The fMRI success rate of children and adolescents: Typical development, epilepsy, attention deficit/hyperactivity disorder, and autism spectrum disorders

Abstract

FMRI in children is increasingly used in clinical application and in developmental research; however, little is known how pediatric patient and typically developing populations successfully complete studies. We examined pediatric success rates with Epilepsy, Attention Deficit/ Hyperactivity Disorder (ADHD), Autism Spectrum Disorders (ASD), and typically developing children (TYP). We also examined the affect of age, and, for ADHD populations, medication status on success rates. We defined a successful fMRI individual run when the data were interpretable and included in group statistics. For unsuccessful runs, datasets with excessive motion or floor task performance were categorized when possible. All clinical groups scanned less successfully than controls; medication status did not affect ADHD success (Epilepsy: 80%; ADHD (off methylphenidate): 77%; ADHD (on methylphenidate): 81%; ASD: 70%; TYP: 87%). Ten to 18-year-olds had a significantly greater scan success rate than 4-6-year-olds; adolescents (13-18-year-olds) demonstrated greater scan success rates than 7-9-year-olds. Success rate for completing an entire battery of experimental runs (n=2-6), varied between 50-59% for patient populations and 69% for TYP (79% when excluding 4-6-year-olds). Success rate for completing one run from a battery was greater than 90% for all groups, except for ASD (81%). These data suggest 20-30% more children should be recruited in these patient groups, but only 10-20% for TYP for research studies. Studies with 4-6-year-olds may require 20-40% additional participants; studies with 10-18-year-olds may require 10-15% additional participants.Functional magnetic resonance imaging (fMRI) is an established tool in the study of brain function in children with developmental disorders, acquired disorders, and typical development (TYP) and has a clinical application in pre-surgical planning for children with Epilepsy (Medina et al., 2007). Unlike structural MRI where participants are required to lie still (and may do so while sleeping), fMRI requires awake and cooperative participants which precludes the use of sedation. There is a paucity of data examining the success rate of scanning children in fMRI paradigms.Address Correspondence: Benjamin E. Yerys, Children's National Medical Center, Children's Research Institute -Neuroscience, 111 Michigan Ave, NW, Washington, DC 20010, byerys@cnmc.org, Phone: 301-738-8940. NIH Public Access Author ManuscriptHum Brain Mapp. Author manuscript; available in PMC 2010 October 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptOne study has examined scan success rate in over 200 TYP children between 5-to 18-years of age (Byars et al., 2002). This study defined scan success as children completing at least one of four fMRI tasks and an anatomical reference scan. Children between the ages of five and six had a success rate of 47%; children between the ages of seven and nine had a success rate of 76%; and children above the age of ten had a success rate of 96%. It is unk...

Erratum to: Brief Report: Approaches to 31P-MRS in Awake, Non-Sedated Children With and Without Autism Spectrum Disorder

“…Our findings comport with and extend prior reports: Children pose greater obstacles for magnetic resonance scanning (Raschle et al 2009;Poldrack et al 2002), and challenges are greater with younger age (Kern et al 2006;Byars et al 2002;Yerys et al 2009) and magnified with conditions such as ASD (Kern et al 2006;Yerys et al 2009). We built on others' successes, and findings support relaxation (Raschle et al 2009), high-quality personal interactions (Poldrack et al 2002;Clark and Rutter 1981), and strong parental input (Nordahl et al 2008) to enhance comfort and compliance.…”

“…Successful completion of MR protocols is often compromised by participant inattention and non-compliance (Corbett and Constantine 2006;Sturm et al 2004), anxiety (Gillott and Standen 2007;Gillott et al 2001), fatigue, and sensory (auditory and tactile) sensitivity (Cascio et al 2008;Kern et al 2006;Rogers et al 2003), leading to higher failure rates in younger children (Raschle et al 2009;Poldrack et al 2002;Byars et al 2002) and those with conditions such as ASD (Yerys et al 2009). …”

Success Rates for Functional MR Imaging in Children

“…4,5 The study by Byars et al 4 examined the success rate in 209 children between 5 and 18 years of age completing 4 fMRI tasks and 1 anatomic reference scan. In that study, most of the children in the age range of 9 through 18 years completed all 4 functional tasks and the anatomic task.…”

“…Yerys et al 5 determined that groups with clinical conditions like attention deficit/hyperactivity disorder, autism spectrum disorder, and epilepsy had lower success rates than nonclinical control groups.…”

Cortical Activation Through Passive-Motion Functional MRI

“…Compliance with the tasks and remaining still is a particular concern in young children and patients with developmental or acquired cognitive deficits. 26,27 Even children who can perform the task during training sessions may not be able to comply in the MR imaging scanner. 27 A strategy that allows this information to be obtained from subjects who are unable to cooperate is to perform a similar fMRI task under sedation.…”