Methods for acquiring MRI data in children with autism spectrum disorder and intellectual impairment without the use of sedation

Abstract

BackgroundMagnetic resonance imaging (MRI) has been widely used in studies evaluating the neuropathology of autism spectrum disorder (ASD). Studies are often limited, however, to higher functioning individuals with ASD. MRI studies of individuals with ASD and comorbid intellectual disability (ID) are lacking, due in part to the challenges of acquiring images without the use of sedation.MethodsUtilizing principles of applied behavior analysis (ABA), we developed a protocol for acquiring structural MRI scans in school-aged children with ASD and intellectual impairment. Board certified behavior analysts worked closely with each child and their parent(s), utilizing behavior change techniques such as pairing, shaping, desensitization, and positive reinforcement, through a series of mock scanner visits to prepare the child for the MRI scan. An objective, quantitative assessment of motion artifact in T1- and diffusion-weighted scans was implemented to ensure that high-quality images were acquired.ResultsThe sample consisted of 17 children with ASD who are participants in the UC Davis Autism Phenome Project, a longitudinal MRI study aimed at evaluating brain developmental trajectories from early to middle childhood. At the time of their initial scan (2–3.5 years), all 17 children had a diagnosis of ASD and development quotient (DQ) <70. At the time of the current scan (9–13 years), 13 participants continued to have IQs in the range of ID (mean IQ = 54.1, sd = 12.1), and four participants had IQs in the normal range (mean = 102.2, sd = 7.5). The success rate in acquiring T1-weighted images that met quality assurance for acceptable motion artifact was 100 %. The success rate for acquiring high-quality diffusion-weighted images was 94 %.ConclusionsBy using principles of ABA in a research MRI setting, it is feasible to acquire high-quality images in school-aged children with ASD and intellectual impairment without the use of sedation. This is especially critical to ensure that ongoing longitudinal studies of brain development can extend from infancy and early childhood into middle childhood in children with ASD at all levels of functioning, including those with comorbid ID.Electronic supplementary materialThe online version of this article (doi:10.1186/s11689-016-9154-9) contains supplementary material, which is available to authorized users.

Reduced Hemispheric Asymmetry of White Matter Microstructure in Autism Spectrum Disorder

“…Implementation of a similar or more extensive behavioral training regimen as well as imaging sequences designed to recover from subject motion 67 may help to extend the functional range of participants who can be included in future studies. 68,69 Third, for inter-subject alignment of scans, our TBSS analyses utilized the FMRIB58_FA template that was based on a sample of 20–50-year-olds. A better approach given our sampled age range (7–17-year-olds) would be a study-specific registration template.…”

Minimizing noise in pediatric task-based functional MRI; Adolescents with developmental disabilities and typical development

“…A presentation with pictures of the MRI scanner and laying out the procedure for the child is very useful and employed by many laboratories. The scanner is sometimes “decorated” with child-friendly decorations to make it appear as a spaceship or other non-medical looking device (Nordahl et al, 2016). Other programs may use prerecorded videos of other children being screened for metal, entering a scanning environment, being placed in the scanner and performing a task to be used in the scanner (Thomason, 2009).…”

Reprint of: Minimizing noise in pediatric task-based functional MRI; Adolescents with developmental disabilities and typical development

“…Training in mock scanners prior to the fMRI session has consistently shown to improve the quality of data acquisition in pediatric groups (de Amorim e Silva et al, 2006;De Bie et al, 2010;Kotsoni et al, 2006;Poldrack et al, 2002) and pediatric clinical groups (Epstein et al, 2007). Training often integrates methods from the applied behavior analytic (ABA) methodology (Nordahl et al, 2016;Slifer et al, 1993). Keith Slifer and colleagues pioneered the use of applied behavior analysis to reduce movement in the scanning environment with verbal feedback and a prize provided for improvements in head movement during mock scan training (Slifer et al, 1993(Slifer et al, , 2002.…”

“…The application of ABA procedures in the imaging context has become quite sophisticated including using such techniques as behavioral shaping, developing conditioned reinforcers associated with the scanning procedure, peer modeling, combined with systematic desensitization strategies. These methods allow researchers to obtain data of optimal quality from pediatric subjects (Nordahl et al, 2016). State-ofthe-art ABA methods can be especially helpful when imaging children with developmental disorders such as autism spectrum disorders and intellectual impairment (Nordahl et al, 2016).…”

“…These methods allow researchers to obtain data of optimal quality from pediatric subjects (Nordahl et al, 2016). State-ofthe-art ABA methods can be especially helpful when imaging children with developmental disorders such as autism spectrum disorders and intellectual impairment (Nordahl et al, 2016). Some laboratories furnish children with headsets that allow researchers to monitor their movement while they perform the practice tasks in the mock scanning environment.…”