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Animal-Assisted Intervention for Autism Spectrum Disorder: a Systematic Literature Review

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Animal-Assisted Intervention for Autism Spectrum Disorder: a Systematic Literature Review J Autism Dev Disord (2013) 43:1606–1622 DOI 10.1007/s10803-012-1707-5 ORIGINAL PAPER Animal-Assisted Intervention for Autism Spectrum Disorder: A Systematic Literature Review Marguerite E. O’Haire Published online: 5 November 2012 Ó Springer Science+Business Media New York 2012 Abstract The inclusion of animals in therapeutic activi- inclusion of animals in therapeutic activities is known as ties, known as animal-assisted intervention (AAI), has been animal-assisted intervention (AAI), which encompases suggested as a treatment practice for autism spectrum both animal-assisted therapy and animal-assisted activities disorder (ASD). This paper presents a systematic review of (Griffin et al. 2011; Kruger and Serpell 2010). It dates back the empirical research on AAI for ASD. Fourteen studies to the late eighteenth century when animals were brought published in peer-reviewed journals qualified for inclusion. into mental health institutions to increase socialization The presentation of AAI was highly variable across the among patients (Serpell 2006). Its current implementation studies. Reported outcomes included improvements for has been related to positive treatment outcomes in a multiple areas of functioning known to be impaired in number of clinical populations, including improved phys- ASD, namely increased social interaction and communi- ical health and psychological well-being in Alzheimer’s cation as well as decreased problem behaviors, autistic patients (Edwards and Beck 2002), increased social func- severity, and stress. Yet despite unanimously positive tioning in patients with schizophrenia (Barak et al. 2001), outcomes, most studies were limited by many methodo- and reduced aggressive and pathological behaviors among logical weaknesses. This review demonstrates that there is children with conduct disorder and attention-deficit preliminary ‘‘proof of concept’’ of AAI for ASD and hyperactivity disorder (Katcher and Wilkins 1998). highlights the need for further, more rigorous research. Recently, autism spectrum disorder (ASD) has been high- lighted as a target population that may benefit from AAI Keywords Animal-assisted intervention (Esposito et al. 2011a). Á Animal-assisted therapy Autism Children The rationale for including animals in ASD treatment Human-animal interactionÁ SocialÁ functioningÁ stems from a multi-disciplinary field of research known as Á anthrozoology, or human-animal interaction (HAI), which encompasses ‘‘the mutual and dynamic relationships Introduction between people and animals and the ways in which these interactions may affect physical and psychological health Interacting with animals can enhance psychosocial well- and well-being’’ (Esposito et al. 2011b, p. 3). HAI theory being (O’Haire 2010). Documented benefits include suggests that many humans seek out contact with animals reduced stress, lowered heart rate and blood pressure, as calming and non-judgmental sources of support and reduced loneliness and isolation, increased social interac- facilitators of social interaction (Kruger and Serpell 2010). tion and connection, and increased socio-emotional func- Particularly for socially isolated individuals such as those tioning (e.g., Friedmann and Son 2009; Wells 2009). The with ASD, animals have been speculated to offer a unique outlet for positive social engagement. It has further been suggested that social aversion among individuals with ASD M. E. O’Haire (&) may be human-specific and does not necessarily extend to School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia animals (Johnson 2003). Laboratory based studies have e-mail: [email protected] demonstrated that children with ASD tend to prefer 123 J Autism Dev Disord (2013) 43:1606–1622 1607 pictures of animals over humans and inanimate objects Despite the use of AAI for ASD and its potential pop- (Celani 2002; Prothmann et al. 2009). In a meta-analysis of ularization through anecdotal media, there has been no 49 studies of AAI for a range of populations, Nimer and comprehensive review of its empirical research base. Lundahl (2007) deduced four key areas of improvement Therefore, the purpose of this review is to move beyond from AAI, including autism-spectrum symptoms, medical anecdotal accounts by presenting a comprehensive over- difficulties, behavioral problems, and emotional well- view of empirical research on AAI for ASD. The goal is to being. They concluded that AAI may be a promising systematically identify, summarize, and evaluate any additive to established interventions for children with existing empirical studies of AAI for ASD in order to ASD; however, only 4 of the 49 reviewed studies included document currently researched AAI practices and their participants with ASD. The limited number of studies in reported findings, as well as to provide directions for fur- their review is attributed to the exclusion of most studies ther, more rigorous research. The specific aims are to: based on methodological weaknesses, which are common (a) describe the characteristics of AAI for ASD, (b) evalu- among AAI research. The shortage of robust scientific ate the state of the evidence base, and (c) summarize the research on the topic has led to criticism of a reliance on reported outcomes of AAI for ASD. anecdotal evidence (Griffin et al. 2011). Indeed, anecdotal reports of AAI for ASD are pervasive and subjectively positive. Pavlides (2008) compiled a Methods handbook of predominantly anecdotal evidence of AAI for ASD, which taken together suggests that AAI can assist Protocol individuals with ASD to develop sensory and social skills, manage problem behaviors, and improve quality of life. The preferred reporting items for systematic reviews and Anecdotal cases are also highlighted in popular media such meta-analyses (PRISMA) guidelines were consulted to as news stories, biographical novels, and films of individ- perform this systematic review (Liberati et al. 2009; Moher uals with ASD whose connection with animals leads to et al. 2009). The study procedures were defined a priori in a improved social functioning and quality of life. Examples study protocol that specified the search strategy, inclusion include The horse boy (Isaacson 2009), A friend like Henry and exclusion criteria, and data extraction items. (Gardner 2008), and Songs of the gorilla nation (Prince- Hughes 2005). The work of Temple Grandin, a world- Eligibility Criteria renowned animal behaviorist with ASD, has also received a great deal of attention through her books, such as Animals The following inclusion criteria were used to select rele- in translation: Using the mysteries of autism to decode vant articles for review: (a) publication in English in a animal behavior (Grandin and Johnson 2005), and her peer-reviewed journal, (b) collection of original, empirical reports of the benefits of animals for some individuals with data on AAI, which was defined as any intervention that ASD, including herself (Grandin 2008, 2010, 2011). intentionally incorporated a live animal, and (c) reporting Whether these cases are unique or indicative of a replicable of results for participants with a diagnosis on the autism phenomenon is the subject of growing inquiry. Their spectrum, including autism, autism spectrum disorder influence on ASD treatment selection is currently (ASD), autistic disorder, asperger’s disorder, or pervasive unknown; however, it has been suggested that media por- developmental disorder not otherwise specified (PDD- trayals of AAI with dolphins, in particular, may be falsely NOS). alluring to desperate parents of children with ASD (Herzog 2010). There are estimated to be over 100 programs Search Procedure worldwide providing AAI with dolphins (Esposito et al. 2011b, Herzog 2010), which have been both lauded as Studies were identified by searching the following elec- uniquely effective (Nathanson et al. 1997) and criticized as tronic databases from their inception date through June expensive and poorly evaluated (Marino and Lilienfeld 2012: ERIC (1966—Present), Medline (1966—Present), 2007). The number and format of AAI programs with other ProQuest (1971—Present), PsycARTICLES (1894—Pres- animals is presently unknown, yet AAI does appear to be a ent), PsycINFO (1840—Present), and Scopus (1966— commonly enlisted technique for ASD. For example, an Present). In order to increase coverage, two specialized online survey study of 248 parents of children with ASD databases of HAI research were also searched: HABRI found that nearly a quarter (23.8 %) of children had par- Central, through the Human Animal Bond Research Ini- ticipated in AAI, and the majority of their parents (62.7 %) tiative, and Anthrozoology.org (Adams 2011). Search reported perceived improvements from AAI (Christon et al. terms for all databases included at least one identifier for 2010). ASD and at least one identifier for AAI in the full text of 123 1608 J Autism Dev Disord (2013) 43:1606–1622 Table 1 List of terms to identify AAI in database search Animal intervention Canine therapy Dolphin assisted Human animal Therapeutic animal(s) Animal therapy Canine assisted Dolphin facilitated Interaction(s) Therapeutic dog(s) Animal assisted Canine facilitated Equine therapy Pet therapy Therapeutic horse(s) Animal facilitated Companion animal(s) Equine assisted Pet assisted Therapeutic horseback Anthrozoology Dog therapy Equine facilitated Pet facilitated Therapeutic pet(s) Assistance animal(s) Dog assisted Hippotherapy Service animal(s) Therapeutic riding Assistance dog(s) Dog facilitated Horseback
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