honors undergrad thesis
TRANSCRIPT
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Running head: A REVIEW OF ANIMAL-ASSISTED THERAPY
A Review of Animal-Assisted Therapy
Sara H. Tischler
Michigan State University
Honors Capstone Paper
2011
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Abstract
Despite increasing interest in alternative therapies, there is insufficient research in the area
of animal-assisted therapy. Much of the current research has had similar results: that there is
not enough solid evidence to make an accurate conclusion and that more research needs to be
done. However, there have been several studies that show some promising results. Through this
literature review, it can be concluded that there are definite benefits to the use of animal-assisted
therapy, but that more work needs to be done in order to reach a more definite conclusion.
Animal-assisted therapy can be particularly beneficial to individuals on the autism spectrum,
but it is unclear how or why this works and the amount of empirical evidence is relatively low.
This literature review will cover the effects of animal-assisted therapy in a variety of context, but
focus mainly on autism spectrum disorders.
Keywords: animal-assisted therapy, autism, developmental disorders
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Introduction
Alternative medicine is defined as any practice that is used with the intention of healing
and that is not currently within the realm of traditional medicine. The World Health Organization
defines traditional medicine as:
The health practices, approaches, knowledge and beliefs incorporating plant, animal and
mineral-based medicines, spiritual therapies, manual techniques and exercises, applied
singularly or in combination to treat, diagnoses and prevent illnesses or maintain well-
being. (Fact sheet no. 134)
With the passing of time, enormous advances in medical technology have been made, and many
interesting ideas for alternative medicine have come about as a result. Some of these have been
controversial and perhaps even potentially dangerous, while others have been tested and retested
with promising results. One fascinating example of an alternative therapy is animal-assisted
therapy, or AAT. AAT involves the use of an animal (typically a dog but horses, dolphins,
birds, and other animals can be used) to promote the physical and psychological well-being of
a patient. AAT can constitute therapy in the traditional sense of the word but can also include
pet ownership. It can be provided on an individual or group basis. The animals must possess
a specific set of characteristics, such as good temperament and lower energy levels, which are
beneficial to the well-being of the patient and can be smoothly integrated into the individual or
groups treatment plan.
Animal-assisted therapy has been widely praised for its ability to help patients with a
large variety of disabilities, illnesses, and physiological conditions. Most of the information of
the effect of AAT has been patient, family, or therapist testimonies. There have been relatively
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few empirically-based studies conducted on AAT and many of these have been inconclusive.
Perhaps this is because AAT is a fairly new and ever-growing field. Isolated incidents of using
animals for therapeutic purposes occurred during World War II but it wasnt until the 1970s that
the use of animals for therapeutic purposes was not fully established, and the first non-profit
organization dedicated to this endeavor was founded in 1977. The Delta Society is a national
non-profit that incorporates therapy and companion animals into the lives of patients. To become
fully trained in AAT and work for the Delta Society, students must take a course taught by a
certified healthcare professional. Practical applications are taught and the students engage in role-
plays and exercises with the animals. To be sponsored by the Delta Society, therapists must
register with the organization and make an effort to keep up with the latest research through
conferences and additional courses (Delta Society, 2009).
There are many hypothesized benefits of animal-assisted therapy, mostly dealing with
autism spectrum symptoms, medical problems, behavioral issues, and emotional and
psychological well-being. In the 19th century, Florence Nightingale hypothesized that the
presence of a bird in a hospital units kept the patience occupied and happy (Nimer & Lundahl,
2007). Animals have been thought to promote human well-being and physical health for years.
For example, patients get much needed exercise when walking or playing with an animal, and
caring for animals can lead to increased responsibility. Interaction with the animals can give
patients a feeling of companionship, which leads to increased overall happiness.
The following is a review of the current literature on animal-assisted therapy and pet
ownership. The results of each study will be discussed at length, and the potential positive and
negative consequences of AAT will be extensively detailed. While there is likely not enough
evidence at this point to make a solid conclusion as to the potential benefits or risks of AAT, this
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review will attempt to cover as much of the information currently available as possible. This
should aid the field in reaching a fuller understanding of AAT and promote further research.
Effects of Animal-Assisted Therapy and Pet Ownership on Physiological Health
Research has examined the relationship between pet ownership, animal-assisted therapy,
and physiological health. A study by Friedmann et al. (Friedmann, Katcher, Lynch, & Thomas,
1980) focused on the effects of pet ownership on patients with cardiovascular illnesses after
being released from the coronary unit of a hospital. 92 patients with a diagnosis of myocardial
infarction or angina pectoris were first interviewed in the hospital using an inventory of social
data and psychological mood status. Pet ownership was included in the interview. After a year,
fourteen of the patients had died. The physiological health of the remaining patients was
evaluated. Of the 39 patients who had reported owning pets, 11 died. Only 3 of the 52 pet
owners died within the year. After a year, the average physiological severity score of pet owners
was a 2.0 on a 6 point scale. These results suggest that animal affiliation and companionship has
important health effects.
In Australia, a study was conducted in which the health of pet owners was screened in
comparison to individuals without pets. It was found that the risk factors related to
cardiovascular health were noticeably lower in pet owners (Anderson, Reid, & Jennings, 1992).
A follow-up study, however, found no correlation between decreased risk and pet ownership
(Headey, 1999). One reason for this discrepancy could be the different methodologies of the
studies. A later study found that pet owners tended to be in better health than those without pets
(Jorm & Parslow, 2003). This information was obtained from records of physician visits and
medication history. These studies could potentially aid in the understanding of AAT, but the
results are so varied that it is difficult to reach a conclusion. More research needs to be done, and
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it needs to be carried out carefully and methodically in order to obtain meaningful results.
Effects of Animal-Assisted Therapy on Psychological Well-Being
Research has examined the relationship between animal-assisted therapy and human
psychological well-being. It has shown to improve self-esteem and feelings of security, reduce
stress and anxiety, and increase the rate of social interaction and communications (Barba, 1995).
While animal-assisted therapy does lead to better psychological functioning, it is questionable as
to whether or not this is a benefit exclusive to AAT. In a study by Sandra Barker, Ph.D. and
Kathryn Dawson, Ph.D., 313 adult psychiatric patients were referred for therapeutic recreation
over an eight-month period and attended both an animal-assisted therapy group session and a
therapeutic recreation group session. At the beginning and the end of each session, the therapists
administered the State-Trait Anxiety Inventory. The decrease in anxiety after AAT was twice as
great for patients with mood disorders, psychotic disorders, and other disorders than after other
forms of recreational therapy. The researchers suggested that this was due to the heavier
demands of traditional recreational therapy. AAT was easier on patients with psychotic disorders
and was therefore more effective. The researchers also emphasized the importance of repeated
studies. Their methods included only one day per week of AAT, and it is recommended that
more frequent exposure be studied, as it may have a greater impact on participants (Barker &
Dawson, 1998).
Animal-assisted therapy and pet ownership have also shown promising results among the
aging population. For example, married white females were found to be happier when they rated
their level of animal attachment at a five (very attached) (Banks, 2002). 45 residents were
administered the Demographic and Pet History Questionnaire and the UCLA Loneliness Scale.
They were randomized into three groups with varying levels of AAT. One of these groups
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received no AAT whatsoever. The participants were then retested at the end of the study. An
interesting finer point of this study was that those of lower socio-economic status (SES) were
unhappier having pets than those of higher SES. In a follow-up study, it was found that, at the
end of a one-hour AAT session, participants in a long-term care facility for the elderly were
restless and tired. However, all of the residents interviewed had a strong desire for more animal
interaction in their lives, and their feelings of loneliness decreased as a result of the therapy.
Levinson, seen as the father of animal-assisted therapy, conducted studies on young
children in educational contexts. He found that the presence of a therapy animal, in this case a
dog, stimulated social interaction between the child and the human therapist, making for a more
relaxed environment (Levinson, 1969). Levinson discussed the use of a companion animal as a
therapeutic adjunct, finding that an animal decreases the shock of beginning the therapeutic
process and helps the participant become more comfortable with the human therapist. Levinson
also found, however, that the presence of an animal has negative consequences as well. The
patient, especially a child, may feel resentment at having to share the animal with the therapist,
or may feel that the animal has unwillingly been imposed upon him or her.
The most well-known incorporation of animals into the learning environment is the
Reading Education Assistance Dogs program in Salt Lake City, Utah. The program was founded
in 1999 by Intermountain Therapy Animals, who found that all of the students who participated
for 13 months gained at least two grade levels. The researchers suggested that this was due to the
comfort level of the children. The dogs seemed to be a catalyst to reading aloud, something the
children were afraid to do before the implementation of the program. The presence of the dog
also added an element of fun, which promoted relaxation and helped the children forget their
perceived limitations (Bueche, 2003). Similar results were obtained in the Carolina Canines for
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Service program. A group of children who tested below grade level for reading ability were
paired up with a therapy dog once a week for the entire school year. Most of these children
improved their reading level by at least two grade levels (Newlin, 2003). The results of this
particular study, however, are questionable at best, due to the lack of a control variable.
Effects of Animal-Assisted Therapy on Children with Autism Spectrum Disorders and other
Developmental Disabilities
The current literature on the use of animal-assisted therapy and animal-assisted activities
(including pet ownership) on children with autism spectrum disorders (ASD) and other
developmental disabilities shows promising results. A study on 68 children found that nearly half
of them named their pets as a source of emotional support (Melson & Schwartz, 1994). The
children reported that they could tell their pets when they were sad, angry, happy or wanting to
share a secret. Their parents stated that the children were less anxious and withdrawn than other
children as a result of having an animal in the home. Another study found that children who
reported that they had intimate talks with their pets had more empathy toward their peers
(Bryant, 1985). Thus, pet ownership has shown to be particularly useful for children on the
autism spectrum, as a lack of empathy is a common characteristic of the disorder.
While children, especially those with developmental disorders, can be reluctant to open
up to adults and discuss their feelings and problems, and animal-assisted therapy may ease
their stress and anxiety and help them to open up (Fine, 2000). Children might observe the
amount of care the therapist gives to the therapy animal and feel more comfortable and cared
for themselves. In addition, research has shown that the mere presence of a therapy animal can
support inclusion in classrooms. In one study, children without disabilities were ten times more
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likely to interact with a disabled peer if that peer was accompanied by their therapy animal
(Katcher, 1997). This gives support to the idea that therapy animals are an effective social
lubricant.
It is possible that animal-assisted therapy may help children on the autism spectrum
increase attachment and establish bonds with others (George, 1988). The children may transition
from an attachment with the animal to an attachment with a human being, typically their
caregiver (Winnicott, 1986). Because of the difficulties children with developmental disabilties
may have with social interaction, AAT could prove highly effective for them. Children in
particular could benefit from the use of animals as an alternative therapy. Triebenbacher found
that animals are a key part of social development in children (Triebenbacher, 2000). Because
pharmacological methods and many educational therapies have not been effective for all, many
parents and caregivers have turned to alternative treatments. Early research supports using AAT
as a treatment; it was found to increase the rate of pro-social behaviors in children on the autism
spectrum, as well as decrease self-absorption (being in their own world or obsession with
narrow interests) (Redefer & Goodman, 1989).
School is a large part of a childs day, and it also has perhaps the biggest influence on
children, particularly those with developmental disabilities. While it is likely that school staff
and administrators may not be fully supportive of animals in the school setting, AAT is possible
for children in school and can also be helpful not just for the child but for his or her peers. The
children can learn about the animals and about how to treat them, as well as how much they can
help people. While AAT can help the participant with discipline and self esteem, it can do the
same for the children observing these interactions. AAT teaches responsibility in many forms;
children learn to care for an animal and treat it with kindness as well as to work on their therapy
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goals and gain motivation and knowledge (Chandler, 2001).
In a study done by Griess in 2010 on participants with learning disabilities, the children
stated that they were more motivated to read and had positive feelings about interacting
with the therapy dog. Children with autism who may feel unmotivated due to ridicule or a
misunderstanding of their disability may gain some encouragement from the use of a therapy
animal, and perhaps an increase in self-esteem that naturally will lead to greater success.
Animal-assisted therapy can provide children with a source of unconditional love and an outlet
for the expression of emotions (Griess, 2010). A study by Sams et al. in 2006 compared the
effects of AAT on children with autism to those of traditional occupational therapy techniques.
The researchers hypothesized that AAT would have more of an impact in the areas of social
interaction and language use. They found that, when children participated in AAT, they
exhibited greater use of language and social interaction than they did when exposed to traditional
occupational therapy practices. The authors of this particular study even went as far as to say that
AAT should be standard practice for children and families living with autism spectrum disorders.
Another characteristic of autism is stereotypical, repetitive behavior. These are often
referred to as self-stimulating behaviors, or stims. Examples of stimming include hand
gestures, humming, and rocking back and forth. Some of these, such as head banging, can be
dangerous to the child. In a study by Redefer and Goodman, a therapy dog was introduced to
sessions with children on the autism spectrum. It was found that the rate of stereotypical
behaviors decreased after the introduction of the dog, and the rate of socially appropriate
behaviors increased (Redefer & Goodman, 1989). Children with autism can also have deficits in
motor and language skills, as well as emotional control.
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One pilot study in the realm of occupational therapy examined the amount of social
interactions and language use when animals were incorporated into therapy (Sams, Fortney, &
Willenbring, 2006). Twenty-two children with autism participated in the study, and they
received school-based therapy twice per week; once with animals and once without for control
purposes. The children were observed by trained research assistants, who recorded each instance
of social interaction and language use. These instances were classified as either spontaneous
or prompted. The results of the study were obtained using paired-samples t-tests and indicated
that both use of language and social interactions were significantly more common in the sessions
which incorporated an animal. This seems to support the idea that AAT is a beneficial addition
to the lives of children with autism, particularly those that are struggling with deficits in the
areas of language and social interaction.
A study by Martin and Farnum focused on ten children with ASD between the ages of 3
and 13. The children were assessed using the Psycho-educational Profile-Revised, a highly
reliable and valid measure. The PEP-R measures imitation, perception, fine motor control, gross
motor control, hand-eye coordination, cognitive performance, and verbal performance. These
combined measures are used to pinpoint a childs developmental age, and are related to a typical
autism diagnosis. When AAT was incorporated into the childrens treatment, scores on this
assessment increased. In addition, the children laughed more and appeared to be happier and
more relaxed when the therapy dog was present. This study, while lacking in generalizability due
to the smaller sample size, lends support to AAT and its usefulness for children with ASD and
developmental disabilities (Martin & Farnum, 2002).
In another study, fourteen students on the severe end of the spectrum of developmental
disabilities were exposed to animal-assisted therapy in addition to their regular treatment plan at
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a residential facility (Heimlich, 2001). The students were seen for a half an hour each, twice per
week, with a trained animal handler and therapy dog. After evaluating the behavioral outcomes
of the participants using the Measurement of Pet Intervention (created specifically for this
study), it was evident that the data indicated a positive effect in the areas of cognitive
functioning and positive behavior. However, the research team was still unable to draw a solid
conclusion due to a number of confounding variables. Inter-rater reliability was relatively low, as
the opinions of the three research assistants as to the success of the therapy varied.
Administrative support at the residential facility was not as high as the researchers would have
liked. A major issue that came up during the course of the study was the health and well-being of
the therapy animal. Cody, a black Labrador retriever, suffered from a weakened immune system
due to the stress of the therapy sessions and eventually fell ill. He was responsible for all
fourteen sessions and had very little time in between sessions. This brings to light the importance
of having multiple trained and certified therapy animals available. While it is perhaps more
beneficial to have one animal per participant, this does not rule out the possibility of having
different animals for different participants. An additional concern that the researchers had was an
ethical one. They did not find it appropriate to separate the animal and participant as soon as the
therapy sessions were terminated. It is probable that each participant will develop some sort of
emotional bond or relationship with their therapy animal, and the research team suggests that
meetings be planned on an intermittent basis and in a less structured and formal environment
A more unique example of the use of animals in therapy for children with developmental
disabilities is to use them to help with debilitating shyness. A common symptom of autism is
social anxiety and the inability to read social cues. Children with autism can have a large amount
of difficulty in school because of this. The use of therapy animals has been shown to help people
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overcome their shyness. The children can interact with the animal, perhaps by speaking or
reading to it, and use it as practice for communicating with other human beings.
Dogs are not the only viable option for animal-assisted therapy. Other animals,
particularly horses have proven effective therapeutic tools for children with autism. A study by
Bass, et al. worked with existing research to determine the effects therapeutic horseback riding
had on children with autism spectrum disorders, particularly in the social domain of functioning
(Bass, et al., 2009). Therapeutic horseback riding has been defined as using horseback riding to
improve the participants posture, balance, and mobility while helping them to form a
therapeutic bond with the animal, potentially leading to improved social skills (All & Loving,
1999). It is best suited for children with a combination of motor, cognitive, and social difficulties.
Research in the area of therapeutic horseback riding is limited, just as it is for AAT with
a canine. It consists mostly of case studies and anecdotal evidence, as opposed to empirical
studies. Bizub and Bizub (2003) studied the effect of horseback riding therapy on five adult
patients with psychiatric disabilities. The therapy, which was divided into animal bonding
activities, riding skills, and post-ride processing activities with the group, resulted in an increase
in the participants self-esteem, as well as their levels of social engagement and self-efficacy.
This was measured through interviews conducted with both participants and guardians before
and after the therapy took place. They were scored for thematic content such as social skills and
self-esteem by a team of trained researchers.
Macauley and Guiterrez in 2004 studied the effect of horse-assisted therapy on
children with language impairments. The goals of each participant were increase their receptive
and expressive language skills. After the therapy sessions, the parents of the participants reported
that there was an increase in speech and language abilities in their children. When compared to
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traditional therapies, the researchers found that horse-assisted therapy was more successful in
improving the self-concept of the participants. They formed relationships with each other as a
group, as well as with their therapy animal. They also became increasingly confident in their
riding abilities as the therapy progressed, challenging their initial doubts about their abilities.
The riders were able to recognize that they had met their early fears of riding head on, which
seemed to please them. They developed a sense of respect and empathy for animals throughout
the course of therapy, and reported feeling encouraged by the staff and volunteers. Despite these
promising results, this study was conducted on only three young boys, which is obviously not an
accurate representation of the population of children with language impairments or
developmental disabilities.
In regards to motor functioning, an area in which some children on the autism spectrum
have difficulty, Sterba et al. (2002) ran an eighteen-week study to determine if horse-assisted
therapy would have any effect. The researchers split gross motor functioning into five domains
including lying and rolling, sitting, crawling and kneeling, standing and walking/running, and
jumping. It was determined through this study that horse-assisted therapy had a significant
positive impact on all five of these domains
The aforementioned study done by Bass et al. examined the effects of a twelve-week
therapeutic horseback riding program on the social functioning of children with autism. It was
hypothesized that these children would exhibit improvements in their social functioning when
compared to participants who did not receive this particular therapy. A highly trained staff at a
therapeutic riding center was responsible for administering the therapy and sessions were held
one hour per week for a period of 12 weeks. Horse assignments were randomized except in cases
were height and weight adjustments had to be made. Participants engaged in mounting and
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dismounting exercises, riding skills, horsemanship, and playing games while on the horse.
During the course of these activities, the children were expected to form a therapeutic bond with
their assigned horse. At the end of the program, there was an observed increase in social
functioning, as coded by trained researchers, but this may have been due to a number of different
factors. First, exposure to a horse, a relatively novel creature for most children, could have been
what stimulated the children. The introduction of a novel stimulus may have encouraged children
to move away from the more rigid and routine lifestyle that typically comes with autism
spectrum disorders and become more active both physically and socially. Riding a horse is a
multisensory experience, and children with sensory-processing difficulties that are often
associated with autism may have found this particularly stimulating. The environment of the
sessions was highly structured (participants were instructed to listen and follow directions, speak
to and give instruction to their horse, and identify parts of the horse) and this may have
encouraged children to become actively engaged in the activities and maintain this involvement
for extended periods of time. The treatment effects in the areas of fine motor and perceptual
skills, social cognition, and social awareness, however, were not statistically significant. It is
possible that, had the therapy lasted longer than 12 weeks, these results would have improved. It
is also important to note that no information on medication regimens was collected, nor was
parent therapy information, and thus there were some possible confounding variables that could
not be controlled for.
Dolphins have also been used in animal-assisted therapy, but this is an area in which
there is very little research. The use of wild animals such as dolphins is fairly rare as it is, for the
most part, inaccessible, expensive, and highly unpredictable. The major exception to this is the
use of the dolphin. Swimming with dolphins is not as dangerous and has become more feasible
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and accessible to families (Capaldo, 1989). Using dolphins to help people with psychological
disorders dates back to the 1970s, when people realized the healing potential of swimming with
the animals (Cochrane & Callen, 1992). In Betsy Smith, PhDs book, Between Species:
Celebrating the Dolphin-Human Bond(2003), she discussed her work with dolphin-assisted
therapy and children with autism. She reported that the attention spans of the children increased,
and in her 1980s writings, reported that children with autism began reaching out and touching
the dolphins spontaneously within minutes of therapy beginning. Interactive play behavior was
also observed more frequently after the introduction of dolphin-assisted therapy (Smith, 1987).
Dave Nathanson was the first to coin the term dolphin human therapy and he had some
intriguing findings. He studied both verbal and nonverbal children with developmental
disabilities and observed their behavior before and after dolphin-assisted therapy sessions.
Nathanson developed a series of controlled language experiments using dolphins as the teachers.
The goal was to increase sensory stimulation and attention, leading to increased rates of learning.
He found that nonverbal children were four times more likely to respond in some way to the
dolphin than to a parent, and that verbal children improved their vocabulary by up to 13% after
therapy (Nathanson, 1980). When attempting to replicate these results several years later, he
found that children were able to learn information 2 to 10 times faster with greater retention as
compared to the classroom (Nathanson, 1989). This was a six-month study with the same goal of
improved functioning among the children. It was a one-group, reverse-treatment design with
both a pretest and a posttest, and involved interactions with the dolphins from both the dock and
in the water. Parent surveys were collected before and after treatment. It validated the original
study and served as the basis for a treatment program involving dolphins. In 1997, Nathanson
and his colleagues conducted a study involving more children with autism among other
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disabilities. It was very similar in design to the study done in 1989, except this time behaviors
were charted from direct observations and more precautions were taken. For example, the water
temperature was repeatedly measured and the same dolphin and therapist was used every time.
The goal was to see if dolphin-assisted therapy could achieve the same or better results than six
months of traditional therapy. The results showed significantly greater improvement amongst the
children when DAT was utilized, and they also concluded that it was a more cost-effective
option (Nathanson, deCastro, Friend, and McMahon, 1997). Marino and Lilienfeld argued that
there were flaws in the previous studys data and thus their conclusion was premature. They
claimed that the validity of the study was threatened by the natural maturation of the participants,
and thus that Nathanson and his colleagues misinterpreted the results of their study and their data
could not be properly interpreted (Marino and Lilienfeld, 1998).
Other studies have had less promising results. Research done by Servais assessed the
interactions between children with autism and therapy dolphins. The Autidolfijn project was
designed to see if simply swimming with dolphins caused increased learning in children with a
diagnosis of autism. The project consisted of two pretest and posttest designs with a control
group, and the observations were videotaped for coding purposes. The results were inconclusive.
While one group of children displayed some benefits of working with the dolphins, it is highly
possible that they had a better relationship with the human therapist than they did with the actual
animal. Any positive changes were only seen when the child and the therapist had bonded.
Servais suggested that more research be done, and that it is more carefully organized.
Standardized experimental designs should be utilized and the scientific method should be strictly
adhered to (Servais, 1999).
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One issue with dolphin-assisted therapy is that dolphins have been found to prefer the
company of children to that of adults. They keep more distance between themselves and the
adult subjects (Brensing and Linke, 2003). A similar study was conducted in 2005, and it was
found that limited space affected the dolphins attraction to the swimmers and thus the quality of
therapy they were able to provide. The need for large, open spaces and greater distance between
the animal and the participant could negatively affect the outcome of dolphin-assisted therapy
and make it less effective or even ineffective (Brensing, Linke, Busch, Matthes, and Eke van der
Woude, 2005). This is particularly difficult because the therapy will be ineffective if too little
space is provided as well. The perfect amount of space must be determined and provided in order
to make DAT effective, and this is a unique difficulty not encountered in therapy with other
animals.
Potential Concerns of Animal-Assisted Therapy
A common concern to therapy animals in hospitals, schools, and other settings is that of
sanitation. An animal could be a carrier of diseases and infections transmitted from animals to
humans. This is of particular concern in hospital settings. Research has concluded that, while this
risk is certainly present, it can be completely avoided if responsible safety measures are taken
(Brodie, Biley & Shewring, 2002). These safety measures include having everyone involved
wash their hands before and after each visit, providing one-time use barriers such as pads for
the animals to sit on, and adhering to strict grooming and health care measures for every animal.
Therapy animals are also trained not to lick or scratch participants as this is a major way of
spreading infection. They have regular veterinary checkups and are kept in good health. While
trained not to, dogs can occasionally urinate or defecate in the hospital or school environment.
The responsibility of properly cleaning this up lies with their handlers, and they are trained to do
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so thoroughly and quickly. Allergic reactions to the animals are also a possibility. To minimize
the potential for allergic reactions, therapy animals are bathed and groomed immediately before
visiting with participants, and staff is requested to report specific allergies of the participants so
that proper accommodations can be made. This can include holding sessions in large, airy spaces
or outdoors, or simply reducing amount of time the participant is in contact with the animal. The
health and well-being of the animal is also a concern, and every effort should be made to ensure
that the animal is kept relatively stress-free. This includes having multiple therapy animals on
hand for different participants and a decent amount of time between sessions for the animal to
take a break and relax for a period of time.
General safety is another major concern, and this is addressed in therapy animal training
programs. Every animal must graduate from basic obedience classes as well as more specialized
training courses. They are tested for aggression towards humans or other animals and are trained
to stay calm and collected. Therapy animals are trained to the point that they are capable of
coping with situations that would irritate a typical animal or family pet. In some cultures
however, some animals, particularly dogs, are seen as unclean or uncivilized. It is up to the
professionals to determine whether or not the presence of a therapy animal is acceptable to all
participants. It is important that these matters are discussed in a way that is culturally receptive
and respectful. It has been found that, although not all cultures consider dogs to be acceptable
companions, a childs response to them can still be positive and helpful. It is important that
everyone involved keep an open mind. A related concern is that some participants or staff
members might have a fear of dogs or other animals involved in therapy. It is recommended that
professionals refrain from forcing the issue. If necessary, frightened children can stay a good
distance away from the animal and observe its interaction with others. This will allow the child
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to realize that animals are capable of being gentle and loving, and can help reframe their fears
into more positive mindsets.
With the growing recognition of animal-assisted therapy as a legitimate means of helping
people, it is important that professionals and participants alike educate and prepare themselves.
Handlers should ensure that their animals are properly trained and certified, as well as in good
health with up-to-date vaccines and tests. Handlers themselves should also be trained and
certified, and must pass a background test, a TB test, and several other clearances. Risk and
liability concerns should be minimized. Children and other participants should be properly
prepared for their visit with a therapy animal. They should be instructed on how to treat and
handle an animal, and taught to keep the animals safety and well-being in mind. Handlers
should be alert and keep their eyes open for any threatening or unsafe situations that could arise
during the therapy session. Everyone involved should stay calm and be responsible. In todays
society, it is also likely that handlers will have to sign into the building they are visiting and
possibly be screened.
A final concern of note is the cost of animal-assisted therapy. Hiring and training
handlers and animals is a lengthy process, and caring for the animals properly while at the same
time ensuring the handler is compensated can be difficult. Many families have already depleted
their resources on other therapies and treatments, and AAT may not be seen as an option to
them. It is important that every effort be made to help and accommodate families in need,
especially if AAT will be a beneficial and worthwhile part of their childs treatment.
Discussion
It is clear that there is a significant amount of evidence in favor of animal-assisted
therapy, particularly with children on the autism spectrum. However, AAT is a relatively new
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phenomenon that may or may not be right for all children. It is imperative that more research be
done on AAT. A majority of the studies discussed in this review lack scientific control, and
much of the information gleaned has been anecdotal or qualitative rather than quantitative. It is
important that the scientific method is adhered to as more investigating is done on AAT.
There were some significant limitations to the studies discussed. Besides the fact that
there is simply not enough research, many of the studies discussed are not empirical or unbiased.
There are a significant amount of discrepancies among the studies. For example, Anderson,
Reid, and Jennings (1992) had very different results than those found by Headey (1999). This is
due mostly to the different methodologies used by the researchers. The research is inconsistent.
Many of the studies had a very small number of participants, and the sample size was often not a
good representation of the population. This leads to a lack in generalizability. A number of
studies were affected by the natural maturation of the participants, and thus the data is
inconclusive. Overall, the research has been sloppy must consistently adhere to the scientific
method in the future in order to receive higher quality data.
In addition, there is the question of whether or not the benefits found in the studies are
exclusive to animal-assisted therapy. The same benefits could be taken from a variety of other
therapies, but since a majority of the studies discussed failed to appropriately compare and
contrast AAT to other types of therapies, it is unclear. What is also unclear is why AAT seems to
work. Researchers have questioned whether it is simply because of exposure to the animal, or if
a specific bonding process takes place. The full experience of AAT must also be taken into
consideration. The participants may bond with the human therapist over the animal therapist, and
it may be the sensory experience that elicits a change in behavior.
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Katcher (2000) notes that it is unknown whether or not responses to the animal are being
conditioned by the behavior of the owner or therapist, which could be a major flaw in the
therapy. Another issue is the possibility that simply owning a companion animal is as beneficial
to health and well-being as actively participating in animal-assisted therapy. A study done in
South Africa analyzed participants blood before and after interaction with both a pet dog and an
unfamiliar dog. The researchers came to the conclusion that there was a positive impact under
both conditions (Odendaal, 2001), and thus the need for human therapists may not be as great as
believed.
There is a definite need for more and better research in the area of animal-assisted
therapy. A set of standards must be consistently adhered to, and the scientific method should be
followed. Researchers should be unbiased and assistants should be properly trained. More effort
and time should be put into studies, as well as more thought and consideration as to possible
confounding factors and issues that may arise. The research discussed could use a great deal of
fine-tuning, and it should be used as an example of how to improve research on AAT in the
future.