Monday, May 19, 2014

Dramatic Research on Autism and Animals, but Changing Educational Policies WIll Require a Broader Consensus

An increasing number of teams are conducting very well structured research on the effects of animals on children with autism.  Research findings that will be discussed here include that guinea pigs kept in classrooms increase the social behavior of children with autism spectrum disorders as well as the social behaviors of mainstream students towards their classmates with ASD.  The presence of the guinea pigs also reduces the amount of self-stimulating activity of the children with ASD, and lowers the time they spent crying and whining.  Another study found that when a pet arrives in the house of an autistic child between age five and six, the child will be more likely to share with others, and will be more concerned about others if they were sad or hurt, than if a pet is present in the household from the time the child is born, or if the household never gets a pet.  Thus, the timing of when a pet is obtained may sometimes matter in terms of its positive effects on a child.  Yet another paper finds that a commonly used therapy, the social story method, designed to develop social skills, may be more effective in the presence of a dog than without. 

Chloe, 2009 (courtesy Joan Ensminger)
These findings are impressive, and will provide directions for additional research, but two of the lead researchers in the teams involved in this work have written separate review papers detailing the problems with the current state of research: a prevalence of anecdotal accounts, lack of methodological consistency, small sample sizes, inadequate controls, imprecise diagnoses, potentially biased informants, non-blind behavioral observations, and other problems.  These issues mean that administrators still do not have an easy decision when considering whether to approve animal-related therapies, and lawyers cannot simplistically assume that the current state of research automatically supports legal arguments of clients who want to have service animals in classrooms or to have animals incorporated into educational or treatment programs. 

Guinea Pig Study

Studies of the effects of animals on children with autism might be divided by the species of animal involved.  Although most studies involve dogs, there have been significant lines of research involving horses, dolphins, and cats, some of which are listed in the bibliography at the end of this blog.  An Australian group headed by Marguerite O’Haire has been studying classrooms with guinea pigs intensively, and O’Haire, with and without her colleagues, published five papers on animals and autistic children in 2013 alone.

One of the 2013 studies (O’Haire, McKenzie, Beck, and Slaughter, 2013a) sought to compare interactions of autistic children with people when guinea pigs were near them with such interactions when there were toys in the classroom.  The researchers chose to contrast toys to animals because toys have been found to promote interaction among children with autism (Clifford, S., Hudry, K., Brown, L., et al., 2010). 

O'Haire, 2013a (courtesy PLoS ONE)
Almost 100 children were videotaped in 15 classrooms at four schools for ten-minute sessions with either toys or two guinea pigs. The researchers noted that prior studies generally did not offer the subjects of a study an alternative focus of attention from the animal in the experiment and none involved blind observers of behavior.  Children were between ages 5 and 13, had an autism spectrum disorder (ASD) diagnosis, with which the parents agreed, and had no prior parent-reported history of animal abuse.  The children were  in classrooms where other children did not have an ASD diagnosis.  All subjects were in mainstream schools in the greater Brisbane area. 

The guinea pigs lived in the classroom and were taken out twice a week for 20-minute sessions.  Same-sex pairs of guinea pigs were used to prevent breeding.  They were fed fruit, vegetables, and pellets, and had brushes for grooming and small-animal shampoo.  Fresh bedding was regularly supplied. 

Toys used in the study included two spinning tops with rip-cord launchers for use in a plastic battle arena, tow fashion dolls, two fashion design art kits for the dolls, erasable markers to draw on clothing, a restaurant set of 50 plastic pieces (food, cutlery, menu, serving trays, aprons, money), a set of 80 building bricks, two paddle-ball games, modeling material (Play-DohTM), bubble liquid and a blower, two toy cars, one slinky, and writing and drawing materials. 

O'Haire, 2013a (courtesy PLoS ONE)
The researchers determined that the children “talked more, looked more at human faces, and made more tactile contact with people in the presence of animals compared to toys.” The differences in social behaviors, categorized between verbal, visual, and physical behaviors, are indicated in the first graph above. In all three categories of behavior the presence of the guinea pigs was correlated with more social approach behaviors (as indicated by the dark bars) than was true when toys were present.

The effect was not just one involving the children with autism.  Non-ASD peers in the same classrooms displayed more social approach behaviors towards the children with ASD during more intervals per minute in the presence of animals compared to toys.  Thus, the benefits of the animals were not just in how the children with ASD behaved, but also in how the children without ASD behaved towards the children with ASD.  “When asked whether they preferred reading, toys, or the guinea pigs, 81.8% of children with ASD indicated that they preferred the guinea pigs, followed by toys (12.1%), or both (6.1%).”

Children with ASD also displayed more prosocial behaviors (activities intended to benefit either their peers or the adult) during more intervals per minute in the presence of animals compared to toys.  In contrast, in the presence of toys, they more often engaged in self-focused activities (play or self-stimulatory behaviors directed to themselves) in the presence of toys than when they were with the animals.  They also smiled and laughed more often in the presence of animals compared to toys.  In contrast, they demonstrated fewer instance of negative affecting, including frowning, crying, and whining, in the presence of animals compared to toys.  Finally, children with ASD “talked more about positive things (and less about negative things) in the presence of animals compared to toys.”  The second graph contrasts prosocial and problem behaviors (with the darker bar indicating the presence of the guinea pigs), clearly indicating a much better result in the presence of animals over toys.  The third graph compares emotional displays in the two situations. 

O'Haire, 2013a (courtesy PLoS ONE)
The researchers found their results were consistent across schools, classrooms, individuals, grade levels, whether the subjects owned pets or not, and test determinations of the degree of autism in the subjects.   They note that previous studies had reported increases in social behaviors during therapeutic sessions with animals, but their study “demonstrates that the presence of an animal alone, without concurrent therapeutic protocols, can increase social interaction.”  They note that the increased social approach behaviors of typically-developing children towards children with autism argues for the presence of animals in “inclusion” classrooms with both types of children. This is an important consideration as many schools will not have the resources to bring in both a therapy animal and a psychologist or other mental health professional to work with children with autism. 

Such benefits appear not to be confined only to classes that contain autistic children.  In another study, the same researchers (O’Haire et al., 2013b) compared a group of children who took part in animal-assisted activities (AAA) versus a control group on a waiting list.  They found that children who participated in the AAA program demonstrated significantly greater improvements in social functioning than their control group peers, as well as demonstrating greater decreases in problem behaviors.   There was, however, no significant difference between the groups in terms of academic competence, meaning that the benefits were in the social skills that the children displayed, not in academic test scores.   

The researchers note that half the teachers in the latter study adopted the guinea pigs following the program in order to maintain the benefits of having an animal in their classroom. Thus, the school apparently approved the guinea pigs continuing to be in the classrooms without the presence of the psychological testers.

Arrival of a Pet after Age Five

The scientific research on animals and children with autism could be categorized not only by the type of animal involved but, particularly with dogs, into the type of function the animal is fulfilling: pet, therapy animal, or service animal.  A French team headed by Marine Grandgeorge considered whether the arrival of a pet after a child with autism reached the age of five might lead to measurably different development from the child growing up with a pet from birth, or never having a pet at all.  Pets in the study were dogs, cats, and rabbits.  The study showed that autistic children who obtained a pet after their fifth birthday were more likely to share food or toys with parents or other children after the arrival of the pet than before.  After the arrival, they were more likely to reassure parents or peers who were sad or hurt.  This change occurred with both boys and girls.  It did not matter whether the parents acquired the animal for the child or for the family, indicating results were not influenced by parents’ expectations on the pet’s impact.  Changes in prosocial behaviors were not correlated with IQ scores, which “might imply that these changes were not related to the level of cognitive functioning.”

Such changes were not found in comparison groups of families that never had a pet or which had a pet from the time the child with autism was born. Also, autistic children were much more likely to play with a pet that arrived after age five than autistic children in families that had always had pets.  About half the parents reported that children who got a pet after age five took care of it, whereas none of the children in families that always had pets did so.  In sum, “the individual-pet interactions (i.e. bonding) were more—qualitatively and quantitatively—reported in the case of pet arrival than pet presence since birth.”  This may be due to the fact pets in families that always had them may “have formed a preferential bond with another member of the family and therefore been less demanding on the individual with autism.”  The researchers also suggest that another “non-exclusive possibility is that the arrival of a pet strengthens the cohesion of the family and increases the levels of interactions between their members.”  Thus, the arrival of the pet may change a family dynamic. 

Thus, my own intuition that it would be best to bring in a pet as early as possible for a child with autism may not be correct, and it may be better to wait.  Of course, introducing a pet at different ages than five should also be examined to determine if such results remain consistent. 

Combining a Therapy Dog with the Social Story Method

Two autism researchers in Romania, Andreea A. Grigore and Alina S. Rusu (2014), sought to determine whether the presence of a therapy dog might improve the effectiveness of a specific behavioral intervention designed to improve the social abilities of autistic children.  This behavioral intervention used in the study is the “social story method,” which involved a therapist saying something like:

I have a new story for you. Let us read it! It is a story about how to greet someone. I will read the story, and then I will ask you some questions.

The following story was told to a boy named Nicu. 

People greet each other when they meet people they already know.

Whenever I meet a person I already know, that person might smile to me and say: “Hello, Nicu.”

I should smile, too, and reply to her: “Hello.”

She might stop and talk to me.

The social story is designed to target a specific social skill or behavior expected for a specific social situation.  Social stories have been found to reduce behaviors in ASD children such as aggression, screaming, grabbing toys, and crying.  Behaviors such as greeting, sharing toys, playful behavior, and other positive social interactions have been found to increase with the use of social stories. 

In order to use the Social Story method with a child, it has been recommended that the child be able to recognize basic facial expression and demonstrate an interest in books.  The study involved two boys, Nicu and Catalin, and a girl, Georgia, all seven or eight years old and with IQs between 85 and 115.

For Catalin, appropriate social interactions increased when the Social Story was given with the therapy dog, decreased afterward when the dog was not present in a session, but increased again when the dog returned.  For Catalin, far less prompting was needed when the dog was present, decreased after the dog was not present, and increased again when the dog returned.  For Nicu, no statistical significance was found to distinguish the amount of prompting needed with and without the dog.  For Georgia, the level of prompting needed was lowest with the dog present.  As to initiation of social interactions, the presence of the dog increased the frequency of such initiations for all three children. 

The researchers acknowledge that their study involved a small sample size, but conclude that their “results suggest that the presence of a dog while reading a social story can bring important social improvements by increasing the frequency of social initiations and by decreasing the level of social prompt that the autistic children usually need to perform appropriate social interactions.”

Again, the presence of an animal seems to improve social interaction of a child with autism, but in this study there are indications that the presence of the animal can also make other therapies more effective. 

Review Papers Push for Greater Precision and Consistency in Research  

The call for greater rigor in the scientific analysis of therapies involving animals with autistic children has been discussed before in this blog (Berry et al., 2013); Marcus, 2013).  Marguerite O’Haire, the leader of the guinea pig research team discussed above, has written a review paper that sought to “systematically identify, summarize, and evaluate any existing empirical studies of AAI [animal-assisted intervention] for ASD in order to document currently researched AAI practices and their reported findings, as well as to provide directions for further, more rigorous research.”  The analysis excluded studies in which ASD was only one of several categories from which participants were taken and results were not separated for ASD participants.  In the end, only 14 studies met all inclusion criteria, and 11 of these 14 were published since 2008.  She noted that sample sizes were generally small, mostly under 12 subjects, and often indicated little about ASD severity.  Few studies reported whether concurrent treatments were being used at the same time as the animal interventions.  No studies of adults with ASD were described.  About 80% of subjects in studies analyzed were boys.  Many studies lacked controls beyond “simple pre-post designs,” meaning that factors other than the animal might sometimes be involved in measured differences.   Very few studies collected any data at a follow-up point, meaning that there was little information on the long-term effects of animal-assisted intervention studies.  There were other problems with the surveyed research:

“Only two studies used blind raters of behavior and only one study collected physiological data. Advancing the research base on AAI for ASD will require blind ratings of participant behavior and further physiological assessment in order to reduce the likelihood of expectancy biases and lead to greater confidence in genuine treatment outcomes. Additionally, no two studies in the current review used the same standardized assessment tool, which limited cross-study comparisons.”

O’Haire raises an issue with funding, and perhaps legal, implications:

“[I]f extensive training is unnecessary for positive treatment outcomes, AAI may provide a feasible and inexpensive option for parents and teachers to present to individuals with ASD. Or, if formal certification is necessary for or enhances positive treatment outcomes, this information should dictate  interventionist selection and standards.”

Increased social interaction was reported in 9 of 14 studies, all finding this increased in the presence of an animal compared to no animal.  Five studies reported increased communication and use of language as a result of AAI for ASD.  One study suggested to O’Haire that individuals with ASD in AAI “may display greater interest in speaking about animals than other objects, but not necessarily a greater overall propensity for speaking.”  It is possible that increased language and communication may occur during and immediately following AAI, but long-term benefits may not be established. Some studies suggested AAI may reduce ASD “for certain individuals.”  Three studies reported decrease in problem behaviors associated with AAI, but O’Haire cautioned that this only amounted to “preliminary evidence.”  There is also some evidence that “AAI may be related to reduced stress and increased well-being through enhanced mood, motivation, and energy.” 

Marine Grandgeorge and Martine Hausberger, who were both co-authors on the age-five pet arrival paper, have written a review paper arguing that the experimental data on the effect of animals in the development of social skills in children is “indeed a promising line,” but argue that there is “a lack of clear scientific data that would help define what the most appropriate procedures or species may be.”  These authors conclude:

“[T]here are a lack of clear scientific data and strong needs for proper scientific researches. Further studies are needed that would be based on adapted observational and experimental approaches on larger samples of patients. Only precise and quantified descriptions both of the interactions and the outcomes may help evaluate the real impact and understand the process involved. Long term studies, such as researches about human-pet at home, may bring robust results about potential profound and durable improvements.”

Thus O’Haire and Grandgeorge, as did Berry, Marcus, and Nimer and Lundahl (2007), express optimism, but accept that definitive conclusions, particularly conclusions that can shape long-term and broad-scale policies with respect to children with autism, are still not present, despite the increasing number of studies. 

Policy and Legal Implications 

There have been studies of pets in home environments of children with autism, such as Grandgeorge’s study of pets arriving when autistic children are five-year-olds, as well as the presence of classroom pets, as described by O’Haire’s guinea pigs. Having guinea pigs in the classroom would often be classified as an animal-assisted activity, where the children were able to touch the animals on occasion.  Many of the teachers in the classrooms where the guinea pig studies were conducted sought to keep the animals at the end of the study in order to continue the benefits they provided.  This is telling, and makes a good policy argument that schools should consider having such easily maintained pets in the classroom.  Even without outside scientific support, it would be possible for the school to watch test results administered by school psychologists to see if measurable differences can be noted. Results such as O’Haire’s are insufficient to argue that policy changes must be made, but a school’s administration might be wise to consider placing a few guinea pigs in some classrooms of teachers who are interested. 

Chloe, 2009 (courtesy Joan Ensminger)
As to the incorporation of animals into therapies and educational activities, the research continues to demonstrate benefits, though it is often not clear whether such benefits endure after the animals are taken away.  With service animals it should not be expected that they are with children to have curative effects (blind children are not cured by guide dogs, nor should it be expected that children with autism will be cured by autism service dogs that are trained to interrupt dangerous behaviors), but with animal-related therapies and activities, there is an appropriate concern that the influence of the animals is temporary and that the improvements noted might disappear when the animals are no longer present or after the children have gotten bored with them. As Grandgeorge et al. (2011) noted, it “remains to be shown whether these effects are durable (beyond the sessions) and may be extended to other situations (child-pet at home).”

Still, there are other factors to consider, such as the increased calmness in classrooms when activities involving animals are occurring, the increased socialization exhibited by students with autism during such activities, the ability of non-autistic students to more easily communicate with the ASD students during the activities, reductions in tantrums and other disruptive behaviors, and so forth.  The fact that academic improvement may not occur simultaneously with such changes is important to consider, particularly when balanced against the problems arising from having to care for an animal or animals, concerns about the health of the animals, the need to care for the animals at night, on weekends, and during vacations, and other logistical issues.   

Service animals were not considered in the studies discussed above (but see Burrows et al., 2008, and Viau et al., 2012, discussed in a prior blog) and the research in this area is weaker than is the case with pets in families or animals in activities and therapies in schools.  This is largely because many schools will have only one or two service animals, usually dogs, coming to the school, and methodological consistency would generally be impossible in any large-scale study of service animals in classrooms given the high number of variables inevitable in gathering data from different schools and different classroom environments. 

The regulations of the U.S. Department of Education, in a provision regarding federal assistance to states for the education of children with disabilities, provide for the use of a “long cane or a service animal to supplement visual travel skills or as a tool for safely negotiating the environment for children with no available travel vision.”  (30 CFR 300.34(c)(7)(ii)(B))  This, however, only applies to a guide dog for purposes of travel.  Nevertheless, as discussed several times before in this blog, there have been cases on the rights of children to have other kinds of service dogs accompany them to schools.  It has been argued (Wieselthier, 2011) that the federal educational code should be revised to list service animals as a “related service” so that they could be considered in the development of individualized educational programs for students with disabilities. While I think this is a good argument, the state of the research on the value of service animals is not yet strong enough to get the support of some in the educational community who are likely to become involved should any legislative, or even regulatory change, of this sort be initiated.   

Conclusion
  
In 2006, Katherine Kruger and James A. Serpell described animal-assisted interventions as a “category of promising complementary practices that are still struggling to demonstrate their efficacy and validity.”  That is still true, but the science has advanced and will continue to advance.  The calls of O’Haire, Grandgeorge, and others for increased rigor and methodological consistency in studies involving animals in educational programs for children with disabilities are leading to better research designs, and to findings that can be demonstrated as comparable across different school environments and even countries. 

In the end, I think that many school districts will make decisions based not so much on an administration’s consideration of the research, but rather on the predisposition of a controlling set of administrators concerning the idea of dogs or other animals coming into the schools they control.  More simply, or perhaps simplistically, this often depends on whether the administration is made up of “dog people” or not. Those who have a knee-jerk reaction that having a dog or guinea pig in a classroom somehow makes the school less educational, less clean, less controlled, less presentable—whatever—will resist suggestions about animal activities and interventions, and even service animals, where others will not. This has been true in some of the legal cases regarding service animals in schools, where certain administrators have objected despite any offers of scientific evidence or the legal status of service dogs.  Even more broadly, I find that such human dynamics are often at play, such as when a person with a service dog has no problem with one restaurant, while the owner of another restaurant down the street immediately begins to throw up roadblocks. 

The psychological and educational value of interactions with animals for children with autism will continue to be a focus of scientific research.  Once the research begins to settle on procedures and approaches, policy will follow and the law will take care of itself.  

Thanks to Dr. J. Lawrence Thomas, Leigh Anne Novak, and L.E. Papet for corrections and suggestions. Thanks to Maggie O'Haire for telling me about the wonderful website on human-animal interaction research she maintains with Samantha McKenzie and Virginia Slaughter, which includes links to important developments in this area.        

Bibliography (with Notes) of Scientific and Legal Sources on Animals and Autism

Adams, Naomi (2009). Animal Assisted Interventions for Adolescents with Emotional and Behavioural Problems: A Review of Selected Literature. Paper for Postgraduate Diploma, Monash University.  (“[T]he majority of studies have been anecdotal, or in the form of hypothesis-generating case studies, rather than hypothesis-testing empirical studies…. [E]mpirical research is required to test whether the benefits of animal assisted interventions on a small number of individuals can be generalised to larger populations. There is also often no clear distinction between animal assisted therapy and animal assisted activity modalities, making it difficult to determine the effects of the animal's presence and the effect of the animal as a 'co-therapist', or a living „tool‟ in a therapeutic intervention.”)

Alison, Courtney E. (2010). Using Dogs in a Home-Based Intervention with Children with Autism Spectrum Disorders.  Ph.D. Thesis, Texas A&M University.  This thesis contains a particularly good summary of prior literature.  (“The participants in the current study also showed decreases in Looking at Environment and Solitary Activity when a dog was present. Taken with the increase in eye contact, the decrease in directing their gazes away from others suggests more social visual attention. Thus, the decrease in solitary activity also evidences an increase in social interaction. These results are consistent with others’ findings that dogs served to increase positive social interactions between children with autism and adults and dogs.”).

Anderson, Katherine L., and Olson, Myrna R. (2006).  The Value of a Dog in a Classroom of Children with Severe Emotional Disorders.  Anthrozoos, 19(1), 35-49 (Qualitative analysis indicated that a dog's placement in a classroom of children with severe emotional disorders contributed to students' overall emotional stability evidenced by prevention and de-escalation of episodes of emotional crisis, improved students' attitudes toward school, and facilitated students' learning lessons in responsibility, respect and empathy.)

Berget, Bente, Ekeberg, Oivind, and Braastad, Bjarne O. (2008). Animal-Assisted Therapy with Farm Animals for Persons with Psychiatric Disorders: Effects on Self-Efficacy, Coping Ability and Quality of Life, a Randomized Controlled Trial.  Clinical Practice and Epidemiology in Mental Health, 4(9).  DOI: 10.1186/1745-0179-4 (“AAT with farm animals may have positive influences on self-efficacy and coping ability among psychiatric patients with long lasting psychiatric symptoms.”).

Berry, Alessandra, Borgi, Marta, Francia, Nadia, Alleva, Enrico, and Cirulli, Francesca (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    (discussed in detail in prior blog).

Bodmer, N.M. (1998). Impact of Pet Ownership on the Well-Being of Adolescents with Few Familial Resources. In Companion Animals in Human Health. Wilson, C.C. and Turner, T.C. (eds.) 237-247. Sage Publications, Thousand Oaks, CA: Sage Publications.

Breitenbach, E., Stumpft, E., Fersen, L. V., and Ebert, H. (2009). Dolphin-Assisted Therapy: Chainges in Interaction between Children with Severe Disabilities and Their Caregivers.  Anthrozoös, 22(3), 277-289. DOI: 10.2752/175303709x457612  .

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 (discussed in a prior blog).

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.

Carlisle, Gretchen K. (2012).  Pet Dog Ownership in Families of Children with Autism: Children’s Social Skills and Attachment to Their Dogs.  Ph.D. Thesis, University of Missouri-Columbia. (Carlisle tested two hypotheses: (1) children with ASD who live in a family with a pet dog will have greater social skills than those who do not live with a dog; (2) children with ASD who are very attached to the family’s pet dog will have more social skills than children who are not very attached.  Both hypotheses were rejected on the data collected.  Nevertheless, the doctoral thesis contained some interesting results:  “The present study found that the longer a family owned a dog the greater the SS and fewer the related PB for their children, after controlling for age of the child…. The longer a family owned a dog, the stronger the child with ASD perceived their relationship to the dog.”)

Carlisle, Gretchen K. (2014).  Pet Dog Ownership Decisions for Parents of Children with Autism Spectrum Disorder.  Journal of Pediatric Nursing, 29(2), 114-123.  

Celani, G. (2002).  Human Beings, Animals and Inanimate Objects: What Do People with Autism Like?  Autism, 6(1), 93-102. 

Christon, Lillian M., Mackintosh, Virginia H., and Myers, Barbara J. (2010). Use of Complementary and Alternative Medicine (CAM) Treatments by Parents of Children with Autism Spectrum Disorders.  Research in Autism Spectrum Disorders, 4, 249-259 (online survey of 248 parents of children with ASD found 23.8% of their children had participated in AAI, and 62.7% of those parents saw improvements from the use of AAI). 

Clifford, S., Hudry, K., Brown, L., Pasco, G., Charman, T., and PACT Consortium (2010).  The Modified-Classroom Observation Schedule to Measure Intentional Communication (M-COSMIC): Evidence for Reliability and Validity.  Research in Autism Spectrum Disorders, 4, 509-525. 

Cohen, Matthew (2009). A Guide to Special Education Advocacy: What Parents, Clinicians and Advocates Need to Know.  London: Jessica Kingsley Publishers.

Condoret, A. (1983). Speech and Companion Animals: Experience with Normal and Disturbed Nursery School Children. In Katcher, A.H., and Beck, A. M. (eds.), New Perspective on Our Lives with Companion Animals, 467-471. Philadelphia: University of Pennsylvania Press (“The display of emotion which is evoked by the presence of an animal can be considered as a facilitator of speech acquisition. The desire to communicate with animals appears to be one of the motives for acquiring language. There is, at this level, an ambiguity, even a paradox, which should be clarified: the animal, who does not speak, allows the child to speak.”).

Davis, B.W., Nattrass, K., O’Brien, S., Patronek, G., and MacCollin, M. (2004). Assistance Dog Placement in the Pediatric Population: Benefits, Risks, and Recommendations for Future Application.  Anthrozoos, 17(2), 130-145 (“Our study used interviews to evaluate the outcome of placing assistance dogs in the pediatric population, looking specifically at the unique advantages and disadvantages of this application of the human–animal bond. We administered a structured interview assessing risks and benefits of assistance dog relationships to 17 families with a child under 18 years who graduated from a single provider (NEADS) over a five-year time period. Benefits were found in 88% of families, and were overwhelmingly social and cognitive, with additional physical and medical benefits for the pediatric client. However, risks, including behavioral, financial, and time/cost issues were significant, becoming a burden in 53% of families. Perhaps more than with adult placements, we found that it was of prime importance to understand the assistance animal in the context of the family, rather than just in relation to the individual with a disability.”).

Endenburg, Nienke, and van Lith, Hein A. (2011).  The Influence of Animals on the Development of Children.  The Veterinary Journal, 190, 208-214.

Ensminger, John (2010). Service and Therapy Dogs in American Society: Science, Law and the Evolution of Canine Caregivers.  Springfield, Ill.: Charles C. Thomas (discussing at 93 et seq. research on physiological effects of dogs on humans).

Esposito, Layla, McCune, Sandra, Griffin, James A., and Maholmes, Valerie (2011).  Directions in Human-Animal Interaction Research: Child Development, Health and Therapeutic Interventions.  Child Development Perspectives, 5(3), 205-2011.  DOI: 10.1111/j.1750-8606.2011.00175.x (reviews “key themes” from two international conferences on human-animal interaction research). 

Esteves, S. W., and Stokes, T. (2008). Social Effects of a Dog’s Presence on Children with Disabilities. Anthrozoös, 21(1), 5-15. doi: 10.2752/089279308X274029 (The effects of the presence of a dog on social interactions between three 5-9-year-old children with developmental disabilities and their teacher at an elementary school were analyzed.  All participants demonstrated an increase in overall positive initiated behaviors (verbal and non-verbal) toward both the teacher and the dog. The children also showed an overall decrease in negative initiated behaviors. In addition, observational ratings showed positive generalization of improved social responsiveness by the children in their classroom following the completion of the experimental sessions. This study supports the position that children with developmental disabilities benefit from the use of skilled dogs as teaching assistants and therapeutic adjuncts.).

Filiâtre, J. C., Millot, J. L., Montagner, H., Eckerlin, A., & Gagnon, A. C. (1986). Advances in the Study of the Relationship between Children and Their Pet Dogs. Anthrozoös, 21(1), 22-32.  DOI: 10.2752/089279389787058190.

Friesen, L. (2010). Exploring Animal-Assisted Programs with Children in School and Therapeutic Contexts. Early Childhood Education Journal, 37(4), 261–267.

Gallo-Lopez, Loretta, and Rubin, Lawrence C. (2012).  Play-Based Interventions for Children and Adolescents with Autism Spectrum Disorders.  New York, NY: Taylor & Francis/Routledge (unique in containing discussions of dog training for work with autistic children).

Gasalberti, D. (2006). Alternative therapies for children and youth with special health care needs. Journal of Pediatric Health Care, 20(2), 133-136. DOI: 10.1016/j.pedhc.2005.12.015.

Gee, N. R., Church, M. T., and Altobelli, C. L. (2010). Preschoolers Make Fewer Errors on an Object Categorization Task in the Presence of a Dog. Anthrozoös 23(3): 223–230 (“[T]he presence of the real dog does not appear to alter typical performance patterns seen in object categorization, but the fact that fewer errors were made in the presence of the dog indicates that the presence of the dog does have a positive impact on performance of this cognitive task.”).

Gee, Nancy R., Gould, Jared K., Swanson, Chad C., and Wagner, Ashley K. (2012).  Preschoolers Categorize Animate Objects Better in the Presence of a Dog.  Anthrozoos, 25(2), 187-198 (finding evidence that the presence of a real dog has an impact on cognitive task performance). 

Gervais, Helene, Belin, Pascal, Boddaert, Natalie, Leboyer, Marion, Coez, Arnaud, Sfaello, Ignacio, Barthelemy, Catherine, Brunelle, Francis, Samson, Yves, and Zilbovicius, Monica (2004). Abnormal Cortical Voice Processing in Autism. Nature Neuroscience, 7(8), 801-2 (“[I]ndividuals with autism may be unable to process voice stimuli using the selective mechanisms activated by vocal sounds in normal controls. This is consistent with behavioral studies showing abnormal voice perception in autism as well as with findings relating to event-related potentials in children with autism that show a selective impairment in the attention to vocal-speech sounds. One possible interpretation of these results is that autistic individuals could be characterized by an attentional bias towards non-vocal sounds, in line with recent findings of enhanced sensitivity to pitch in individuals with autism.”).

Ghorban, H., Sedigheh, R.D., Marzieh, G., and Yabhoob, G. (2013).  Effectiveness of Therapeutic Horseback Riding on Social Skills of Children with Autism Spectrum Disorder in Shiraz, Iran.  Journal of Education and Learning, 2(3).  DOI:10.5539/jel.v2n3p79 

Grandgeorge, Marine, and Hausberger, Martine (2011).  Human-Animal Relationships: from Daily Life to Animal-Assisted Therapies.  Annali dell’Istituto Superiore di Sanita, 47(4), 397-408. DOI: 10.4415/Ann_11_04_12. (“The finding that the primary auditory area is shaped by social bonding sheds a new light on Gervais et al.’s results showing a deficit in voice processing in the brain of autistic patients: is this perceptual disorder a source or a consequence of social withdrawal? Where this questioning is especially interesting in the current review is that if bonding occurs between a patient and an animal, one may wonder whether this new stimulation will not trigger brain plasticity (as observed in the other direction when animals develop new skills as a result of their privileged relationship with humans). Brain plasticity is much larger than long thought and while the predominant view has been that brain controls our behaviours, and it is true that brain disorders lead to behavioural disorders, experimental evidence increases that shows the huge impact of environmental (in particular social) factors on cognitive development and repair…. According to Prothmann et al. [121], animals − especially dogs − communicate their intentions in a more comprehensible way than human beings for children with autism (as previously hypothesized [94]) while autistic patients may be more sensitive to animals than human signals [126] which may explain the observed improvement. It remains to be shown whether these effects are durable (beyond the sessions) and may be extended to other situations (child-pet at home).”)

Grandgeorge, Marine, Tordjman, Sylvie, Lazartigues, Alain, Lemonnier, E., Deleau, Michel, and Hausberger, Martine (2012). Does Pet Arrival Trigger Prosocial Behaviors in Individuals with Autism? PLoS ONE, 7(8), e41739.

Gray, Carol (1993). The Original Social Story book. Jenison, MI: Jenison Public Schools.

Grigore, Andreea A., and Rusu, Alina S. (2014). Interaction with a Therapy Dog Enhances the Effects of Social Story Method in Autistic Children.  Society & Animals, 22(3), 241-261. DOI: 10.1163/15685306-12341326.

Guttman, G., Predovic, M. and Zemanek, M. (1985). The Influence of Pet Ownership in Non-Verbal Communication and Social Competence in Children. Proceedings of the International Symposium on the Human-Pet Relationship, 58-63. Vienna.

Haven, M., Rush, B.R., Reisbig, A.M., McDaniel, K.Z., and White, M.B. (2007).  The Role of Family Therapists in Veterinary Medicine: Opportunities for Clinical Services, Education, and Research.  Journal of Marital and Family Therapy, 33(2), 165-176.

Heimlich, K. (2001). Animal-Assisted Therapy and the Severely Disabled Child: A Quantitative Study. Journal of Rehabilitation, 67(4), 48-54.

Heimlich, K. (2001). Animal-Assisted Therapy and the Severely Disabled Child: A Quantitative Study. Journal of Rehabilitation, 67(4), 48-54 (A quantitative research design was developed to assess the efficacy of an animal-assisted therapy program being conducted at a residential facility for children with multiple disabilities. Analysis of the data indicated a positive effect for all participants, but no generalizations could be made due to confounding factors.).

Heimlich, K., Schiro-Geist, C., & Broadbent, E. (2003). Animal-Assisted Therapy and the Child with Severe Disabilities: A Case Study. Rehabilitation Professional, 11(2), 41-53.

Hergovich, Andreas, Monshi, Bardis, Semmler, Gabriele, and Zieglmayer, Verona (2002). The Effects of the Presence of a Dog in the Classroom, Anthrozoos, 15(1), 37-50 (Subjects were 46 first-graders in two school classes (control and experimental). In the experimental group, a dog was present in the classroom for three months. Multivariate analyses revealed significant enhancement of field independence and empathy with animals in the experimental group in comparison to the control group (no dog). Thus, the presence of the dog fostered the development of autonomous functioning and a better segregation of self/non-self, which is the foundation of sensitivity towards the needs and moods of other people. Moreover, according to the views of the teachers, the children in the experimental group exhibited higher social integration, and there were fewer aggressive children, compared with the children in the control group.)

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 (discussed in a prior blog).

Jalongo, M. (2005). What Are All These Dogs Doing in School?  Using Therapy Dogs to Promote Children’s Reading Practice. Childhood Education, 81(3), 152-158.

Jalongo, M., Astorino, T., and Bomboy, N. (2004). Canine Visitors: The Influence of Therapy Dogs on Young Children’s Learning and Well-Being in Classrooms and Hospitals. Early Childhood Education Journal, 32(1), 9-16.

Johnson, Susan C. (2003).  Detecting Agents.  Philosophical Transactions of the Royal Society B: Biological Sciences, 358, 549-559. DOI: 10.1098/rstb.2002.1237  (“Studies with typically developing infants, adults and children with autism all converge on the claim that there is a specialized input system that uses not only morphological cues, but also behavioural cues to categorize novel objects as agents…. Results from adults and children with autism are strikingly similar, despite adults’ contradictory beliefs about the objects in question and the failure of children with autism to ultimately develop more advanced theory-of-mind reasoning.”)

Katcher, A. and Wilkins, G.G. (1994). Helping children with attention-deficit hyperactive and conduct disorders through animal-assisted therapy and education. Interactions, 12 (4), 5-9.

Kotrschal, K. and Ortbauer, B. (2003). Behavioral effects of the presence of a dog in a classroom. Anthrozoös,16(2), 147–159.

Kršková L, Talarovičová A, Olexová L. (2010). Guinea Pigs—The “Small Great” Therapist for Autistic Children, or Do Guinea Pigs Have Positive Effects on Autistic Child Social Behavior?  Society & Animals, 18(2), 139-151 (The frequency of contacts of autistic children with their acquaintances significantly increased in the presence of the therapeutic animal, a guinea pig.  The frequency of contacts with the guinea pig was significantly higher than the frequency of contacts with an unfamiliar person.).

Kruger, K. A., and Serpell, J. A. (2006). Animal-assisted interventions in mental health: Definitions and theoretical foundations. In A. H. Fine (Ed.), Handbook of Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice (2nd ed., 21-38). San Diego, CA: Academic Press.

Lechner, H. E., Kakebeeke, T. H., Hegemann, D., & Baumberger, M. (2007). The effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 88(10), 1241-1248. doi: DOI: 10.1016/j.apmr.2007.07.015.   

Lehrman, J., & Ross, D. B. (2001). Therapeutic riding for a student with multiple disabilities and visual impairment: A case study. Journal of Visual Impairment & Blindness, 95(2), 108-109.

Limond, J.A., Bradshaw, J.W.S., and Cormack, K.F.M. (1997). Behavior of Children and Learning Disabilities Interacting with a Therapy Dog. Anthrozoos, 10(2/3): 84-89.

Macauley, B. L., & Gutierrez, K. M. (2004). The effectiveness of hippotherapy for children with language-learning disabilities. Communication Disorders Quarterly, 25(4), 205-217. DOI: 10.1177/15257401040250040501.  

Mader, B., Hart, L. & Bergin, B. (1989). Social Acknowledgements for Children with Disabilities: Effects of Service Dogs. Child Development, 60, 1529-1534.

Mallon, G. P. (1994). Cow as Co-Therapist: Utilization of Farm Animals as Therapuetic Aides with Children in Residential Treatment. Child & Adolescent Social Work Journal, 11 (6), 455-474.

Marcus, Dawn A. (2013). The Science Behind Animal-Assisted Therapy. Current Pain and Headache Reports, 17, 322 (discussed in a prior blog). 

Martin, F., and Farnum, J. (2002). Animal-Assisted Therapy for Children with Pervasive Developmental Disorders. Western Journal of Nursing Research. Special Issue: Human-Animal Interaction, 24(6), 657-670. doi: 10.1177/019394502320555403 (While interacting with a therapist, children with pervasive developmental disorders (PDD) were exposed to three different conditions: (a) a nonsocial toy (ball), (b) a stuffed dog, and (c) a live dog. The children exhibited a more playful mood, were more focused, and were more aware of their social environments when in the presence of a therapy dog.).

Maurer, M. (2008). Etude de l'intérêt de l'enfant atteint d'autisme pour le dauphin à partir de deux méthodologies complémentaires. A.N.A.E. Approche Neuropsychologique des Apprentissages chez l'Enfant, 20(3[98]), 143-145.  

McCardle, Peggy, McCune, Sandra, Griffin, James A., and Esposito, Layla (2011).  Animals in Our Lives: Human-Animal Interaction in Family, Community, and Therapeutic Settings.  Baltimore: Brookes Publishing. 

Melson, G.F. (2003). Child Development and the Human-Companion Animal Bond. Animal Behavioral
Scientist, 47(1), 31–39.

Melson, G.F., and Fine, A.H. (2006). Animals in the lives of children. In Fine, A.H. (ed.), Animal-
Assisted Therapy: Theoretical Foundations and Guidelines for Practice (2nd ed.). San Diego: Academic Press.

Michalon, J., Langlade, L., and Gauthier, G. (2008) Points de vue sur la recherche autour des Interactions avec l’Animal à but Thérapeutique et/ou Educatif. Note de synthèse. Micoud, A. and F. Charvolin, F. (eds.), Modys (UMR 5264 - CNRS) / Fondation Adrienne & Pierre Sommer

Millot, J.L., Filiatre, J.C., Eckerlin, A., Gagnon, A.C., and Montagner, H. (1987).  Olfactory Cues in the Relations between Children and Their Pet Dogs.  Applied Animal Behaviour Science, 19(1), 189-195.    (During spontaneous interactions with familiar children, the olfactory behavior of the dog appeared to differ according to the behaviors which had just been shown by the child. In an experimental situation, two dummies were dressed in underclothes which had been worn by a familiar or by an unknown child, i.e. with or without the familiar child's odor. The body areas smelt by the dogs differed according to whether the odor was familiar or not.  Members of this team have published a number of papers regarding olfactory cues between children and dogs.) 

Murphy, D., Kahn-D'Angelo, L., & Gleason, J. (2008). The effect of hippotherapy on functional outcomes for children with disabilities: A pilot study. Pediatric physical therapy: The official publication of the Section on Pediatrics of the American Physical Therapy Association, 20(3), 264-270. DOI: 10.1097/PEP.0b013e31818256cd.

Nimer, J., and Lundahl, B. (2007). Animal-Assisted Therapy: A Metaanalysis.  Anthrozoos, 20(3), 225–238.

O’Haire, Marguerite E. (2010).  Companion Animals and Human Health: Benefits, Challenges, and the Road Ahead.  Journal of Veterinary Behavior: Clinical Applications and Research, 5(5), 226-234.

O’Haire, Marguerite E., McKenzie, Samantha J., McCune, Sandra, and Slaughter, Virginia (2013a).  Effects of Classroom Animal-Assisted Activities on Social Functioning in Children with Autism Spectrum Disorder.  The Journal of Alternative and Complementary Medicine, 20(3), 162-168 (DOI: 10.1089/acm.2013.0165).

O’Haire, Marguerite E., McKenzie, Samantha J., McCune, Sandra, and Slaughter, Virginia (2013b). Effects of Animal-Assisted Activities with Guinea Pigs in the Primary School Classroom.  Anthrozoos, 26(3), 445-458 (“Children who participated in the AAA program demonstrated significantly greater improvements in social functioning than their control group peers, as defined by greater increases in social skills (teacher SSRS) and decreases in problem behaviors (parent and teacher SSRS). There were no significant differences between the groups in academic competence. AAA participants demonstrated significant increases in social skills and decreases in problem behaviors from pre- to post-program on the teacher version of the SSRS [Social Skills Rating System]. Control group participants did not show significant changes on these measures.”).

O’Haire, Marguerite E., McKenzie, Samantha J., Beck, Alan M., Slaughter, Virginia (2013c). Social Behaviors Increase in Children with Autism in the Presence of Animals Compared to Toys.  PLoS One, 8(2), e67010. DOI: 10.1371/journal.pone.0057010.

O’Haire. Marguerite E. (2013d).  Review of Current Evidence and Future Directions in Animal-Assisted Intervention for Children with Autism.  OA Autism, 2013 Mar 10;1(1):6.

O’Haire, Marguerite E. O’Haire (2013e).  Animal-Assisted Intervention for Autism Spectrum Disorder: A Systematic Literature Review.  Journal of Autism and Developmental Disorders, 43(7), 1606-1622. 

Philippe, S. (1995). Animal-Assisted Therapy (Educational and Psychological Aspects) with Dogs for Psychotic and Autistic Children.  Presentation, 7th International Conference on Human-Animal Interactions, Geneva.

Pavlides, Merope (2008).  Animal-Assisted Interventions for Individuals with Autism.  London: Jessica Kingsley Publishers. 

Peacock, J., Chur-Hansen, A., and Winefield, H. (2012). Mental Health Implications of Human Attachment to Companion Animals. Journal of Clinical Psychology, 68(3), 292-303 (March 2012) (discussed in a prior blog).

Poresky, R.H. (1996). Companion Animals and Other Factors Affecting Young Children’s Development. Anthrozoos, 9, 159–168 (reviewing both companion animal and therapy animal research). 

Prothmann, A., Albrecht, K., Dietrich, S., Hornfeck, U., Stieber, S., and Ettrich, C. (2005). Analysis of Child-Dog Play Behavior in Child Psychiatry.  Anthrozoos, 22(2), 161-171. 

Prothmann, A., Ettrich, C., and Prothmann, S. (2010). Preference for, and Responsiveness
to, People, Dogs and Objects in Children with Autism. Anthrozoos, 22, 161–171  (When given a choice between interacting with a dog, an adult, or inanimate objects, children with autism chose to interact with the dog twice as often as with the adult and 16 times as often as the objects.  The children interacted with the dog four times as long as with an adult.).

Redefer, L. A., and Goodman, J. F. (1989). Pet-Facilitated Therapy with Autistic Children. Journal of Autism and Developmental Disorders., 19(3), 461-467. DOI: 10.1007/BF02212943.

Sams, M. J., Fortney, E. V., & Willenbring, S. (2006). Occupational Therapy Incorporating Animals for Children with Autism: A Pilot Investigation. American Journal of Occupational Therapy., 60(3), 268-274  (Results suggest that the children demonstratedsignificantly greater use of language and significantly greater social interaction in sessions incorporating animals when compared to sessions using exclusively standard occupational therapy techniques.  This study was discussed in a previous blog).

Schoenbaechler, Danny (2010).  Autism, Schools, and Service Animals: What Must and Should Be Done.  Journal of Law and Education, 39, 455. (“School administrators should proactively find ways to accommodate a service animal request. When a request is made, administrators should give strong deference to the decision of the parents and try to accept the animal in school unless the there is a serious imbalance to the cost-benefit analysis.”).

Serpell, J.A., Coppinger, R., Fine, H.A. (2006). Welfare Considerations in Therapy and Assistance Animals. In Fine, H.A. (ed.), Handbook on Animal-assisted Therapy (2nd ed.), 453-474. San Diego: Academic Press (“Animal Assisted Intervention has encountered growing popularity in the absence of a systematic assessment of the potential threats to the welfare of the animals.”).

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 Stuy.  Journal of Alternative and Complementary Medicine, 17, 655–659.

Smith, Bradley P., and Dale, Ashley A. (2016).  Integrating Animals in the Classroom: The Attitudes and Experiences of Australian School Teachers toward Animal-Assisted Interventions for Children with Autism Spectrum Disorder.  Pet Behaviour Science, 1, 13-22.  

Solomon, Olga (2010).  What a Dog Can Do: Children with Autism and Therapy Dogs in Social Interaction.  Ethos: Journal of the Society for Psychological Anthropology, 38(1), 143-166 (DOI: 10.1111/j.1548-1352.2009.01085.x) (providing exceptionally well-written narratives of how children interact with therapy and service dogs).

Solomon, Olga (2012).  Doing, Being and Becoming: The Sociality of Children with Autism in Activities with Therapy Dogs and Other People. Cambridge Anthropology, 30(1), 109-126.  (“In both examples of children with ASD engaged with therapy dogs, there is an identifiable dialectical process underway in which the activity on the way (doing) and the emerging relationship with the dogs and, through the dogs, with the people (being), produces new horizons of possibility (becoming) which in turn informs the practices of sociality between the children and the other people in their lives, even aft er the therapy dogs have gone.” Also: “It may be that animal-assisted therapy interactions make visible the potentiality of some children with autism to have a heightened social, affiliative response to animals, and if this is so then the myths and the historical accounts converge in these interactions to reveal something about autism that has not been known before: namely, that like in the myths and fairytales, animals matter in important ways in how these children’s lives will unfold and what will become of them in their lifeworlds.”)

Sterba, J. A. (2007). Does Horseback Riding Therapy or Therapist-Directed Hippotherapy Rehabilitate Children with Cerebral Palsy? Developmental Medicine and Child Neurology, 49(1), 68-73.  

Tissen, Isabelle, Hergovich, Andreas, and Spiel, Christiane (2007). School-Based Social Training with and without Dogs: Evaluation of Their Effectiveness.  Anthrozoos, 20(4), 365-373.

Udelle, M., and Wynne, C. (2008). A Review of Domestic Dogs’ (Canis familiaris) Human-Like Behaviors: Or Why Behavior Analysts Should Stop Worrying and Love Their Dogs.  Journal of Experimental Analysis of Behavior, 89(2), 247-261.

Velde, Beth P., Cipriani, Joseph, and Fisher, Grace (2005). Resident and Therapist Views of Animal-Assisted Therapy: Implications for Occupational Therapy Practice.  Australian Occupational Therapy Journal, 52, 43-50.  DOI: 10.1111/j.1440-1630.2004.00442.x.

Viau, R., Arsenault-Lapierre, G., Fecteau, S., Champagne, N., Walker, C.D., and Lupien, S. (2010).  Effect of Service Dogs on Salivary Cortisol Secretion in Autistic Children.  Psychoneuroendocrinology, 35(8), 1187-93.  DOI: 10.1016/j.psyneuen.2010.02.004  ("We measured the salivary cortisol levels of 42 children with ASD in three experimental conditions; prior to and during the introduction of a service dog to their family, and after a short period during which the dog was removed from their family. We compared average cortisol levels and Cortisol Awakening Response (CAR) before and during the introduction of the dog to the family and after its withdrawal. We found that the introduction of service dogs translated into a statistically significant diminished CAR. Before the introduction of service dogs, we measured a 58% increase in morning cortisol after awakening, which diminished to 10% when service dogs were present. The increase in morning cortisol jumped back to 48% once the dogs were removed from the families.").

Walsh, Froma (2009). Human-Animal Bonds I: The Relational Significance of Companion Animals.  Family Process, 48, 462-480.

Weiss, D. (2009). Equine assisted therapy and Theraplay. In E. Munns (Ed.), Applications of Family and Group Theraplay, 225-233. Lanham, Maryland: Jason Aronson.

Winkle, M., Crowe, T.K., and Hendrix, I. (2012). Service Dogs and People with Physical Disabilities Partnerships: A Systematic Review.  Occupational Therapy International, 19(1), 54-66 (discussed in a prior blog).

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