title: Methods for acquiring MRI data in children with autism spectrum disorder and intellectual impairment without the use of sedation.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 %.
  
  
  CONCLUSIONS
  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.
authors.affiliation: MIND Institute, UC Davis School of Medicine, 2805 50th Street, Sacramento, CA 95817 USA ; Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA USA.
authors.forename: Christine Wu
authors.initials: CW
authors.lastname: Nordahl
authors.affiliation: MIND Institute, UC Davis School of Medicine, 2805 50th Street, Sacramento, CA 95817 USA ; Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Mello
authors.affiliation: MIND Institute, UC Davis School of Medicine, 2805 50th Street, Sacramento, CA 95817 USA.
authors.forename: Audrey M
authors.initials: AM
authors.lastname: Shen
authors.affiliation: MIND Institute, UC Davis School of Medicine, 2805 50th Street, Sacramento, CA 95817 USA ; Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Shen
authors.affiliation: MIND Institute, UC Davis School of Medicine, 2805 50th Street, Sacramento, CA 95817 USA ; Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA USA.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Vismara
authors.affiliation: MIND Institute, UC Davis School of Medicine, 2805 50th Street, Sacramento, CA 95817 USA ; Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA USA.
authors.forename: Deana
authors.initials: D
authors.lastname: Li
authors.affiliation: MIND Institute, UC Davis School of Medicine, 2805 50th Street, Sacramento, CA 95817 USA ; Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA USA.
authors.forename: Kayla
authors.initials: K
authors.lastname: Harrington
authors.affiliation: Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA USA ; Imaging Research Center, UC Davis School of Medicine, Sacramento, CA USA.
authors.forename: Costin
authors.initials: C
authors.lastname: Tanase
authors.affiliation: MIND Institute, UC Davis School of Medicine, 2805 50th Street, Sacramento, CA 95817 USA ; Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Goodlin-Jones
authors.affiliation: MIND Institute, UC Davis School of Medicine, 2805 50th Street, Sacramento, CA 95817 USA ; Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Rogers
authors.affiliation: MIND Institute, UC Davis School of Medicine, 2805 50th Street, Sacramento, CA 95817 USA ; Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA USA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Abbeduto
authors.affiliation: MIND Institute, UC Davis School of Medicine, 2805 50th Street, Sacramento, CA 95817 USA ; Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Amaral
keywords: Applied behavior analysis; Brain; Compliance; Intellectual disability; Low-functioning autism; MRI; Neurodevelopment