Developing Best Practice Procedures to Increase Success Rates for Functional and Structural MRI Scans In Individuals with Autism Spectrum Disorder

Background: There has been an increasing interest in gathering neuroimaging data on individuals with Autism Spectrum Disorders. Individuals with this disorder, particularly those who are lower functioning or younger, can often have great difficulty completing the protocols due to behavioral and sensory issues.  This bias can significantly impact the ability to generalize data gained in these studies.  There is currently no standard of best practice for helping to prepare individuals with ASD for imaging procedures and only one paper, (Nordahl, et al., 2008), which has examined the success rates of particular imaging interventions.  This paper was also limited to sleep studies.   

Objectives:  

1. To develop a behavioral intervention program specific to individuals on the Autism Spectrum to increase completion success rates of structural and functional MRI scans.
2. To create a standard of best practice for clinical application in the use of structural and functional MRI scans for patients on the Autism Spectrum.

Methods:  

Our intervention program plans to target those families how have endorsed concerns about the participant’s abilities to complete an MRI scan. We plan to have data on 25 probands analyzed by the IMFAR meeting.

The social stories were developed in accordance with guidelines established by Gray and Garand (1993). The stories detailed the steps of having an MRI scan and were broken down into five practice sessions. Each practice session was endorsed with the use of a positive reinforcement for the child. Desired rewards were chosen by the child’s preference. Additionally each child received a Boardmaker picture schedule outlining the MRI scanning process.

Supplementary to the social story and picture schedule, we included a habituation kit of MRI related materials. These included: headphone, earbuds, an audio CD of MRI sounds and photobook of imaging staff and MRI bay locations. Dependent upon the participant’s age and level of cognitive functioning kits were tailored to their specific needs. Parents were instructed to practice for approximately 2 weeks before the mock MRI scan.

Preceding the actual MRI scan, families are scheduled for a mock MRI scan to prepare for the actual scan. Children are given 5-10 minutes to acclimate themselves to the MRI suite and are then encouraged to watch a parent go through a mock scan and then attempt a mock scan themselves. Ability to “pass” mock scans was based on the researcher’s observation of behaviors and compliance during the session.

Following the MRI scan sessions, families receive a general satisfaction survey.  We inquire about the length and duration which they practiced, as well as which aspects were most useful.

Results:  

We plan to track participants’ success rates utilizing pass/fail checklists for both mock and actual MRI scans, as well as parental response surveys. 

Conclusions: We anticipate that participant’s adherence to the behavioral intervention program with increase their completion success of functional or structural MRI scans