Jorgenson 1 - Organization for Autism Research · 2018. 10. 24. · Jorgenson 2 rabbits. The most support exists for using horses, but because is not feasible to have a horse in most

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Final Research Paper: The Effectiveness of Animal-Assisted Social Skills Interventions

for Children with ASD

Introduction

Deficits in social communication is one of the main concerns associated with a diagnosis of

autism spectrum disorder (ASD, American Psychiatric Association, 2013). These deficits have many

negative impacts on the lives of children with autism, such as less time spent interacting with peers,

higher levels of loneliness than peers, poorer quality of friendships, and increased feelings of loneliness

(Bauminger, Shulman, & Agam, 2003; Bauminger & Kasari, 2000; Lasgaard, Nielsen, Eriksen, & Goossens,

2010; Locke, Ishijima, Kasari, & London, 2010). As such, many interventions for children with ASD focus

on improving social skills. Animal-Assisted Interventions (AAIs) are becoming increasingly popular for

children with autism due to the reported social benefits of human-animal interaction (HAI) for typically

developing individuals (e.g., Daly & Morton, 2006; Endenburg & van Lith, 2011).

Many benefits of HAI have been shown among diverse populations. For example, therapy

including therapy dogs reduced anxiety and increased pro-social behaviors in patients who were

hospitalized for psychiatric concerns (Barker & Wolen, 2008; Marr et al., 2000). As little as five minutes

of interaction with a therapy level was associated with a significant decrease in salivary cortisol levels for

healthcare professionals (Barker, Knisely, McCain, & Best, 2005). Pet owners are more likely to get to

know people in their neighborhood (Wood et al., 2015). There has been particular focus on therapy dogs

for children with autism. Families of children with autism who have dogs report lower levels of anxiety

(Wright et al., 2015), and higher social skills (Carlisle, 2015) in their child with ASD.

However, there is limited research to support the efficacy of using AAIs to increase social skills

for children with ASD. Despite the reported benefits, two comprehensive literature reviews of AAIs for

ASD have identified only 42 total studies. Among those 42 studies, only 12 utilized dogs as the therapy

animal (O’Haire, 2013, 2017). Other species used included horses, dolphins, guinea pigs, llamas, and

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rabbits. The most support exists for using horses, but because is not feasible to have a horse in most

clinics, dogs are becoming more prevalent in settings with children with autism.

Not only is there a paucity of research on the use of therapy dogs to increase social skills in

children with autism, but many existing studies suffer from methodological flaws and limited

replicability. A major reason for the limited replicability is a lack of detailed descriptions of procedures

for the AAI. In one study, researchers assessed pro-social and nonsocial behaviors in children with ASD

in three conditions: with a ball, with a stuffed dog, and in the presence of a live dog (Martin & Farnum,

2002). The authors reported increased pro-social behaviors for some participants; however, there was

no detailed description of the intervention. Redefer & Goodman (1989) reported an increase in social

behaviors in children with ASD when including a dog in therapy sessions, but the study lacked a control

condition and procedures were not described in enough detail to allow replication. Similarly, a dog’s

presence in therapy sessions was found to increase engagement for a child with ASD (Silva, Correia,

Lima, Magalhães, & de Sousa, 2011), but there was no detailed description of the protocol included.

Existing studies using AAIs to increase social skills in children with ASD also have limitations related to

the measurement of the dependent variables. The majority of studies measured the dependent

variables related to social skills and communication through anecdotal reports by parents and therapists

(Burrows, Adams, & Spiers, 2008; Obrusnikova, Bibik, Cavalier, & Manley, 2012; Pawlik-Popielarska,

2010; Solomon, 2010). Some studies that used dogs for AAI with children with ASD measured dependent

variables using direct observation. However, many of these either did not report interobserver

agreement (IOA; Funahashi, Gruebler, Aoki, Kadone, & Suzuki, 2014) or reported insufficient IOA (Martin

& Farnum, 2002; Prothmann, Ettrich, & Prothmann, 2009; Sams, Fortney, & Willenbring, 2006), which

raises concerns about the accuracy of the data.

The increasing demand for therapy dogs as pets for families of children with autism, increased

prevalence of therapy dogs in settings for children with ASD, lack of research on the use of AAIs to

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increase social skills for children with autism, and flaws of many existing studies all support the need for

further research. The purpose of this study was to provide further evidence regarding the use of therapy

dogs in AAIs for children with ASD. The study utilized a behavior analytic approach to examine the

effects of two AAIs using therapy dogs to increase the social interactions of young children with ASD.

The research questions were (1) Does access to a therapy dog that is contingent upon social interactions

with a therapist increase those social interactions for a child with ASD? and (2) Does noncontingent

access to a therapy dog increase the social interactions with a therapist of a child with ASD?

Method

Participants and Setting

Five children diagnosed with autism participated. Jared was a 5-year-old male, Ginny was a 5-

year-old female, Allen was an 8-year-old male, Adam was a 4-year-old male, and Arthur was a 6-year-old

male. All children were able to speak in short sentences. Additionally, parents reported that the children

liked dogs and each participant demonstrated appropriate behavior toward the therapy dog prior to

beginning participation.

All sessions were conducted in therapy rooms located in an outpatient clinic. Sessions were

recording using audio-video equipment available in the rooms.

Response Measurement and Interobserver Agreement

The dependent variable, social responses, was defined as a verbal statement to the therapist.

This meant that the child looked at the therapist during the statement, said something intended to get

the therapist’s attention (e.g., “look”), or responded on-topic within 3 seconds of a statement by the

therapist. Trained observers used event recording to collect data on the dependent variable using data

collection software on laptop computers.

Each session was divided into 10-second intervals. Interobserver agreement was calculated for

each participant by dividing the smaller reported frequency of the dependent variable by the larger

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reported frequency of the dependent variable for each interval and averaging the percentage

agreement for all intervals in each session. Interobserver agreement data was collected for at least 40%

of all sessions for each participant.

Procedure

Participants visited the clinic 1-2 days per week for research sessions lasting 30 minutes to 1

hour. Session duration for all participants was 5 minutes. Due to time constraints, Ginny’s final sessions

were reduced to 1 minute each.

A multiple stimulus without replacement (MSWO) preference assessment including the therapy

dog was conducted with each participant prior to beginning the study. Next, rates of social responses

were compared across 3 to 4 conditions for each participant using alternating treatments and reversal

designs. In all conditions, the therapist responded to participant social responses on a fixed-ratio 1

schedule (i.e., the therapist responded to every social response of the participant). To control for

potential differences in therapist prompting across conditions, the therapist did not initiate any

conversation with the participant, did not ask the participant any questions, and did not play with the

therapy dog or any toys unless the child asked her to.

Baseline. Baseline sessions began following the MSWO preference assessment. During baseline,

the participant was in the therapy room with a table, two chairs, and three moderately preferred toys as

identified in the MSWO. The therapist began each baseline session with a contingency review stating

that the participant could play with the toys, and no reinforcement would be provided for social

responses.

NCR dog. NCR dog sessions were identical to baseline sessions, except the therapy dog was

seated next to the participant. The therapist began each NCR dog session with a contingency review

stating that the participant could play with the toys or the dog, and no reinforcement would be provided

for social responses.

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Token Training. Token training was conducted for each reinforcer used in DRA sessions for each

participant. Token training consisted of two phases. Phase 1 consisted of pairing the tokens with the

backup reinforcer (the therapy dog for DRA dog sessions, and the iPad for DRA iPad conditions). During

phase 1, the therapist gave the participant a token noncontingently, followed by immediate access to

the therapy dog. The therapist conducted 5 trials in phase 1 before moving to phase 2. During phase 2,

the therapist explained that tokens could be earned for talking to her, and that earning all the tokens

resulted in time to play with the backup reinforcer (therapy dog or iPad). A verbal prompt was given if

the participant did not respond within 10 seconds. Mastery criteria for token training was 80%

independent responses across trials on 3 consecutive sessions.

The number of trials in each trial block was equal to the number of tokens the participant had to

earn to access the backup reinforcer. This was initially set at 1 token for each participant and increased

to up to 3 tokens based on rates of responding in the previous DRA session for the given reinforcer.

Phase 2 was conducted again each time the number of tokens required to access the backup reinforcer

increased.

DRA dog. DRA dog sessions were identical to baseline sessions, except social responses were

reinforced with 30-seconds of access to the therapy dog (Ralph). Prior to first DRA dog session of each

day, the therapist exposed the participant to the contingency by saying, “When you talk to me, you get a

token. When you get all your tokens, you can play with Ralph. Let’s practice.” Earning all tokens resulted

in 30 seconds access to the therapy dog. The therapist then began the session with a contingency review

stating that the participant could play with the toys, that each social response would be reinforced with

a token, and that earning all the tokens would result in access to the therapy dog. Session time was

paused during reinforcement to control for the potential effect of the presence of the dog during this

time on the participant’s social responses.

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DRA iPad. DRA iPad sessions were identical to DRA dog sessions, except social responses were

reinforced with 30-seconds of access to an iPad with internet access and games, and the contingency

reviews specified the iPad as the reinforcer.

Results and Discussion

Each participant’s preference for the therapy dog are shown in Table 1. Jared showed high

preference for Ralph. Ginny and Adam showed moderate preference for Ralph. Allen and Arthur showed

low preference for Ralph. It is also worth noting that for Ginny and Allen, the iPad was the highest

preferred item included in the preference assessment.

Table 1. Results of MSWO Preference Assessments.

Participant Preference for Therapy Dog (Percentage of Trials Selected)

Jared Highly Preferred (75%)

Ginny Moderately Preferred (30%)

Allen Not Preferred (15%)

Adam Moderately Preferred (30%)

Arthur Not Preferred (15%)

Results of the comparisons of AAI conditions for the 5 participants are shown in Figure 1. Jared’s

rate of social responses was highest during the NCR dog condition (baseline mean = 1.34, NCR mean =

7.69, DRA dog mean = 4.13), although there was significant overlap across conditions. Ginny and Allen’s

rates of social responses were highest during the DRA iPad condition (Ginny: baseline mean = 0.17, NCR

mean = 0.15, DRA dog mean = 2.78, DRA iPad mean = 12.14; Allen: baseline mean = 0.53, NCR mean =

0.49, DRA dog mean = 1.16, DRA iPad mean = 7.27). Both Ginny and Allen showed a sharp increasing

trend in the DRA iPad condition immediately after it was introduced. Although both participants had

some DRA dog conditions with significantly higher rates of social interactions than baseline, these were

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not consistent. Adam’s rate of social responses were undifferentiated across conditions (baseline mean

= 0.17, NCR mean = 0.15, DRA dog mean = 2.78). Arthur’s highest rate of social responses was in the

DRA dog condition (baseline mean = 0.67, NCR mean = 0.07, DRA dog mean = 6.13).

Figure 1. Results of Alternating Treatments and Reversal Condition Comparisons.

Note. SR+ = positive reinforcement.

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Although all parents reported in the interviews prior to their child’s participation in the study

that their children liked dogs, results of the preference assessments showed that the therapy dog was

more preferred than toys for only one participant (Jared). Interestingly, the results of the preference

assessment showed that Arthur did not prefer the therapy dog over toys. In fact, he only chose the

therapy dog in 15% of the trials in which it was available during the preference assessment. However,

therapists noted that Arthur did not play with the toys after choosing them in the preference

assessment. They reported that he would choose the toys first, not play with them, choose the therapy

dog last every time, and play with the therapy for the full 30 seconds that was allowed. This

phenomenon is known as “saving the best for last.” Solberg, Hanley, Layer, & Ingvarsson (2007)

described a participant saving her favorite for last during MSWO preference assessments.

Arthur engaged in very few social responses during the baseline and NCR dog conditions. During

the DRA dog condition, his social responses immediately and rapidly increased. These results are

counterintuitive to human-animal interaction theory, which would posit that Arthur would be more

social during the NCR dog condition as well. However, during this condition, Arthur played with and

petted the dog the entire session while ignoring the therapist. When access to the therapy dog was

made contingent on social responses, Arthur began interacting with the therapist.

Although results for Adam were undifferentiated, they still show a steady increase in social

responses during his participation in the study. During sessions and across all conditions, the therapist

responded to every child initiation. It is possible that the therapist’s social response acted as the

reinforcer across conditions and this is why Adam’s social responses increased but were not

differentiated between conditions.

A condition including a highly preferred toy was included for Allen and Ginny when no

differentiation was seen between the original baseline, NCR dog, and DRA dog conditions. For both Allen

and Ginny, the highly preferred toy was an iPad. Allen’s rate of social responses initially increased in the

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DRA dog condition, but this quickly returned to baseline levels. It is possible that this is due to satiation,

and similar results were not shown for the DRA iPad condition, which had an immediate positive effect

on the rate of responses and showed an increasing trend in the rate of responses across sessions. A

similar trend was seen for Ginny, who showed some increases in rates of social responses during the

DRA dog condition, but more consistent increases during the DRA iPad condition.

Jared highly preferred the therapy dogs over the toys in the preference assessment, choosing

the therapy dog in 75% of the trials in which it was available. Results for Jared show that noncontingent

access to the therapy dog slightly increased his rate of social responses above the rates in the baseline

and DRA dog conditions. Despite this, there was no meaningful improvement in his social responses

during his participation in the study. It is possible that Jared was close to his ceiling for social responses

already, although it is unclear whether a different reinforcer could have meaningfully increased social

responses or decreased the variability in social responses across sessions. We were unable to include a

condition with a different reinforcer for Jared due to time constraints. Future research could include a

condition with a highly preferred toy for all participants.

Our study is limited because of the stringent definition of social responses for our dependent

variable. For this study, participants had to verbally initiate a social interaction with the therapist or

respond to a therapist’s statement after their own initial statement. We defined a social response this

way to maximize experimental control across sessions. However, social skills involve many other

aspects, such as eye contact, appropriate verbal responses to the initiations of others, facial expressions,

body language, and more. Future studies could examine the effects of the therapy dog on a broader

range of social skills as dependent variables.

Another limitation is that data collectors were not blind to the purpose of the study. This could

have affected their data collection, however, interobserver agreement was calculated and

demonstrated acceptable agreement across data collectors. This increased the likelihood that the data

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collection methods resulted in accurate data. A final limitation is the limited age range of participants.

All participants in this study were between the ages of 4 and 8 years. Future studies could examine the

effects of a therapy dog on the social skills of older participants.

Overall, the results of this study suggest that therapy dogs may be helpful in increasing social

responses in children with autism. However, the results also suggest that this effect cannot be assumed.

The animal-assisted interventions (AAI) with the therapy dog did increase social interactions for some

participants, but AAI with the therapy dog was only the most effective intervention for one participant

in this study. Although therapy dogs are becoming more prevalent in settings with individuals with

developmental disabilities, practitioners should be aware that some children may be better suited for

AAI than others. Practitioners should use data-based progress monitoring to identify the most effective

intervention for each client. Researchers should continue to examine the benefits of using therapy dogs

for children with autism in order to provide more clear guidelines for practitioners.

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