How much is "enough"? Considerations for functional connectivity reliability in pediatric naturalistic fMRI.

Reliable functional connectivity (FC) measurements are important for robust neuroimaging findings, yet pediatric functional magnetic resonance imaging (fMRI) faces unique challenges due to head motion and bias toward shorter scans. Passive viewing conditions during fMRI offer advantages for scanning pediatric populations, but FC reliability under these conditions remains underexplored. Here, we used precision fMRI data collected across three passive viewing conditions to directly compare FC reliability profiles between 25 pre-adolescent children and 25 adults, with each participant providing over 2.8 hours of data over 4 sessions. We found that FC test-retest correlations increased asymptotically with scan length, with children requiring nearly twice the post-censored scan time (24.6 minutes) compared with adults (14.4 minutes) to achieve comparable reliability, and that this effect was only partly attributable to head motion. Reliability differences between lower-motion adults and higher-motion children were spatially non-uniform and largest in ventral anterior temporal and frontal regions. While averaging features within functional networks improved intraclass correlation coefficient (ICC) reliability, values for higher-motion children remained in the poor-to-fair ICC range even with 24 minutes of data. Of note, we observed substantial increases in edge-wise ICC between 24 and 54 minutes of data. Viewing conditions with greater engagement reduced head motion in children but had lower FC reliability than less engaging "low-demand" videos, suggesting complex state- or condition-related trade-offs. These findings have important implications for developmental neuroimaging study design, particularly for higher motion pediatric populations.