Autism spectrum disorder (ASD), a heterogeneous neurodevelopmental disorder (NDD) with significant lifelong social, communication, and behavioral challenges, has reached an unprecedented estimated U.S. prevalence of 1-in-54 (Maenner et al., 2020). Treatment plans for ASD not only need to address core symptoms, but also a variety of co-occurring medical, developmental, behavioral, or psychiatric conditions that further impact daily functioning and quality of life (Masi, DeMayo, Glozier, & Guastella, 2017). One approach with the potential to address multiple concerns for autistic individuals and their families is the integration of animal-assisted interventions (AAIs) into home, school, and hospital settings (Dimolareva & Dunn, 2020; Esposito, McCune, Griffin, & Maholmes, 2011; Johnson, Odendaal, & Meadows, 2002); several studies have reported promising results for the use of animal assistance in ASD treatment (Dimolareva & Dunn, 2020; Droboniku & Mychailyszyn, 2021; Funahashi, Gruebler, Aoki, Kadone, & Suzuki, 2014; Martin & Farnum, 2002; O'Haire, McKenzie, Beck, & Slaughter, 2013). This may not be surprising since, as early as 9-months of age, infants are already attracted to animals and prefer them to inanimate objects (Ricard & Allard, 1993). Research has shown that human-canine interactions induce oxytocin release in both humans and dogs and generate effects such as decreased cortisol levels and blood pressure (Handlin, Nilsson, Ejdebäck, Hydbring-Sandberg, & Uvnäs-Moberg, 2015; Odendaal & Meintjes, 2003). During a physical examination, the presence of a companion animal has been shown to reduce a child’s physiological arousal and behavioral distress (Nagengast, Baun, Megel, & Leibowitz, 1997). Correspondingly, during a laboratory-based stressor, rise in perceived stress for typically-developing (TD) children (7-12 years) was buffered significantly by the presence of the family pet dog, relative to children who were alone or with a parent (Kertes et al., 2017). As invaluable sources of socio-emotional support (Melson, 2003), animals may also serve as transitional objects, through which children can transfer their established bonds to humans (Martin & Farnum, 2002).
In particular, the domestic dog (Canis familiaris) may have evolved with the abilities to both attune to human social cues and to cue humans in turn (Udell & Wynne, 2008). For children especially, dogs provide multisensory experiences and direct feedback in the context of nonverbal actions that may be more easily deciphered at early developmental stages (Prothmann, Ettrich, & Prothmann, 2009; Redefer & Goodman, 1989). Trained service dogs may offer the further advantage of allowing for rewarding interactions using simple language that may scaffold less scripted social interactions (Solomon, 2010). Notably, some studies have that shown autistic children undergo a reduction in salivary cortisol levels in the presence of trained service dogs (Burrows & Adams, 2008; Viau et al., 2010). Moreover, assistance-dogs, trained for individuals with various disabilities, may serve as social catalysts, enhancing social interactions, increasing social networks, and reducing instances of social discrimination (Becker, Rogers, & Burrows, 2017; Camp, 2001; Carlisle, 2015; Mader, Hart, & Bergin, 1989; McNicholas & Collis, 2000).
An adjacent development in the burgeoning service dog industry has been the compounding demand for autism-assistance dogs (AADs) trained specifically to address issues of physical safety. One primary source of apprehension for families of autistic children is their child’s risk of elopement, defined as a “dependent person exposing him or herself to potential danger by leaving a supervised, safe space or the care of a responsible person” (Anderson et al., 2012). An AAD team work as a triad; in public, the child wears a specially designed belt that connects to the dog’s vest while an adult handler holds the dog’s leash. AADs are trained to passively resist using their body weight if their child partner attempts to bolt and the tethering system prevents children from running away. Caregiver and case study reports have highlighted that AADs can prevent elopement effectively while providing a sense of security for both parents and children (Burgoyne et al., 2014; Burrows, Adams, & Spiers, 2008). Further, AADs can also be trained to provide a modified form of pressure touch therapy practiced by occupational therapists that has been found to help autistic individuals reduce arousal and anxiety levels (Bestbier & Williams, 2017; Grandin, 1992; Krauss, 1987). Essentially, AADs can be trained to use their weight and warmth to not only apply physical pressure on their child (e.g., leaning, laying atop) bur to also stop promptly on command.
Another major concern for families of autistic children is the wellbeing of parents/caregivers who report experiencing higher physiological stress and parenting-related stress than parents of TD children and children with other NDDs (Estes et al., 2013; Fecteau et al., 2017). Myriad factors including child characteristics and behavioral challenges (Olson et al., 2021), as well as sociocultural and economic circumstances (e.g., access to resources, stigma associated with mental health, financial burden of care), may impact parental outcomes negatively (Bonis, 2016; Iadarola, Perez-Ramos, Smith, & Dozier, 2019) and, by extension, child wellbeing and behavior (Rodriguez, Hartley, & Bolt, 2019). However, of import to the present study is the growing focus on unanticipated secondary effects that have been observed by families with AADs. One key study reported that the contribution of service dogs to family welfare extended beyond physical safety to behavioral and psychosocial domains; parents reported improved quality of sleep and a greater sense of independence, their children exhibited fewer negative behaviors (e.g., “meltdowns”, “tantrums”, “bolting”), and families experienced an increase in social acknowledgement and a decrease in embarrassment or shame in public (Burrows et al., 2008).
While the positive, multidimensional impact of these AADs has been supported by anecdotal reports, empirical data demonstrating quantifiable improvements is lacking. Evidential corroboration for the benefits of these human-canine partnerships will further the acceptance and recognition of AADs as “service animals” as defined by the Americans with Disabilities Act (ADA) - with all provisions for access given by the U.S. Department of Justice. Hence the overarching objective of the present study has been to investigate systematically the impact of AADs on families affected by ASD. To accomplish these goals, we used standardized measures to collect longitudinal, pre- and post-intervention psychosocial and biobehavioral data from families who received highly-trained AADS. Our study contributes quantitative data from validated assessments to address the question of whether families benefit from the integration of these assistance dogs into their daily lives across multiple domains and contexts.
One critical caveat to address is that the families participating in this research study received their AADs from an internationally recognized, Assistance Dogs International (ADI) accredited, nonprofit organization that trains assistance dogs for hearing loss, mobility challenges, seizure disorders, Type 1 Diabetes, as well as ASD in children. Families are provided with the dogs free-of-charge and the economic burden and time-investment for each certified handler/dog team, combined with the stringent training and placement standards enforced by the organization severely limits the number of dogs placed each year. Conclusions drawn from these AAD-teams should be considered in view of their highly-specialized training and not generalized across all animals described as “therapy” or “support” with no consistent, ratified criteria for certification or registration.