Directions in Human-Animal Interaction Research: Child Development, Health, and Therapeutic Interventions
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CHILD DEVELOPMENT PERSPECTIVES
Directions in Human–Animal Interaction Research:Child Development, Health, and Therapeutic
Interventions
Layla Esposito,1 Sandra McCune,2 James A. Griffin,1 and Valerie Maholmes1
1Eunice Kennedy Shriver National Institute of Child Health and Human Development,National Institutes of Health and 2Waltham Centre for Pet Nutrition
ABSTRACT—Research on human–animal interaction (HAI)
is a relatively new field of inquiry for developmental scien-
tists seeking to understand the potential role pets play in
children’s health and well-being. It has been documented
that pets offer a source of emotional support to children.
However, most studies focusing on how animals affect
children’s health are limited and stop short of providing
answers to key developmental questions. Addressing this
need, beginning in 2008, scientists at the Eunice Kennedy
Shriver National Institute of Child Health and Human
Development, in collaboration with the Waltham Centre
for Pet Nutrition, a subsidiary of the Mars Corporation,
convened two international conferences of researchers to
review the current science on HAI. These groups crafted a
research agenda aimed at looking at how animal interac-
tion affects children and promotes optimal development.
This article reviews the key themes emerging from the
conferences, addresses the application of HAI to child
health and development, and discusses the potential of
The views expressed in this article are those of the authors and donot necessarily represent those of the National Institutes of Health,Eunice Kennedy Shriver National Institute of Child Health andHuman Development, or the Department of Health and HumanServices.
Correspondence concerning this article should be addressed toValerie Maholmes, Social and Affective Development ⁄ ChildMaltreatment and Violence Program, Eunice Kennedy ShriverNational Institute of Child Health and Human Development, ChildDevelopment and Behavior Branch, 6100 Executive Blvd.,Bethesda, MD 20892; e-mail: maholmev@mail.nih.gov.
ª 2011 The Authors
Child Development Perspectives ª 2011 The Society for Research in Child Development
DOI: 10.1111/j.1750-8606.2011.00175.x
Volume 0, Number 0
HAI as an important field of inquiry for developmental
scientists.
KEYWORDS—human-animal interaction; animal-assisted
intervention; animal-assisted therapy; child health; child
development
The contemporary scientific and lay literatures underscore the
important role pets play in the lives of children and in society as
a whole (Melson, 2003). More than two thirds of U.S. homes, and
three of four households with a child over age 6, include a pet
(American Veterinary Medical Association, 2007). However, lit-
tle is known about the role pets play in children’s growth, health,
and well-being. Although an increasing number of therapeutic
interventions involve human–animal interaction (HAI; Nimer &
Lundahl, 2007), justification for the inclusion of animals in these
interactions is often based on anecdotal evidence and short-term
observation. More research is needed on the physical and psy-
chological health benefits that can accrue to children through
their interactions with pets, both in daily life and in therapeutic
settings.
In 1987, the National Institutes of Health (NIH) held a confer-
ence on the Health Benefits of Pets (NIH, 1987). A panel of
experts from a variety of disciplines were brought together to
review the research in five topical areas and identify concepts
needing a stronger scientific base. One of the areas discussed
was the role of pets in child development. The panel reviewed
research that investigated how children interact with pets and
how they view their relationships with pets. The research
reviewed was made up primarily of observational studies of
actual interactions between child and pet and interviews with
children about their attitudes and beliefs regarding animals in
general and their own pet in particular. It was noted that major
developmental changes in how children interact with pets are
, 2011, Pages 1–7
2 Layla Esposito et al.
generally parallel to the developmental changes in interaction
patterns that children have with familiar humans, including par-
ents, siblings, and peers. It also was noted that children ascribe
a rich range of social attributes to their pets. Some of these attri-
butes—especially love and affection, companionship, intimacy,
and nurturance—also are used in the children’s descriptions of
their relationships with specific people, but other attributes—for
example, ownership and entertainment—are uniquely ascribed
to pets. The panel pointed out that the long-term consequences
for children of establishing relationships with pets and other ani-
mals have not been studied to date in any detail, although a
number of studies they reviewed suggested that, at least for
some, the presence of a pet is greatly beneficial. In addition to
calling for more research to determine long-term consequences,
the panel emphasized the need to identify any conditions, situa-
tions, or characteristics of particular children whose specific
relationships with their pets put them at risk for developing prob-
lems in subsequent social, emotional, and cognitive develop-
ment. They suggested that prospective longitudinal studies in
home or neighborhood settings would be very useful.
Since that time, interested researchers have continued to inves-
tigate topics such as those addressed at the 1987 NIH meeting.
Although there is a great deal of promise in this area, the body of
work, especially as it relates to understanding the role pets play in
children’s development, has been limited. To address this gap in
the literature, in 2008 the Eunice Kennedy Shriver National Insti-
tute of Child Health and Human Development (NICHD) of the
NIH and the Waltham Centre for Pet Nutrition of Mars entered
into a public–private partnership with the goal of encouraging rig-
orous scientific research on the interaction of children and
pets—that is, HAI—especially as it relates to child development,
health, and the therapeutic involvement of animals with children
and adolescents. Toward that end, the partners held two inter-
national research conferences to review the current science and
discuss the feasibility of a research agenda aimed at looking at
how HAI affects children (for the reviews in question, see
Esposito, McCardle, Maholmes, McCune, & Griffin, 2010; Griffin,
McCune, Maholmes, & Hurley, 2010).
The purpose of this article is to review the key themes that
emerged from those conferences, address the application of HAI
to child health and development, and discuss the potential of
HAI as an important field of inquiry for developmental scientists.
INFLUENCES ON CHILD DEVELOPMENT
Children grow up in complex, dynamic environments where
there are multiple influences on their development. Therefore, it
is important to use relevant theories from developmental science
as conceptual frameworks for examining the potential influences
that companion animals may have on children’s development.
Theories of cognitive development (e.g., Piagetian theory; Piaget,
1983), theory of mind (Wellman, 1990), ecological systems the-
ory (e.g., bioecological model; Bronfenbrenner & Evans, 2000),
Child Development Perspectives, Vol
theories of socioemotional development (e.g., attachment theory;
Bowlby, 1969; Cassidy & Shaver, 2008), and theories of socio-
cultural development (e.g., zone of proximal development; Vygot-
sky, 1986) offer frameworks in which hypotheses about
children’s interactions with animals can be embedded.
Child development theories have clear application for HAI
research. For example, Melson (2003) reports on emerging evi-
dence suggesting that the affordances of companion animals may
stimulate a young child’s cognitive growth through curiosity and
learning, while also providing a source of emotional support.
From this perspective, child-focused HAI research should exam-
ine how individual differences in children, animals, and context
interact. Studies should combine analyses of multiple aspects of,
and influences on, child development, including behavioral
interactions, cognitive representations, emotions, culturally con-
ditioned attitudes, and biological influences (Melson, 2003). In
addition, a child’s interaction with animals is mediated by his or
her interactions with adults, siblings, and peers, so a life-course
approach to help specify mediational models and pathways to
later outcomes is needed to understand both the different forms
of social and emotional support pets may provide and how this
support is contextualized within relationships (child–adult,
child–peer, and child–pet) and over time. Finally, examining
HAI within an ecological framework (Bronfenbrenner, 1979) is
important because research indicates that pets can be a catalyst
for social engagement and cohesiveness in communities. For
example, a 4-year Australian study that looked at the relation
among social capital, health, and neighborhood environments
found that pets created a common bond among neighbors and
acted as an icebreaker, sparking conversation and neighborly
interest (Wood, Giles-Corti, & Bulsara, 2005). Children poten-
tially benefit from this social capital through family experiences
or as part of the community.
HAI INTERVENTIONS FOR CHILDREN
Animals are being used in a variety of settings to help children
with behavioral and emotional problems, including adolescents
in correctional facilities. Although more research is needed in
this area, it appears that companion animals can play a role in
providing social support to children and adolescents, especially
during stressful or difficult situations (Nagengast, Baun, Megel,
& Liebowitz, 1997). The literature links social support provided
by animals to better physical and psychosocial outcomes in
humans (Allen, 1997; Garrity & Stallones, 1998) and suggests
that the effectiveness of social support is influenced by the char-
acteristics of the adults and children, as well as by the purpose
or function of the intervention.
Assessing the impact of animal-assisted interventions (AAIs) to
encourage responsible behavior in children at risk for behavioral
and emotional problems has proven difficult to study. The inability
to use blind studies, as well as the need to control for multiple
variables such as environment, other treatments, and the age and
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Human–Animal Interaction Research 3
condition of the child, contribute to this difficulty. In addition, in
some cases, animals in treatment or education programs may be
vulnerable to neglect or cruelty. Even normal interactions with
children might be stressful for some animals, and thus basic
research on healthy social interactions between specific animals
and humans should be a priority. The development of standards of
care for these animals is urgently needed, as is the establishment
of interdisciplinary collaborations to assess the short- and long-
term effects of interventions.
A meta-analysis of 49 studies on various AAIs, including ani-
mal-assisted therapies (AAT) and animal-assisted activities
(AAA), supports the theory that animals can help improve health
outcomes, particularly when added to established interventions
(Nimer & Lundahl, 2007). AAT, an intervention implemented by
a trained professional to meet a patient’s treatment goals, has
been shown to reduce symptoms of certain physical or psycho-
logical disorders, as well as enhance emotional well-being gener-
ally (Fine, 2006). For example, including animals in psychiatric
therapy has been shown to improve personal interactions in chil-
dren with communication disorders, such as autism or impaired
speech or hearing (e.g., Limond, Bradshaw, & Cormack, 1997;
Martin & Farnum, 2002). Results from another meta-analysis of
hospitalized children suggest that they become more engaged
and communicative in treatment when an animal is present,
thereby boosting the potential effectiveness of traditional psycho-
therapeutic and medical therapies (Kaminski, Pellino, & Wish,
2002; Mallon, 1992).
Other research has also provided evidence of benefits from
AAI. One study found equine-assisted therapy to be associated
with improved muscle symmetry in children with cerebral palsy
(Benda, McGibbon, & Grant, 2003). In reviewing the hippo-
therapy and horseback-riding therapies literature, Snider,
Korner-Bitensky, Kammann, Warner, and Saleh (2007) con-
cluded that these strategies may show short-term positive effects
for improved gross motor function but that much research is
needed before definitive claims can be made regarding the effi-
cacy of this therapeutic approach with children with cerebral
palsy. Similarly, AAA, which include animal visits led by volun-
teers without specific treatment goals, have been shown in small
studies to be associated with a reduction in postoperative pain
(Sobo, Eng, & Kassity-Krich, 2006), and in the same vein, the
use of animals in palliative care has been reported to ease
depression, stress, and fatigue in cancer patients (Geisler, 2004;
Orlandi et al., 2007).
Despite the potential therapeutic aspect of AAI, not all chil-
dren have positive experiences with animals. It is therefore
essential to consider a child’s emotional readiness to relate to a
therapeutic animal and whether the animal is the right match
temperamentally for the child. If a child is fearful of pets or has
had negative experiences with animals, treatment efforts with
pets may be further traumatizing. Conversely, it is important to
consider that certain animals may interpret the child’s behavior
as threatening, and may not respond positively to the interaction.
Child Development Perspectives, Volu
Researchers evaluating the utility of these methods for at-risk
children must address these issues.
CHILD HEALTH AND SAFETY
There is emerging evidence that interaction with animals can
have an impact on a variety of child health issues. Studies have
shown that interaction with animals, or even looking at pictures
of animals, correlates with indicators of stress reduction (Baun,
Oetting, & Bergstrom, 1991). However, even though studies
show that the presence of an animal in a variety of settings is
associated with improved physiological responses (Kaminski
et al., 2002), the mechanisms by which this improvement occurs
and how it translates to better child health are not fully under-
stood. Numerous studies have looked at the moderating effect
that pets have on adults in terms of cortisol and epinephrine
production, blood pressure, and heart rate variability (i.e., Allen,
Shykoff, & Izzo, 2001; Anderson, Reid, & Jennings, 1992;
Wilson, 1987), but more of these kinds of studies focused on
childhood stress are needed.
Recent research has examined the influence of pet ownership
on childhood overweight and obesity. Childhood obesity is a grow-
ing public health problem worldwide. Up to one third of children
in developed countries are overweight or obese, putting them at
higher risk for a variety of health problems, including cardiovas-
cular disease, Type 2 diabetes, liver problems, and psychosocial
distress (Daniels et al., 2005). A cross-sectional study in Australia
(Timperio, Salmon, Chu, & Andrianopoulos, 2008) found that
young children in dog-owning families were less likely to be over-
weight or obese than were those in families without a dog. One
plausible explanation is that interaction with dogs may increase
children’s physical activity, suggesting that dogs could play a role
in the management and treatment of overweight and obesity. How-
ever, there are obese dog owners, both adults and children, so fac-
tors that may moderate this relation clearly warrant further study.
Many think of pet dogs as enhancing safety, as they bark at
intruders and often act as protectors of their owners. However, it
is important to recognize the potential for pets to have a negative
impact on safety in communities. The Centers for Disease Con-
trol (CDC; 2009) reports that 4.5 million Americans are bitten
by dogs each year, and one in five dog bites results in injuries
that require medical attention. Among children, the rate of inju-
ries related to dog bites is highest for those ages 5–9 years, and
children are more likely than adults to require medical attention
from dog bites. Dog bites are a serious public health problem
that can inflict considerable physical and emotional damage on
victims and be costly to communities. All of these concerns must
be considered in any research undertaking.
Another concern relates to pets in households in which there
is family violence or child abuse. Although some children who
have been exposed to either one may turn to animals as a source
of emotional support, it has been documented (Ascione, 1999)
that abused children are more likely to abuse animals, as are
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4 Layla Esposito et al.
those who witness intimate partner violence (Becker, Stuewig,
Herrera, & McCloskey, 2004; Currie, 2006). Having a pet in
an abusive home can create several other challenges as well.
Research has clearly linked animal abuse with domestic
violence: More than half of the women in shelters report that
their abusers hurt or killed animals, and abusers themselves also
report such behavior (Ascione, Weber, & Wood, 1997). Many
women say that they delayed fleeing to the safety of shelters
because of concern for their pets. Increasingly, shelters are
arranging with local animal-rescue groups and veterinary hospi-
tals to provide safe havens for these pets, although problems
associated with these programs include the ethics of allowing a
pet to return to the home if the family decides to reunite with the
abuser and the question of what to do about pets that are aban-
doned by their families in these safe havens. In addition, chil-
dren who have bonded with a companion animal in a violent or
abusive home may be further traumatized if they are placed in
foster care or a shelter that separates them from the pet. There-
fore, a better understanding of child development and HAI in
contexts marked by domestic violence or child abuse is critical
to understanding the long-term effects that exposure to such vio-
lence or abuse has on children’s attitudes toward pets and
whether or not pet ownership may ameliorate those effects.
METHODOLOGICAL ISSUES
To delve into the mechanisms of HAI effects on health and
determine who benefits from pet interaction and under what cir-
cumstances, larger, more focused studies that include crossover
designs (in which subjects receive a sequence of different treat-
ments) and look at environmental variables and a variety of pet
species are needed. Well-controlled experiments and research
that extends beyond studies of short-term physiological
responses are also needed to provide more conclusive evidence
of effects on health. Studies aiming to more precisely detect
physiological changes that occur in people in the presence of
pets could be more powerful if researchers would agree to use a
common model and then conduct path analyses to show causal
connections among the variables. The fact that studies have been
done independently without common data elements limits the
extent to which contradictions in findings can be explained.
Relatively few empirical studies have demonstrated that pet
ownership has clear and long-lasting health benefits for children.
There is therefore a particular need for comprehensive evaluation
of specific therapeutic programs, as these programs are widely
used despite the lack of a strong evidence base. Questions
remain as to how best to take advantage of the promise of these
interventions and how to reliably measure their outcomes. Chief
among these questions are those regarding who might benefit
most under what circumstances and what represents the ideal
treatment or ‘‘dose’’ of exposure to the animal-assisted inter-
action. The full spectrum of therapeutic benefits with at-risk chil-
dren cannot be determined until such questions are answered.
Child Development Perspectives, Vol
Program evaluation should be developed carefully and
planned at the onset of implementation, selecting target groups
and using appropriate sample sizes to sufficiently power the out-
come analyses. Evaluation should be based on questions that
reflect program goals. Research designs also should address
moderating and mediating variables, and assess for unintended
outcomes. Data collection instruments must be psychometrically
sound, sensitive to changes associated with HAI, and standard-
ized; detailed procedures and monitoring must be in place.
FUTURE DIRECTIONS
Several major themes emerged from the NICHD–Mars confer-
ences that have potential to move the field toward greater knowl-
edge and credibility in terms of the impact of HAI on the health
and development of children and youth. Below is an overview of
those themes.
Social Interaction Research
Rigorously designed and conducted research should be under-
taken to better understand the nature of interactions between
children and various types of animals, including studies of the
relationships themselves as well as the contexts and conditions
under which they occur. Studies should address why relation-
ships with pets are more important to some children than to
others and should explore the quality of child–pet relationships,
noting variability of human–animal relationships within a family.
Developmental studies are needed to examine qualitative and
quantitative change in HAI over time and within changing family
dynamics. Community-level and social benefits of pets also
should be considered (e.g., associations between quality of family
interactions and quality of child–animal interactions).
Biopsychosocial and Epigentic Research
The study of biobehavioral and physiological responses to HAI
is crucial for a deeper scientific understanding of HAI and its
impact on child health and development. It will be important to
examine the neuroendocrine responses of both animals and
humans to determine how they vary during HAI. Exciting new
work is starting to emerge on the role of oxytocin and other hor-
mones underpinning the bond between people and animals.
Polymorphisms of the vasopressin 1A receptor gene are linked to
pair bonding and found in a variety of species. The obvious
question is whether pair bonding between people and animals is
also linked to this gene. If so, could this gene be useful in the
identification of pets for HAI activities? Likewise, the canine
genome has been available since 2005, and dogs have the poten-
tial to model various aspects of human socioemotional behavior,
such as attachment, temperament, and self-regulation. Can
genetics thus help in the selection of pets or particular breeds
most likely to be compatible with individuals with specific condi-
tions? For example, the repeat polymorphism of the DRD4 gene,
associated with attention deficit hyperactivity disorder (ADHD)
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Human–Animal Interaction Research 5
in humans, is also present in certain breeds of dogs, and these
breeds exhibit high activity–impulsivity and other behavioral
traits that are likely to have a negative impact on HAI. It needs
to be determined whether there are other genetic markers that
could be useful in determining which pets or particular breeds
are or are not likely to be good candidates for working with indi-
viduals with specific conditions.
Applied Research
For applied research, a clinical trial approach is recommended,
using experimental or quasi-experimental methods. Mixed meth-
ods are also recommended for understanding not only whether
an intervention is effective but also why and under what condi-
tions. Although randomized controlled trials are the gold stan-
dard, there may be times when such a design cannot be fully
implemented, in which case, the next most rigorous design
should be used. Dose-response issues should be carefully tar-
geted in research designs wherever possible. There is a need to
examine the role of pets in the treatment of at-risk children, as
well as of those with confirmed diagnoses, such as autism
spectrum disorder, developmental disabilities, and behavioral
disturbances.
Research to Inform Practice and Policy
Childhood obesity, asthma, ADHD, conduct disorder, autism,
and depression are among the pressing public health issues that
could be informed by HAI research. It will be important to deter-
mine empirically how HAI can offer the greatest public health
benefits and the most cost-effective treatment and intervention
programs in both formal and informal situations (e.g., pet owner-
ship and formal therapeutic interactions). It cannot be empha-
sized enough that in designing studies to address these
questions, determining which methodologies and outcome mea-
sures are needed to demonstrate a causal relation between HAI
and improved health will be essential. Effective HAI programs
could have policy implications for such issues as payment and
cost containment for widespread implementation of interventions
or practices that proved beneficial. Reducing the rate and length
of hospital stays and providing services for at-risk youth to lower
the incidence of problem behaviors are other relevant policy
issues.
Standardized Methodology
A core set of common measures should be established to improve
the potential for cross-discipline communication, collaboration,
and dissemination of findings. There is also a need for a taxon-
omy of common, frequently used index terms such as HAI and
AAT. These are standard terms as agreed upon by the main pro-
fessional AAI bodies. Common health outcomes to be measured
across studies using common measures or techniques would
allow for comparisons that could lead to convergent evidence
and move findings to practice more quickly. For example, if the
convergence of evidence suggests that physical growth and activ-
Child Development Perspectives, Volu
ity were important outcomes in studies of the impact of HAI on
child development, then common measures of these should be
shared across studies. If obesity is the focus of a study, then
investigators could agree to include body mass index and a stan-
dard means of determining height and weight measurements in
the data to be collected. In addition, a core set of behavioral
measures should be decided upon for studies that investigate
HAI and child development across similar age ranges, thereby
enabling the pooling of data across samples to answer broader
questions with larger data sets at lower cost.
Ethical Standards Must Be Adopted and Adhered to in
HAI Research
HAI research raises ethical considerations for both the human
and the animal partners in any interaction (e.g., Iannuzzi &
Rowan, 1991). Ethical standards must ensure the protection and
safety of both partners before and during the time any research is
conducted. Gathering information ethically and responsibly from
children who are particularly vulnerable and for whom parental
permission may be difficult to obtain (e.g., those in foster care) is
a challenge that must be carefully addressed. Animal welfare
must be considered at all times and is especially important when
animals are working with children who are emotionally disturbed
or when animals are placed in potentially abusive situations.
Opportunities for Further Research and Collaboration
HAI takes place in a multitude of settings, both formal and infor-
mal; thus, there may be a variety of opportunities to collaborate
with ongoing or to-be-planned studies where HAI is not the pri-
mary focus. For example, relevant items from surveys and ques-
tionnaires designed by developmental scientists could be shared
with HAI researchers conducting large-scale longitudinal stud-
ies. Such collaborations offer a cost-effective way of gathering
important cross-sectional information about pets in the home and
community and their impact on child health and development. It
is also important to collect longitudinal data where possible, with
attention given to collaborating with researchers working with
diverse samples. The paucity of research into ethnic, cultural,
and socioeconomic differences in pet ownership and attitudes
needs to be addressed, and relevant questions could be included
in longitudinal studies. Intergenerational studies may offer a
unique opportunity to better understand such complex issues as
childhood obesity and the role of pets. Other potential opportuni-
ties for investigation include the use of pets in classrooms for
teaching social interaction, the use of animals in therapeutic or
work activities with the military or with veterans (e.g., treatment
for post-traumatic stress disorder), and the use of service or assis-
tance animals.
SUMMARY AND CONCLUSION
It is widely accepted that pets play an important role in the lives
of children and adolescents. Companion animals are an integral
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6 Layla Esposito et al.
part of life for many families across cultures and socioeconomic
strata, yet remarkably little is known about the specific benefits
they may offer to a child’s health, well-being, and development.
Developmental scientists studying attachment issues, relation-
ships, and family dynamics are well-positioned to ask and answer
some of the compelling questions that have emerged from this
field of study. Nascent yet promising areas of inquiry include bio-
behavioral studies that examine the mediating and moderating
roles of pets in children’s response to stress. Research collabora-
tions among basic and applied developmental scientists and those
from other disciplines, such as ethology, can shed light on the
complex interactions that occur between animals and humans.
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