The Awake States Indicator Checklist: A Measure of Arousal for Targeted Intervention

This research sought to determine the content validity and inter rater reliability of the Awake States Indicator checklist (ASIC). Children with sensory processing and integration challenges have a higher degree of arousal and regulation difficulties. Needed is an evidence-based tool for occupational therapy practitioners to assess physiological biomarkers of arousal in pediatric populations. This study employed a qualitative method to study content validity and a quantitative, experimental design to study the interrater reliability of the ASIC. Data sources for content validity were obtained from a panel of 15 experts and from videotapes of children (3 months to 10 years) for inter rater reliability. Qualitative data were collected from experts on relevancy, representativeness, clarity and comprehensiveness of the items on the ASIC, with modifications made based on expert recommendations. Quantitative data were collected from 2 coders who independently coded a total of fifty 30-second videos using the ASIC. Analyses included percent agreement and statistical test of inter rater reliability. Experts validated the biomarkers of arousal by item within 6 categories (e.g., eyes, face, voice, posture, movement, breathing) and within 5 zones (e.g., Green, Blue, negative Red, Positive Red, Combo). Overall percent agreement between the two raters was .93 with a Cohen’s Kappa, of .90, p < .001. Percent agreement by category ranged from 44% to 97%. Lowest categories were posture in Combo zone and movement in Blue zone, with all other categories above 80% agreement. Operational definitions were refined. These preliminary findings indicate the ASIC can reliably be used to identify physiological indicators of arousal within a pediatric population. These findings are relevant to occupational therapy practice by introducing the ASIC as an evidence-based tool to enhance occupational therapists’ clinical observation, educate caregivers and support more targeted intervention.

References

Christensen, J. S., Wild, H., Kenzie, E. S., Wakeland, W., Budding, D., & Lillas, C. (2020). Diverse autonomic nervous system stress response patterns in childhood sensory modulation. Frontiers in Integrative Neuroscience, 14. https://www.frontiersin.org/articles/10.3389/fnint.2020.00006

Lillas, C. (2022, July). NRF Interactive Manual. https://app.nrfcare.org/gde_view.asp?faq=