Animal-Assisted Interventions for Children with Attention Deficit/Hyperactivity Disorder: A Theoretical Review and Consideration of Future Research Directions

Can Interacting with Animals Improve Executive Functions? A Systematic Review

There has been growing interest in the potential benefits of using human-animal interactions to improve executive functions: cognitive processes that allow individuals to plan, solve problems, and self-regulate behaviour. To date, no comprehensive review has been conducted. The purpose of this study was to evaluate existing literature, adopting broad inclusion criteria. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 16 papers were identified from peer-reviewed literature. Additional papers were identified from grey literature, including 6 dissertations and 1 thesis. A review of these 23 studies found that human-animal interactions and executive functions are investigated in three main ways: (1) exploring the potential benefits of the human-pet relationship, (2) exploring the impact of an animal's presence during administration of executive function tests, and (3) evaluating the efficacy of animal-assisted services (e.g., animal-assisted therapy) on executive functions. Five of the included studies reported a significant improvement across all measured domains of executive functions, but effect sizes were underreported. Comparatively, 9 studies reported mixed findings, d = 0.32-0.55, while 8 studies reported no significant results. The overall rigour of the research was limited, with great heterogeneity between the study methodologies and outcome measures used. It is recommended that future studies utilise high-quality research methodologies through the use of randomisation, pre- and postmeasures, and appropriate control conditions, where possible.

Interdisciplinary approach of Yalom's group therapy factors: A theoretical model for including animal presence in social work education and practice

An increasing number of studies in the field of Social Work (SW) address the incorporation of animal presence in practice and improved understanding of social support and therapeutic components. Education programs on the ethical and practical principles of animal-assisted interventions, including models and theories supporting the psycho-physiological effects of human-animal interactions (HAI), are being implemented around the world, especially in the US. While designing and implementing a new interdisciplinary curriculum can be time-consuming and, depending on the many variables, integrating elements of HAI components in existing curricula can be a more efficient approach. We present a step-by-step approach for inclusion of HAI knowledge and practice in teaching Yalom's principles and therapeutic factors of group therapy to SW students. Based on a qualitative analysis of the existent literature and on the results of several research projects in the field of HAI, we propose an approach for infusing research-informed examples and theories supporting the beneficial effects of HAI in the direction of the interdisciplinary understanding of the Yalom's primary factors in the therapeutic process, such as: instillation of hope, corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, interpersonal learning, and group cohesion. Applied values of HAI are discussed for each factor, emphasizing the added value of animal presence in group therapy settings from the perspective of the dynamic of interspecific social networks, i.e., animal-handler-group members.

Child–Dog Attachment, Emotion Regulation and Psychopathology: The Mediating Role of Positive and Negative Behaviours

Emerging evidence suggests that pet dogs can offer features of a secure attachment which has been associated with healthy psychological development across the lifespan. Limited research has investigated the underpinning mechanisms that may contribute to the benefits and risks of child–dog attachment during childhood. This study aimed to test the potential mediating role of caregiver-observed positive and negative child–dog behaviours, on the relationship between child-reported child–dog attachment, and caregiver-reported child psychopathology and emotion regulation. Data from 117 caregiver reports and 77 child self-reports were collected through an online survey in the context of the COVID-19 pandemic. Parallel mediation analyses indicated that child–dog attachment had a significant indirect effect on conduct problems through negative child–dog behaviours only. Child–dog attachment had a significant indirect effect on emotional symptoms, peer problems, prosocial behaviour, emotion regulation, and emotional lability/negativity through both positive and negative child–dog behaviours. Although this study found modest effect sizes, the findings suggest that the types of interactions that children engage in with their pet dogs may be important mechanisms through which pet attachment contributes to psychological development throughout childhood, and therefore further attention is warranted. Positive and safe child–dog interactions can be facilitated through education and intervention, which may have implications for promoting positive developmental outcomes.

Dog training alleviates PTSD symptomatology by emotional and attentional regulation

Background

Post-Traumatic Stress Disorder (PTSD) symptoms include re-experiencing, avoidance, hyperarousal, and cognitive deficits, reflecting both emotional and cognitive dysregulation. In recent years, non-pharmacological approaches and specifically animal-assisted therapy have been shown to be beneficial for a variety of disorders such as Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and PTSD. However, little is mentioned in the literature about the reciprocal effects of the animal-human interaction.

Objective

To evaluate the effects of a one-year dog training programme on PTSD symptomatology in youngsters with PTSD and on dogs' behaviour.

Methods

Fifty-three adolescents, previously exposed to interpersonal trauma, were clinically diagnosed with PTSD and assigned to a dog-training programme group (n = 30) and a control group (n = 23) that engaged in other training programmes (e.g. cooking, hairstyling, etc.). Both groups were evaluated at baseline and following 12-months by The Clinician-Administered PTSD Scale for DSM-5 in Children and Adolescents (CAPS-CA-5) and Beck-Depression Inventory (BDI). Additionally, we physiologically measured both emotional and attention dysregulation.

Results

Post-12-months training, a significant alleviation of PTSD symptomatology accompanied by lower depression severity was observed in the dog-training group, compared with a insignificant recovery in the control group. Furthermore, improved emotional and attentional regulation was observed in the dog-training group. Measuring the dogs' behaviour revealed increased anxiety and decreased selective attention performance, which was inversely correlated with the beneficial effects observed in the dog-training programme group.

Conclusions

Our findings emphasize the role of emotional and attentional regulations on the dog-handler interface, as evidence-based support for the beneficial effects of the dog-training programme, as either a non-pharmacological intervention or as complementary to anti-depressants treatment of PTSD. Though pharmacological treatments increase the patients' well-being by treating certain PTSD symptoms, our suggested dog-training programme seems to influence the PTSD diagnostic status, thus may be implemented in civilians and veterans with PTSD.

Impacts of Participation in Community-Based Physical Activity Programs on Cognitive Functions of Children and Youth with Neurodevelopmental Disabilities: A Scoping Review

This review paper aimed to undertake an extensive exploration of the extent, range, and nature of research activities regarding the effect and emerging evidence in the field of physical activity interventions on cognitive development among children and youth (0–17.99 years) with neurodevelopmental disorders (NDD), and to help identify key gaps in research and determine precise research questions for future investigations. To carry out this scoping review, five electronic databases were searched. A total of 12,097 articles were retrieved via search efforts with an additional 93 articles identified from the identified review papers. Sixty articles were eligible for inclusion. The results of this scoping review revealed many positive key cognitive outcomes related to physical activity including, but not limited to: focus, attention, self-control, cognitive process, and alertness. No studies reported a negative association between physical activity and cognitive outcomes. Based on the findings from this scoping review, physical activity appears to have a favorable impact on the cognitive outcomes of children and youth with NDD.

Animal-Assisted and Pet-Robot Interventions for Ameliorating Behavioral and Psychological Symptoms of Dementia: A Systematic Review and Meta-Analysis

Patients with dementia suffer from psychological symptoms such as depression, agitation, and aggression. One purpose of dementia intervention is to manage patients’ inappropriate behaviors and psychological symptoms while taking into consideration their quality of life (QOL). Animal-assisted intervention (AAI) and pet-robot intervention (PRI) are effective intervention strategies for older people with cognitive impairment and dementia. In addition, AAI and PRI have been shown to have positive effects on behavioral and psychological symptoms of dementia (BPSD). However, studies into the association between AAI/PRI and BPSD have elicited inconsistent results. Thus, we performed a meta-analysis to investigate this association. We analyzed nine randomized controlled trials on AAI and PRI for dementia patients published between January 2000 and August 2019 and evaluated the impact of AAI/PRI on agitation, depression, and QOL. We found that AAI and PRI significantly reduce depression in patients with dementia. Subsequent studies should investigate the impact of AAI and PRI on the physical ability and cognitive function of dementia patients and conduct a follow-up to investigate their effects on the rate of progression and reduction of symptoms of dementia. Our research will help with neuropsychological and environmental intervention to delay or improve the development and progression of BPSD.

Pets Are Associated with Fewer Peer Problems and Emotional Symptoms, and Better Prosocial Behavior: Findings from the Longitudinal Study of Australian Children

OBJECTIVE

To investigate the longitudinal association between pet ownership and children's social-emotional development.

STUDY DESIGN

Two time-points of data from the Longitudinal Study of Australian Children were analyzed for children at ages 5 (n = 4242) and 7 (n = 4431) years. The Strengths and Difficulties Questionnaire (SDQ) measured children's social-emotional development. Pet ownership status and type (dog, cat, other) as well as sociodemographic and other potential confounders were collected. Longitudinal panel regression models were used.

RESULTS

Overall, 27% of children had abnormal scores on 1 or more SDQ scales. By age 7, 75% of children had pets with ownership highest in single-child households. Owning any type of pet was associated with decreased odds of abnormal scores for emotional symptoms (OR, 0.81; 95% CI, 0.67-0.99), peer problems (OR, 0.71; 95% CI, 0.60-0.84), and prosocial behavior (OR, 0.70; 95% CI, 0.38-0.70), compared with non-pet owners. Dog ownership was associated with decreased odds of abnormal scores on any of the SDQ scales (OR, 0.81; 95% CI, 0.71-0.93). For children without any siblings, only the prosocial behavior scale was significantly associated with pet ownership (OR, 0.21; 95% CI, 0.07-0.66). In longitudinal models, cat-only and dog-only groups were associated with fewer emotional symptoms and peer problems compared with non-pet owners.

CONCLUSIONS

Early school age is an important period for family pet acquisition. Pets may protect children from developing social-emotional problems and should be taken into account when assessing child development and school readiness. Children without siblings may benefit most in terms of their prosocial behavior.

Methodological and Terminological Issues in Animal-Assisted Interventions: An Umbrella Review of Systematic Reviews

Simple Summary

Animal-assisted interventions (AAIs) include a wide range of activities aimed at improving the health and well-being of people with the help of pets. Although there have been many studies on the effects of these interventions on animal and human wellbeing and health, univocal data on the methodological aspects, regarding type and duration of intervention, operators, involved animal species, and so on, are still lacking. In this regard, several systematic reviews in the scientific literature have already explored and outlined some methodological aspects of animal-assisted interventions. Therefore, we developed an umbrella review (UR) which summarizes the data of a set of suitable systematic reviews (SRs), in order to clarify how these Interventions are carried out. From our results, it is shown that there is a widespread heterogeneity in the scientific literature concerning the study and implementation of these interventions. These results highlight the need for the development and, consequently, the diffusion of protocols (not only operational, but also research approaches) providing for a univocal use of globally recognized terminologies and facilitating comparison between the numerous experiences carried out and reported in the field.

Abstract

Recently, animal-assisted interventions (AAIs), which are defined as psychological, educational, and rehabilitation support activities, have become widespread in different contexts. For many years, they have been a subject of interest in the international scientific community and are at the center of an important discussion regarding their effectiveness and the most appropriate practices for their realization. We carried out an umbrella review (UR) of systematic reviews (SRs), created for the purpose of exploring the literature and aimed at deepening the terminological and methodological aspects of AAIs. It is created by exploring the online databases PubMed, Google Scholar, and Cochrane Library. The SRs present in the high-impact indexed search engines Web of Sciences and Scopus are selected. After screening, we selected 15 SRs that met the inclusion criteria. All papers complained of the poor quality of AAIs; some considered articles containing interventions that did not always correspond to the terminology they have explored and whose operating practices were not always comparable. This stresses the need for the development and consequent diffusion of not only operational protocols, but also research protocols which provide for the homogeneous use of universally recognized terminologies, thus facilitating the study, deepening, and comparison between the numerous experiences described.

Animal-Assisted Therapy in the Residential Treatment of Dual Pathology

Animal-assisted therapy (AAT) is a complementary intervention of therapy that has shown positive results in the treatment of various pathologies. This study assesses the viability of the implementation and the effectiveness of an AAT program in patients diagnosed with substance abuse disorder and associated mental disorders (dual pathology). For the study, a dynamic prospective cohort was used, consisting of 43 patients in residential treatment. The program consisted of 10 sessions with a duration of about 60 min, where data was collected in the 3rd, 6th and 10th sessions. The Life Skills Profile questionnaire (LSP) and the Barratt Impulsiveness Scale (BIS-11) were used for subsequent evaluation. Patients who participated in the program showed an improvement in daily skills, which favoured a better quality of life and decreased impulsiveness, enabling them to regain self-control. These results suggest that the dog can be a multi-sensory stimulus that captures attention, and improves motivation, cooperation and patient involvement in therapy. It was concluded that AAT can serve as an adjunctive therapy in the rehabilitation processes of people diagnosed with dual pathology.

Improved Wellbeing for Both Caretakers and Users from A Zoo-Related Nature Based Intervention-A Study at Nordens Ark Zoo, Sweden

Nature-based interventions have been proposed to promote physical and mental health and give stress reduction. Little attention has been given to the potential of zoos for human health and wellbeing. A disadvantaged group in Sweden regarding access to nature are individuals with disabilities who consequently do not have the same access to these health benefits as other groups. To increase awareness and knowledge regarding spending time in nature and with animals, courses directed at caretakers for persons with disabilities and their users were held at Nordens Ark, a zoo in Sweden. To explore if the courses had led to increased nature activities, and if participating in the courses had affected caretakers' and their users' health and wellbeing, questionnaires and interviews for evaluating the courses were used. The results showed improved quality in nature visits because of course participation as well as positive effects for the wellbeing, sustainability for the caregivers and users in their working lives, and relationships were positively affected. The conclusion from this study is that nature and animal-based education should be more frequent to provide opportunities for a disadvantaged group to have the positive effects of nature of which most other groups have obvious access to.

Animal-Assisted Interventions in the Classroom-A Systematic Review

The inclusion of animals in educational practice is becoming increasingly popular, but it is unclear how solid the evidence for this type of intervention is. The aim of this systematic review is to scrutinise the empirical research literature relating to animal-assisted interventions conducted in educational settings. The review included 25 papers; 21 from peer-reviewed journals and 4 obtained using grey literature databases. Most studies reported significant benefits of animal-assisted interventions in the school setting. Despite this, studies vary greatly in methods and design, in intervention types, measures, and sample sizes, and in the length of time exposed to an animal. Furthermore, a worrying lack of reference to risk assessment and animal welfare must be highlighted. Taken together, the results of this review show promising findings and emerging evidence suggestive of potential benefits related to animals in school settings. The review also indicates the need for a larger and more robust evidence base driven by thorough and strict protocols. The review further emphasises the need for safeguarding for all involved-welfare and safety are paramount.

Horseback riding therapy for a deafblind individual enabled by a haptic interface

We present a haptic interface to help deafblind people to practice horseback riding as a recreational and therapeutic activity. Horseback riding is a form of therapy which can improve self-esteem and sensation of independence. It has been shown to benefit people with various medical conditions-including autism. However, in the case of deafblind riders, an interpreter must stand by at all times to communicate with the rider by touch. We developed a simple interface that enables deafblind people to enjoy horseback riding while the instructor is remotely providing cues, which improves their independence. Experiments demonstrated that an autistic deafblind individual exhibits similar responses to navigational cues as an unimpaired rider. Motivation is an important factor in therapy, and is frequently determinant of its outcome; therefore, the user attitude toward the therapy methods is key. The answers to questionnaires filled by the rider, family, and the instructor show that our technique gives the rider a greater sense of independence and more joy compared to standard riding where the instructor is walking along with the horse.

Research on animal-assisted intervention and autism spectrum disorder, 2012-2015

Including animals in autism intervention is growing in both research and practice. A systematic literature review was conducted to collate and synthesize all empirical research on animal-assisted intervention (AAI) for autism published from 2012 to 2015. Findings from 28 included studies revealed that AAI programs generally include one animal per participant with a total contact time of approximately 10 hours over the course of 8 to 12 weeks. Research methodology is diverse and though limited in many cases, has improved over the last few years. The most commonly reported outcome was increased social interaction, which was unanimously significant across 22 studies. The need for further research is highlighted, calling for a focus on refining AAI techniques, identifying optimal circumstances for positive change as well as individuals who may not benefit, and independent replication of high quality studies to move AAI from an enrichment activity to an evidence-based practice for autism.

Benefits of an experimental program of equestrian therapy for children with ADHD

BACKGROUND

Equestrian therapy has been shown to be a useful instrument in the sphere of the emotional wellbeing and mental health of different population groups.

AIMS

To empirically determine the effects of a program of equestrian therapy on quality of life and various psychosocial variables of a group of 14 pupils diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), aged from 7 to 14 years.

METHODS AND PROCEDURES

A quasi-experimental design, with a pre-test and a post-test, was implemented with an experimental group and a control group. The program consisted of 24 biweekly sessions, therefore lasting some 3 months. The data acquisition instruments used were: the "Behavior Assessment System for Children" (BASC) and an ad-hoc quality of life questionnaire.

OUTCOMES AND RESULTS

The results deriving from the teachers' responses and the different scales of the BASC showed no significant group differences, but for the experimental group there was an improvement in the indicator corresponding to interpersonal relationships in the quality-of-life questionnaire.

CONCLUSIONS AND IMPLICATIONS

It would seem that it is currently possible to recommend this activity, for this target population, as a sporting activity that provides similar benefits to other physical activities, but which is still far from being able to be recognized as a therapeutic activity.