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Research Focus 2

Assistance dogs and children

Author: Alison Murray BSc (Hons) MSc VN, SCAS member
Alison is currently Training and research manager for Pets as Therapy
Contact details:   AReynolds@petsastherapy.org

Please note: No part of this paper may be reproduced without permission from SCAS. 

The Spring 2005 issue of the SCAS Journal reported on the placement of skilled companion dogs by the organisation Dogs for the Disabled.  These dogs are specifically trained to assist disabled children.  Children with disabilities face the same hurdles as adults, for example, having to rely on other people for their care and being excluded or not accepted in society.  These dogs are not only trained to assist the children in practical tasks, but also specifically trained to engage in simple play activities.  

There is now a wealth of research literature available documenting the association between simple pet ownership or companion animal contact and human physical and psychological health.  There are more recent studies examining the physical and emotional benefits for owners of assistance animals, although these are fewer in number. Research studies have demonstrated the obvious physical benefits to the human recipients of assistance dogs, such as retrieving objects, opening and closing doors and switching lights on and off, while others have attempted to evaluate the often more subjective social and emotional benefits. 

The subject of this issue of Research Focus is a paper published last year in the journal Anthrozoos, examining the specific risks and benefits of placing assistance dogs with children.  Guide dogs were the first to be trained to provide assistance to soldiers blinded during World War 1.  Assistance dogs for people with disabilities, hearing dogs, seizure alert and medical assistance dogs have all followed within the last twenty years.  The placement of assistance dogs for children is a relatively new application in many countries, including the UK and USA. 

Key research paper

Assistance dog placement in the paediatric population: Benefits, risks and recommendations for future application

This was an American study examining the risks and benefits of placing assistance, hearing and social therapy dogs* with disabled children. 

In brief

Due to its novelty, the child-assistance animal relationship has received little research attention. 

It was anticipated that the benefits experienced by child recipients of assistance dogs would be broadly similar to those enjoyed by adults, such as companionship and social support, increased independence, confidence and self-esteem.

This was also a viability study which examined and attempted to quantify any negative aspects of assistance dog ownership within the family, as well as for the individual child. 

The benefits highlighted are similar to other studies examining the value of assistance dogs for disabled people and included physical, medical and emotional benefits.  Risks included financial, medical and behavioural problems (of the animal).  The financial burden was shown to be a significant one and the authors found that most people were also not well prepared to expect health or behavioural problems in their assistance animals.      

Methods

Child-assistance dog teams who had all graduated from the National Education for Assistance Dogs Services (NEADS) between 1996 and 2000 were interviewed for this study.

The types of assistance dog roles were defined as follows:

• Service dogs
• Facilitated service dogs
• Hearing dogs
• Facilitated hearing dogs
• Social therapy dogs

Facilitated refers to the fact that, depending upon the child's age and type of disability, an adult facilitator, trained in the same way as the child client, takes ultimate responsibility for the dog.  In other cases, children were responsible for maintaining the dog themselves.  Ultimately, the facilitator's role is anticipated to decline as the child matures, having an important effect on the child/assistance animal relationship.  In the case of social therapy dogs, which assist the child with emotional and psychological difficulties, an adult facilitator was always required.

Twenty-two teams were interviewed; this is considered to be a fairly small sample size. In each of these teams, the child was between 5 and 17 years of age with the average age being 10.9 years.  The children had been paired with their dogs for between 1 and 5 years.  

In addition, group discussions were held to identify the major advantages and disadvantages to the family of owning and working with an assistance dog.  This information was developed into an open-ended questionnaire regarding the perceived risks and benefits. 

Findings

Potential risks

• Financial the average annual cost to maintain a dog was $1307 (approximately £850).  Nearly one-quarter of recipients considered cost to be a burden, with food being the major cost.
• Time on average, families spent 6.2 hours a week caring for their assistance dogs, with nearly one-third describing this as a burden.  Half of all the children participated in some way towards the care of the dog.
• Medical one-quarter of the teams reported allergic responses to the dog in either a family member or a regular family visitor.  However, no family reported this as a burden and one even re-arranged the structure of their home to accommodate it. 
• Behaviour - surprisingly, over half of the teams reported behavioural problems in their dogs and recognised the need for on-going training. Interestingly, the study included aggression as a category of risk, since it had been reported by medical professionals when dogs had accompanied the children on hospital visits.  
• Accessibility - despite the provisions of the ADA (Americans with Disabilities Act), some families reported problems with accessibility to public places and over two-thirds had encountered this problem at least once since obtaining the dog.
• School - only one assistance dog accompanied the child to school on a daily basis.  Reasons cited for not taking the dog to school included it being a social dog; concerns that its presence may cause disruption; the potential for allergic reactions and logistical difficulties when using the bathroom, although this last point wasn't expanded upon. 
• Social visibility - interestingly, some children wanted to actively avoid being singled out due to the increased attention that having an assistance animal inevitably causes; wanted to play during recess and to be normal.  These factors contributed to the decision to leave the dog at home during the day whilst the child was at school.

Most dogs were part of the family's social events and accompanied them to a variety of social settings, including churches, cinemas and on aeroplanes. 

• Animal welfare the study highlighted some problems with the lack of a bond between child and dog.  The authors suggested that this may be because the dog and child are separated for a large part of the day while the child attends school.

Benefits

• Physical - one-quarter of all recipients interviewed reported experiencing physical benefits of having an assistance dog, allowing the child increased independence. 
• Medical nearly 20% of the teams interviewed cited medical benefits, primarily in occupational and physical therapy sessions during which the dog participated. 
• Emotional and developmental - the majority of teams reported cognitive benefits as a result of interaction with the assistance dog, for example providing focus, being soothing or calming, allowing an opportunity for time-out and aiding concentration during daily tasks such as completing homework.  Emotional benefits were reported, especially by the parents of autistic children.  The dogs were helpful in broadening the child's experiences, teaching humane attitudes and as metaphors e.g. being able to explain when the dog was feeling hurt or upset. 
• Social - the most oft-cited benefit, (by in excess of 80% of teams), was that of promoting the child's interpersonal skills and receiving positive social acceptance from others.   For example, the presence of the assistance dog invited other children to play and promoted conversations less focussed on the child's visual disability.  The dog too became the child's playmate or confidant, a benefit often reported in studies examining the importance of pets to children.  It must be remembered, though, that some children were uncomfortable with the extra attention that having an assistance dog attracted.  

The dog benefited the family's social life too, often reducing feelings of isolation experienced by the parents.  Although, in general terms, having the dog strengthened family bonds, the dog's position within the household was perceived differently, with some families viewing the dog as a working animal, while others fully integrated it as a pet. 

Discussion

This was an interesting study because it highlighted not only the benefits but also the potential risks or burdens associated with placing assistance dogs with children. 

The benefits are similar to those seen in other studies examining the effects of assistance animals for adults and included physical, socio-emotional and cognitive benefits.  Traditionally, an assistance dog has been provided to perform physical tasks for a disabled individual.  Due to the fact that most of these dogs were facilitated by the child's parents, physical benefits were not perceived to be the greatest gain. This could be anticipated to change as the child matured and became able to direct their dog's behaviour unaided. 

Potential risks included cost, time and medical risks, such as allergic reactions.  Such risks were often not anticipated by the family prior to obtaining a dog.  Surprisingly, behavioural problems in the dog were cited to be the biggest problem, although the study didn't discuss possible reasons why this may be the case.  Other studies, such as those of Hart, Zasloff and Benfatto (1995) and Lane et. al (1998) suggest that the expectations of assistance dog recipients may be very high leading to disappointment with the dog's performance.  Interestingly, these findings echoed those of this present study where the general benefits of having an assistance dog were over-estimated by the potential recipients. 

Importantly this study reported that, in some cases, child recipients are not always prepared for the amount of extra attention having an assistance dog attracts; increasing a disabled person's visibility in public due to the presence of an assistance dog has both advantages and disadvantages.  On the one hand, some people are uncomfortable with the extra attention they receive as a result of having the dog and feel that their disability is being made more visible; others welcome the approachability factor that having a dog creates. 

The authors in this study also suggested that the dog may compete for family attention causing family relationships to suffer as a result.  However, the parents in this study cited an additional emotional benefit to them of their child having an assistance dog in public that it saved them from having to explain their child's often erratic behaviour, reducing their own feelings of stress.

The animal's welfare must be a critical factor in the decision to place an assistance animal with a child.  Since most child clients required an adult facilitator (usually the parents) for the care and control of their assistance dog, this prevented the majority of children taking their dogs to school with them.  Therefore, child and dog were separated for a large proportion of their day, which the authors argued affected the bonding process.  The level of bonding between child and dog was shown to be lower and to occur more slowly than between adults with disabilities and their assistance dogs.  This may be an important animal welfare consideration for the future placement of assistance dogs for children.  A further consideration is that assistance dogs are often highly social and seek out social contact, which could be problematic for a dog accompanying a child to school and therefore spending a large proportion of its day in a socially demanding situation.  

Some parents acquired an assistance dog for their child primarily to accompany them on frequent hospital stays and no infection control issues were reported in this study. 

The findings of this study echo the comments made by Helen McCain, training director for the Dogs for the Disabled in the Spring 2005 SCAS Journal.  She identified the potential emotional, physical and cognitive benefits to the child, as well as recognising the medical benefits of working alongside health professionals to integrate the dog into the child's treatment plan. 

She also felt that any findings related to the child-assistance dog relationship would have relevance to the disabled adult population who own an assistance dog. 

Glossary

Social therapy dogs American terminology to describe the placement of dogs for people with mental health problems

Sample size - The number of patients studied in a trial, including the treatment and control groups.  Generally the larger the sample size, the more valid the results.

Open-ended questionnaire - A set of questions designed to permit spontaneous and unguided responses

Reference

Davis, B. W., Nattrass, K., O'Brien, S., Patronek, G. and MacCollin, M. 2004. Assistance dog placement in the paediatric population: Benefits, risks and recommendations for future application.  Anthrozoos 17 (2): 130-145.

Other useful reading

Beck, A. M. and Katcher, A. H. 2003. Future Directions in Human-Animal Bond Research. American Behavioral Scientist. 47 (1): 79-93.

Johnson, R. A., Odendaal, J. S. J. and Meadows, R. L. 2002. Animal-Assisted Interventions Research: Issues and answers.  Western Journal of Nursing Research. 24 (4) 422-440.

Lane, D. R., McNicholas, J. and Collis, G. M. 1998. Dogs for the disabled: benefits to recipients and welfare of the dog.

Hart, L. A., Zasloff, R. L. and Benfatto, A. M. 1995. The pleasures and problems of hearing dog ownership.  Psychological Reports 773 (3pt.1): 969-970.