Animal-Assisted Therapy For Autism Spectrum Disorders

  • Adriana Roxana BotaDoctor of Medicine - MD, Medicină, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca
  • Priyanka ThakurBachelor in Medicine, Bachelor in Surgery (MBBS), DRPGMC, India
  • Regina LopesSenior Nursing Assistant, Health and Social Care, The Open University

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Overview

Can a dog be a therapist? We can say yes. Animals are innocent and loving creatures that have a “natural talent” for bringing out the best in people. The friendliness, peace, and acceptance animals express, have a positive effect on people suffering from autism. Formally known as autism spectrum disorders (ASD), this is a group of mental health conditions related to brain development, defined by social and communication difficulties, particular behaviour showing repetitive movements, avoiding eye contact, flapping hands, and restrictive interests.

Animal-assisted therapy (AAT) is a type of psychotherapy in which “trained” animals, most commonly dogs, play an important role. They bond with the patient and create a safe, trusting environment, where the person can open up and work effectively towards their goal.1 This article unveils animal-assisted therapy in autism, how it works, how it improves the patient's outcomes, efficacy, challenges, limitations, and other relevant aspects, aiming to paint a picture of this alternative therapeutic approach. 

Understanding autism spectrum disorders (ASD)

Definition and prevalence of ASD

According to the American Psychological Association, ASD is the medical term for autism and defines a group of conditions related to the development of the brain:

The term “spectrum” is used because all the conditions have in common social interaction and communication difficulties, unusual, repetitive behaviours, and restricted interests, but they vary in severity of the symptoms, and intellectual status – from intellectual disability to above-average intelligence.2 Usually identified in childhood, according to The Centers for Disease Control and Prevention (CDC), autism affects 1 in 36 children in the United States and is almost 4 times more frequent in people assigned male at birth, rather than in people assigned female at birth.3

Characteristics and challenges of ASD

People suffering from ASD act differently from the rest of the people. They have difficulties in social interaction and communication because they struggle to understand how other people think and react emotionally. They rather spend time alone, avoid eye contact, present restricted interests, show repetitive behaviours, and need routine and predictability in their everyday life, because unknown events and changes in the routine can be perceived as sensory overload and trigger stress and anxiety.4

People suffering from autism may also present anxiety, depression, attention deficit disorder (ADHD), epilepsy, obsessive-compulsive disorder, and others, for example, sleep disorders.5 Intellectual disability is also a condition related to brain development, and can co-exist with autism. In the world, 3 to 5% of the population suffer from both at the same time.6 

The Autism and Developmental Disabilities Monitoring Network data shows that 32% of the children affected by autism have intellectual disability (IQ below 70 or 70); 44% have average or above average intelligence (IQ above 85); and 25% have borderline intelligence (IQ between 71 and 85). Considering that autism is a developmental disorder, signs and symptoms appear early in children and a diagnosis can be made before the age of 2.

Having a child with autism is challenging because every child is unique in presentation and severity of symptoms, and a team of specialists is needed to ensure the best possible outcome for the patient: paediatrician, child neurologist, audiologist, geneticist, psychiatrist, psychologist, occupational therapist, speech-language pathologist and even social worker in some cases.7 

Improving outcomes for individuals with ASD

Caring for a child with autism requires a team effort. Due to the social and communication difficulties these children face, psychotherapy is a key factor in reaching their best development potential, independence, and functionality later in life. Animal-assisted therapy (AAT) can be integrated into psychotherapy sessions, and studies validate the improvement it brings to the treatment and even report a reduction in autistic symptoms. AAT adds emotional, sensory, and even physical benefits for the patient.1,5 

What is animal-assisted therapy? 

Definition and goals of animal-assisted therapy

Animal-assisted therapy (AAT) is an alternative type of psychotherapy that takes place with the participation of an animal. AAT implies a therapeutic process focused on a specific goal, working towards defined outcomes, usually during around 10 sessions, and over a few weeks. The animal acts as a “co-therapist” by building a bond with the patient and creating a safe, trusting environment where the patient can open up more easily. That improves the connection with the therapist and positively impacts the therapy results.1,5,8

The goal of this therapeutic intervention is to bring “physical, social, emotional, and/or cognitive” improvements for the patient. This treatment is handled by a team of professionals involving also a physician, responsible for setting the objectives. The process is carefully planned, monitored, and documented. The animal involved in the therapy is trained for its role.9 

Types of animals used in therapy sessions

Animal-assisted therapy can involve horses, dogs, guinea pigs, and dolphins, but can also include cats, birds, ferrets, and animals from farms or zoos. “The man’s best friend” – the dog – is the most popular animal in this type of therapy, due to its natural loving and friendly behaviour. In a study, they are referred to as an “emotional bridge” to the patient. Playing with the dog makes the child more calm, more open to communication, and focused attention.

When horses are used in therapy, it is called equine-assisted therapy (EAT). Studies showed that horseback riding helped children with autism improve motor skills, and gain self-confidence. Guinea pigs used in a school setting activity also showed positive results in social interactions and behaviour.5,10,11

How does AAT work? 

Therapy animals, especially dogs, have a calming effect on patients. Due to their friendly and caring nature, dogs create this “safe space” where they offer warmth and acceptance with no judgement, laying a bright light on a stressful situation. This can alleviate stress and anxiety from a child, by lowering the heart rate and blood pressure.1,9

Even the presence of a dog in the room, and just looking at its face helps children with autism improve their social skills by activating some regions in the brain connected to reward and emotional arousal.10 For an autistic person, it’s difficult to “read” and react accordingly to other people’s behaviour. With their simple and predictable movements and reactions, animals can “train” patients to learn social cues.

The presence of a friendly dog in a therapy session is a source of visual, auditory, olfactory, and tactile stimuli. For autistic children, this multi-sensory “activation” makes them engage more easily in social interactions, but it also improves behaviour, attention, language, and communication.5,9

Efficacy of animal-assisted therapy for autism

Multisensory stimulation can have a calming effect, because of the oxytocin release. Studies show that AAT improves some psychiatric autistic symptoms, for example, hyperactivity and aggression. It can help reduce meltdowns, tantrums, and repetitive behaviours.

By not rejecting people with autism, animals make them feel accepted, and this increases their self-confidence. This brings an improvement to their behaviour, anger management, focus, and even “hidden qualities” emerge.5 Studies also revealed social interaction improvement, but also language, communication, and motor skills benefits.10 Horseback riding improves balance and coordination in children with autism.8

Practical considerations

Qualifications and training

To become an animal-assisted therapist, a person needs to be a licensed-to-practice mental health professional, for example, a psychologist, or a social worker, with further specialisation training in animal therapy. This can be obtained in various ways, via online, or graduate-level certification programs, offered by European or international organisations. Some might require even a Master's or doctoral degree in mental health or education. 

A therapy animal must pass an evaluation before “starting to work”. There are multiple models to evaluate a pet. The animal needs to reach maturity to be evaluated, for example, cats and dogs must be at least 1 year old.1

Setting up a successful AAT program 

A successful animal-assisted session is all about preparing accordingly. Each session needs to be carefully prepared ahead, including the suitability of the animal to the patient’s characteristics and particular needs, everybody’s safety, therapy goals, and session plan. Most treatments last 8 to 12 weeks, with 1 or 2 sessions a week, 15 to 60 minutes each.5,10

Safety and ethical considerations

The psychotherapist conducting animal-assisted therapy needs to acquire special training and education to be able to ethically and safely use animals in therapy. Before starting treatment with a patient, the certified animal-assisted therapist must take into consideration several factors: proper animal training and “working in therapy suitability”, patient and animal safety, including patient-animal compatibility, while respecting the Ethical Principles of Psychologists and Code of Conduct.

The preparations before the therapy also imply informed consent, and making sure the patient doesn’t have allergies, phobias, fears, past traumatic experiences, or cultural, religious, or other particular beliefs that could be related to the animal used in the sessions, in this way, affecting the patient-animal compatibility.1,12

Potential risks and limitations

An important concern is that the animal would scare, upset the patient, or trigger autistic traits, causing anger, agitation, aggression, or a meltdown. Carefully assessing the patient-animal compatibility ahead of the therapy, and considering what characteristics of the animal could represent a sensory overload to the patient, might prevent unpleasant outcomes. The risk of accident or injury is controlled, as long as the therapist follows the human-animal interaction concepts and applies the models and principles acquired during their training.

One last concern to be mentioned is the risk that the animal may transmit a disease to the patient. This is called a “zoonoses”, but animals working in this setting are considered safe to interact with, and are closely monitored by a veterinarian. Patients suffering from immunocompromising disorders should be included in AAT only after a careful assessment, and only if the benefits exceed the potential health risks.1,5,10,12

Summary

Animal-assisted therapy is a complementary form of psychotherapy that offers important benefits to people suffering from autism spectrum disorders. Cats, dogs, horses – many animals can be trained to “work” with a certified mental health professional. Animals, by their nature, are a calming and positive presence, offering acceptance, warmth, and friendship unconditionally.

The animals can “reach” the patient, they have a calming effect, reducing stress and anxiety and improving the therapist-patient connection. As therapy outcomes, autistic persons show improvements in social interactions, behaviour, hyperactivity, anger management, attention, language, communication, and even motor skills. Introducing a therapy animal in psychotherapy might work wonders for some autistic children, bridging the “emotional gap” and opening the door to positive outcomes.

References

  1. Chandler CK. Animal assisted therapy in counselling [Internet]. New York: Routledge; 2005. Available from: https://doi.org/10.4324/9780203956755
  2. Hodges H, Fealko C, Soares N. Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation. Transl Pediatr [Internet]. 2020 [cited 2024 Feb 15]; 9(Suppl 1):S55–65. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082249/
  3. Maenner MJ. Prevalence and characteristics of autism spectrum disorder among children aged 8 years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveill Summ [Internet]. 2023 [cited 2024 Feb 14]; 72. Available from: https://www.cdc.gov/mmwr/volumes/72/ss/ss7202a1.htm?s_cid=ss7202a1_w 
  4. Schipper E de, Mahdi S, Vries P de, Granlund M, Holtmann M, Karande S, et al. Functioning and disability in autism spectrum disorder: A worldwide survey of experts. Autism Res [Internet]. 2016 [cited 2024 Feb 14]; 9(9):959–69. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064728/
  5. Ang C-S, MacDougall FA. An Evaluation of Animal-Assisted Therapy for Autism Spectrum Disorders: Therapist and Parent Perspectives. Psychol Stud (Mysore) [Internet]. 2022 [cited 2024 Feb 14]; 67(1):72–81. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8907032/
  6. Verma V, Paul A, Amrapali Vishwanath A, Vaidya B, Clement JP. Understanding intellectual disability and autism spectrum disorders from common mouse models: synapses to behaviour. Open Biol [Internet]. 2019 [cited 2024 Feb 16]; 9(6):180265. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597757/
  7. Sanchack KE, Thomas CA. Autism Spectrum Disorder: Primary Care Principles. afp [Internet]. 2016 [cited 2024 Feb 16]; 94(12):972-979A. Available from: https://www.aafp.org/pubs/afp/issues/2016/1215/p972.html
  8. Friedman E, Krause-Parello C.a. Companion animals and human health: benefits, challenges, and the road ahead for human–animal interaction [Internet]. 2018 [cited 2024 Feb 14]; 37(1):71. Available from: https://doc.woah.org/dyn/portal/index.xhtml?page=alo&aloId=36892
  9. Cirulli F, Borgi M, Berry A, Francia N, Alleva E. Animal-assisted interventions as innovative tools for mental health. Ann Ist Super Sanita [Internet]. 2011; 47(4):341–8. Available from: https://www.iss.it/documents/20126/45616/ANN_11_04_04.pdf
  10. O’Haire M. Research on animal-assisted intervention and autism spectrum disorder, 2012-2015. Appl Dev Sci [Internet]. 2017 [cited 2024 Feb 13]; 21(3):200–16. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510492/
  11. Turner J. Animal Assisted Therapy and Autism Intervention: A Synthesis of the Literature. Research Papers [Internet]. 2011. Available from: https://opensiuc.lib.siu.edu/gs_rp/119
  12. Fine AH. Handbook on Animal-Assisted Therapy: Foundations and Guidelines for Animal-Assisted Interventions [Internet]. 4th ed. Academic Press; 2015 [cited 2024 Feb 17]. p. 151-152. Available from: https://books.google.ro/books?id=0eacBAAAQBAJ&pg=PA151&lpg=PA151&dq=Fine%E2%80%99s+(2015)+%E2%80%9CGuidelines+for+Incorporating+Animals+in+AAT%E2%80%9D&source=bl&ots=FsC5SRYZTq&sig=ACfU3U19LE7A1WNgRDQQsBFVTS-O1aWZgA&hl=ro&sa=X&ved=2ahUKEwjUravqpLKEAxU48QIHHRBwDrcQ6AF6BAgaEAM#v=onepage&q=Fine%E2%80%99s%20(2015)%20%E2%80%9CGuidelines%20for%20Incorporating%20Animals%20in%20AAT%E2%80%9D&f=false.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Adriana Roxana Bota

Doctor of Medicine - MD, Medicină, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca

Adriana Bota is a medical doctor interested in medical genetics, effective communication, and medical writing. After graduating from "Iuliu Hatieganu" Medicine and Pharmacy University in Cluj-Napoca, Romania, she worked for 3 years as a medical genetics resident at the Clinical Emergency Hospital for Children and gained laboratory and clinical experience.

Recognizing the critical role of clear and accessible communication in healthcare, Dr. Bota also studied professional coaching, focusing on mental health. As a medical writer, she is committed to delivering medical information efficiently, leveraging her expertise to ensure that medical knowledge is accessible to all.

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