Wednesday, April 3, 2013

Can the Benefits of Dogs for Children with Autism Be Quantified? A Review Paper Gathers the Evidence

There is a growing amount of research, much of it published in respectable scientific journals, concerning the benefits that service and therapy dogs provide to children with autism.  Unfortunately, much of it is anecdotal—stories about what a dog did for a child or the child’s family.  Papers of this sort, while interesting, even inspirational, do not provide much solid proof that letting therapy dogs visit special schools or having autism service dogs accompany autistic children is really providing long-range benefits.  Establishing long-range and other substantial benefits will encourage school administrators to implement therapy dog programs and provide judges with a solid scientific basis (on top of legal requirements) for ordering schools to accept service dogs in classrooms. 

A team of scientists at the Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità in Rome, recently sifted the published literature for objective research on the use of assistance and therapy dogs with children who have autism.  The team defines autism as “the prototypical form of a spectrum of related, complex, neurodevelopmental disorders” that includes autism, Asperger syndrome, and atypical autism. Autism involves impairments in three behavioral areas:
  1. Social interaction. 
  2.  Language, communication, and imaginative play. 
  3.  Restricted range of interests and activities. 
The condition generally manifests itself by the age of three and affects about one in 150 children, though this estimate may be too low.  The fact that classic autism affects about four times as many boys as girls suggests “a potential involvement of perturbations in the typical trajectory and maturation of the sexually dimorphic brain in the etiology of this disease.”

The team of Italian scientists, led by Alessandra Berry, have published their analysis in The Journal of Alternative and Complementary Medicine. They observe that “despite the large number of therapeutic approaches, at present, neither proven therapies nor preventive measures exist for the universal treatment” of the disease.  As to the general way in which dogs may help children with autism, they hypothesize:

“The simple and interpretable pattern of movements that characterizes dogs might facilitate the engagement of children with ASD in structurally simple social actions that do not require the interpretation of verbal cues and are highly repeatable and predictable (e.g., throw, fetch and retrieve play, walking the dog on a leash, giving a hand command).”

Research on Autistic Children and Dogs

Among the papers reviewed by this team was one by Mona J. Sams of Mona’s Ark, an organization in Virginia that uses animals in therapy work.  Sams and her colleagues “suggest that acquiring the ability to interpret and respond to the social and behavioral cues of dogs may provide a bridge toward learning to interpret the more subtle behavior of human beings.”  Others have noted that dogs, with their special smell and their desire to be touched, could “target the low sensory and affective arousal levels characterizing children with ASD.” 

Unfortunately, there is no standard methodology in the small number of objective studies using dogs with autistic children, “making it difficult to evaluate the efficacy of the intervention.”  Nevertheless, we must be thankful that Berry and her colleagues have made the effort to highlight what quantitative results there are. They note that although Boris Levinson used dogs with children in the 1960s (as described in Service and Therapy Dogs in American Society), “it was only from 2000 that this field of research has been receiving growing attention, as reflected in the increasing amount of studies published.” 

The review paper excluded anecdotal studies and those not appearing in peer-reviewed journals, as well as studies that looked at too broad a range of diagnoses for participants.  They ended up with only six studies, listed in the following table (full citations at the end of this blog).  Four of the studies concerned therapy dogs, while the final two concerned assistance dogs. 

Research Paper, Journal
Use of Dog in the Study
General Results
Redefer and Goodman, Journal of Autism and Developmental Disorders, 1989
20 minute interactions with therapist and therapy dog 
In presence of dog, seriously withdrawn children showed increase in frequency of verbal and nonverbal social behaviors, which remained detectable a month later
Martin and Farnum, Western Journal of Nursing Research, 2002
15 minute interactions with therapist in presence of therapy dog, stuffed dog, or ball
Children were less distracted, more playful, and more aware of their social environment in presence of dog; increased talking, hand flapping (excitement)
Sams, Fortney, and Willenbring, American Journal of Occupational Therapy, 2006
20-30 minute occupational therapy sessions with animals, including llamas, dogs, and rabbits
Sessions with animals increased language use of children, particularly in comparison to standard occupational therapy techniques
Silva, Correia, Lima, Magalhaes, and de Sousa, Journal of Alternative and Complementary Medicine, 2011
45 minute session with therapist with or without a therapy dog
Increased engagement in presence of therapy dogs (including smiling, visual contact, and affectionate behavior) and decreased negative behavior such as aggressive and obsessive manifestations; reduction in self-absorption
Burrows, Adams, and Spiers, Qualitative Health Research, 2008
Service dog placed with family of autistic child
Increased physical safety of autistic child, decreased anxiety and anger, increased calmness, fewer tantrums, more manageable bedtime routines; additional benefits to other members of families
Viau, Arsenault-Lapierre, and Fecteau, Psychoneuroendocrinology, 2012
Service dog placed with family of autistic child
Cortisol awakening response (CAR) decreased upon introduction of doga to families, but rose after they were removed; dogs also decreased self-stimulation, repetitive behaviors, and tantrums

Possible Problems

Not all results were uniformly positive.  The increased hand flapping noted by Martin and Franum may indicate that some children might be over-stimulated by being in the presence of a dog.  It is to be noted, as I have done before, that not all service dog placements with families having autistic children work out.  Sometimes autistic children become abusive to dogs, which may then seek to bond with other members of the family.

Berry and her colleagues acknowledge that research in this area is just beginning: 

“[I]t is important to take into account that overall most of the AAI [Animal-Assisted Intervention] programs lack a standard methodology, and there is a need for basic research aimed at including larger sample sizes to assess their effectiveness, using randomized controlled trial designs. In addition, studies specifically aimed to examine whether the effects of contact with dogs are enduring or are strictly related to a continuous exposure to the animal are still lacking.”

Interactions of dogs with autistic children should not be studied only for therapeutic effects. The researchers note that interactions with children may also have diagnostic value for clinicians:   

“[I]t is possible to hypothesize that the identification of specific behavioral patterns displayed during child–dog interactions might provide a novel additional tool for the early diagnosis of some ASD signs, such as deviation from typical attentive and social behaviors (gazes, smiles, directed vocalizations) and changes in posture and movements towards the dog.”

Is There Still a Furry Ceiling Over Research on Psychological Benefits of Animals? 

Carol D. Raupp, in an article in Society and Animals, noted that research articles referencing animal-assisted therapy could not be found in clinical psychology journals and tended to end up in health services publications. Writing in 2002, she speculated that this “furry ceiling” in academic clinical psychology might begin to break because of “images of AAT teams at work with survivors and workers following September 11.” 

In a paper that Dr. J. Lawrence Thomas and I wrote for the Journal of Forensic Psychology Practice, we found that some mainstream psychology journals are now accepting articles dealing with the psychological significance of service and therapy dogs.  A review paper by Dawn Marcus concerning the science behind animal-assisted therapy, discussed here only a week ago, contained a large number of references from prestigious publications.  Indeed, Harold Herzog (2011) described a trend that may be something of an opposite to the furry ceiling—a tendency of research that is negative concerning the therapeutic benefits of animals not to get published, while research giving a thumbs up to animals sails through the referee system.  Herzog cites the media bias towards stories telling people how good their pets are for them, and that research to the contrary has less appeal to the press and the public, and perhaps even to medical journals.

Animals do not easily fit into psychological research parameters.  There are too many variables that cannot be controlled, too many explanations for the results, too little quantification, too many anecdotes.  Nevertheless, if the benefits are real, science will have to find ways to explain them, and prestigious journals will have to allow researchers to present results that meet academic standards.  Research on the benefits of animals for populations with psychological conditions need not continue to run on a parallel track to more traditional research approaches. 

The furry ceiling still exists—the psychology journals most valued by authors for their career paths are generally not cited here—but it is beginning to rend.  Although much more research will be necessary, the early indications are very positive about the benefits of using trained dogs with children on the autism spectrum.    

Thanks to Patty Dobbs Gross for additional observations.  

  1. Berry, A., Borgi, M., Francia, N., Alleva, E., and Cirulli, F. (2013). Use of Assistance and Therapy Dogs for Children with Autism Spectrum Disorders: A Critical Review of the Current Evidence.  The Journal of Alternative and Complementary Medicine, 19(2), 73-80.
  2. Burrows, K.E. and Adams, C.L. (2008) Challenges of Service-Dog Ownership for Families with Austistic Children: Lessons for Veterinary Practitioners.  Journal of Veterinary Medical Education, 35, 559–566.
  3. Burrows, K.E., Adams C.L, and Spiers, J. (2008). Sentinels of Safety: Service Dogs Ensure Safety and Enhance Freedom and Well-Being for Families with Autistic Children.  Qualitative Health Research, 18(12), 1642–1649.
  4. Ensminger, J.J., and Thomas, J.L (2013). Writing Letters to Help Patients with Service and Support Animals, Journal of Forensic Psychology Practice, 13(2), 92-115.
  5. Herzog, H. (2011). The Impact of Pets on Human Health and Psychological Well-Being: Fact, Fiction, or Hypothesis?  Current Directions in Psychological Science, 20(4), 236-239.
  6. Martin, F., and Farnum, J. (2002). Animal-Assisted Therapy for Children with Pervasive Developmental Disorders.  Western Journal of Nursing Research, 24, 657–670.
  7. Raupp, C. D. (2002). The “Furry Ceiling”: Clinical Psychology and Animal Studies. Society andAnimals, 10(4), 353–360.
  8. Redefer,L.A., and Goodman, J.F. (1989).  Brief Report: Pet-Facilitated Therapy with Autistic Children.  Journal of Autism and Developmental Disorders, 19(3), 461-7.
  9. Sams, M.J., Fortney, E.V.,  and Willenbring, S.  (2006). Occupational Therapy Incorporating Animals for Children with Austism: A Pilot Investigation.  American Journal of Occupational Therapy, 60, 268-274.
  10. Silva, K., Correia, R., Lima, M., Magalhaes, A., and de Sousa, L. (2011). Can Dogs Prime Autistic Children for Therapy? Evidence from a Single Case Study.  Journal of Alternative and Complementary Medicine, 17, 655–659.
  11. Viau, R., Arsenault-Lapierre, G., Fecteau, S., Champagne, N., Walker, C.-D., and Lupien, S. (2012). Effect of Service Dogs on Salivary Cortisol Secretion in Autistic Children. Psychoneuroendocrinology,35(8), 1187–1193.

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