Directions in Human-Animal Interaction Research: Child Development, Health, and Therapeutic Interventions

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: [email protected].

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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