CONFIRM · WITHIN PERSON
07Which state-dependent functional changes reproduce within a person?
Parent-observed variation can be real and clinically important without identifying its cause. Apparent variable access must remain distinguishable from pain, internal discomfort, altered arousal, seizure, sleep loss, medication effect, practice, developmental fluctuation, acquired loss, and informant drift.
POPULATION / COMPARATOR
Who or what should be compared?
Each participant serves as their own primary comparator across multiple stable baselines, naturally occurring windows, negative-control days, and recovery; group summaries use hierarchical models rather than counting events as people.
STUDY DESIGN
How could the question be tested?
Prospectively repeat the same brief language, motor, attention, regulation, social, and adaptive measures at stable baseline, during naturally occurring clinically managed windows, and through complete recovery. Time-lock sleep, intake, bowel state, temperature, heart rate, illness, pain, and all medication or procedure exposures.
EVIDENCE GATE
What would support the proposed link?
a pre-specified functional measure changes in the same direction in at least two independent naturally occurring windows, the timing is documented, recovery is measured, and competing explanations remain visible until tested.
STOP RULE
What would weaken it?
the signal exists only in global impressions, the task or rater changes between windows, baseline variability is unknown, recovery is not measured, or a safer clinical explanation has not been evaluated.