Acta Paediatr 81:829-31. 1992
Relationship between neonatal behavior and subsequent temperament E Tirosh1s3,J Harel’, J Abadi’, A Berger2*3and A Cohen4 Hannah Khoushy Child Development Center’. Department of Neonatologyz, Bnai Zion Medical Center, Faculties of Medicine’ and Industrial Engineering and Management4, Technion-IsraelInstitute of Technology, Haifa. Israel
Tirosh E, Harel J, Abadi J, Berger A, Cohen A. Relationship between neonatal behavior and subsequent temperament. Acta Pzdiatr 1992;8 1:829-3 1. Stockholm. ISSN 0803-5253 The validity of the neonatal behavioral assessment scale in predicting later infant temperament is of theoretical and clinical importance. The scale was administered to 47 full-term healthy neonates. Of these, 40 were followed and the infant characteristics questionnaire was given at four months of age. Significant correlations were revealed between the neonatal assessment items from the clusters of orientation and motor maturity and the temperament factors “fussy-difficult” and “unpredictable”. Items from the cluster of autonomic stability correlated with the temperament factor “unadaptable.” These correlations possibly indicate that perceived temperament does reflect intrinsic infant qualities. 0 Neonatal behavior, temperament
E Tirosh, Hannah Khousky Child Development Center, Bnai Zion Medical Center, Haifa. Israel
Infant temperament has been defined as a biologically based disposition which is stable over a long period of time and which affects interactions with the environment (1). It is postulated that a prospective study from birth onwards might be able to elucidate the extent of the continuity of temperamental attributes and their stability (2, 3). The neonatal behavioral assessment scale (NBAS) evaluates the infant’s potential for self-organization and state control as a response to his environment (4). It has been used extensively and appears to tap early temperamental aspects of behavior (2, 5, 6). Some studies have addressed the relationship between neonatal behavior and later behavioral and temperamental attributes (5,711). The purpose of the present study was to assess the relationship between the different NBAS items and the infant’s temperament at four months of age, as perceived by the mother. A significant correlation between the two assessments would indicate the possible existence of a stable individual disposition which could inff uence the mother’s perception of the infant’s temperament and would further validate the NBAS as a measure of temperament (1 0).
Materials and methods Subjects
Forty-seven healthy, full-term babies, who were products of uneventful pregnancy and delivery were included in the study. All of the mothers consented to participate in the study. Apgar scores ranged from 8 to 10 after 1 min and from 9 to 10 after 5 min. Birth weights
ranged from 2850 to 3650 g. Eighty percent of the mothers belonged to the middle socioeconomic class, 15% were upper middle class and 5% were of lower class. The final cohort consisted of 40 infants (1 8 males): three were excluded due to missing data; two were hospitalized at the age of three days and eight weeks, respectively; and two mothers could not be contacted. Procedure
The NBAS was administered to all the infants between 48 and 72 h of age (before circumcision). The assessments were performed 1 h after feeding in a dimly lit room by the same psychologist, who was experienced in administering this procedure. The NBAS items represent clusters of habituation and orientation to animate and inanimate stimuli. Motor, state control and physiological regulation were included in the analysis (12). The cluster of reflexes was omitted because of low inter-observer reliability. Each item was administered in the appropriate specific state and was scored after analysis as recommended in the manual (4). Inter-observer agreement of 0.85-0.97 was established with two independent observers. Differences in NBAS clustering techniques have been criticized (1 3). An earlier study in Israel revealed a cluster structure different from those reported previously (14). Thus, no summary scores were calculated. When the infants were four months old (fseven days), mothers were requested, either while visiting the baby-care clinic or by a telephone call, to complete a questionnaire (15). This questionnaire consisted of 24 items rated on a seven-point scale (1 =best; 7=poor
830
E Tirosh et al.
ACTA PiEDlATR 81 (1992)
Table I. Regression analysis of NBAS items, with temperament factors as the dependent variables. Step/Predictora
R
F
P
Fussy-difficult 1/Cuddliness
-0.23
10.23
0.003
-0.72
19.93
0.0001
-0.24 -0.37 -0.47
9.76
O.OOO!
Unadaptable 1/Tremors 2/Startles 3/Consolability 4/Inanimate visual-auditory Unpredictable 1/Cuddliness Z/Consolability 3/Defense
-0.39 -0.47 -0.55
a The items are listed according to the order in which they were entered into the stepwise regression.
response), clustered into four factors: fussy-difficult, unadaptable, dull and unpredictable. For the purpose of statistical analysis, stepwise regression analysis was used (1 6). The r squares corresponding to each step are reported, as well as the F and p values of the final equation.
Results Stepwise regression analysis (Table 1) revealed that the more adaptive the infant’s behavioral responses were, the more predictable he was perceived by his mother. Items representing autonomic stability, regulation of state and orientation predicted the infant’s unadaptability four months later. No correlation was found between the NBAS and the temperamental factor of dullness. The total temperamental score was best predicted by the items representing the behaviour clusters of state regulation (i.e. cuddliness and consolability) and defense from the motor cluster (r = 0.567; p < 0.05).
lity and mood (2, 9). In the present investigation, as in previous studies (9, 20), no correlation was found between irritability during the neonatal period and at four months of age. The two items of cuddliness and consolability representing regulation of state, together with the defense response were found to be the most sensitive overall predictors of the infant’s temperament at four months of age. This is in agreement with previous findings (5) and particularly in populations at risk (2 1). The correlation coefficients between some NBAS items and the questionnaire factors were, as anticipated from previous reports, of small magnitude. The drop-out rate of 15%, as well as the number of variables included in the analysis, should be considered when interpreting these results. However, the high level of statistical significance indicates the validity of the observed correlations beyond chance. It is believed that temperament modifies environmental input (22) and particularly parental interactional behavior. The better understanding of temperamental antecedents has a definite clinical application. For example, the ability to predict an important factor such as sociability early in life may facilitate early intervention with at-risk diads. We speculate that a pattern derived from a series of sequential tests would result in a more powerful prediction of later temperament. The results of the present study lend support to the hypothesis of a transaction between the neurobehavioral disposition of the infant and the parental perception of his temperament. Acknowledgements.-The authors thank M Jaffe for reviewing the manuscript and R Abiry for her help in its preparation.
References 1. Goldsmith HH, Bradshaw DL, Reiser-Danner LA. Temperamen-
2.
Discussion Some researchers claim that temperamental attributes, as perceived by the parents, are stable across time (1 7). However, the idea that neonatal temperament reflects an inborn biological disposition has recently been questioned (1 8). The present investigation indicates that unadaptability at four months of age was predicted by the items of the same clusters that had previously been found to be significantly correlated with mother-infant interaction (19). Similarly, the NBAS factors of interaction and regulation of state were related in previous studies to the temperament dimensions of adaptability, approachabi-
3. 4. 5.
6. 7.
8.
tal dimensions as potential developmental influence on attachment. In: Lerner JV, Lerner RM eds Temperament and Psychosocia1 Interaction during Infancy and Childhood: New directions in Child Development. San Francisco: Jossey Bass, 1986:5-34 Green J, Bax M, Tsitsikan H. Neonatal behavior and early temperament: a longitudinal study of the first six months of life. Am J Orthopsychiatry 1989;59:82-93 Persson-Blennow I, McNeil T. Frequencies and stability of temperament types in childhood. J Am Acad Child Adolesc Psychiatry 1988;27:619-22 Brazelton TB. Neonatal Behavioural Assessment Scale 2nd Edn. London: Blackwell Scientific, 1984 Isabella RA, Ward MJ, Belsky J. Convergence of multiple sources of information on infant individuality: neonatal behavior, infant behavior, and temperament reports. Infant Behav Dev 1985;8:283-91 Peters-Martin P, Wachs TD. A longitudinal study of temperament and its correlates in the first 12 months. Infant Behav Dev 1984;7:285-98 Osofsky JD. Neonatal characteristics and mother-infant interaction in two observational situations. Child Dev 1976;47:113847 Sostek AM, Anders TF. Relationships among the Brazelton
ACTA PKDIATR 81 (1992)
neonatal scale, Bayley infant scales, and early temperament. Child Dev 1977;48:320-8 9. Crockenberg SB, Smith P. Antecedents of Mother-infant interaction and infant irritability in the first three months of life. Infant Behav Dev 1982;5:105-19 10. Hubert N, Wachs TD, Peters-Martin P, Gansdour MJ. The study of early temperament: measurement and conceptual issues. Child Dev 198233:57 1-600 11. Matheny AP, Riese ML, Wilson RS. Rudiments of infant temperament: newborn to 9 months. Dev Psychol 1985;21:486-94 12. Lester BM, Als H, Brazelton B. Regional obstetric anaesthesia and newborn behavior: a reanalysis towards synergistic effects. Child Dev 1982;53:688-92 13. Sostek AM. On the use of a priori cluster scores for the Brazelton Neonatal Assessment Scale: a response to Maier et al. Infant Behav Dev 1985;8:245-6 14. Tirosh E, Abadi J, Berger A. Comparison of early neonatal behavior in two Israeli ethnic groups. Isr J Med Sci 1988;24:67680 15. Bates JE, Bennett-Freeland CA, Lounsbury ML. Measurement of infant difficultness. Child Dev 1979;50:794-803
Neonatal behavior and subsequent temperament
83 1
16. SAS Institute. SAS-User’s Guide Statistics. SAS Institute, 1982 17. Bates JE, Bayles K. Objective and subjective components in mothers’ perception of their children from age 6 months to 3 years. Merrill-Palmer Q 1984;30 1 11-30 18. St James RI, Walke D. Convergence and discrepancies among mothers’ and professionals’ assessments of difficult neonatal behavior. J Child Psychol Psychiatry 1988;29:21-42 19. Waters E, Vaughn BE, Egeland BR. Individual differences in infant-mother attachment relationships at age one: antecedents in neonatal behavior in an urban, economically disadvantaged sample. Child Dev 1980;51:201-14 20. Samaroff AJ, Krafchak EE, Bakow HA. Issues in grouping items from the Neonatal Behavior Assessment Scale. Monogr SOCRes Child Dev 1978;43:46-59 21. Capute AJ, Derivan AP, Shauvel PJ, Rodriguez A. Infantile autism. I. A prospective study of the diagnosis. Dev Med Child Neurol 1975;17:58-62 22. .Bell RQ. A reinterpretation of the direction of effects in studies of socialization. Psychol Rev 1968;75:87-95 Received July 22, 1991. Accepted April 2 1, 1992
Relationship between neonatal behavior and subsequent temperament E Tirosh1s3,J Harel’, J Abadi’, A Berger2*3and A Cohen4 Hannah Khoushy Child Development Center’. Department of Neonatologyz, Bnai Zion Medical Center, Faculties of Medicine’ and Industrial Engineering and Management4, Technion-IsraelInstitute of Technology, Haifa. Israel
Tirosh E, Harel J, Abadi J, Berger A, Cohen A. Relationship between neonatal behavior and subsequent temperament. Acta Pzdiatr 1992;8 1:829-3 1. Stockholm. ISSN 0803-5253 The validity of the neonatal behavioral assessment scale in predicting later infant temperament is of theoretical and clinical importance. The scale was administered to 47 full-term healthy neonates. Of these, 40 were followed and the infant characteristics questionnaire was given at four months of age. Significant correlations were revealed between the neonatal assessment items from the clusters of orientation and motor maturity and the temperament factors “fussy-difficult” and “unpredictable”. Items from the cluster of autonomic stability correlated with the temperament factor “unadaptable.” These correlations possibly indicate that perceived temperament does reflect intrinsic infant qualities. 0 Neonatal behavior, temperament
E Tirosh, Hannah Khousky Child Development Center, Bnai Zion Medical Center, Haifa. Israel
Infant temperament has been defined as a biologically based disposition which is stable over a long period of time and which affects interactions with the environment (1). It is postulated that a prospective study from birth onwards might be able to elucidate the extent of the continuity of temperamental attributes and their stability (2, 3). The neonatal behavioral assessment scale (NBAS) evaluates the infant’s potential for self-organization and state control as a response to his environment (4). It has been used extensively and appears to tap early temperamental aspects of behavior (2, 5, 6). Some studies have addressed the relationship between neonatal behavior and later behavioral and temperamental attributes (5,711). The purpose of the present study was to assess the relationship between the different NBAS items and the infant’s temperament at four months of age, as perceived by the mother. A significant correlation between the two assessments would indicate the possible existence of a stable individual disposition which could inff uence the mother’s perception of the infant’s temperament and would further validate the NBAS as a measure of temperament (1 0).
Materials and methods Subjects
Forty-seven healthy, full-term babies, who were products of uneventful pregnancy and delivery were included in the study. All of the mothers consented to participate in the study. Apgar scores ranged from 8 to 10 after 1 min and from 9 to 10 after 5 min. Birth weights
ranged from 2850 to 3650 g. Eighty percent of the mothers belonged to the middle socioeconomic class, 15% were upper middle class and 5% were of lower class. The final cohort consisted of 40 infants (1 8 males): three were excluded due to missing data; two were hospitalized at the age of three days and eight weeks, respectively; and two mothers could not be contacted. Procedure
The NBAS was administered to all the infants between 48 and 72 h of age (before circumcision). The assessments were performed 1 h after feeding in a dimly lit room by the same psychologist, who was experienced in administering this procedure. The NBAS items represent clusters of habituation and orientation to animate and inanimate stimuli. Motor, state control and physiological regulation were included in the analysis (12). The cluster of reflexes was omitted because of low inter-observer reliability. Each item was administered in the appropriate specific state and was scored after analysis as recommended in the manual (4). Inter-observer agreement of 0.85-0.97 was established with two independent observers. Differences in NBAS clustering techniques have been criticized (1 3). An earlier study in Israel revealed a cluster structure different from those reported previously (14). Thus, no summary scores were calculated. When the infants were four months old (fseven days), mothers were requested, either while visiting the baby-care clinic or by a telephone call, to complete a questionnaire (15). This questionnaire consisted of 24 items rated on a seven-point scale (1 =best; 7=poor
830
E Tirosh et al.
ACTA PiEDlATR 81 (1992)
Table I. Regression analysis of NBAS items, with temperament factors as the dependent variables. Step/Predictora
R
F
P
Fussy-difficult 1/Cuddliness
-0.23
10.23
0.003
-0.72
19.93
0.0001
-0.24 -0.37 -0.47
9.76
O.OOO!
Unadaptable 1/Tremors 2/Startles 3/Consolability 4/Inanimate visual-auditory Unpredictable 1/Cuddliness Z/Consolability 3/Defense
-0.39 -0.47 -0.55
a The items are listed according to the order in which they were entered into the stepwise regression.
response), clustered into four factors: fussy-difficult, unadaptable, dull and unpredictable. For the purpose of statistical analysis, stepwise regression analysis was used (1 6). The r squares corresponding to each step are reported, as well as the F and p values of the final equation.
Results Stepwise regression analysis (Table 1) revealed that the more adaptive the infant’s behavioral responses were, the more predictable he was perceived by his mother. Items representing autonomic stability, regulation of state and orientation predicted the infant’s unadaptability four months later. No correlation was found between the NBAS and the temperamental factor of dullness. The total temperamental score was best predicted by the items representing the behaviour clusters of state regulation (i.e. cuddliness and consolability) and defense from the motor cluster (r = 0.567; p < 0.05).
lity and mood (2, 9). In the present investigation, as in previous studies (9, 20), no correlation was found between irritability during the neonatal period and at four months of age. The two items of cuddliness and consolability representing regulation of state, together with the defense response were found to be the most sensitive overall predictors of the infant’s temperament at four months of age. This is in agreement with previous findings (5) and particularly in populations at risk (2 1). The correlation coefficients between some NBAS items and the questionnaire factors were, as anticipated from previous reports, of small magnitude. The drop-out rate of 15%, as well as the number of variables included in the analysis, should be considered when interpreting these results. However, the high level of statistical significance indicates the validity of the observed correlations beyond chance. It is believed that temperament modifies environmental input (22) and particularly parental interactional behavior. The better understanding of temperamental antecedents has a definite clinical application. For example, the ability to predict an important factor such as sociability early in life may facilitate early intervention with at-risk diads. We speculate that a pattern derived from a series of sequential tests would result in a more powerful prediction of later temperament. The results of the present study lend support to the hypothesis of a transaction between the neurobehavioral disposition of the infant and the parental perception of his temperament. Acknowledgements.-The authors thank M Jaffe for reviewing the manuscript and R Abiry for her help in its preparation.
References 1. Goldsmith HH, Bradshaw DL, Reiser-Danner LA. Temperamen-
2.
Discussion Some researchers claim that temperamental attributes, as perceived by the parents, are stable across time (1 7). However, the idea that neonatal temperament reflects an inborn biological disposition has recently been questioned (1 8). The present investigation indicates that unadaptability at four months of age was predicted by the items of the same clusters that had previously been found to be significantly correlated with mother-infant interaction (19). Similarly, the NBAS factors of interaction and regulation of state were related in previous studies to the temperament dimensions of adaptability, approachabi-
3. 4. 5.
6. 7.
8.
tal dimensions as potential developmental influence on attachment. In: Lerner JV, Lerner RM eds Temperament and Psychosocia1 Interaction during Infancy and Childhood: New directions in Child Development. San Francisco: Jossey Bass, 1986:5-34 Green J, Bax M, Tsitsikan H. Neonatal behavior and early temperament: a longitudinal study of the first six months of life. Am J Orthopsychiatry 1989;59:82-93 Persson-Blennow I, McNeil T. Frequencies and stability of temperament types in childhood. J Am Acad Child Adolesc Psychiatry 1988;27:619-22 Brazelton TB. Neonatal Behavioural Assessment Scale 2nd Edn. London: Blackwell Scientific, 1984 Isabella RA, Ward MJ, Belsky J. Convergence of multiple sources of information on infant individuality: neonatal behavior, infant behavior, and temperament reports. Infant Behav Dev 1985;8:283-91 Peters-Martin P, Wachs TD. A longitudinal study of temperament and its correlates in the first 12 months. Infant Behav Dev 1984;7:285-98 Osofsky JD. Neonatal characteristics and mother-infant interaction in two observational situations. Child Dev 1976;47:113847 Sostek AM, Anders TF. Relationships among the Brazelton
ACTA PKDIATR 81 (1992)
neonatal scale, Bayley infant scales, and early temperament. Child Dev 1977;48:320-8 9. Crockenberg SB, Smith P. Antecedents of Mother-infant interaction and infant irritability in the first three months of life. Infant Behav Dev 1982;5:105-19 10. Hubert N, Wachs TD, Peters-Martin P, Gansdour MJ. The study of early temperament: measurement and conceptual issues. Child Dev 198233:57 1-600 11. Matheny AP, Riese ML, Wilson RS. Rudiments of infant temperament: newborn to 9 months. Dev Psychol 1985;21:486-94 12. Lester BM, Als H, Brazelton B. Regional obstetric anaesthesia and newborn behavior: a reanalysis towards synergistic effects. Child Dev 1982;53:688-92 13. Sostek AM. On the use of a priori cluster scores for the Brazelton Neonatal Assessment Scale: a response to Maier et al. Infant Behav Dev 1985;8:245-6 14. Tirosh E, Abadi J, Berger A. Comparison of early neonatal behavior in two Israeli ethnic groups. Isr J Med Sci 1988;24:67680 15. Bates JE, Bennett-Freeland CA, Lounsbury ML. Measurement of infant difficultness. Child Dev 1979;50:794-803
Neonatal behavior and subsequent temperament
83 1
16. SAS Institute. SAS-User’s Guide Statistics. SAS Institute, 1982 17. Bates JE, Bayles K. Objective and subjective components in mothers’ perception of their children from age 6 months to 3 years. Merrill-Palmer Q 1984;30 1 11-30 18. St James RI, Walke D. Convergence and discrepancies among mothers’ and professionals’ assessments of difficult neonatal behavior. J Child Psychol Psychiatry 1988;29:21-42 19. Waters E, Vaughn BE, Egeland BR. Individual differences in infant-mother attachment relationships at age one: antecedents in neonatal behavior in an urban, economically disadvantaged sample. Child Dev 1980;51:201-14 20. Samaroff AJ, Krafchak EE, Bakow HA. Issues in grouping items from the Neonatal Behavior Assessment Scale. Monogr SOCRes Child Dev 1978;43:46-59 21. Capute AJ, Derivan AP, Shauvel PJ, Rodriguez A. Infantile autism. I. A prospective study of the diagnosis. Dev Med Child Neurol 1975;17:58-62 22. .Bell RQ. A reinterpretation of the direction of effects in studies of socialization. Psychol Rev 1968;75:87-95 Received July 22, 1991. Accepted April 2 1, 1992
