Methods for acquiring MRI data in children with autism spectrum disorder and intellectual impairment without the use of sedation.
ABA practice sessions let every child with autism and intellectual disability finish an MRI without sedation.
01Research in Context
What this study did
The team worked with 17 children who had both autism and intellectual disability.
Each child first visited a pretend MRI room.
Staff used ABA tools—pairing, shaping, and edible rewards—to teach the kids to lie still.
After 5-8 practice runs, the children tried the real 30-minute scan without any sedation.
What they found
Every single child stayed still enough for a clear T1 brain image.
Sixteen of the 17 also gave usable diffusion-weighted images.
No child needed medicine to stay calm.
The protocol took about three weeks from first visit to final scan.
How this fits with other research
Scahill et al. (2015) picked the best tools to confirm autism diagnosis.
Their review says ADI-R and ADOS-2 are trial-ready.
Nordahl used those same tools, so the sample is solid.
Balboni et al. (2022) showed the Italian DABS quickly spots intellectual disability.
Nordahl’s kids had both ASD and ID, showing the protocol works for the hardest cases.
Noterdaeme et al. (2002) proved that ADI-R plus ADOS-G catch true autism and rule out language disorder.
Nordahl’s 100 % scan rate extends that work—accurate diagnosis plus ABA gets even the most impaired kids into neuroimaging studies.
Why it matters
You can copy this plan in your clinic.
Use short mock-scan visits, stickers, and praise.
You will cut sedation risks and open the door to brain research for every child you serve.
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02At a glance
03Original abstract
Magnetic 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. Utilizing 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. The 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 %. By 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. The online version of this article (doi:10.1186/s11689-016-9154-9) contains supplementary material, which is available to authorized users.
Journal of Neurodevelopmental Disorders, 2016 · doi:10.1186/s11689-016-9154-9