MRIs can be very helpful to knowledgeable doctors.
But many times we have to make the decision if sedation is worth it?
There is a great research article on how to teach a child to lay still for an MRI. Such great research. So many parents don’t do MRIs because of not wanting to sedate their children. Totally understandable. Now there’s another option backed by published research. This is an important option to know about. I love good science.
I’m going to walk you through a research article that talks about non sedated MRI and it’s a preview into hopefully what will become standard practice for all MRI.
Magnetic Resonance Imaging (MRI)
MRI has been widely used to visualize brains. Non-contrast MRI is a safe and non-invasive technology that can provide insight into brain development super important for those with autism. MRI studies can be done several times over several years, which can then provide researchers insight into changes in the brain as a child with autism ages.
Why MRI in autism
In autism, research studies are often limited to higher functioning individuals with autism who can stay still for a period of time. Right? That makes sense. Sedation of an individual can have lasting impacts. So most research studies do not include those with autism who cannot stay still. And as you can imagine, this skews research results completely. There’s a whole section of the autism spectrum that has not really been given the proper attention based on whether they can stay still or not. That’s completely unfair. So I’m very excited for these researchers to have taken the time to really think about how can we include everyone in our research studies and in the study of the brain using MRI.
Real-life
Okay, in real life, our children often get scared to do something or anxious in new situations. We’re all pretty familiar with that. This study shows how to overcome that at an institutional level. But that doesn’t mean you can’t be inspired and use what they did in your real life. And just to put this out there, sometimes a sedated MRI is needed. If it makes sense, if it is what is medically needed, then of course, by all means, it’s something to do. We’re not here to judge whether sedated MRI is bad or wrong. Many times it’s what’s needed and you have to do what’s needed for your child. But if you can learn about how MRI can be done, or maybe even the idea of a non-sedated MRI is mindblowing to you. Sometimes we just need an idea to get our creativity going, and then we could see more and more potential for our child. So there is no judgment here whatsoever. If you have done or will do a sedated MRI, if it makes sense, then it is the right thing to do. I just want you to know the options.
The Study
Children were enrolled in the UC Davis MIND Institute Autism Phenome Project (APP). The APP is a longitudinal study, and initial enrollment took place when the children were between two and three and a half years of age. A longitudinal study, meaning they’re going to try and study these children maybe for like a decade or two decades. They really want to find out what changes over time. There were 17 children enrolled in this particular aspect of the study, the non sedated MRI.
Methods
And here are the methods. A board-certified behavior analyst works closely with the parents prior to the first mock MRI session to prepare each child for the procedure. So everything was customized. The plan was customized based on the children’s understanding, their use of communication, developmental abilities, level of anxiety, or other comorbid symptoms. This was customized. Things were really thought out very well.
Task Analysis
And I want to give a snapshot of the task analysis. So it’s like, how do you get a child to be comfortable doing an MRI? There are many adults who are not comfortable doing an MRI! So here’s the step breakdown.
- Entering the mock MRI room
- Approaching the mock MRI bed
- Sitting down on the scanner bed
- Putting on earplugs and or headphones
- Lying down on the scanner bed
- Lowering the head coil
- Tolerating the movement of the bed into the scanner – this certainly could be very scary
- Tolerating gradient noises
- Staying still and gradually increasing the amount of time to lie still to five to ten minutes.
These are the steps that were broken down by a BCBA saying, okay, we’ve got to get each child comfortable with each of these steps. They have to know these are the steps that are coming. Let’s get them comfortable with what’s coming next. So there are no surprises.
And natural reinforcers were used. So things like headphones, it’s kind of loud. Or they played videos during the MRI. So obviously you need to put the headphones on to see the videos. And the video monitor was angled in such a way that you could only really see it if you were laying down. Right? So that’s a natural reinforcer. Those are the best kind of reinforcers.
Behavior Strategies
Here are some different behavior strategies.
Choices: How do you get a child to do this? Choices are one thing. So giving the participant a variety of choices serves to increase motivation and give the child some degree of control.
For example, the child could choose which video to watch or other reinforces they wanted during the mock MRI session. So this is all the kind of analysis that goes on to figure out, all right, how can this child be successful? Choices? Yes. Give the child some degree of control. Of course, that works so well. And I really like this research article because it goes into so much depth about how they put this together from a behavioral standpoint.
Premack Principle: That’s the first thing. I think we’re all familiar with that – “First, then!” So they used first, then instruction. Provided participants with a verbal understanding of both expectations and the schedule. The behavior analyst would give the instruction first, keep your hands down, followed by the reinforcer. Then we will start the movie. So this another great example of how at an institutional level is a procedure created to help a child overcome a new and scary situation.
Behavior Momentum: This one I love. I talk with my clients about this quite a bit. So behavior momentum is the strategy that involves asking the child to do several relatively easy tasks or behavior in rapid succession so that the child was then more capable and likely to complete the desired behavior.
So “Give me a high five. Give me a low five. Okay. Lay down. Great job!” Right? You can see there’s just that momentum like, yeah, I can do it. I can do it. I can do it. Oh, lay down. That’s a little scary! But I’ve got such great momentum. Yeah, I’m going to lay down. So these are all different methods that are used. The article goes a little bit more into details and talks about other behavior strategies. I just wanted to highlight these three so you can see how at the institutional level, something is created.
Results
For all participants, only one MRI visit was necessary to acquire high-quality scans!
Yay!!!
Congrats to those 17 children. They overcame their fears. They had just they did it. They were successful. They were Champions. They had to do something that was kind of scary, and they did it.
Within the single MRI visit, the number of attempts to get the scan ranged from one to five attempts. So things weren’t perfect, right? We can’t put high expectations on our children to be one and done. And it’s life. Right. So they didn’t give up. It sometimes took between one and five attempts. That is amazing.
Conclusions
And this is directly from the paper. You could see it’s in quotes.
“Our experiences make us confident that acquiring high-quality structural MRI scans in severely affected, minimally verbal children with autism and comorbid intellectual disability is possible at a high rate of success without the use of sedation.”
This is so important. Oh, my goodness. This is a population of autism that often gets left out of so much. And they really need to be involved in research. They really need to be respected. And look, they can achieve amazing things.
“The current MRI literature in autism is largely limited to studies of high functioning individuals with autism who represent only part of the entire spectrum.
In order to gain a complete understanding of the neural alterations associated with autism, we must evaluate individuals at all severity levels.”
I am really proud of these researchers. They did a great job and so did the children and parents!!
