Occupational Therapy Practice and ResearchCerebral Palsy and Movement DisordersTraumatic Brain Injury Research

Jacquelyn S. Christensen, Sarah A. Schoen, Hannah Robertson, C. A. Hapchyn, Rebekah Givens, K. Markarian, Connie Lillas

2026.3.4Occupational Therapy in Mental Health

DOI: 10.1080/0164212x.2026.2638313

Abstract

This study reports on content validity and interrater reliability of the Awake States Indicators Checklist (ASIC) in pediatrics. NeuroRelational Framework clinicians (n = 16) rated the biobehavioral indicators’ clarity, relevance, and comprehensiveness. Item-level and scale-level content validity index ratings were high. Two interns rated 50 short video clips. Results demonstrated high interrater reliability on arousal states (Cohen’s Kappa = 0.90, p<.001) and acceptable to good across the biobehavioral indicators (45% to 100% agreement, with over 80% agreement in most categories). The ASIC demonstrates good preliminary psychometric properties supporting use in transdisciplinary, transdiagnostic practice. Findings are limited by small samples and lack of diversity.

Citation format

CHRISTENSEN, Jacquelyn S., et al. The neurorelational framework awake states indicators checklist: Preliminary psychometrics for use in pediatric occupational therapy. Occupational Therapy in Mental Health, 2026: 1–25.