Kelley L. Harrison, MA, BCBA, LBA-KS
Thomas Zane, PhD, BCBA-D
Department of Applied Behavioral Science, University of Kansas
Throughout history, animals have been used to provide unique services for individuals in need of specialized assistance. Specifically, animals have been used to provide basic services such as security and protection. For example, “seeing-eye dogs” are trained to provide assistance negotiating the physical environment to people with visual impairments. However, more recently, animals have also been used to provide emotional and psychological comfort and support (e.g., Cirulli, Borgi, Berry, Francia, & Alleva, 2011; Hall & Malpus, 2000). In fact, it has been experimentally shown that social interactions between typically developing adults increase simply by being in the presence of a dog (McNicholas & Collis, 2000).
The increasing incidence of autism spectrum disorders (ASD) has resulted in an increase in therapies designed to treat this condition. One recent therapy is the use of autism service dogs specifically trained to work with individuals with ASD. The first service dog was placed with a child with ASD in 1997 by National Service Dogs. Since then, the popularity of such support appears to be increasing. National Service Dogs alone has placed over 170 dogs with children with ASD, averaging 10 – 16 dogs per year (Burrows, Adams, & Millman, 2008). Additionally, National Service Dogs is currently constructing a new facility for training and education, and eventually will be able to place 40 dogs annually.
What is the Conceptual Link Between ASD and Autism Dogs?
Proponents of service dogs for children with ASD assert that these dogs can support the unique challenges associated with ASD (e.g., safety, social and emotional communication). Through thousands of years of domestication, dogs have developed social behaviors, including cooperation and communication with humans. This is referred to as emotional evolution and may be the underlying mechanism responsible for the establishment of strong human-dog bonds (Cirulli, et al., 2011). In fact, some researchers suggest that a close relationship with a pet is correlated with significant health improvements, such as a lowered risk for cardiovascular disease (e.g., Anderson, et al., 1992), a reduction in doctor visits during stressful life events (e.g., Siegel, 1990), and a reduction in everyday minor health problems (e.g., Serpell, 1991). However, these researchers acknowledge that it may not be the human-dog bond that is responsible for health improvements, but simply that pet ownership may be correlated with an increase in exercise (e.g., taking a dog for a walk; Anderson, Reid, & Jennings, 1992). Still, researchers have demonstrated that simply the presence of dogs is correlated with a decrease in blood pressure and heart rate (i.e., signs of stress and anxiety) for adults and children (e.g., Friedmann & Son, 2009). Based on the suggestion that dogs may improve physical and emotional health, many health care settings have begun integrating animals into healthcare practices.
“Autism dogs” (Circulli et al., 2011) are trained to help a person with autism, and are usually physically connected to the person with ropes or some other form of tethers (Burrows, et al., 2008). Autism dogs are considered “service” dogs and serve two primary purposes. The first purpose of these dogs may be to increase the safety of the person with autism (National Service Dogs, 2011). For example, the dogs may be trained to follow commands from parents to slow or stop a child at doorways or resist a child moving away. This may decrease the likelihood of a child bolting (eloping) or crossing a busy street (Burrows, Adams, & Spiers, 2008). Additionally, autism dogs also have been trained to alert parents of potentially dangerous situations at night (e.g., child leaves bed or bedroom). This allows parents and other family members to rest while ensuring their child is safely in bed and cannot leave without their knowing (Burrows, et al., 2008).
The second purpose of autism dogs may be to improve the social wellbeing of the child through increasing social interactions and improving sensory integration. Specifically, autism dogs may function as a “transitional object,” allowing the child with autism to first bond with the dog and then eventually bond with humans (e.g., Sams, Fortney, & Willenbring, 2006). Additionally, Autism Service Dogs of America suggests autism dogs provide a “calming presence” that “can minimize and often eliminate emotional outbursts.” Further, they suggest that autism dogs may improve arousal and sensory stimulation, allowing the autism dog to function as a living and breathing sensory integrative tool (e.g., Rederer and Goodman, 1989).
Proponents of autism dogs hypothesize that children with ASD are naturally interested in animals, especially dogs. Additionally, they hypothesize that dog interactions consist of simple and predicable movements, making the interactions more interpretable. Because a common feature of ASD is communication impairments with others, the combination of a natural interest in dogs and more interpretable interactions may facilitate engagement with the dog from a child with ASD. This engagement with the dog would generalize to engagement with other humans. Thus, proponents of autism dogs suggest these dogs may increase social interactions (e.g., Silva, Correia, Lima, Magalhães, & de Sousa, 2011).
Is There Any Research to Support Autism Dogs?
As with all strategies suggested to treat ASD, one must ask whether there is evidence that autism dogs are effective at providing such therapeutic effects like an increase in physical safety and the social wellbeing of a child with ASD. Unfortunately, research on the effects of autism dogs consists mostly of testimonials (i.e., interviews as a means of collecting data), some case studies, and only a few actual studies which utilize formal research designs. Thus, the quality and validity of the information collected on ascertaining the effects of the autism dogs must be viewed cautiously.
Burrows, Adams, and Millman (2008) qualitatively (i.e., observation and parental report) evaluated the effects of autism dogs on child safety and improved social lives of both parents and child. Overall, parents reported immediate satisfaction and reduction in concerns about safety issues. Specifically, they reported that the autism dogs prevented eloping or unsafe nighttime behavior. Additionally, parents reported feeling relaxed during bedtime knowing that the dogs would alert them should the child with ASD leave the bed or exhibit some other potentially dangerous behavior. Finally, parents reported that the children exhibited decreased anxiety, were calmer, and engaged in fewer tantrums and other disruptive behaviors. In addition to parental report, Burrows et al. (2008) also observed that some of the children began regulating their walking pace, developing improved motor skills and control, and began learning dog-care tasks (e.g., feeding the dog by taking lid off food container; putting food in bowl; putting bowl on floor; commanding dog to eat). Although these findings are promising, they must be approached with caution as they are based largely on testimony (i.e., parental report) and observations. [Learn about the pitfalls of testimonials here: www.asatonline.org/for-parents/becoming-a-savvy-consumer/the-pitfalls-of-testimonials/].
Other studies have attempted to empirically evaluate (i.e., through experimental manipulation) the effects of autism dogs. Although this is an improvement from qualitative research, these studies also utilize poor research design and contain other methodological flaws. For example, Silva and colleagues (2011) asserted that children with autism dogs may be more receptive to, and be more influenced by, one-on-one therapy. Specifically, a condition in which a therapist and dog interacted with a child with ASD was compared to a condition in which the same child and therapist interacted alone. The authors concluded that the child engaged in more positive behavior (e.g., smiling, eye contact) and engaged in less inappropriate behavior (e.g., physical aggression, verbal aggression) in the presence of the dog. However, conclusions were based on one participant. Therefore, the results were not replicated. Additionally, the researchers used a statistical analysis to evaluate differences in behavior between conditions. Such analysis may mask other variables that may have affected behavior. For example, the authors mentioned that the increase in positive behavior may have occurred when the dog was present simply because of the addition of the novel stimulus (i.e., the dog) and that negative behavior may have occurred when the dog was absent simply because of the removal of a preferred stimulus (i.e., the dog). Perhaps, if looking at the chronology of the case study’s methods, an analysis would show positive behavior decreased over time when the dog was no longer novel and negative behavior increased only after the dog was removed, but then subsequently decreased. The statistical analysis would mask these changes. Thus, a causal relationship between autism dogs and a child’s receptiveness to one-on-therapy is far from being established.
Becker, Rogers, and Burrows (2017) also attempted to empirically evaluate the effects of autism dogs. Specifically, Becker and colleagues (2017) used a group design to evaluate the effects of animal-assisted social skills training on a group of children ages 8-14 with a diagnosis of ASD or Pervasive Developmental Disorder (PDD). An experimental group that included animal-assisted social skills training was compared to a control group that included the same social skills training in the absence of the animal. Dependent measures (i.e., what is measured to compare pre- and post-intervention and draw conclusions about the intervention) consisted of indirect measures of the behaviors targeted; specifically, surveys and self-reports such as the Childhood Autism Rating Scale, Children’s Depression Inventory, Reading the Mind in the Eyes Test, and two social language/responsiveness scales were used. The authors reported that those who participated in animal-assisted social skills training exhibited a statistically significant decrease in social skills deficits, repetitive behaviors, depressive symptoms, and symptoms of ASD overall. Additionally, those who participated in animal-assisted social skills training exhibited a statistically significant increase in social communication, as measured by the indirect measurement tools. Thus, the authors concluded that the use of dogs in social skills training enhanced skill acquisition and development. However, no direct behavioral observations were conducted. Instead, the primary data were collected from survey results (some of which were self-reported), which are known to be inherently flawed. [Learn more about how to evaluate effectiveness of interventions here: www.asatonline.org/for-parents/becoming-a-savvy-consumer/asd-intervention-how-do-we-measure-effectiveness/].
Other researchers have evaluated the effects of autism dogs using more sophisticated research design (e.g., single-subject). For example, Martin and Farnum (2002) investigated the impact of autism dogs on behavioral and verbal interactions for 10 children with ASD. Using an ABCA design, the researchers systematically varied three different conditions: a simple toy, stuffed dog, and real dog. The authors reported a mix of findings. Specifically, inappropriate behavior (e.g., hand flapping) increased and lasted longer in the presence of the dog. Participants also made eye contact with the therapist less in the presence of the dog as compared to the other conditions, answered questions with less detail in the presence of the dog, and talked less about the therapist in the presence of the dog. However, participants laughed more frequently and for a longer duration in the presence of the dog. Participants also made eye contact with the dog more than with the stuffed dog or the toy, talked more about the dog and for longer durations in the presence of the dog, and engaged in more on-topic conversations (i.e., conversations relevant to the immediate environment) in the presence of the dog. Finally, participants were more like to comply with requests in the presence of a dog. Overall, the authors concluded that there may be tentative support for the use of autism dogs for children with ASD. However, the authors relied on statistical analysis to evaluate differences across conditions. The use of statistical analyses with such a small sample size limits the validity and generalization of these conclusions. [Learn more about how to evaluate effectiveness of interventions here: www.asatonline.org/for-parents/becoming-a-savvy-consumer/asd-intervention-how-do-we-measure-effectiveness/].
Interestingly, Burrows, Adams, and Millman (2008) studied the impact of autism dogs on the dogs themselves. The authors conducted a series of interviews with members of 11 families who used dogs for their children with ASD. Parents were interviewed at three different time periods – when they were receiving training about their new dog, and every third month for 6 months. The authors reported that generally the dogs were loved and bonded well with all members of the family. However, the dogs were placed under significant stress. Typically, service dogs are trained to bond primarily with the person whom the dog will be helping. One difference between autism dogs and other service dogs is that autism dogs are trained to primarily bond with and take instructions from the parent(s), but must also work with the child with ASD. Families reported that dogs developed a primary relationship with one or both parents, and to a lesser extent, the child with ASD. Only four of the 11 children with ASD showed interest in the dog, with interest defined as petting or initiating any sort of social approach. Thus, dogs seemed to prefer interactions with parents and were more likely to follow their commands. Generally, the children with ASD provided less attention and social contact with the dog than the other family members.
Additionally, some of the unique features of ASD (e.g., disrupted sleep schedules, aggression) placed the autism dogs under significant stress. For example, some dogs could not sleep for long periods of time, if the child with ASD went without sleep. Some dogs spent long hours “working” when accompanying a child to school, which inhibited urination and defecation. Some children engaged in aggression towards the dogs, causing dogs to startle and move away from the child. Thus, dogs often received mixed social signals from the child with ASD, but were then still expected to respond appropriately to commands from the parents and bond with the child. Thus, if autism dogs are to be used, the caregivers should consider the physical well-being of the dog as well (e.g., ensure appropriate rest-recovery time, recreational activities).
Financial Cost Associated with Autism Service Dogs
To obtain a dog, parents must apply to one of the organizations that supply these animals (e.g., 4 Paws for Ability, 2017; Autism Service Dogs of America, 2010; National Service Dogs, 2012). The cost is approximately $20,000. The prerequisites for a child to obtain such a trained dog seem unspecified. For example, the organization “4 Paws for Ability” states that age or severity of disability does not exclude one from getting a dog. However, Autism Service Dogs for America, specifies that children under the age of five will not receive a dog and that dogs are solely for individuals with ASD.
Training programs are lengthy and extensive. Training begins for the dog as a puppy with socialization, basic obedience, and public outings in the service jacket. This is followed by advanced training which includes suitability testing, advanced obedience training, distraction training, and training in busy environments (e.g., grocery stores). Ideally, the dog is fully trained and placed with a family between the ages of 18-24 months. Dogs are matched with a family based on an interview with the parents. Once a dog is matched with a family, a trainer and family work together to habituate the dog to the family and child with ASD, train the parents on the commands that will be given to the dog, and to assimilate the dog into the family routine (Burrows, Adams, & Millman, 2008).
Overall, research on the use of autism dogs is sparse and inconsistent. Although preliminary research seems promising, the experimental rigor is lacking, which decreases the validity and generalization of the findings. Additionally, the current research fails to isolate the effects of the dog on the child’s behavior. Thus, it is unclear if the autism dog is solely responsible for changes in behavior or if other factors may contribute. Future research should focus on identifying if animal-assisted interventions are more effective than typical interventions. Additionally, future research may identify the necessary behaviors that autism dogs need to learn to most effectively change the child’s behavior (e.g., safety skills, social skills). Finally, future research may identify the necessary training for caregivers of autism dogs to ensure the health and optimal performance of the dog.
What is the Bottom Line?
There is some (qualitative) evidence that autism service dogs may provide a measure of safety to a child with autism. When tethered to a child, such dogs can prevent or minimize the child getting injured or lost. The dogs are trained to prevent bolting, running away, and entering a street when unsafe to do so. Such dogs also seem to be able to provide monitoring during the evening, allowing parents to be more confident that their child will remain safe while they sleep. The evidence is less compelling when considering whether the autism dogs themselves are the reason for increased learning in the areas of motor, emotion, social, or adaptive behavior. Such dogs do not have any special capacity or “sense” of a special emotional connection with persons with autism. Rather, dogs can be the medium in which the child practices skills, such as learning to feed the dog. However, the reason for learning is most likely the repeated practice and not any special characteristic of the animal. In addition, the other areas of improvement noted in these qualitative studies – such as the children looking happier, engaging more in positive social interactions, and displaying reduced number of tantrums – are lacking in confidence, due to the data collection methodology and lack of reliability and validity of those data.
Autism dogs seem to have a role to play for the physical security and safety of children with autism, and that reason alone may be powerful enough to consider using one if it can be financially afforded. The impact of the dog on learning and problem behavior remains to be determined in a more rigorous manner, and until that time, the use of autism dogs should be limited to enhancing safety of the child.
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Citation for this article:
Harrison, K. L., & Zane, T. (2017). Is there science behind that? Autism service dogs. Science in Autism Treatment, 14(3), 31-36.