Rehab Measures Database
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  2. Behavioral Assessment Screening Tool

Behavioral Assessment Screening Tool

Last Updated

Purpose

Behavioral Assessment Screening Tool (BAST) is a 47-item (41 primary, 6 sub-items) self-reported measure to assess neurobehavioral symptoms in chronic brain injury.  The BAST has five subscales: Negative Affect, Executive Function, Fatigue, Impulsivity, & Substance Abuse. It also includes an Environmental Context Questionnaire made up of a checklist of recent major life events and four open-ended questions about current stressors and supports.

Link to Instrument

Acronym BAST

Area of Assessment

Attention & Working Memory
Behavior
Cognition
Depression
Executive Functioning
Insight
Life Participation
Mental Health
Motivation
Negative Affect
Personality
Positive Affect
Reasoning/Problem Solving
Self-efficacy
Sleep
Social Relationships
Social Support
Stress & Coping
Substance

Assessment Type

Patient Reported Outcomes

Cost

Free

Cost Description

Cost is free for students, physicians, clinical practice, and not-funded academic users. Fees may apply for funded academic users, healthcare organizations, commercial users, and IT companies. See tutorial for submitting request at https://eprovide.mapi-trust.org/catalog?search=bast.

CDE Status

Not a CDE -- last searched 6/11/2024.

Populations

Stroke
Brain Injury

Key Descriptions

  • Behavioral Assessment Screening Tool (BAST) – English and Spanish
    ? 48-items (42 primary, 6 sub-items) rated on a 5-level ordinal scale (never, rarely, sometimes, often, very often), with average subscale scores ranging from 1-5. Higher scores indicate more frequent symptoms.
    ? Five primary subscales:
    ? Negative Affect (13 items)
    ? Executive Function (11 items)
    ? Fatigue (6 items)
    ? Impulsivity (4 items)
    ? Substance Abuse (4 items)
    ? Maladaptive Coping (4 items): a 6th subscale made up of sub-items and only answered if individuals endorse having stress
    ? One item assessing Nightmares that does not factor into a subscale
    ? Environmental Context Questionnaire
    ? Checklist of recent major life events (total number of recent major life events checked)
    ? Four yes/no questions about current stressors and supports, with open-ended follow-up for “yes” responses (qualitative)
  • BAST-A: adolescent version of the BAST – English and Spanish
    ? 52 items (46 primary, 6 sub-items) rated on a 5-level ordinal scale (never, rarely, sometimes, often, very often), with average subscales scores ranging from 1-5. Higher scores indicate more symptoms.
    ? Three subscales
    ? Negative Affect & Fatigue (24 items)
    ? Executive & Social Function (16 items)
    ? Risk Behaviors (6 items)
    ? One item assessing Nightmares that does not factor
    ? Environmental Context Questionnaire – modified for adolescents
    ? Checklist of recent major life events (total number of recent major life events checked)
    ? Four yes/no questions about current stressors and supports, with open-ended follow-up for “yes” responses (qualitative)
  • The BAST and BAST-A were designed to be completed independently by individuals with ABI, either on paper or electronically.
  • There is also a short-form version using mobile health technology -- the BAST mHealth.

Number of Items

BAST: 48
BAST-A: 52

Time to Administer

7-15 minutes

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Shannon B. Juengst, PhD, CRC

University of Texas Southwestern Medical Center

TIRR Memorial Hermann

 

 

 

ICF Domain

Body Function
Activity
Participation
Environment

Measurement Domain

Cognition
Emotion
Activities of Daily Living

Professional Association Recommendation

None found -- last searched 6/11/2024.

Considerations

Designed to be completed independently by an individual with ABI.

Brain Injury

back to Populations

Standard Error of Measurement (SEM)

Moderate-Severe TBI (English-speaking National Cohort): (calculated from Juengst, Nabasny, & Terhorst, 2019; n = 52, mean age = 44.15 (15.72) years, age range = 21-82 years, OSU-TBI Worst Injury Score = 4 or 5)

  • SEM for Negative Affect subscale (n = 52): 0.239
  • SEM for Fatigue subscale (n = 52): 0.350
  • SEM for Executive Function subscale (n = 52): 0.254
  • SEM for Impulsivity subscale (n = 52): 0.449
  • SEM for Substance Abuse subscale (n = 52): 0.449

Mild TBI (English-speaking National Cohort): (calculated from Juengst, Nabasny, & Terhorst, 2019; n = 211; mean age = 40.55 (15.50) years, age range = 18-81, OSU-TBI Worst Injury Score = 2 or 3)

  • SEM for Negative Affect subscale: 0.237
  • SEM for Fatigue subscale: 0.308
  • SEM for Executive Function subscale: 0.229
  • SEM for Impulsivity subscale: 0.390
  • SEM for Substance Abuse subscale: 0.451

Mild-Severe TBI (Spanish-speaking) National Cohort: (calculated from Juengst, Nabasny, Terhorst, 2019; n = 11; mean age = 37.80 (13.40) years, age range = 18-65 years, OSU-TBI Worst Injury Score = 2 to 5)

  • SEM for Negative Affect subscale: 0.279
  • SEM for Fatigue subscale: 0.364
  • SEM for Executive Function subscale: 0.266
  • SEM for Impulsivity subscale: 0.490
  • SEM for Substance Abuse subscale: 0.324

Adolescent mTBI: (Juengst et al., 2021; n = 138, female = 69, mean age = 14.9 (1.6) years, age range = 12-20, mild TBI w/scores collected 3 months after initial clinic visit for concussion, Behavioral Assessment Screening Tool for Adolescents—BAST-A)

  • Negative Affect and Fatigue (mean subscale score = 2.10)
    • SEM for entire group: 0.170
  • Executive and Social Function (mean subscale score = 2.14)
    • SEM for entire group: 0.212
  • Risk Behaviors (mean subscale score = 1.26)
    • SEM for entire group: 0.183

Minimal Detectable Change (MDC)

Moderate-Severe TBI (English-speaking National Cohort): (calculated from Juengst, Nabasny, & Terhorst, 2019; n = 52, mean age = 44.15 (15.72) years,  age range = 21-82 years, OSU-TBI Worst Injury Score = 4 or 5)

  • 95% MDC for Negative Affect subscale (n = 52): 0.66
  • 95% MDC for Fatigue subscale (n = 52): 0.97
  • 95% MDC for Executive Function subscale (n = 52): 0.71
  • 95% MDC for Impulsivity subscale (n = 52): 1.24
  • 95% MDC for Substance Abuse subscale (n = 52): 1.24

Mild TBI (English-speaking National Cohort): (calculated from Juengst, Nabasny, & Terhorst, 2019; n = 211; mean age = 40.55 (15.50) years, age range = 18-81, OSU-TBI Worst Injury Score = 2 or 3)

  • 95% MDC for Negative Affect subscale: 0.66
  • 95% MDC for Fatigue subscale: 0.85
  • 95% MDC for Executive Function subscale: 0.63
  • 95% MDC for Impulsivity subscale: 1.08
  • 95% MDC for Substance Abuse subscale: 1.25

Mild-Severe TBI (Spanish-speaking) National Cohort: (calculated from Juengst, Nabasny, Terhorst, 2019; n = 11; mean age = 37.80 (13.40) years, age range = 18-65 years, OSU-TBI Worst Injury Score = 2 to 5)

  • 95% MDC for Negative Affect subscale: 0.77
  • 95% MDC for Fatigue subscale: 1.01
  • 95% MDC for Executive Function subscale: 0.74
  • 95% MDC for Impulsivity subscale: 1.36
  • 95% MDC for Substance Abuse subscale: 0.90

Adolescent mTBI: (Juengst et al., 2021; n = 138; mean age = 14.9 (1.6) years; mild TBI w/ scores collected 3 months after initial clinic visit for concussion, BAST-A)

  • Negative Affect and Fatigue: MDC95 = 0.47
  • Executive and Social Function: MDC95 = 0.59
  • Risk Behaviors: MDC95 = 0.51

 

Normative Data

 

Healthy Controls (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2019; n = 1548; mean age = 44.55 (17.73) years, age range = 18-90 years)

  • Mean (SD) Negative Affect subscale score: 2.55 (0.61)
  • Mean (SD) Fatigue subscale score: 2.40 (0.70)
  • Mean (SD) Executive Function subscale score: 2.05 (0.52)
  • Mean (SD) Impulsivity subscale score: 2.04 (0.69)
  • Mean (SD) Substance Abuse subscale score: 1.43 (0.67)

 

Mental Health Conditions only (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2019; n = 427; mean age = 39.58 (15.15) years, age range = 18-86 years, selected only one or more of the following: Post-traumatic stress disorder, Bipolar disorder, depression, anxiety, alcohol abuse/dependence, drug abuse/dependence, other mental health condition)

  • Mean (SD) Negative Affect subscale score: 3.34 (0.68)
  • Mean (SD) Fatigue subscale score: 3.15 (0.80)
  • Mean (SD) Executive Function subscale score: 2.32 (0.58)
  • Mean (SD) Impulsivity subscale score: 2.41 (0.81)
  • Mean (SD) Substance Abuse subscale score: 1.81 (0.96)

 

Other Neurological Conditions (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2019; n = 273; mean age = 37.45 (14.73) years, age range = 18-78 years, selected any of the following: learning disability, ADHD, Stroke, Multiple Sclerosis, Parkinson’s Disease, Autoimmune condition, or Other neurological condition)

  • Mean (SD) Negative Affect subscale score: 3.26 (0.69)
  • Mean (SD) Fatigue subscale score: 3.14 (0.76)
  • Mean (SD) Executive Function subscale score: 2.37 (0.57)
  • Mean (SD) Impulsivity subscale score: 2.43 (0.76)
  • Mean (SD) Substance Abuse subscale score: 1.72 (0.93)

 

Moderate-Severe TBI (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2019; n = 52; mean age = 44.15 (15.72) years, age range = 21-82 years, OSU-TBI Worst Injury Score = 4 or 5)

  • Mean (SD) Negative Affect subscale score: 3.16 (0.69)
  • Mean (SD) Fatigue subscale score: 3.07 (0.70)
  • Mean (SD) Executive Function subscale score: 2.40 (0.68)
  • Mean (SD) Impulsivity subscale score: 2.44 (0.82)
  • Mean (SD) Substance Abuse subscale score: 2.10 (1.03)

 

Women with Moderate-Severe TBI (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 20, OSU-TBI Worst Injury Score = 4 or 5)

  • Mean (SD) Negative Affect subscale score: 3.39 (0.67)
  • Mean (SD) Fatigue subscale score: 3.24 (0.76)
  • Mean (SD) Executive Function subscale score: 2.45 (0.71)
  • Mean (SD) Impulsivity subscale score: 2.41 (0.58)
  • Mean (SD) Substance Abuse subscale score: 1.97 (1.00)

 

Men with Moderate-Severe TBI (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 30, OSU-TBI Worst Injury Score = 4 or 5)

  • Mean (SD) Negative Affect subscale score: 3.06 (0.66)
  • Mean (SD) Fatigue subscale score: 2.98 (0.12)
  • Mean (SD) Executive Function subscale score: 2.40 (0.66)
  • Mean (SD) Impulsivity subscale score: 2.53 (0.17)
  • Mean (SD) Substance Abuse subscale score: 2.20 (1.10)

 

Individuals, with ≤ high school education, with Moderate-Severe TBI (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 9,  OSU-TBI Worst Injury Score = 4 or 5)

  • Mean (SD) Negative Affect subscale score: 3.32 (0.80)
  • Mean (SD) Fatigue subscale score: 3.22 (0.62)
  • Mean (SD) Executive Function subscale score: 2.52 (0.64)
  • Mean (SD) Impulsivity subscale score: 2.31 (0.54)
  • Mean (SD) Substance Abuse subscale score: 2.15 (1.03)

 

Individuals, with > high school education, with Moderate-Severe TBI (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 43, OSU-TBI Worst Injury Score = 4 or 5)

  • Mean (SD) Negative Affect subscale score: 3.12 (0.68)
  • Mean (SD) Fatigue subscale score: 3.04 (0.72)
  • Mean (SD) Executive Function subscale score: 2.37 (0.69)
  • Mean (SD) Impulsivity subscale score: 2.47 (0.87)
  • Mean (SD) Substance Abuse subscale score: 2.09 (1.05)

 

Moderate-Severe TBI (English-speaking Medical Center Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 133; mean age = 47.42 (14.42) years, age range = 21-86, OSU-TBI Worst Injury Score = 4 or 5)

  • Mean (SD) Negative Affect subscale score: 2.67 (0.73)
  • Mean (SD) Fatigue subscale score: 2.66 (0.85)
  • Mean (SD) Executive Function subscale score: 2.15 (0.59)
  • Mean (SD) Impulsivity subscale score: 2.08 (0.74)
  • Mean (SD) Substance Abuse subscale score: 1.33 (0.66)

 

Women with Moderate-Severe TBI (English-speaking Medical Center Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 51, OSU-TBI Worst Injury Score = 4 or 5)

  • Mean (SD) Negative Affect subscale score: 2.83 (0.77)
  • Mean (SD) Fatigue subscale score: 2.84 (0.84)
  • Mean (SD) Executive Function subscale score: 2.14 (0.57)
  • Mean (SD) Impulsivity subscale score: 1.98 (0.62)
  • Mean (SD) Substance Abuse subscale score: 1.34 (0.69)

 

Men with Moderate-Severe TBI (English-speaking Medical Center Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 82, OSU-TBI Worst Injury Score = 4 or 5)

  • Mean (SD) Negative Affect subscale score: 2.56 (0.69)
  • Mean (SD) Fatigue subscale score: 2.55 (0.85)
  • Mean (SD) Executive Function subscale score: 2.16 (0.61)
  • Mean (SD) Impulsivity subscale score: 2.14 (0.73)
  • Mean (SD) Substance Abuse subscale score: 1.33 (0.65)

 

Individuals, with ≤ high school education, with Moderate-Severe TBI (English-speaking Medical Center Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 80, OSU-TBI Worst Injury Score = 4 or 5)

  • Mean (SD) Negative Affect subscale score: 2.82 (0.80)
  • Mean (SD) Fatigue subscale score: 2.74 (0.91)
  • Mean (SD) Executive Function subscale score: 2.22 (0.64)
  • Mean (SD) Impulsivity subscale score: 2.13 (0.69)
  • Mean (SD) Substance Abuse subscale score: 1.49 (0.95)

 

Individuals, with > high school education, with Moderate-Severe TBI (English-speaking Medical Center Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 97, OSU-TBI Worst Injury Score = 4 or 5)

  • Mean (SD) Negative Affect subscale score: 2.61 (0.70)
  • Mean (SD) Fatigue subscale score: 2.63 (0.79)
  • Mean (SD) Executive Function subscale score: 2.12 (0.57)
  • Mean (SD) Impulsivity subscale score: 2.06 (0.76)
  • Mean (SD) Substance Abuse subscale score: 1.27 (0.52)

 

Mild TBI (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2019; n = 211; mean age = 40.55 (15.50) years)

  • Mean (SD) Negative Affect subscale score: 3.26 (0.75)
  • Mean (SD) Fatigue subscale score: 3.16 (0.89)
  • Mean (SD) Executive Function subscale score: 2.27 (0.66)
  • Mean (SD) Impulsivity subscale score: 2.30 (0.75)
  • Mean (SD) Substance Abuse subscale score: 1.83 (0.94)

 

Women with Mild TBI (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 114)

  • Mean (SD) Negative Affect subscale score: 3.42 (0.74)
  • Mean (SD) Fatigue subscale score: 3.36 (0.90)
  • Mean (SD) Executive Function subscale score: 2.22 (0.67)
  • Mean (SD) Impulsivity subscale score: 2.23 (0.76)
  • Mean (SD) Substance Abuse subscale score: 1.61 (0.82)

 

Men with Mild TBI (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 92)

  • Mean (SD) Negative Affect subscale score: 3.06 (0.71)
  • Mean (SD) Fatigue subscale score: 2.91 (0.08)
  • Mean (SD) Executive Function subscale score: 2.34 (0.63)
  • Mean (SD) Impulsivity subscale score: 2.37 (0.08)
  • Mean (SD) Substance Abuse subscale score: 2.08 (0.99)

 

Individuals, with ≤ high school education, with Mild TBI (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 37)

  • Mean (SD) Negative Affect subscale score: 3.32 (0.71)
  • Mean (SD) Fatigue subscale score: 3.14 (0.89)
  • Mean (SD) Executive Function subscale score: 2.39 (0.64)
  • Mean (SD) Impulsivity subscale score: 2.31 (0.79)
  • Mean (SD) Substance Abuse subscale score: 1.83 (1.01)

 

Individuals, with > high school education, with Mild TBI (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 174)

  • Mean (SD) Negative Affect subscale score: 3.25 (0.75)
  • Mean (SD) Fatigue subscale score: 3.16 (0.90)
  • Mean (SD) Executive Function subscale score: 2.24 (0.66)
  • Mean (SD) Impulsivity subscale score: 2.29 (0.75)
  • Mean (SD) Substance Abuse subscale score: 1.83 (0.92)

 

Mild TBI (English-speaking Medical Center Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 85; mean age = 43.25 (15.68) years)

  • Mean (SD) Negative Affect subscale score: 2.69 (0.72)
  • Mean (SD) Fatigue subscale score: 2.99 (0.83)
  • Mean (SD) Executive Function subscale score: 2.11 (0.55)
  • Mean (SD) Impulsivity subscale score: 1.84 (0.65)
  • Mean (SD) Substance Abuse subscale score: 1.13 (0.33)

 

Women with Mild TBI (English-speaking Medical Center Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 52)

  • Mean (SD) Negative Affect subscale score: 2.68 (0.73)
  • Mean (SD) Fatigue subscale score: 3.11 (0.79)
  • Mean (SD) Executive Function subscale score: 2.09 (0.51)
  • Mean (SD) Impulsivity subscale score: 1.75 (0.62)
  • Mean (SD) Substance Abuse subscale score: 1.06 (0.19)

 

Men with Mild TBI (English-speaking Medical Center Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 33)

  • Mean (SD) Negative Affect subscale score: 2.71 (0.70)
  • Mean (SD) Fatigue subscale score: 2.81 (0.86)
  • Mean (SD) Executive Function subscale score: 2.15 (0.61)
  • Mean (SD) Impulsivity subscale score: 1.98 (0.68)
  • Mean (SD) Substance Abuse subscale score: 1.23 (0.46)

 

Individuals, with ≤ high school education, with Mild TBI (English-speaking Medical Center Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 5)

  • Mean (SD) Negative Affect subscale score: 2.86 (1.14)
  • Mean (SD) Fatigue subscale score: 3.30 (1.31)
  • Mean (SD) Executive Function subscale score: 2.18 (0.74)
  • Mean (SD) Impulsivity subscale score: 2.05 (0.41)
  • Mean (SD) Substance Abuse subscale score: 1.07 (0.15)

 

Individuals, with > high school education, with Mild TBI (English-speaking Medical Center Cohort): (Juengst, Nabasny, & Terhorst, 2020; n = 36)

  • Mean (SD) Negative Affect subscale score: 2.68 (0.69)
  • Mean (SD) Fatigue subscale score: 2.97 (0.79)
  • Mean (SD) Executive Function subscale score: 2.11 (0.54)
  • Mean (SD) Impulsivity subscale score: 1.83 (0.66)
  • Mean (SD) Substance Abuse subscale score: 1.13 (0.34)

Healthy Controls (Spanish-speaking): (Juengst, Nabasny, & Terhorst, 2019; n = 296; mean age = 38.80 (12.90) years, age range = 18-80 years)

  • Mean (SD) Negative Affect subscale score: 2.51 (0.61)
  • Mean (SD) Fatigue subscale score: 2.26 (0.72)
  • Mean (SD) Executive Function subscale score: 2.14 (0.56)
  • Mean (SD) Impulsivity subscale score: 1.91 (0.71)
  • Mean (SD) Substance Abuse subscale score: 1.29 (0.60)

 

Mental Health Conditions (Spanish-speaking): (Juengst, Nabasny, & Terhorst, 2019; n = 27; mean age = 39.10 (10.90) years, age range = 19-65 years, selected only one or more of the following: Post-traumatic stress disorder, Bipolar disorder, depression, anxiety, alcohol abuse/dependence, drug abuse/dependence, other mental health condition)

  • Mean (SD) Negative Affect subscale score: 3.21 (0.70)
  • Mean (SD) Fatigue subscale score: 2.99 (0.86)
  • Mean (SD) Executive Function subscale score: 2.31 (0.63)
  • Mean (SD) Impulsivity subscale score: 2.23 (0.70)
  • Mean (SD) Substance Abuse subscale score: 1.38 (0.57)

 

Other Neurological Conditions (Spanish-speaking): (Juengst, Nabasny, & Terhorst, 2019; n = 16; mean age = 35.30 (21.50) years, age range = 18-80 years; selected any of the following: learning disability, ADHD, Stroke, Multiple Sclerosis, Parkinson’s Disease, Autoimmune condition, or Other neurological condition)

  • Mean (SD) Negative Affect subscale score: 3.19 (0.55)
  • Mean (SD) Fatigue subscale score: 3.02 (0.86)
  • Mean (SD) Executive Function subscale score: 2.35 (0.50)
  • Mean (SD) Impulsivity subscale score: 2.64 (0.93)
  • Mean (SD) Substance Abuse subscale score: 1.63 (1.15)

 

Mild-Severe TBI (Spanish-speaking): (Juengst, Nabasny, & Terhorst, 2019; n = 11; mean age = 37.80 (13.40) years; age range = 18-65, OSU-TBI Worst Injury Score = 2 to 5)

  • Mean (SD) Negative Affect subscale score: 3.40 (0.64
  • Mean (SD) Fatigue subscale score: 3.38 (1.01)
  • Mean (SD) Executive Function subscale score: 2.84 (0.84)
  • Mean (SD) Impulsivity subscale score: 3.16 (0.68)
  • Mean (SD) Substance Abuse subscale score: 2.15 (1.08)

Internal Consistency

Healthy Controls (English-speaking) Sample: (Juengst, Nabasny, & Terhorst, 2019; n = 1548, mean age = 44.55 (17.73), age range = 18-90)

  • Excellent: Cronbach's alpha = 0.86 for Negative Affect subscale and 0.80 for Executive Function subscale
  • Adequate: Cronbach's alpha = 0.79 for Fatigue subscale, 0.72 for Impulsivity subscale, and 0.70 for Substance Abuse subscale

 

Mental Health Conditions (English-speaking Sample): (Juengst, Nabasny, & Terhorst, 2019; n = 427,  mean age = 39.58 (15.15), age range = 18-86, selected only one or more of the following: Post-traumatic stress disorder, Bipolar disorder, depression, anxiety, alcohol abuse/dependence, drug abuse/dependence, other mental health condition)

  • Excellent: Cronbach's alpha = 0.88 for Negative Affect subscale, 0.83 for Fatigue subscale, and 0.81 for Executive Function subscale
  • Adequate: Cronbach's alpha = 0.76 for Substance Abuse subscale and 0.73 for Impulsivity subscale

 

Other Neurological Conditions (English-speaking National Cohort) Sample: (Juengst, Nabasny, & Terhorst, 2019; n = 273, mean age = 37.45 (14.73), age range = 18-78, selected any of the following: learning disability, ADHD, Stroke, Multiple Sclerosis, Parkinson’s Disease, Autoimmune condition, or Other neurological condition)

  • Excellent: Cronbach's alpha = 0.87 for Negative Affect subscale, 0.80 for Executive Function subscale, and 0.80 for Substance Abuse subscale
  • Adequate: Cronbach's alpha = 0.78 for Fatigue subscale
  • Poor: Cronbach's alpha = 0.67 for Impulsivity subscale

 

Moderate-Severe TBI (English-speaking National Cohort) Sample: (Juengst, Nabasny, & Terhorst, 2019; n = 52)

  • Excellent: Cronbach's alpha = 0.88 for Negative Affect subscale, 0.86 for Executive Function subscale, and 0.81 for Substance Abuse subscale
  • Adequate: Cronbach’s alpha = 0.75 for Fatigue subscale and 0.70 for Impulsivity subscale

Mild TBI (English-speaking National Cohort): (Juengst, Nabasny, & Terhorst, 2019; n = 211)

  • Excellent: Cronbach's alpha = 0.90 for Negative Affect subscale, 0.88 for Fatigue subscale, and 0.88 for Executive Function subscale
  • Adequate: Cronbach’s alpha = 0.77 for Substance Abuse subscale and 0.73 for Impulsivity subscale

Healthy Controls (Spanish-speaking) Sample: (Juengst, Nabasny, & Terhorst, 2019; n = 296)

  • Excellent: Cronbach’s alpha = 0.84 for Negative Affect subscale and 0.80 for Fatigue subscale
  • Adequate: Cronbach’s alpha = 0.78 for Executive Function subscale, 0.73 for Impulsivity subscale, and 0.73 for Substance Abuse subscale

 

Mental Health Conditions (Spanish-speaking Sample): (Juengst, Nabasny, & Terhorst, 2019; n = 27)

  • Excellent: Cronbach’s alpha = 0.88 for Negative Affect subscale, 0.83 for Executive Function subscale, and 0.81 for Fatigue subscale
  • Adequate: Cronbach’s alpha = 0.71 for Substance Abuse subscale
  • Poor: Cronbach’s alpha = 0.61 for Impulsivity subscale

 

Other Neurological Conditions (Spanish-speaking) Sample: (Juengst, Nabasny, & Terhorst, 2019; n = 16)

  • Excellent: Cronbach’s alpha = 0.93* for Substance Abuse subscale and 0.80 for Fatigue subscale
  • Adequate: Cronbach’s alpha = 0.75 for Impulsivity subscale
  • Poor: Cronbach’s alpha = 0.69 for Negative Affect subscale and 0.69 for Executive Function subscale

 

Mild-Severe TBI (Spanish-speaking)  Sample: (Juengst, Nabasny, & Terhorst, 2019; n = 11)

  • Excellent: Cronbach's alpha = 0.91* for Substance Abuse subscale, 0.90 for Executive Function subscale, 0.87 for Fatigue subscale, and 0.81 for Negative Affect subscale
  • Poor: Cronbach’s alpha = 0.48 for Impulsivity subscale

Adolescent mTBI: (Juengst et al., 2021, n = 138)

  • Excellent: Cronbach's alpha range from 0.80-0.95 for 46 primary BAST-A items:
    • Factor 1: Affect and Fatigue (Cronbach’s alpha = .95*)
    • Factor 2: Executive and Social Function (Cronbach’s alpha = .89)
    • Factor 3: Risk Behaviors (Cronbach’s alpha = .80)
  • Poor:  Cronbach's alpha = 0.67 for four retained maladaptive coping items

*Scores higher than .9 may indicate redundancy in the scale questions.

Construct Validity

Adults with TBI: (Juengst et al., 2024; n = 110, mean age = 48.5 (14.5), male = 69 (62.7%), community-dwelling adults with complicated mild to severe TBI)

  • Generalized Anxiety Disorders-7 total score (convergent with Negative Affect, Executive Function, Impulsivity; discriminant with Substance Abuse, Fatigue)
    • Excellent: Negative Affect (r = .813)
    • Excellent: Substance Abuse (r = .271)
    • Adequate: Fatigue (r = .478)
    • Adequate: Executive Function (r =.475)
    • Adequate: Impulsivity (r =.435)
  • Patient Health Questionnaire-8 total (convergent with Negative Affect, Fatigue, Executive Function; discriminant with Substance Abuse, Impulsivity)
    • Excellent: Negative Affect (r = .684)
    • Excellent: Substance Abuse (r = .137)
    • Excellent: Fatigue (r = .674)
    • Excellent: Executive Function (r =.617)
    • Adequate: Impulsivity (r =.399)
  • Frontal Systems Scale: Apathy subscale (convergent with Negative Affect, Executive Function, Fatigue; discriminant with Substance Abuse, Impulsivity
    • Adequate: Negative Affect (r = .587)
    • Excellent: Substance Abuse (r = .152)
    • Excellent: Fatigue (r = .605)
    • Excellent: Executive Function (r =.622)
    • Excellent: Impulsivity (r =.271)
  • Frontal Systems Scale: Disinhibition subscale (convergent with Negative Affect, Executive Function, Impulsivity; discriminant with Substance Abuse, Fatigue)
    • Adequate: Negative Affect (r = .589)
    • Adequate: Substance Abuse (r = .375)
    • Adequate: Fatigue (r = .430)
    • Adequate: Executive Function (r =.489)
    • Adequate: Impulsivity (r =.577)
  • Frontal Systems Scale: Executive Function subscale (convergent with Negative Affect, Executive Function, Fatigue, Impulsivity; discriminant with Substance Abuse)
    • Excellent: Negative Affect (r = .601)
    • Excellent: Substance Abuse (r = .211)
    • Adequate: Fatigue (r = .508)
    • Excellent: Executive Function (r =.683)
    • Adequate: Impulsivity (r =.533)
  • Fatigue Impact Scale: Cognitive Fatigue (convergent with Fatigue, Executive Function, Negative Affect; discriminant with Substance Abuse, Impulsivity)
    • Excellent: Negative Affect (r = .688)
    • Excellent: Substance Abuse (r = .212)
    • Excellent: Fatigue (r = .726)
    • Adequate: Executive Function (r =.543)
    • Adequate: Impulsivity (r =.482)
  • Fatigue Impact Scale: Physical Fatigue (convergent with Fatigue; discriminant with Substance Abuse, Executive Function, Impulsivity)
    • Adequate: Negative Affect (r = .485)
    • Excellent: Substance Abuse (r = .136)
    • Excellent: Fatigue (r = .828)
    • Adequate: Executive Function (r =.505)
    • Excellent: Impulsivity (r =.291)
  • Positive and Negative Affect Schedule (PANAS): Positive Affect Subscale (convergent with Negative Affect, Executive Function, Fatigue; discriminant with Substance Abuse, Impulsivity)
    • Adequate: Negative Affect (r = .440)
    • Excellent: Substance Abuse (r = .008)
    • Adequate: Fatigue (r = -.527)
    • Adequate: Executive Function (r = -.587)
    • Excellent: Impulsivity (r = -.144)
  • Positive and Negative Affect Schedule (PANAS): Negative Affect Subscale (convergent with Negative Affect, Fatigue, Impuslivity; discriminant with Executive Function, Substance Abuse)
    • Excellent: Negative Affect (r = .782)
    • Adequate: Substance Abuse (r = .353)
    • Adequate: Fatigue (r = .470)
    • Adequate: Executive Function (r = .377)
    • Adequate: Impulsivity (r = .460)
  • Aggression Questionnaire: Physical Aggression Subscale: (convergent with Substance Abuse, Impulsivity; discriminant with Fatigue, Negative Affect, Executive Function)
    • Excellent: Negative Affect (r = .287)
    • Adequate: Substance Abuse (r = .374)
    • Excellent: Fatigue (r = .175)
    • Excellent: Executive Function (r =.251)
    • Adequate: Impulsivity (r =.305)
  • Aggression Questionnaire: Verbal Aggression Subscale: (convergent with Substance Abuse, Impulsivity; discriminant with Fatigue, Negative Affect, Executive Function)
    • Medium: Negative Affect (r = .261)
    • Medium: Substance Abuse (r = .248)
    • Medium: Fatigue (r = .103)
    • Small to medium: Executive Function (r = .256)
    • Low: Impulsivity (r = .278)
  • Aggression Questionnaire: Anger Aggression Subscale: (convergent with Negative Affect, Executive Function, Impulsivity; discriminant with Fatigue, Substance Abuse)
    • Excellent: Negative Affect (r = .602)
    • Adequate: Substance Abuse (r = .319)
    • Excellent: Fatigue (r = .264)
    • Adequate: Executive Function (r =.468)
    • Adequate: Impulsivity (r = .458)
  • Aggression Questionnaire: Hostility Aggression Subscale: (convergent with Negative Affect, Executive Function, Impulsivity; discriminant with Fatigue, Substance Abuse)
    • Adequate: Negative Affect (r = .510)
    • Excellent: Substance Abuse (r = .289)
    • Adequate: Fatigue (r = .364)
    • Adequate: Executive Function (r = .351)
    • Adequate: Impulsivity (r = .398)
  • Aggression Questionnaire: Indirect Aggression Subscale: (convergent with Impulsivity; discriminant with Fatigue, Substance Abuse, Negative Affect, Executive Function)
    • Medium: Negative Affect (r = .522)
    • Medium: Substance Abuse (r = .522)
    • Medium: Fatigue (r = .522)
    • Small to medium: Executive Function (r =.336)
    • Low: Impulsivity (r =.241)

Convergent validity:

Adolescent mTBI: (Juengst et al., 2021; n = 138)

  • Adequate convergent validity of BAST-A Affect and Fatigue subscale with:
    • Post-concussion symptoms total score (r = 0.341)
    • Generalized Anxiety Disorders-7 total score (r = 0.522)
    • Patient Health Questionnaire-8 total score (r = 0.553)
    • Brief Resilience Scale total score (r = -0.531)
    • Pittsburgh Sleep Quality Index global score (r = 0.551)
  • Adequate convergent validity of BAST-A Executive and Social Function subscale with the Brief Resilience Scale (r = -0.501)

 

Discriminant validity:

Adolescent mTBI: (Juengst et al., 2021; n = 138)

  • Excellent discriminant validity of BAST-A Executive Function and Social Function subscale with the Post-concussion symptom total score (r = 0.260)
  • Adequate discriminant validity of BAST-A Executive Function and Social Function subscale with:
    • Generalized Anxiety Disorders-7 total score (r = 0.336)
    • Patient Health Questionnaire-8 total score (r = 0.339)
    • Pittsburgh Sleep Quality Index global score (r = 0.426)
  • Excellent discriminant validity of BAST-A Risk Behaviors subscale with:
    • Post-concussion symptoms total score (r = 0.107)
    • Generalized Anxiety Disorders-7 total score (r = 0.241)
    • Patient Health Questionnaire-8 total score (r = 0.283)
    • Brief Resilience Scale total score (r = -0.044)
    • Pittsburgh Sleep Quality Index global score (r = 0.222)

 

Content Validity

Content validity of the BAST was determined by an expert panel, overseen by the principal investigator (a rehabilitation counselor), including one mother of a TBI survivor, one physiatrist, two neuropsychologists, one physical therapist, one occupational therapist, and one speech-language pathologist.  Each expert rated the clarity and relevance of the individual items, provided qualitative feedback regarding the wording and content, and voted to include or exclude each item with an inclusion threshold of 83% agreement to include each item.  From the results of this panel, Juengst, Terhorst, Dicianno, Niemeier, & Wagner (2018) concluded that the BAST has strong content validity, with a Content Validity Index (CVI) of 89.3% (p.1203).

The 10 panel members included rehabilitation counselors, pediatric neuropsychologists as well as psychologists and a physiatrist with clinical experience in concussion. After the original measure (BAST-A) was modified and questions specific to adolescent experiences were added, 5 members rated each item on a scale from 1 to 5 (not at all to extremely) relevant. A score of greater than 3.5 was determined to indicate relevance. The final calculated Content Validity Index was 97.3% and the average relevance score was 4.31 indicating good content validity and relevance (Juengst et al., 2021). 

Face Validity

A panel of experts and focus groups of individuals with TBI and their care partners provided qualitative feedback on the relevance of items to behavioral and emotional consequences of TBI.  General consensus in the focus groups and high relevance scores for individual items by experts indicate face validity of the BAST (Juengst et al., 2018).

The 10 panel members included rehabilitation counselors, pediatric neuropsychologists as well as psychologists and a physiatrist with clinical experience in concussion indicated high relevance of items (4.31 of 5), thus indicating face validity of the BAST-A (Juengst et al., 2021).  

Stroke

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Cut-Off Scores

Adults with stroke vs. healthy controls: (Osborne et al., 2022; w/stroke: n = 47, mean age = 46.8 (16.5), male = 24 (51.1%); healthly controls: n = 1843, mean age = 43.6 (17.1), male = 64.0%)

  • Significant differences in AUC for classifying individual with stroke and healthy controls for BAST subscales:
    • Negative Affect (AUC = .744, p < .001)
    • Executive Function (AUC = .669, p < .001)
    • Fatigue (AUC = .758, p  < .001)
  • Subscale scores of 2.75 (sensitivity = .766, specificity = .620) for Negative Affect, 2.5 (sensitivity = .787, specificity = .531) for Fatigue, and 2.05 (sensitivity = .723, specificity = .509) appeared to best balance sensitivity and specificity, with preference given to higher sensitivity.

Internal Consistency

Adults with stroke: (Osborne et al., 2022; n = 75, male = 43 (57.3%); mean age = 49.24 (16.1) years)

  • Excellent: Cronbach’s alpha range from 0.75 to 0.89 for BAST subscales

Construct Validity

Discriminant validity:

Adults with stroke vs. healthy controls: (Osborne et al., 2022; w/stroke: n = 47, mean age = 46.8 (16.5), male = 24 (51.1%); healthly controls: n  = 1843, mean age = 43.6 (17.1), male = 64.0%)

  • Significant mean subscore differences on BAST between those with stroke and healthy controls for four of the five subscales:
    • Negative Affect (t = -6.63, p < .001, Cohen’s d = .89)
    • Executive Function (t = -4.23, p < .001, Cohen’s d = .60)
    • Fatigue (t = -7.34, p < .001, Cohen’s d = 1.00)
    • Impulsivity (t = -2.05, p < .041, Cohen’s d = .32)
  • Mann-Whitney U-test run for the Substance Abuse subscale as assumptions for parametric testing were not met revealed no significant difference between the groups (p = .913, Cohen’s d = .13)

Bibliography

Juengst SB, Terhorst L, Dicianno BE, Niemeier JP, Wagner AK. (2018, January). Development and content validity of the behavioral assessment screening tool (BASTβ). Disability & Rehabilitation, 41(10), 1200-1206. doi:10.1080/09638288.2017.1423403

Juengst SB, Nabasny A, Terhorst L. (2019). Neurobehavioral Symptoms in Community-Dwelling Adults With and Without Chronic Traumatic Brain Injury: Differences by Age, Gender, Education, and Health Condition. Front Neurol., 10:1210. doi:10.3389/fneur.2019.01210

Juengst SB, Nabasny A, Terhorst L. (2020). Cohort Differences in Neurobehavioral Symptoms in Chronic Mild to Severe Traumatic Brain Injury. Front Neurol., 10:1342. doi:10.3389/fneur.2019.01342

Juengst SB, Nabasny A, Kajankova, M, Wright, B, & Terhorst L. (2021). Factor analysis of the adolescent version of the Behavioural assessment screening tool (BAST-A) in adolescents with concussion. Brain Injury, 35(1), 130-137. doi:10.1080/02699052.2020.1857838

Osborne, C., Wong, A., Vo, W., and Juengst SB. (2022, July). Psychometric Analysis of the behavioral assessment screening tool (BAST) in adults with stroke. Topics in Stroke Rehabilitation, 29(5), 321-330. doi:10.1080/10749357.2021.1895495

Juengst, SB, Wright, B, Vos, L, Rodriguez, G, Conley, M, Terhorst, L. (2024). Convergent, discriminant, and known groups validity of the Behavioral Assessment Screening Tool. Research Square (Preprint made available via a pilot program of the National Library of Medicine to provide preprints of research funded by the NIH), February 15. https://doi.org/10.21203/rs.3.rs-3909294/v1

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