Preparing for the Testing Session
You need to be calm.
Feeling anxious before a testing session is completely normal, especially if you are new to this. Most people get nervous when they have to handle small children that are not their own. However, anxiety decreases concentration, thus increasing the chances of technical errors, and contributes to creating a tense environment that will negatively affect the experience of parent and child.
Therefore, you need to be honest regarding your feelings before and during the testing session, and work on any negative feeling starting from these three pillars:
Nobody hurts
We are nervous around small children because they look frail and defenseless, and we are afraid of hurting them. However, there is no way that you or the EEG can hurt the child: caps are stretchy and made of soft material that has been designed especially for children. For example, the ENOBIO cap that I often use is made of the same fabric of swim suits and does not pull the skin.
Gel: Many systems use water as conductive, but even if they use gel, the gel is water-soluble, and is hypoallergenic. If you need a syringe to insert the gel in the electrodes, use a blunt plastic tip that is absolutely inoffensive.
Novelty: You may have to apply other pieces of equipment on the child, for example, a earclip. If the child protests against the earclip, it is not because of any significant pressure that it applies, but because of the novel contact sensation on the skin. For the vast majority of children, it might be annoying, but not painful. If you distinguish between the majority of children with a normal and expected reaction to novelty, and the minority with real sensory sensitivity, you are going to be able to offer specialty alternatives to the second group.
Research EEG caps are very small and compact: if you have never worked with EEG before, this might sound very strange to you - certainly research caps with 20 cables look bulky? In fact, EEG used in hospitals for paediatrics are thrice as big, and connect to up to 300 electrodes with as many cables - resulting in very heavy caps and very little freedom of movement. In some cases, the patient is even tight to a chin-rest.
Also, clinical EEGs require scrubbing the skin (that can bleed) and gluing the electrodes. This is generally not needed for research. Instead, sessions for the diagnosis of epilepsy can last 3-6 hours, are extremely tedious and sometimes require that the patient sleeps with the cap on. Clearly, research EEG caps are lean and simple in comparison. If you feel anxious about using a research EEG, try to visualise these other cumbersome systems - and feel the relief of having to use a research system instead!
Lastly, the EEG cap does not conduct electricity to the participant: it only records passively the very tiny electric current coming from the participant’s brain to the electrodes.
No EEG no cry
Children differ in personalities: some may be vocal and take initiative, some others may be shy and cautious. Culture plays a significant role in individual differences: in some parts of the world, children are not used to receiving explanations, and may feel confused if you are too talkative, in some other regions, they are used to receive structuring from the adults, and may feel upset if you do not engage with them directly. If you are a local, you are the best judge of what is the local custom with children, so try out different strategies that are compatible with what you experience at home and at work.
Some (or many) children will cry or whine when you cap them. Make peace with it. When a child cries because of something that we did, we feel awful: are we monsters? Shall we stop? Is it all wrong and unnatural? But a child’s cry has evolved thousands of years exactly to trigger this kind of feeling - it is instinctive and it does not mean that what you are doing is harmful. It is simply novel. Turning the tides and calming the child all depends if you do not let that cry arouse your negative feelings.
Just like you ignore turbulence on a plane, behave calmly to feel calm: keep smiling, release your muscles, and focus on nice distracting things (such as the cartoon playing, your colleague blowing bubbles etc).
Fight against the fear that what we do may traumatise children: this is absolutely untrue - what we do with them is short and insignificant and will simply leave no mark. When the session is over, and the child is free to go, rest assured that - even if they cried for half an hour - they will forget about the whole experience and go on with their life. The same applies to when you had an absolute fantastic time with the child: they will forget you, you are as meaningful as the entertainer that they stayed with for half an hour while their parents shopped in IKEA. Just observe them as they walk out the lab door, jumping or running, not even turning to look at you, already in the future.
The first rule about EEG club is you do not talk about EEG club
No child loves a hat: parents wanting to shield their child from the sun or from the cold know that too well. Unfortunately, there is only one way to really prevent a child that is not super obedient from removing the EEG cap: they need to forget about it.
If you thought they had, but they still try to remove it at some point, it means they tricked you: they acted like they were focusing on something else, but had been waiting for a moment of your distraction this whole time.
There are two ways (that I know) to make the child forget the cap:
Literally overwhelm them with distraction, entertainment and reward
You will have to continuously interact with the child from start to end and make them have the best time of their life. This is difficult if the child was crying at the start, but not impossible: keep close different toys, bubbles, stickers, snacks, and try them out one by one. If the participant engages with one toy, stick with it; if they do not like it, forget it. Try not to overwhelm them by pushing toys onto them, or holding them to close, and - very importantly - do not change the focus of attention or the item your are holding too quickly. Maintain a very soothing and likable attitude. When you obtain the smallest smile from them, exaggerate and celebrate that little smile to escalate it into a laugh.
Make them so comfy and cozy and bored that they almost fall asleep
To bore the child and make them half asleep, you must provide a sitting position that is extremely comfortable. This might not be easily available: when we focus on cables and screens, or try to replicate a setting that is always the same (for example, from another study), we end up with parent and child sitting stiffly and uncomfortably.
You might want to investigate: almost every EEG study involves a screen, and often parents use screens to make the child sleep. Can you ask the parents how they put the child to sit when they watch a screen? And if the child is not allowed/not exposed to screens, what is the position they sit when they are doing another comfortable activity, such as reading a story?
Asking the parent to hold the child in their arms and even rock them can also work, or using a baby car sit that blocks external stimulation.
Finally, you want the environment around them to be extremely calm - including yourself: move smoothly and slowly, talk quietly, literally whisper instead of talking.
What if I am still nervous?
Take a walk or have a break.
During my first year of testing, I always used to go for a brief walk before the parent arrived. If you cannot take a walk, have a brief break: stop any work you are doing 15 minutes earlier and drink a cup of tea. If you are testing in the morning, arrive early so that you can relax 10-15 minutes after your commute.
Have all the equipment lined up and ready.
Go to the testing room early, even hours before if you are doing a long composite session, and check that everything is in place for you to use. For example you can pre-fill syringes with gel, take two or three caps of different measures out of the drawer, put battery-operated equipment to charge (just in case, and it won’t hurt). You can even switch on the laptop, set up software, try out the equipment already. There is no better antidote to anxiety than practice, knowledge and routine.
Repeat to yourself that there is no way you can harm the child, and that what you are doing is actually pretty cool.
Even for the parent and the child, it must be quite exciting and novel. Not many people without neurological conditions have the chance to do EEG. That surprised expression on their face can quickly turn into curiosity - play with that, encourage them to ask questions and share your thoughts about what you find exciting about the study!
What if the parent is nervous?
The parent will be calm if you are calm. If you are both calm, there is a very high chance that the child will be calm too.
Parents are great at understanding body language: if you are frustrated or stressed, they will know - and since they do not know about that cable or that line of code that is troubling you, they will simply assume that something is wrong. You must avoid to create that impression.
Just repeat to yourself: whatever happens, a cable or a line of code does not work, it doesn’t really matter. What is the worst thing that can happen? One dataset less collected. It is not a big deal like breaking expensive equipment forever or having an accident. The parent does not know about sample sizes and will not really care as long as everything is fine.
Chat with the parents before/during/after capping. Small talk makes (most) people comfortable. If you notice that the parent is a little nervous, try to put them at ease and diverge their attention beyond the EEG: ask them anything about their travel, how was their week, if they have anything fun planned ahead (of course use topics that are appropriate to your cultural context). While you chat, the child may observe you while interacting with their carer and become more accustomed to you.
Always act like and tell them that their child is doing a good job. Even if the child has not looked at the screen for a second, they still came all the way to the lab and sat in a room with you for quite some time. That counts as good performance. If the parent fells disappointed, tell them that not being engaged with the task is expected and that you will use every tiny second of data that the child graciously allowed you to record.
If the parents express the concern that the equipment may harm the child, be ready to share your knowledge and to show that you are 100% sure that it is absolutely harmless. Be exhaustive: even in simple words, share details about the facts that support your statements. Explain to the parent how the EEG works and that hundreds of children in many countries have done EEG before with those same stimuli. You can show them the study manuals, that usually contains screenshots of the stimuli. Take some time during and after testing to comment on the tasks with them and ask what they are thinking.