Animal-assisted activity improves social behaviors in psychiatrically hospitalized youth with autism

Brain and heart activity during interactions with pet dogs: A portable electroencephalogram and heart rate variability study

Dog ownership has been linked to numerous benefits to human health and wellbeing. However, due to the lack of previous research on changes to brain activity during interactions with pet dogs, the underlying psychophysiological mechanisms are still unclear. The aim of the present study was to examine changes in heart rate (HR), heart rate variability (HRV), and electroencephalogram (EEG) power during interactions between dog owners and their pet dog. Fifty healthy adult dog owners completed baseline psychological measures and pet attachment scales. Subjective units of relaxation (SUR) as well as continuous EEG, HR, and HRV via portable devices were measured during five experimental conditions (baseline resting, relaxation-induction exercise, patting a toy dog, real dog present, and patting a real dog) in participants' homes. SUR was higher in all experimental conditions than at baseline. SUR was also higher during dog interaction than when the dog was present with no interaction. However, SUR during dog interaction was not significantly different from the toy dog and relaxation induction condition. Higher delta, theta, alpha, beta power and HR were found during dog interaction than all other conditions. Higher HRV was found during dog interaction compared to baseline, patting a toy dog, and relaxation-induction exercise, but not significantly different from the real dog present only condition. Lastly, overall HR correlated with psychological measures. Overall, the results show that there are significant changes in brain and heart activity when humans interact with pet dogs, consistent with increases in relaxation and focussed attention. These findings are relevant to understanding the potential mechanisms for health benefits associated with pets.

Job Analysis and Curriculum Design of South Korean Animal-Assisted Therapy Specialists Using DACUM

This study analyzed the jobs of animal-assisted therapy specialists using the Development of a Curriculum (DACUM) technique, a job analysis method for the duties and tasks performed in a specific job. It derived nine duties and 54 tasks through a verification process. In addition, by analyzing the knowledge, skills, and attitudes according to the task, the duties of animal-assisted therapy specialists were derived with 37 knowledge points (K), 32 skills (S), and 46 attitudes (A). The curriculum was designed based on the results derived from the job analysis. The final derived subjects were "understanding the counselee", "clinical practice", "therapy-assisted animal management", "case conceptualization", "psychological test and evaluation", "program development", "understanding and practice of counseling psychology", "animal-assisted intervention introduction", "evaluation analysis and report", "case study and practice", "case guidance and management", "training and behavior", and "animal welfare". These results can improve the professionalism of animal-assisted therapy specialists and the overall quality of the therapy site.

Effectiveness of animal-assisted activities and therapies for autism spectrum disorder: a systematic review and meta-analysis

Background

Given the rising interest in complementary therapeutic strategies for autism spectrum disorder (ASD), this research aims to provide a comprehensive analysis of the impact of animal-assisted activities and therapies (AAAT) on various ASD symptoms.

Methods

A meticulous search of databases, including Scopus and PubMed, was conducted to gather relevant research on AAAT for ASD. This process led to the selection of 45 studies encompassing 1,212 participants. The chosen studies were then subjected to a meta-analysis to evaluate the efficacy of AAAT in alleviating core ASD symptoms.

Results

The meta-analysis revealed significant improvements in several core ASD symptoms due to AAAT. Notably, there were improvements in social communication (MD = -4.96, 95% CI [-7.49, -2.44]), irritability (MD = -2.38, 95% CI [-4.06, -0.71]), hyperactivity (MD = -4.03, 95% CI [-6.17, -1.89]), and different word usage skills (MD = 20.48, 95% CI [7.41, 33.55]). However, social awareness (MD = -1.63, 95% CI [-4.07, 0.81]), social cognition (MD = -3.60, 95% CI [-9.36, 2.17]), social mannerisms (MD = -0.73, 95% CI [-2.55, 1.09]), social motivation (MD = -1.21, 95% CI [-2.56, 0.13]), lethargy (MD = -1.12, 95% CI [-3.92, 1.68]), and stereotypical behaviors (MD = -0.23, 95% CI [-1.27, 0.80]) did not significantly improve.

Conclusion

The study demonstrates the potential of AAAT in improving certain core symptoms of ASD, such as social communication, irritability, hyperactivity, and word usage skills. However, the effectiveness of AAAT in other ASD symptom domains remains uncertain. The research is limited by the absence of long-term follow-up data and a high risk of bias in existing studies. Therefore, while the findings indicate the promise of AAAT in specific areas, caution is advised in generalizing its efficacy across all ASD symptoms.

Autistic sociality: challenging representations of autism and human-animal interactions

PURPOSE

The objective of this synthesis research was to explore representations of autism and human-animal interactions (HAI) in the health sciences literature and the implications for autistic children and their families.

METHODS

Guided by critical interpretive synthesis methods proposed by Dixon-Woods et al. (2006), we synthesized and examined how autism and HAI were described in the health sciences literature and explored assumptions and goals underlying HAI as an intervention.

RESULTS

Across 47 reviewed articles, animals were represented as therapeutic objects whose purpose from a biomedical perspective was to address "problematic" behaviours and "deficits" in social functioning and development. HAI was employed as a therapy to address improvements in these problematic behaviours in the majority of studies. Relational and social aspects of HAI were present but not explicitly discussed. An alternative perspective proposed by Olga Solomon positioned autistic sociality as one form of diverse human socialities that can be embraced, rather than held problematic and in need of being normalized.

CONCLUSIONS

Implications for HAI in rehabilitation include recognizing the multiple purposes of animals in a child's life, not only the therapeutic goal of normalizing functioning.

Autistic patients' experiences of the hospital setting: A scoping review

AIM

To explore the factors that affect the experiences of autistic patients in the hospital setting.

DESIGN

A scoping review.

DATA SOURCES

A systematic literature search using the databases CINAHL, Medline and Google Scholar was undertaken in September 2021 and updated in January 2023. This review is based on the methodological framework of Arksey and O'Malley (International Journal of Social Research Methodology, 8(1):19-32, 2005), which was further refined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

RESULTS

Autistic patients, as well as their families and healthcare staff, face several barriers that can impact their healthcare experiences within hospital settings. Of 211 articles screened, 30 were eligible and included. Through our review, we identified two main themes. The first theme, 'challenges to hospital experiences', includes four sub-themes: (1) communication, (2) a mismatch between the needs for autistic patients and the hospital environment, (3) challenges related to parents' experiences and (4) challenges related to hospital systems. The second theme, 'facilitators that improve hospital experiences', includes three sub-themes: (1) provision of care pathways, (2) partnership between parents and experts and (3) facilitators to improve hospital systems. By understanding these themes, we can work to address the barriers that autistic patients and their families face, while leveraging the facilitators to improve their hospital experiences.

CONCLUSION

It is critical to understand the experiences of autistic patients in the hospital setting because they present a substantial risk of hospital admission due to their associated acute to chronic health conditions. Additionally, nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences. This review further highlights the crucial need to adopt a collaborative and inclusive approach between autistic patients, their families and healthcare staff. To achieve this, co-design initiatives that incorporate the perspectives and lived experiences of the autistic community are necessary. By placing autistic voices at the forefront of these initiatives, it is hoped that changes are meaningful, relevant and can be sustained.

IMPACT

Understanding the unique hospital experiences and challenges of autistic patients can improve their quality of life and well-being by reducing stress and anxiety during hospitalization, leading to better health outcomes and potentially shorter hospital stays. It can also promote a more positive view of healthcare among autistic individuals, encouraging them to seek medical care when needed and have broader societal impacts such as reducing healthcare costs and improving the overall health and well-being of the population. Autistic patients present a substantial risk of hospital admission due to their associated acute to chronic conditions. Nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Observation of human-animal interaction for research (OHAIRE) behavior coding in a randomized control trial of children with attention-deficit hyperactivity disorder (ADHD) and a canine-assisted intervention

Introduction

Diagnosed in about 10% of children in the United States, attention-deficit hyperactivity disorder (ADHD) is characterized by symptoms including inattention, hyperactivity, and impulsivity. Traditional interventions, such as pharmacological and psychological interventions, are often used in conjunction with integrative health options, such as animal-assisted interventions. The objective of this manuscript is to report behavior coding findings from a randomized control trial of children with ADHD.

Methods

As part of a larger randomized control trial focused on the efficacy of combining a canine-assisted intervention (live therapy dog or control stuffed dog) with cognitive behavioral therapy for children with ADHD, the current manuscript focuses on video-captured behavior observations (n = 35 children, approximately 322 minutes of data). Data were extracted and coded using the Observation of Human-Animal Interaction Research (OHAIRE) Coding System. Behavior codes are reported as summary scores for the following domains: animal social interaction and human social interaction (further separated into human-adult social interaction and human-peer social interaction). Repeated measures mixed models analyses were performed using SAS PROC GLIMMIX to evaluate group differences and change across the study period.

Results

There were no significant differences in how much children interacted with the live therapy dogs versus control stuffed dogs. With respect to human-to-human social interactions, children showed greater increases over time in human-directed social interactions in the presence of live therapy dogs compared to stuffed dogs (p = .020). Over the course of the 12-week intervention, children increased in interactions with both adults (p = .006) and their peers (p = .014); however, there were more increases over time in adult-directed social interactions in the live animal condition compared to the control stuffed animal condition (p < 0.0001).

Discussion & conclusions

Findings suggest changes in social interaction when participating in this canine-assisted intervention, specifically greater increases in human-to-human social interactions over time when a live therapy dog is present compared to a control stuffed dog. Children appear to engage relatively equally with both live and stuffed dogs; however, the impact of animals on human socialization differs based on if a live animal is present. Future studies should consider incorporating behavior coding analysis into studies of canine-assisted interventions to identify how human-animal interactions may be moderators or mechanisms for psychosocial outcomes.

How Do Children and Adolescents with ASD Look at Animals? A Scoping Review

Autism spectrum disorder (ASD) is characterized by interaction and communication differences, entailing visual attention skill specificities. Interactions with animals, such as in animal-assisted interventions or with service dogs, have been shown to be beneficial for individuals with ASD. While interacting with humans poses challenges for them, engaging with animals appears to be different. One hypothesis suggests that differences between individuals with ASD's visual attention to humans and to animals may contribute to these interaction differences. We propose a scoping review of the research on the visual attention to animals of youths with ASD. The objective is to review the methodologies and tools used to explore such questions, to summarize the main results, to explore which factors may contribute to the differences reported in the studies, and to deduce how youth with ASD observe animals. Utilizing strict inclusion criteria, we examined databases between 1942 and 2023, identifying 21 studies in international peer-reviewed journals. Three main themes were identified: attentional engagement and detection, visual exploration, and behavior. Collectively, our findings suggest that the visual attention of youths with ASD towards animals appears comparable to that of neurotypical peers, at least in 2D pictures (i.e., eye gaze patterns). Future studies should explore whether these results extend to real-life interactions.

How to Measure Human-Dog Interaction in Dog Assisted Interventions? A Scoping Review

Human-dog interaction is the working tool through which the therapeutic, educational and recreational goals of dog-assisted interventions (DAIs) are achieved. A better understanding of the characteristics of this interaction could improve the effectiveness of DAIs. This scoping review addresses the question: how has the human-dog connection been measured in the context of DAIs? After searching the Web of Science and Scopus platforms, only peer-reviewed, primary research studies reporting measures of therapy dog-human interaction, relationship and bond were included. A total of 70 included articles provided information on what was measured (interaction, relationship or bond) and how, as well as the general context (DAIs or experimental situations with therapy dogs). While the majority of the articles identified use behavioural analysis methods to analyse the interaction between the participant/recipient and the therapy dog during DAIs, it was possible to identify some more structured tools that assess the participant/recipient's interaction, relationship or bond with the therapy dog, as well as tools that consider the animal's perspective or focus on the dog-handler dyad, indicating growing areas of research. The tools and methods identified can be used by both practitioners and researchers to further explore aspects of human-dog interaction in the field of DAIs.

The supporting role of dogs in the inpatient setting: a systematic review of the therapeutic effects of animal-assisted therapy with dogs for children and adolescents in an inpatient setting

Animal-assisted therapy (AAT) is becoming increasingly popular. The possibilities and guidelines for interventions and methods are very diverse. Currently, published studies mainly concentrate on effects in paediatrics, outpatient therapy and schools. Specific recommendations for AAT in the context of inpatient child and adolescent psychiatry do not exist. This systematic review will attempt to evaluate the existing studies in terms of their methodological quality and specify positive and negative effects, aiming to provide a decision-making aid for everyday clinical practice. A systematic literature search (PubMed/MEDLINE, APA PsycINFO, PubPsych, ProQuest, Google Scholar, and Cochrane Library) according to the PRISMA criteria resulted in 1,908 identified hits, of which 49 articles were reviewed in full text. Three raters contributed to the review of the articles using a criteria-guided codebook. This systematic review is listed in the PROSPERO database (CRD42022358909). Quality analysis was conducted using Effective Public Health Practice Project (EPHPP). Five studies were identified. The majority of these showed deficits in quality. Therapeutic effects and positive influences on the psychopathological status, interpersonal relationships and subjective well-being or attitudes towards canine-assisted therapy (CAT) could be identified. Current studies indicate positive therapeutic effects of CAT in the inpatient treatment of children and adolescents. A cautiously positive perspective is warranted, but a general recommendation for CAT cannot be given. CAT should be carefully considered, planned, and implemented by professionals. For the future, further randomised controlled studies including follow-up studies, larger subject groups and clinically evaluated interventions are necessary to validate the current results.

Considerations for the Writing of Certification Letters Endorsing Use of Emotional Support Animals

Emotional support animals (ESAs) are different from service animals, therapy animals, and other disability-related assistance animals. Although pet ownership may confer psychological benefits, limited research has supported the use of ESAs to realize such benefits. If clinicians are asked to write a letter of support for use of an ESA, they need to be familiar with relevant federal, state, and local laws that regulate ESAs and with the essential components of an ESA evaluation. This article provides an overview of terminology; federal, state, and local laws related to ESAs; and clinical and ethical considerations for clinicians who decide to write these letters. The authors also review liability issues related to writing these letters, including those related to ESA aggression.

Paws to Care: Implementation of a Novel Medical Dog Office Hours Program to Foster Pediatric Health Care Staff Resilience and Joy

Burnout and resiliency are significant challenges among health care workers. Animal-assisted therapy (AAT) has shown to improve patient-level outcomes; however, AAT research involving hospital staff is limited. Our novel Medical Dog ("MD") Office Hours Program aimed to provide support to pediatric hospital staff and explore the program's impact on burnout. Participant surveys described work role and years of experience, well-being, and emotional/physical descriptions and symptoms. Of 149 participants, 85% endorsed baseline distress/burnout; nearly half had at-risk Well-Being Index scores. Compared with baseline, postintervention participants endorsed significantly fewer negative (more positive) emotions; greater feelings of comfort and energy; and decreased tiredness and pain (P < .0001). Readiness to return to work scores were high (M = 78.1, SD = 18.4). Our Medical Dog ("MD") Office Hours Program resulted in improvements in emotional descriptions and physical symptoms among pediatric health care staff. Leveraging AAT among health care staff may help mitigate burnout and increase resiliency.

Group Changes in Cortisol and Heart Rate Variability of Children with Down Syndrome and Children with Autism Spectrum Disorder during Dog-Assisted Therapy

Dog-assisted therapy is hypothesized to lower stress in children with autism spectrum disorder (ASD) and children with Down syndrome (DS), which may be visible on a physiological level. In this study, we measured heart rate variability (HRV) and salivary cortisol of 20 children with DS or ASD at the beginning and end of six weekly sessions of dog-assisted therapy. We found a decrease of cortisol levels during single sessions, but no overall effect after six sessions (six weeks). The effect of dog-assisted therapy on the increase of HRV could not be confirmed. This study is one of the first to use physiological measurements to test the effects of DAT.

Animal-Assisted Interventions for Autism Spectrum Disorder: A Systematic Review of the Literature from 2016 to 2020

In the last five years, the literature on animal-assisted intervention (AAI) for Autism Spectrum Disorder (ASD) has doubled in size from 42 studies prior to 2015 to 85 studies (cumulative total assessed in 2020). Horses remain the most commonly researched animal for AAI, followed by dogs. The most commonly researched outcome was social interaction, across 21 studies. Though the quantity of studies has increased, issues with methodological rigor remain. Results highlight the need for a continued focus on methodological rigor as well as refining the structure of animal-assisted interventions, addressing the welfare needs of the animals involved, and continuing to establish an evidence base of both significant and nonsignificant findings for AAI for individuals with ASD.

Specific and Non-specific Factors of Animal-Assisted Interventions Considered in Research: A Systematic Review

Research on animal-assisted interventions (AAIs) has increased massively in the last few years. But it is still not clear how AAIs work and how important the animal is in such interventions. The aim of this systematic review was to compile the existing state of knowledge about the working mechanisms of AAIs. We searched 12 major electronic databases for previous AAI studies with active control groups. Of 2001 records identified, we included 172 studies in the systematic review. We extracted previously published hypotheses about working mechanisms and factors that have been implicitly considered specific or non-specific in AAI research by categorizing control conditions using content analysis. We analyzed the categories using descriptive statistics. We found that 84% of the included studies mentioned a hypothesis of working mechanisms, but 16% did not define specific hypotheses. By analyzing their control conditions, we found that in most controlled studies, the animal or the interaction with the animal was implicitly considered as a specific factor for the effects of the AAI. Non-specific factors such as therapeutic aspects, social interactions, or novelty have also been controlled for. We conclude that AAI research still cannot answer the question of how and why AAIs work. To address this important research gap, we suggest using component studies with innovative control conditions and results from placebo research to address both the specific and non-specific, contextual factors of AAIs to disentangle its mechanisms.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158103, identifier: CRD42020158103.

Terapias y actividades asistidas con animales para niños con TEA: un estudio de revisión

Este trabajo incluye una revisión de la literatura publicada entre 2010 y 2019 que aborda la efectividad de las Terapias y Actividades Asistidas con Animales como intervención con niños y adolescentes con Trastorno del Espectro Autista (TEA). Se realizó una búsqueda bibliográfica en PsycINFO, PsycARTICLES, ProQuest, ERIC y Google Scholar, empleando los términos [(animal assisted therapy OR animal assisted intervention OR dog-assisted therapy OR equine-assisted therapy OR dolphin-assisted therapy) AND (autism OR ASD)]. Se identificaron 245 estudios, de los cuales se seleccionaron 40 con base en diferentes criterios de inclusión, tales como que las intervenciones descritas tengan un enfoque psicoeducativo y sean evaluadas mediante instrumentos rigurosos. En cada uno de ellos se revisaron las variables analizadas, los instrumentos de evaluación utilizados, las características de cada intervención y los resultados obtenidos. Los resultados sugieren que los animales más utilizados son el caballo y el perro, y que este tipo de intervención tiene efectos positivos para niños con TEA en áreas como la interacción y la comunicación social, el comportamiento y el desarrollo motor, entre otros. Se concluye que es una intervención beneficiosa para niños y adolescentes con autismo, aunque siempre como complemento de otro tipo de tratamientos.

Effects of the characteristic temperament of cats on the emotions and hemodynamic responses of humans

Cats positive effects on their owners' physiological and psychological health, including improved mood and activation of the human prefrontal cortex and inferior frontal gyrus in the brain. However, the association between the health benefits provided by cat ownership and the characteristic behaviors and reactions of cats is unclear. We recruited 29 participants to measure human prefrontal cortex activity, using functional near-infrared spectroscopy, during interactions with a cat. After the experiments, participants subjectively responded to a questionnaire regarding success rates for interactions with the cat, and completed the Self-assessment Manikin-a scale used to measure emotion. Interactions comprised eight types in four categories (touch, play, train, and feed). This study showed that interactions with a cat significantly activated the prefrontal cortex, regardless of interaction type. During training, the integral values of oxygenated hemoglobin in the left inferior frontal gyrus were the highest in all the interaction categories; however, success rates were lower than in the touch and feed interactions. Regarding the Self-assessment Manikin scores, all interaction categories showed a positive correlation between success rate and valence score, especially in the train and play interactions than in the touch and feed interactions. These results indicate that interactions with a cat activate the prefrontal cortex in humans, including the inferior frontal gyrus region. Moreover, cats' autonomous behaviors and reactions positively influenced the participants. The characteristic temperament of cats may be a key factor influencing the health benefits of owning cats.