The Science

A Milestone for the NRF: New Research Published on the Awake States Indicator Checklist

We are excited to announce the publication of the first research article on the NeuroRelational Framework (NRF) and one of its core tools, the Awake States Indicator Checklist.

This tool helps practitioners track observable biobehavioral markers of nervous system states, providing a practical way to identify patterns of healthy regulation and stress across contexts. Grounded in the National Institute of Health and Mental Health’s Research Domain Criteria (RDoC) framework, the checklist supports transdisciplinary and transdiagnostic approaches to understanding development and mental health.

By developing practical tools that make nervous system patterns visible and measurable, we hope to support clinicians, educators, and families in working together to promote healthier developmental pathways for children.

This is just the beginning. Additional NRF studies are already underway, and we look forward to sharing the next steps in this journey.

The NeuroRelational Framework Awake States Indicators Checklist: Preliminary Psychometrics for Use in Pediatric Occupational Therapy
Jacquelyn Christensen, Sarah A. Schoen, Hannah Robertson, Carol Anne Hapchyn, Rebekah Givens, Kacey Markarian & Connie Lillas
Published online: 04 Mar 2026

Publications from Connie Lillas, co-author of the NeuroRelational Framework textbook

Lillas, C. M., Langer, L., & Drinane, M. (2005). Forced Separations and Forced Reunions. ZERO TO THREE, July.

Lillas, C. and Turnbull, J. (2009). Infant/Child Mental Health, Early Intervention, and Relationship-Based Therapies: A Neurorelational Framework for Interdisciplinary Practice. New York: W. W. Norton. This book is part of the Interpersonal Neurobiology Series where Dan Siegel, MD, is the Founding Series Editor. Brandt, K., Diel, J., Feder, J., & Lillas, C. (2012). A Problem In Our Field: Making Distinctions Between Evidence-Based Treatment and Evidence-Based Practice As a Decision-Making Process. ZERO TO THREE, March.

Lillas, C. (2014). The Neurorelational Framework (NRF) in Infant and Early Childhood Mental Health. In Infant and Early Childhood Mental Health: Core Concepts and Clinical Applications. Arlington, Virginia: American Psychiatric Publishing.

Lillas, C., Feder, J., Diel, J., & Brandt, K. (2014). Weighing the Evidence: Evidence- Based Practice and Evidence Based Treatments in Infant Mental Health. In Infant and Early Childhood Mental Health: Core Concepts and Clinical Applications. Arlington, Virginia: American Psychiatric Publishing.

Lillas, C. & Marchel, M.A. (2015). Moving Away from WEIRD: Systems-Based Shifts in Research, Diagnosis, and Clinical Practice. Perspectives in Infant Mental Health. Michigan: World Association for Infant Mental Health. Winter.

Lillas, C., TenPas, H., Crowley, C., & Spitzer, S. (2018). Improving Regulation Skills for Increased Participation for Individuals with ASD. In Watling, R. & Spitzer, S. Autism Across the Lifespan: A Comprehensive Occupational Therapy Approach, 4th Edition. Bethesda, Maryland: American Occupational Therapy Association, Inc.

Christensen JS, Wild H, Kenzie ES, Wakeland W, Budding D and Lillas C. (2020) Diverse Autonomic Nervous System Stress Response Patterns in Childhood Sensory Modulation. Front. Integr. Neurosci. 14:6. doi: 10.3389/fnint.2020.000

Lillas, C. (2022) Three Steps to Resilience: NRF Foundations Manual for Interdisciplinary Practice and International Use. Interdisciplinary Training Institute: Los Angeles, California.

Reviews

British Journal of Psychiatry
https://nrfcare.org/wp-content/uploads/2022/11/British-Journal-of-Psychiatry-Book-Review-ADJ-1.pdf

Psychiatry: Interpersonal and Biological Processes
https://guilfordjournals.com/doi/10.1521/psyc.2010.73.2.198

PsycCRITIQUES
https://cdm15960.contentdm.oclc.org/digital/collection/p15960coll21/id/82353/rec/1

Articles citing Connie Lillas and Janiece Turnbull

Evidence-based milestone ages as a framework for developmental surveillance

Self-reg: How to help your child (and you) break the stress cycle and successfully engage with life

Clinical improvements in adopted children with fetal alcohol spectrum disorders through neurodevelopmentally informed clinical intervention: A pilot study

DIR/Floortime: Evidence based practice towards the treatment of autism and sensory processing disorder in children and adolescents

Supporting positive parenting practices within a community-based music therapy group program: Pilot study findings

Addressing challenging behaviors and mental health issues in early childhood

Self-regulation and inquiry-based learning in the primary classroom

Sunshine circles: Randomized controlled trial of an attachment-based play group with preschool students who are at-risk

Infant and toddler development from conception to age 3: What babies ask of us

DIR/Floortime: A developmental/relational play therapy approach towards the treatment of children with developmental delays, including ASD and sensory processing challenges

Updated evidence-based developmental attainments for children: First 6 years

Parenting principles primer

Anticipatory guidance for behavior concerns: School age children

Chapter 14 - The hidden meanings of repetitive behaviors: A window into the child’s inner world from a multidisciplinary perspective

Pearls of wisdom: Updated skill-specific parenting strategies in the first 6 years

“Aggression” in young children on the autism spectrum: The dysregulation-”aggression” hypothesis

The nurture revolution: Grow your baby’s brain and transform their mental health through the art of nurtured parenting

Neurosensory play in the infant-parent dyad

Perspectives in infant mental health

Mentalization in DIR/Floortime: Facilitating reflective functioning in parents of children with developmental challenges

Masking stress with misbehavior: A Shanker Self-Reg lens

Conference poster presentations