prenatal maternal dopamine (HVA) groups based on a tertile split on their dopamine levels at 20 weeks gestation. The high versus the low dopamine group had lower Center for Epidemiological Studies-Depression Scale (CES-D) scores, higher norepinephrine levels at the 20-week gestational age visit and higher dopamine and serotonin levels at both the 20- and the 32-week gestational age visits. The neonates of the mothers with high versus low prenatal dopamine levels also had higher dopamine and serotonin levels as well as lower cortisol levels. Finally, the neonates in the high dopamine group had better autonomic stability and excitability scores on the Brazelton Neonatal Behavior Assessment Scale. Thus, prenatal maternal dopamine levels appear to be negatively related to prenatal depression scores and positively related to neonatal dopamine and behavioral regulation, although these effects are confounded by elevated serotonin levels.     

Deconstructing antenatal depression: What is it that matters for neonatal behavioral functioning?

This prospective study examined the variability within clinical characteristics of antenatal maternal depression and cortisol levels for associations with newborn infant behavior using the Neonatal Behavioral Assessment Scale (NBAS; T.B. Brazelton, 1984 ). Participants were 81 pregnant women at risk for perinatal depression given their histories of depression prior to pregnancy. We took into consideration not only whether the woman experienced antenatal depression but also whether the depression met diagnostic criteria and variability in timing (onset and occurrence) of antenatal depression and symptom severity. Infants of mothers who became depressed during pregnancy scored less optimally on a subset of the NBAS scales, specifically those scales related to infant neuroregulation. Among the clinical characteristics of depression, the fetus' overall exposure to mothers' depression (reflected in the mean) was most often and most strongly associated with NBAS scales. In terms of timing, third‐trimester exposure was significantly related to newborn behavior. The findings are discussed within the S.H. Goodman and I.H. Gotlib ( 1999 ) model for transmission of psychopathology to offspring of depressed mothers.     

Interventions in early infancy

Infants of high-risk pregnancies and deliveries may need early intervention to facilitate attachment both to and from their caregivers. Three early interventions are described: (1) giving high-risk pregnant women video feedback during prenatal ultrasound, which reduced maternal anxiety, obstetric complications, and fetal activity and improved neonatal outcome (increased weight gain, better performance on the Brazelton, and decreased irritability); (2) providing preterm neonates nonnutritive sucking opportunities to reduce stress during heelsticks and gavage feedings; and (3) providing preterm neonates and preterm cocaine-exposed neonates massage therapy, which facilitated weight gain and better performance on the Brazelton scale. Following improved neonatal behavior, infants would be expected to have better interactions with their caregivers.     

An examination of the effectiveness of multiple summary scoring procedures of the BNBAS in detecting group differences

The Brazelton Neonatal Behavioral Assessment Scale is the most widely used and accepted tool in the study of the behavior of the human newborn; yet there remains some controversy over the most appropriate way to score the results. The present research compares three a priori methods of scoring. The sample consisted of 43 infants: (a) 11 preterms, (b) 10 fullterms in intensive care, (c) 7 fullterms with sick mothers, and (d) 15 healthy fullterms. BNBAS exams administered to these four groups of infants were scored using the Als (1978), Lester, Als, and Brazelton (1982), and Jacobsen, Fein, Jacobsen, and Schwartz (1984) clusters. The data from these three methods were analyzed by means of one-way ANOVAs for group differences. In addition, a factor analysis on the BNBAS scores was also completed. These three approaches all detected differences between medically at-risk and healthy infants on those items assessing motor maturity and orientation. These results suggest that at this time no one scoring system can capture the richness of behavior of the newborn and address the question by researchers, clinicians, and parents.     

Newborns of mothers with depressive symptoms are less expressive

The facial expressions of 40 newborns of mothers with depressive symptoms (n = 20) and of nondepressive mothers (n = 20) were recorded during the Brazelton Neonatal Behavior Assessment Scale and during the modeling of happy, sad, and surprised faces. Infants of mothers with depressive symptoms demonstrated inferior performance on the orientation cluster of the Brazelton scale and showed fewer interest and more precry expressions during the Brazelton. During the facial expression modeling, they showed less orientation and fewer facial expressions in response to the modeled happy and surprise facial expressions.     

The impact of childbirth settings and maternal medication on infant behaviors

The Brazelton Neonatal Behavioral Assessment Scale (BNBAS) was administered to 61 full-term, healthy newborns between 7–10 days of age. Three groups of newborns made up the sample: 23 babies were born at planned home births to nonmedicated mothers, 22 were born in the hospital to nonmedicated mothers, and 16 neonates were born in the hospital to mothers who received obsteric medication. Analysis of variance indicated a significant F ratio on the BNBAS cluster for orienting behaviors; comparison of the BNBAS scores of the three groups revealed a significant difference on the BNBAS cluster for orienting behavior between the home-born babies and infants born in the hospital to mothers who received obsteric medication. There was no significant difference between groups for medication or birth setting alone, suggesting these perinatal factors have a complex, perhaps synergistic effect on newborn behavior.     

Perceptions of neonatal behaviors by different caregivers

The current study compared nurses', mothers', and NBAS examiners' perceptions of infant behavior along dimensions of the NBAS using the Newborn Behavior Inventory (NBI; Anderson & Standley, 1979). The hypothesis was that the three observers would differ in their perceptions based on their unique backgrounds. A total of 26 high-risk premature infants and 28 healthy full-term infants were assessed on the Brazelton Neonatal Scale (Brazelton, 1973), which provided a reference point for comparing the observers' views. Multivariate analysis of variance (MANOVA) revealed that the preterm infants obtained significantly lower scores on the cluster of autonomic regulation and on the reflex cluster. A two-way analysis of variance for repeated measures was performed to analyze the NBI data. Rater disagreement appeared on four NBAS clusters of orientation, regulation of state, range of state, and motoric processes. Agreement among observers on the autonomic cluster reflected actual group differences on the NBAS. The variability in ratings is discussed in relation to the observers' differential experience with the infants.     

Use of the Brazelton neonatal assessment scale to educate parents of high-risk infants

This article describes how the Brazelton Neonatal Assessment Scale might be used to assist parents in recognizing their infant's cues and capabilities. Infants to whom the scale as administered were high-risk babies requiring care in an intensivecare unit. The scale can be a useful component of an educational program for parents of newborns.     

Infant's psychophysiological profile and temperament at 3 and 12 months

This study is intended to analyze (1) differences in infant temperament at 3 and 12 months according to infants’ psychophysiological profiles: “withdrawn” “extroverted”, and “underaroused” and (2) changes in infant temperament from 3 to 12 months, namely according to the infant psychophysiological profile and the quality of mother-infant interaction. Ninety-four 8-week-old infants were assessed using the Neonatal Behavioral Assessment Scale (NBAS, Brazelton & Nugent, 1995) and the Alarm Distress Baby Scale (ADBB, Guedeney & Fermanian, 2001). Saliva samples were collected at 8-12 weeks old, both before and after a routine inoculation for cortisol reactivity measurement. Mother-infant interaction was evaluated at 12-16 weeks, using the Global Rating Scales (GRS, Murray, Fiori-Cowley, Hooper, & Cooper, 1996). Mothers’ reports on infant temperament at 3 and 12 months were collected using the Infant Behavior Questionnaire (IBQ, Rothbart, 1981). Significant differences in mothers’ perception of infant temperament were found at both 3 and 12 months in infants with distinct psychophysiological profiles. Stability was observed in most of the temperament's dimensions from 3 to 12 months old; still, there were changes in mothers’ perception of infant temperament in terms of level of distress, cuddliness, sadness and approach. Infant psychophysiological profile and mother-infant interaction both influence with the pattern of those changes. The results corroborate that infant's characteristics early in life as well as contextual factors influence with mothers’ perception of infant temperament and with changes across the 1st year of life.     

The effects of Brazelton intervention: A review

This article reviews research that has used the Brazelton Neonatal Behavioral Assessment Scale (NBAS; Brazelton, 1984) as an intervention. It discusses separately the various effects NBAS intervention has been found to have in areas such as parent-infant interaction, infant development, temperament, and parental attitudes and satisfaction. Inconsistent findings are noted in each of these areas. This article then addresses issues that may play a role in the effectiveness of NBAS intervention, including the risk status of the population, the intensity of the intervention, and the receptivity of the parent. It concludes by suggesting that realistic goals be set concerning the expectations for early, short-term intervention such as the NBAS.     

Predictions of developmental patterns during infancy: Assessments of children 0–1 years

The present study investigated how neonatal behavioural organization was related to later mental development during the first year of life. The study further investigated the relationship between early social affective behaviour and later mental development. A group of 40 infants was assessed five times during the infants' first year, at three and 14 days and at four, eight and 12 months. The Brazelton Neonatal Behavioural Assessment Scale (NBAS), the Duve method (a clinically based method for observation of social affective behaviour), and Griffiths' Mental Development Scales were used to assess the development of the infants. The results indicate that early predictive behavioural components can be identified. Neonatal state control capacity was related to motor development at both eight and 12 months. Social responsitivity at four months was related to hearing and speech at eight as well as at 12 months. The NBAS dimensions were good predictors of eight months performance, but were poor predictors of 12 months performance.     

Depressed mothers' assessments of their neonates' behaviors

Neonates were assessed at delivery and again at 1 month by examiners and by their depressed or nondepressed mothers. Examiner assessments were conducted using the Brazelton Neonatal Behavioral Assessment Scale (NBAS). Maternal assessments were conducted by mothers using a simplified version of the NBAS, the Mother's Assessment of the Behavior of her Infant (MABI). Examiners rated neonates of depressed mothers lower than infants of nondepressed mothers on state organization. At delivery, newborn infants of depressed mothers were given lower state regulation scores by their mothers than by the examiners and, 1 month later, examiners’ state regulation ratings were as negative as those of the depressed mothers. Conversely, infants of nondepressed mothers were given higher social interaction scores by their mothers than by the examiners, and 1 month later, examiner ratings of social interaction were as positive as those of the nondepressed mothers. These findings suggest that infants of depressed mothers may be placed at risk by prenatal influences and by risks associated with maternal perceptions. Perceptions of infants appear to be colored by maternal depression status as early as the immediate postpartum period and, though “subjective,” these perceptions are predictive of infant outcomes.     

Affective behavior and weight changes among hospitalized failure-to-thrive infants

The affective behavior and weight change of 12 nonorganic failure-to-thrive, 12 organic failure-to-thrive, and 12 control infants (M age = 8 months) were compared across their hospitalization. Infant affect was evaluated at approximately the beginning, middle, and endpoints of hospitalization using the Behavioral Assessment Scale. Among the failure-to-thrive infants, positive responses to stimulation at the initial assessment were related to weight loss across the course of hospitalization, while positive responses to the same stimulation at the middle assessment were related to weight gain. These unexpected results coupled with the finding that 70% of the failure-to-thrive infants gained weight and 30% lost weight across hospitalization led to a comparison between infants who gained and infants who lost weight. An increase in positive affect across hospitalization occurred only for the infants who gained weight. Paradoxically, the losers may have experienced hospital stimulation as less adequate than maternal stimulation, while the gainers may have experienced hospital stimulation as more adequate than home stimulation.     

Reduced audiovisual integration in synesthesia – evidence from bimodal speech perception

Recent research suggests synesthesia as a result of a hypersensitive multimodal binding mechanism. To address the question whether multimodal integration is altered in synesthetes in general, grapheme‐colour and auditory‐visual synesthetes were investigated using speech‐related stimulation in two behavioural experiments. First, we used the McGurk illusion to test the strength and number of illusory perceptions in synesthesia. In a second step, we analysed the gain in speech perception coming from seen articulatory movements under acoustically noisy conditions. We used disyllabic nouns as stimulation and varied signal‐to‐noise ratio of the auditory stream presented concurrently to a matching video of the speaker. We hypothesized that if synesthesia is due to a general hyperbinding mechanism this group of subjects should be more susceptible to McGurk illusions and profit more from the visual information during audiovisual speech perception. The results indicate that there are differences between synesthetes and controls concerning multisensory integration – but in the opposite direction as hypothesized. Synesthetes showed a reduced number of illusions and had a reduced gain in comprehension by viewing matching articulatory movements in comparison to control subjects. Our results indicate that rather than having a hypersensitive binding mechanism, synesthetes show weaker integration of vision and audition.     

Newborns of depressed mothers

Eighty-three newborns (M GA = 37 weeks) were assigned to depressed (N = 47) and nondepressed mother (N = 36) groups based on Beck Depression Inventory (BDI) scores. The Brazelton Neonatal Assessment Scale was administered to the infants within 24 hours after birth. Infants of depressed mothers demonstrated poorer performance on the orientation cluster. Further analysis of the orientation cluster items revealed inferior orientation to the inanimate stimuli. Infants of depressed mothers also showed less motor tone and activity and more irritability and less robustness and endurance (unavailability, lethargy, and stress behaviors) during the examination.