Social and Physical effects of Animal Assisted Therapy on Children with Mental Disabilities

Courtney Beatty; Anna M. Gross; Ashley B. Smith; Holly N. Stelter

04/04/2016
NURS 3749: Nursing Research
Dr. Valerie ODell
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Abstract

The purpose of the following research was to evaluate Animal Assisted Therapy effects on

children with mental disabilities socially and physically. Evaluation of pain, the cardiovascular

system, gross motor skills, and social behaviors was done through the collection of qualitative

and quantitative research data located in 8 articles. In every case, there was significant

improvement in the area being studied for effects of Animal Assisted Therapy. Interactions with

the animals varied from only a few minutes, to weekly hour-long sessions over the course of

several months. Every time, there was a prove decrease in the dependent variable being

evaluated. Overall, Animal Assisted Therapy proved every time to be a positive therapy for

children with mental disabilities.

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Social and Physical effects of Animal Assisted Therapy on Children with Mental

Disabilities?

Every day more and more children are being born with and acquiring mental illnesses and

disabilities. Kids with mental illnesses and disabilities tend to have poor mental, physical, and

social skills. This in exchange becomes very stressful for not only the children, but the childrens

parents and families. Many of these children need full on 24hr care to do everyday tasks. As well

as having poor mental, physical and social skills these children are sometimes in great pain. In

todays medical practice there are many medications available for these children and also various

types of verbal, stimulation, motor, and physical therapy measures. From child to child different

therapy measures work in different ways and some do not work as well as others leaving the

parents feeling like there is not much they can do to help their child to progress any further,

Therefore, the following research question was addressed: What are the Social and Physical

effects of Animal Assisted Therapy on Children with Mental Disabilities?

Literature Review

Introduction

In order to address this issue, information was required via OhioLINK databases,

specifically CINHAL Plus and MEDLINE. Eight sources were reviewed for comprehensive data

collection regarding ways animal assisted therapy can have a positive effect on children with

mental illnesses and disabilities. Social skills, pain and physiological effects on children with

mental disabilities will be discussed.

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Pain

It is very common that children with mental disabilities are at a significant high risk of

pain while performing daily care activities. Animal assisted therapy is on the rise in an attempt to

try and alleviate some of the everyday pain that these children are enduring. According to Lima,

M., Silva, K., Amarel, I., Magalhaes, A., & Sousa, L. (2012), an exploratory study was

conducted to assess the pain relief induced by contact with the therapy animal immediately after

the child experience a painful activity. The study measured behaviors to determine patient pain

such as smiling, frowning, grimacing, moaning, crying and heart rate. The therapy animal was

placed in each child's line of view within touching reach. After each painful situation the child

had the opportunity to touch and stare at the animal. It may be the animals cute and cuddly

effect but the animals presence actually produced behaviors such as smiling and decreased heart

rate. The children reacted positively to the animals being present. The behaviors produced by the

children after stimulation, and the presence of the therapy animal, closely related to the same

change in behaviors produced by the comfort of the child's mother. In some situations the

therapy animal actually brought on more positive behavior than the childs mother did. The study

showed that contact with the therapy dog brought about consistent behavior and cardiovascular

changes that point to an apparent decrease in pain level(Lima, M., Silva, K., Amarel, I.,

Magalhaes, A., & Sousa, L. (2012). When discussing pain in children with mental disabilities it

is hard to determine when and how much pain these children are actually in. Many of the

children are unable to express their pain levels due to their inability to verbalize feelings. That is

why this study focused on behaviors and the knowledge of the people who know them best, their

parents. The study is one of the first attempts to show the potential of therapy dogs being used as
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an effective intervention for managing pain in children with mental illnesses and disorders

(Lima, M., Silva, K., Amarel, I., Magalhaes, A., & Sousa, L. (2012).

Cardiovascular System

Animal-assisted therapy has been used and benefits pediatric patients in more than one

way. Studies have shown that it reduces anxiety, fear and has a positive physiological effect on

the patients. One specific study researched the physiological effect aiming at the cardiovascular

system in the children. Research has shown that animal-assisted therapy can decrease fear,

anxiety, heart rate, and blood pressure (Friedmann, Thomas, Tsai, 2010, p. 246). One factor that

can alter the findings related to this intervention have to do with the fact that while interacting

with the animal, the child naturally may have an increased heart rate or blood pressure from

simply talking to the dog, being excited, or performing any physical activity with the animal. To

reduce the chance of this interfering with results, the researcher in this specific study made sure

to baseline the blood pressure and make sure to get readings after the intervention to see if it had

a positive effect on the cardiovascular system as predicted. The sample population being

evaluated included fifteen children whose ages ranged from seven to seventeen years old.

Before the study, the researcher got a baseline blood pressure for the child with the cuff

that was specifically used to fit. During the study, the researcher hooked the child up to a blood

pressure cuff that automatically took the blood pressure and heart rate every two minutes with

the session only being six to ten minutes long (Friedmann, Thomas, Tsia, 2010, p. 241). During

the intervention, the child was allowed to touch, pet, and brush the dog. After reviewing and

analyzing the results of this study, it showed that the physiological factors being measured did, in

fact, decrease. The systolic blood pressure decreased from pre-therapy to post-therapy with the

animal (Friedmann, Thomas, Tsai, 2010, p. 250). As hypothesized by researchers, the heart rate
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and diastolic blood pressure during interventions did slightly rise. Researchers did conclude that

this is, likely due to the physical activity and communication involved in interacting with the do

and researcher. Previous studies document that when people talk, BP and HR increase from 10

to 50%; it is only natural for people to talk to dogs while they are interacting with them

(Freedman, Thomas, Tsai, 2010, p. 255).

The overall hypothesis was supported and concluded in the study, physiologically and

psychologically. In general, it may be accepted that hospitalized children who interact with a

dog may benefit from improved physical and psychological health experiences. Therefore, this

study lends some support to the therapeutic benefit of animal-assisted therapy (Friedmann,

Thomas, Tsai, 2010, p. 256).

Gross Motor Skills

During a recent study, a group of researchers hypothesized and confirmed that there were

moderate to large gains in body coordination, strength and agility, and overall gross motor skills

as a result of participation in an equine-assisted therapy intervention (Cory, Donaldson,

Hawkins, Ryan, 2014, p.135). Many children who suffer from illnesses, chronic or acute, benefit

from therapeutic interventions. During our research, we have discovered that animal-assisted

therapy is becoming therapeutic for children emotionally and physically and helping them to

advance within their illnesses. The study related to the equine-assisted therapy intervention

correlated children with Autism Spectrum Disorder whom show a deficit in gross motor skills

(Cory, Donaldson, Hawkins, Ryan, 2014, p.135). In order to test the predicted outcome of the

horse therapy related to Autism, researchers have found many ways to measure and evaluate

participants before and after including a test called the BOT2 Test (Cory, Donaldson, Hawkins,

Ryan, 2014, p. 138). Many children whom lack in gross motor skills have weak coordination,
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strength, and agility. When children interact with different types of animals and have tasks to

perform and interests in these animals, you could imagine the focus and determination they may

exhibit. Animal intervention is appropriate for people of all ages but most effective and

interesting for children.

The researchers and equine professionals guided the participants while working on leg

placement while riding the horse, catching and throwing balls, Frisbees, and using foam swords

to spear (Cory, Donaldson, Hawkins, Ryan, 2014, p. 140). Not only did this improve gross

motor skills, but there are many other benefits to equine therapy. This type of therapy can help

with social interaction, confidence, and increasing brain activity. Researchers re-evaluated and

used the BOT2 after sixteen sessions of therapy, and the results were determined. Values of

90% or greater indicate highly effective interventions, 70% to 89% represents moderate or fair

effects, 50% to 69% indicates mild or questionable effects, and below 50% is considered to be an

ineffective treatment (Cory, Donaldson, Hawkins, Ryan, 2014, p. 141). There were two

participants in the study with recorded results. The first participants score was 90%, which

according to previous studies, this concludes that the equine-assisted therapy was highly

effective in increasing the participants gross motor skills. The second participants score was

100%, which also indicated that the intervention was highly effective in improving the

participants overall gross motor skills. (2014, p. 144).

There have been many studies done that compare the interaction of children with animal

therapy, specifically equine therapy. As it was proved in this study, the interaction can most

definitely cause an increase in gross motor skills for children who suffer from any sort of deficit;

it of course is not going to cure any deficit, but these studies have shown positive benefits related

to this intervention.
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Social Behavior

In the case of producing positive behaviors in children with Autism Spectrum Disorder

(ASD), the presence of a dog has helped tremendously. According to a study done by Silva,

Correia, Lima, Magalhaes, and de Sousa (2011), the presence of a dog in therapy sessions (Tdog

sessions) with a twelve year old boy allowed the boy to produce more positive social behaviors,

such as affection toward the dog and the therapist, including hugs and kisses, play, visual contact,

and smiling, which are all behaviors that autistic children have trouble producing at any given

time. This specific child has had a history of delayed onset of speech, obsessions with

newspapers and magazines, and crippling anxiety. The boy was able to participate in organized

games with the therapist as well as look directly into the eyes of the therapist without reverting to

any of his usual negative, autism-induced behaviors. Results showed that all of these positive

behaviors occurred far more frequently during the sessions with the dog than the sessions

without the dog (T sessions). The child also exhibited far fewer instances of negative behaviors

in the presence of the dog, such as causing pain and physical harm to the therapist, causing

damage to inanimate objects, using harsh words and expressions as acts of intimidation, and

aggressively grabbing magazines. The boy did not seem emotionally unattached at all during the

sessions with the dog, however, during the sessions without the dog, the child was more self-

absorbed and did not want to participate in the most of the activities that the therapist had to

offer. He also produced multiple, repetitive acts of smelling things in the session when the dog

was not present. On the same hand, the frequency and duration of grabbing behavior were

significantly lower in Tdog than in in T sessions (p. 657).

According to Grigore and Rusu (2014), a therapy dog present in therapy sessions with

three preschool children, Catalin, Nicu, and Georgia, helped with their ability to greet a social
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partner and the ability to introduce oneself to a social partner after reading a social story. For all

three children, in the presence of a therapy dog, less prompt to initiate social interactions was

needed for the children to interact with each other, but only one out of three children showed a

large increase in the frequency of appropriate social interactions such as hugging, smiling, and

laughing. The other two had positive outcomes, just not as significant as the first. All three

children showed statistically significant increases in the frequency of the social initiations in the

presence of the therapy dog (257). It can be concluded from these two articles that canine-

assisted therapy is definitely beneficial to autistic children who are struggling to socially

develop. More investigation should be made into this area of development for autistic children

with the help of dogs.

Equine Assisted Therapy (EAT) and Equine Assisted Activities (EAA) have also begun

being analyzed more to show benefits in the improvement of social skills in children diagnosed

on any part of the ASD. A study done by Lanning, Matyastik Baier, Ivey-Hatz, Krenek, and

Tubbs (2014), took 25 children with a physician or therapist diagnosis of ASD and analyzed the

effects of a 12-week EAA program on the childs social behaviors. 13 of the 25 children

participated in hour-long EAA sessions once a week over the course of 12 weeks (intervention

group) The remaining children, 12 of the 25 children, participated in social circles over the same

12-week period, in one hour sessions once a week (comparison group) (Lanning, Matyastik

Baier, Ivey-Hatz, Krenek, and Tubbs, 2014, p. 1898). All 25 children were evaluated 6 months

prior to the start of the therapies to formulate a baseline assessment for comparison post-therapy.

Qualitative data was collected five times using two instruments: the Pediatric Quality of

Life 4.0 Generic Core Scales (PedsQL), designed to measure health-related

quality of life (HRQOL) in healthy children and adolescents and those with acute
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and chronic health conditions, and the Child Health Questionnarie (CHQ), which

measures 14 unique physical and psychosocial concepts (Lanning, Matyastik Baier, Ivey-Hatz,

Krenek, and Tubbs, 2014, 1898).

Researchers were looking for many improved social behaviors including: improving manners,

keeping eye contact, making friends, being a friend, taking turns, showing empathy and

sympathy. During the EAA sessions, children were taught horsemanship skills such as

grooming, leading and walking with the horse, and also riding the horse (2014). After the 12

week program, positive treatment effects were most noted in the areas of social functioning,

physical functioning, school functioning, and overall mental health and behavior (Lanning,

Matyastik Baier, Ivey-Hatz, Krenek, and Tubbs, 2014, p. 1904). Overall, this study, if nothing

else, added to the currently growing interested in EAA and EAT and their positive effects on

ASD children social behaviors.

Another study on EAA and children with ASD evaluated Childhood Autism Rating Scale

(CARS) and Timberlawn Parent-Child Interaction Scores as a result of a 6 months EAA program

(Kern et al. 2011, p. 14). 24 participants completed both a 3 to 6 month waitlist, were a baseline

assessment was developed, and a 6 month EAA program. The study took place in Corinth, Texas

at the SpiritHorse riding program, where participants meant once a week for hour long sessions

over the course of 6 months. In these sessions the children performed tasks such as leading,

grooming, and tacking responsibilities. This, in turn, helped the child develop relationships with

not only the horse but also the trainer, helped relationship building and bonding skills, and gave

the child a sense of responsibility to their pet horse (Kern et al. 2011, p. 16).

On evaluation of results from this study, CARS scores decreased both at the 3 and 6

month period. Not all subscales of the Timberlawn Parent-Child Interaction Scale showed large
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changes, however there was a significant improvement shown in both subscales of Mood and

Tone and Negative Regard over the 3 and 6 month period (2011, p. 18). Equine Assisted

Therapies are certainly an area of Animal Assisted Therapies that is showing improvement in

social skills of child with ASD and should be more closely studied in the future.

Guinea Pigs introduced into the classroom setting also were shown to help improve social

behaviors of children with ASD. 64 children between the ages of 5 and 12, in 41 different

classrooms spread across 15 different schools were evaluated (OHaire, McKenzie, McCune, and

Slaughter, 2014, p. 163). Social approach behaviors, social withdrawal behaviors, and social

skills were all evaluated over the course of the program. On conclusion of the study, there was a

significant improvement in the social behaviors viewed over the duration of the study. There

was also an increase in the desire to attend school by the children (OHaire, McKenzie, McCune,

and Slaughter, 2014, p. 166). It is clear that even the smallest of animal can significantly help

improve the social behaviors of children with ASD.

Conclusion

When evaluated, the effects of Animal Assisted Therapies (AAT) over both the physical

and social realms of children with mental disabilities, there is a clear improvement in all areas.

Studies have defined that the effects of AAT have been shown to lower pain, decreased effects on

the cardiovascular system, improve gross motor skills, and improve social and behavioral skills.

AAT is proven to be a positive alternative therapy for these children with ASD. More research

and understanding of the field needs to be done, but there is a more evident acceptance forming

for AAT and children with mental disabilities.

References

Cory, A., Donaldson, M., Hawkins, B., & Ryan, J.(2014). Effects of Equine-Assisted Therapy on
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Gross Motor Skills of Two Children With Autism Spectrum Disorder.Theraputic

Recreation Journal, XLVIII, 135-149.

Friedmann, E., Thomas, S., & Tsai, C.(2010).The Effect of Animal-Assisted Therapy on Stress

Responses in Hospitalized Children.Yuanpei UniversityDepartment of Nursing, Taiwan,

R.O.C. University of Maryland School of Nursing, Baltimore, USA, 23(3), 245-258.

Grigore, A. A., & Rusu, A. S. (2014). Interaction with a Therapy Dog Enhances the Effects of

Social Story Method in Autistic Children. Retrieved March 28, 2016.

Kern, J. K., PhD, Fletcher, C. L., Garver, C. R., PhD, Mehta, J. A., PhD, Grannemann, B. D.,

MA, Knox, K. R., MHA, Trivedi, M. H., MD. (2011). Prospective Trial of Equine-

assisted Activities in Autism Spectrum Disorder. Alternative Therapies, 17(30), 14-20.

Retrieved March 25, 2016.

Lanning, B. A., Matyastik Baier, M. E., Ivey-Hatz, J., Krenek, N., & Tubbs, J. D. (2014). Effects

of Equine Assisted Activities on Autism Spectrum Disorder. Journal of Autism

and Development Disorders, 44, 1897-1907. Retrieved March 25, 2016.

Lima, M., Silva, K., Amarel, I., Magalhaes, A., & Sousa, L. (2012). Can You Help When It

Hurts? Dogs as Potential Pain Relief Stimuli for Children with Profound Intellectual and

Multiple Disabilities. Pain Med, 1983-1986

O'Haire, M. E., BA, McKenzie, S. J., PhD, McCune, S., PhD, & Slaughter, V., PhD. (2014).

Effcts of Classroom Animal-Assisted Activities on Social Functioning in Children with

Autism Spectrum Disorder. The Journal of Alternative and Complementary

Medicine, 20, 162-168. Retrieved March 25, 2016.

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Silva, K., PhD, Correia, R., BS, Lima, M., MD, Magalhaes, A., PhD, & De Sousa, L., PhD.

(2011). Can Dogs Prime Autistic Children for Therapy? Evidence from a Single Case

Study. Retrieved March 28, 2016.