Western Journal of Nursing Research

http://wjn.sagepub.com Animal-Assisted Therapy for Children with Pervasive Developmental Disorders

Franois Martin and Jennifer Farnum West J Nurs Res 2002; 24; 657 DOI: 10.1177/019394502320555403 The online version of this article can be found at: http://wjn.sagepub.com/cgi/content/abstract/24/6/657

Published by:
http://www.sagepublications.com

On behalf of:
Midwest Nursing Research Society

Additional services and information for Western Journal of Nursing Research can be found at: Email Alerts: http://wjn.sagepub.com/cgi/alerts Subscriptions: http://wjn.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations http://wjn.sagepub.com/cgi/content/refs/24/6/657

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

Western Journal of Nursing Research, 2002, 24(6), 657-670

Western Journal of Nursing Research October 2002, Vol. 24, No. 6

Animal-Assisted Therapy for Children With Pervasive Developmental Disorders1

Franois Martin Jennifer Farnum

The present study quantitatively evaluated the effects of interaction with dogs on children with pervasive developmental disorders (PDD), disorders characterized by lack of social communications and abilities. While interacting with a therapist, children were exposed to three different conditions: (a) a nonsocial toy (ball), (b) a stuffed dog, and (c) a live dog. Prosocial and nonsocial interactions were evaluated in terms of both behavioral and verbal dimensions. Results show that children exhibited a more playful mood, were more focused, and were more aware of their social environments when in the presence of a therapy dog. These findings indicate that interaction with dogs may have specific benefits for this population and suggest that animal-assisted therapy (AAT) may be an appropriate form of therapy.

Animal-assisted therapy (AAT) has been theorized to be an effective form of treatment for children with pervasive developmental disorders (PDD), disorders characterized by a severe impairment of social functioning and interactions (American Psychiatric Association, 1994). Animals may be one way to increase attachment between children with PDD and their social environments. Animals are believed to act as transitional objects, allowing children to first establish bonds with them and then extend these bonds to humans (George, 1988; Katcher, 2000; Winnicott, 1986). Because forming social bonds is difficult for children with PDD, AAT may be an effective method of therapy for this population. To test this hypothesis, the current study evaluated the effects of supervised interaction with dogs on children with PDD, examining both behavioral and verbal dimensions. This interaction with dogs was compared to interactions in two other conditions: (a) a ball and (b) a stuffed dog. To accurately assess differences between conditions, a
Franois Martin, Ph.D., College of Veterinary Medicine, Washington State University; Jennifer Farnum, M.A., College of Veterinary Medicine, Washington State University.
DOI: 10.1177/019394502236639 2002 Sage Publications 657

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

658

Western Journal of Nursing Research

predetermined research protocol was used throughout supervised sessions. In this way, true distinctions between conditions could be delineated. However, because a strict research protocol was employed instead of a more versatile therapeutic agenda, the claim cannot be made that the research involved AAT per se but rather that it allows for increased insight into the processes underlying AAT.

ANIMALS AS THERAPEUTIC AIDES FOR CHILDREN WITH PERVASIVE DEVELOPMENTAL DISORDERS

In the fields of nursing, medicine, and psychotherapy, AAT has been receiving growing attention as a legitimate means of aiding patients. Looking for alternative methods of treatment for a variety of ailments, many experts in these fields have suggested that AAT may be able to serve an important role in a range of different settings. Such settings include hospitals (Cole & Gawlinski, 2000; Miller & Ingram, 2000), residential care facilities (Kogan, 2000; Taylor, Maser, Yee, & Gonzalez, 1993), rehabilitation facilities, and hospices (Conner & Miller, 2000). AAT may be appropriate in such a wide range of settings because of its potential to influence a large number of health-related problems. For example, research indicates that animal companionship may be associated with lowered heart rates (Friedmann, Katcher, Lynch, & Thomas, 1980) and blood pressure (Anderson, Reid, & Jennings, 1992; Friedmann et al., 1980), reduced anxiety (Barker & Dawson, 1998), alleviation of depression, and greater self-esteem (Walsh & Mertin, 1994). Animals, it appears, may have the ability to enhance both physiological and psychological well-being. Existing literature also indicates that animals may be particularly well suited for children, suggesting that animals are crucial in childrens social (Triebenbacher, 2000) and cognitive development (Melson, 2000). Research has shown that interaction with animals may alleviate stress in children (Hansen, Messinger, Baun, & Megel, 1999), is associated with a reduction of symptoms in children with severe attention deficit/hyperactivity disorder and conduct disorders (Katcher & Wilkins, 1998), and increased positive behaviors of children with Downs syndrome (Limond, Bradshaw, & Cormack, 1997). Other researchers have suggested that AAT may be appropriate for yet another genre of disordersPDD (Law & Scott, 1995; Nathanson, 1998; Nathanson, de Castro, Friend, & McMahon, 1997; Redefer & Goodman, 1989). PDD includes autistic disorder, Retts, child-

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

October 2002, Vol. 24, No. 6

659

hood disintegrative disorder, Aspergers, and PDD not otherwise specified (American Psychiatric Association, 1994). Differences in these disorders include their prevalence in males versus females, their age of onset, and the specific deficits found in each disorder. Deficits common to all PDDs include a lack of social interactions and communication skills, as well as stereotyped behaviors (e.g., hand flapping). In general, these children are socially withdrawn, lack appropriate social skills, and are disinterested and disengaged from their social environments; traditional therapies have not proved particularly advantageous for this population. For instance, neither pharmacological interventions (Aman & Langsworthy, 2000; Volkmar, 2001) nor educational therapies (e.g., sensory-motor therapy, communication therapy) (Dawson & Watling, 2000; Dempsey & Foreman, 2001; Goldstein, 2000) appear to effectively manage all symptoms associated with PDD. For this reason, a more effective treatment for PDD must be determined. AAT may hold the potential to greatly benefit this population. One reason that AAT may be beneficial for children with PDD involves the notion that animals can act as transitional objects. As transitional objects, children establish primary bonds with the animals; these bonds can then be transferred to humans (George, 1988; Katcher, 2000; Winnicott, 1986). Because children with PDD have difficulties forming such bonds, AAT may be a good fit for this population. Preliminary research in the field does support this assertion: In a study involving AAT and children with autistic disorder, AAT was found to increase prosocial behaviors, decrease self-absorption, and lessen stereotypical behaviors (Redefer & Goodman, 1989).

PURPOSE

Although there appears to be some initial evidence that AAT may be effective for PDD, further investigation is necessary. In general, studies evaluating the effectiveness of AAT share a common shortcoming: lack of scientific control and rigor. Because much of the information available about AAT is qualitative or anecdotal (Law & Scott, 1995; Mallon, 1992; Voelker, 1995), there is a need to incorporate scientific protocol in AAT studies. Such protocol includes clear definition of the goals of the research, proper instruments of measurement and documentation, gathering of sufficient sample sizes, and the use of a control condition (Voelker, 1995). Incorporating these criteria, the current study seeks to quantitatively measure the behavioral and verbal interactions of children with PDD.

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

660

Western Journal of Nursing Research

PREDICTIONS

Children were expected to exhibit more frequent and longer durations of prosocial behaviors when in the presence of a therapist with a dog versus (a) a therapist with a nonsocial toy (a ball) or (b) a therapist with a stuffed dog. Prosocial behaviors were those behaviors that indicated interest and engagement in the environment, for example, by giving treats to the dog, laughing, or talking to the experimental object (ball, stuffed dog, live dog). Interaction with a dog was also expected to produce less frequent and shorter durations of nonsocial behaviors than the two other conditions. Nonsocial behaviors included such categories as ignoring questions and hand flapping.

DESIGN

This experiment used a completely within-participants repeated-measures design, with all participants experiencing all three experimental conditions (i.e., the children served as their own control).

SAMPLE Participants

Participants were 10 children ranging in age from 3 to 13 with developmental ages of 2.5 to 6.5. All 10 children had been diagnosed with some form of PDD; 7 were diagnosed with PDD not otherwise specified, 2 with Aspergers, and 1 with autistic disorder. School psychologists or family physicians provided diagnostics. None were institutionalized, and all except the youngest were attending public school. Two participants were female; 8 were male. Participants were recruited via local physicians and school principals who related the nature of the study to the families of potential participants.

METHOD

Research was conducted in accordance with the Institutional Review Boards specifications. After obtaining approval and parental consent, all

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

October 2002, Vol. 24, No. 6

661

children were individually administered the Psychoeducational Profile Revised (PEP-R) (Schopler, Reicher, & Renner, 1990), a widely used instrument possessing high validity and reliability (Muris, Steerneman, & Ratering, 1997; Van Berckelaer-Onnes, & Van Duijn, 1993). The PEP-R assesses seven different areas of functioning including imitation, perception, fine motor control, gross motor control, eye-hand coordination, cognitive performance, and cognitive verbal performance. The combined scores of the PEP-R were used to determine developmental age.
Sessions

Each child participated in 45 research sessions, all of which were conducted one-on-one with the therapist. The sessions were held three times per week for a total of 15 weeks, so that children experienced each of the three conditions every week. In other words, children would experience the ball, stuffed dog, and live dog conditions all in 1 week and then the following week again experience all three conditions. Presentation of conditions was counterbalanced across participants. Sessions were videotaped for data-coding purposes and were held at the school the child was attending. Sessions were conducted in a special room or area that school administration had designated for this purpose. To reschedule missed sessions (due to illness, holidays, etc.), meetings were occasionally held at a childs home or the People-Pet Partnership (PPP) office. A cameraperson was in attendance during sessions and, at times, the childs parent or parents or school aide. These people were asked to limit their contact with the children, interacting with them only when necessary. Sessions lasted approximately 15 minutes, during which time a child was presented with either a ball, a stuffed dog, or a live dog. Therapists consistently used a medium-sized, orange ball ideal for tossing and playing. The stuffed dogs were selected based on their physical similarity to the live dogs that were used in the experiment. Three live dogs were employed for this study, although each child was only exposed to one of the dogs. Live dogs included a Clumber Spaniel, a Newfoundland, and a Border Collie/Yellow Lab cross. To increase generalizability, dogs differing in size and color were selected; all were temperament tested by the PPP director and trained by PPP personnel, and all exhibited particularly social and friendly behaviors. Therapists also received extensive training from PPP personnel. Because practical considerations necessitated the hiring of two people for this position, it was necessary to make instructions and guidelines as uniform as possible. For example, both therapists followed the same research protocol and

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

662

Western Journal of Nursing Research

were instructed to behave and interact in similar manners. Although five of the children were seen by both therapists, statistical analysis did not find any significant trend in the behavior of the children as a function of the therapist. During the research sessions, therapists followed a predetermined research protocol designed to elicit prosocial behaviors. This protocol was constructed in accordance with the developmental and behavioral categories of the PEP-R. Having a consistent protocol also served to limit the influence of therapist style and skill level. Examples of questions include the following: What color is the ball? Can you toss the ball? Do you remember the name of this stuffed dog? Can you brush the dog? and Tell me a story about the dog. According to the developmental age of the child, the therapist would further elicit responses based on these questions.
Interactions

Childrens interactions were analyzed in terms of two categories: behavior and verbal. Within each of these categories, specific variables were evaluated; these variables had been previously established during a pilot study. Frequency of interactions and their corresponding durations were coded. Durations were coded in terms of seconds per minute except in the case of interactions that were too brief (e.g., answering yes to a question). In addition to the behaviors listed in Tables 1 and 2, other behaviors were coded. They are not presented in this article because of their very low occurrence and/or because they were not significantly different across the experimental conditions. These variables included touching the therapist, playing catch, answering a question from the therapist with yes or no, giving a nonverbal answer (e.g., head nodding), ignoring a question, talking about ones family, social agreement (e.g., uh-huh), agreeing to a request with an explanation, complying with a request nonverbally, refusing to comply with a request by saying no, refusing to comply with a request nonverbally, echolalia, and crying.
Coding Data

A Horita TG-50 was used to insert time codes on the videotapes. This allowed coders to analyze the videotapes frame by frame. Four coders assessed the behavior of the children. From each 15-minute session, coders evaluated a total of 3 minutes: 1 minute from the first third, 1 from the

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

TABLE 1: Mean Occurrences of Behaviors in the Three Conditions

Ball Variable
Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

Stuffed Dog
SD M .01 .02a,c a,c 1.57 c 18.89 c .07 a,c .21 a,c .50 a,c 3.43 a 7.27 a,c 3.85 c 16.98 34.39c
a,c

Dog
M .06 .13c b,c 1.37 b,c 8.31 .35c b,c .57 b,c 1.44 b,c 2.75 b 6.63 b,c 4.85 b,c 21.66 29.97b,c
c

M .03 a .09 a,b 2.41 b 19.25 NA a,b .41 a,b .93 a,b 3.82 a,b 9.61 a,b 4.34 b 15.35 b 33.92
a

SD .12 .24 1.45 20.1 .37 .64 3.44 2.92 8.29 2.98 15.25 15.35

SD .35 .93 1.67 13.5 1.10 1.18 4.29 2.92 8.24 2.69 14.95 15.17

F 4.92 5.33 35.52 63.08 28.43 20.09 6.48 26.42 16.87 18.03 27.14 12.43

p .008 .005 .000 .000 .000 .000 .002 .000 .000 .000 .000 .000

Hand flapping (f) Hand flapping (d) Touching experimental object (f) Touching experimental object (d) Giving treats (f) Laughing (f) Laughing (d) Looking at therapist (f) Looking at therapist (d) Looking at object (f) Looking at object (d) Looking around the room (d)

.23 .83 2.27 19.15 NA 1.06 3.15 2.89 9.85 3.35 13.12 15.57

NOTE: NA = not applicable; (d) = duration (in seconds per minute); (f) = frequencies. a. Indicates a difference (paired-samples t test, p < .05) between ball and stuffed-dog conditions. b. Indicates a difference between ball and dog conditions. c. Indicates a difference between stuffed-dog and dog conditions.

663

664

TABLE 2: Mean Occurrences of Verbalizations in the Three Conditions

Ball Variable
Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

Stuffed Dog
SD M SD M

Dog
SD F p

Respond to questions with detailed explanations (f) Talk about therapist (f) Talk about therapist (d) Talk about self (f) Talk about self (d) Talk about experimental object (f) Talk about experimental object (d) Talk to experimental object (f) Talk to experimental object (d) Talk about unrelated topics (f) Talk about unrelated topics (d) Answer a request yes (f) Ignoring a question followed by an unrelated statement (f)

.94 a,b .27 a,b .71 a,b .37 a .97 a,b .38 a,b .87 a,b .02 a,b .06 b 1.21 b 3.46 .05 .18
a

1.22 .74 2.91 .74 2.72 .84 2.38 .16 .66 1.55 6.14 .34 .57

.94c a .13 a .29 .2a a,c .46 a .78 a 1.97 a,c .11 a,c .19 c 1.13 3.69c c .04 .27a,c

1.17 .45 1.46 .54 1.62 1.44 4.33 .43 .82 1.43 6.82 .26 .64

.65b,c b .09 b .25 .26b c .75 b .73 b 1.94 b,c .55 b,c 1.02 b,c .7 2.18b,c c .09 .19c

.92 .35 1.17 .58 2.28 1.27 4.14 1.21 2.62 1.1 5.43 .33 .52

12.99 12.75 4.73 9.18 8.16 18.61 17.99 46.95 28.59 27.51 11.35 3.56 3.38

.000 .000 .009 .000 .000 .000 .000 .000 .000 .000 .000 .029 .035

NOTE: (d) = duration (in seconds per minute); (f) = frequencies. a. Indicates a difference (paired-samples t test, p < .05) between ball and stuffed-dog conditions. b. Indicates a difference between ball and dog conditions. c. Indicates a difference between stuffed-dog and dog conditions.

October 2002, Vol. 24, No. 6

665

second third, and 1 from the last third. To determine which minutes would be evaluated, sessions were assigned a random-coding sequence. To ensure that all coders were making similar judgments of the interactions, coders were instructed on proper procedures until they achieved 90% interrater reliability. Reliability was calculated by means of an Excel program specifically designed for this project. The program determined interrater reliability by calculating the overlap between coders assessments of interactions. Periodic checks of reliability were made throughout the coding process on 10% of the sessions. The overall reliability between coders remained high (91.3%).

ANALYSIS OF DATA

Repeated-measures analysis of variance tests (SPSS 10.0) (SPSS Inc., 1999) were used to evaluate differences in childrens interactions as a function of the three conditions. Paired t tests were employed to determine the location of differences in the model.

FINDINGS

Preliminary analyses suggested no clear trend in terms of developmental age and therefore were not included in subsequent analyses. The limited number of females (N = 2) also prohibited analyses on possible effects of gender. In terms of behavior variables (Table 1), children were more likely to perform hand flapping in the dog condition than in the stuffed-dog condition, t(449) = 2.81, p < .005; hand flapping lasted for a longer period of time, t(449) = 2.50, p < .01. Children were more likely to touch the ball than the dog, t(449) = 8.30, p < .001, as well as the stuffed dog more than the dog, t(449) = 2.14, p < .033. These touching behaviors lasted longer in the ball condition, t(449) = 9.9, p < .001, and the stuffed-dog condition, t(449) = 9.13, p < .01. Children looked at the therapist less frequently in the dog condition than in the ball condition, t(449) = 7.07, p < .001, or stuffed-dog condition, t(449) = 4.48, p < .001. Less time was spent looking at the therapist in the dog condition than in the ball condition, t(449) = 7.17, p < .001.

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

666

Western Journal of Nursing Research

Children were more likely to give treats to the live dog than the stuffed dog, t(449) = 5.33, p < .001. They laughed more frequently in the dog condition than in the ball condition, t(449) = 2.36, p < .019, or the stuffed-dog condition, t(449) = 6.12, p < .001; laughing lasted for longer durations, t(449) = 2.24, p < .025 (ball); t(449) = 3.60, p < .001 (stuffed dog). Children looked at the dog more often than they looked at the ball, t(449) = 2.39, p < .017, or the stuffed dog, t(449) = 6.07, p < .001, and spent longer amounts of time looking at the dog than the ball, t(449) = 7.09, p < .001, or the stuffed dog, t(449) = 5.33, p < .001. Children spent less time looking around the room in the dog condition than in the ball condition, t(449) = 4.01, p < .001, or the stuffed-dog condition, t(449) = 4.51, p < .001. In terms of verbal interactions (Table 2), results indicate that children answered questions with detailed explanations less often in the dog condition than in the ball condition, t(449) = 4.24, p < .001, or the stuffed-dog condition, t(449) = 4.37, p < .001. They also talked about the therapist less in the dog condition than in the ball condition, t(449) = 5.02, p < .001, and for shorter amounts of time, t(449) = 3.12, p < .002. Children talked about themselves less frequently in the dog condition than in the ball condition, t(449) = 2.40, p < .017. They talked about themselves for longer amounts of time in the dog condition than in the stuffed-dog condition, t(449) = 2.28, p < .023. Results also show that children were more likely to talk about the dog than the ball, t (449) = 5.07, p < .001, and for longer durations, t (449) = 4.91, p < .001. Children talked to the dog more frequently than to the ball, t(449) = 9.32, p < .001, or the stuffed dog, t(449) = 7.68, p < .001. Children spent a greater amount of time talking to the dog than to the ball, t(449) = 7.52, p < .001, or the stuffed dog, t(449) = 6.61, p < .001. Also, in the dog condition, children were less likely to talk about topics unrelated to the research protocol. (Unrelated topics were those that were not related to the object, the therapist, or the childfor example, talking about a television program.) This finding was true compared to both the ball, t(449) = 6.37, p < .001, and stuffed-dog conditions, t(449) = 5.87, p < .001. Children talked about unrelated topics for shorter lengths of time in the dog condition, t(449) = 3.51. p < .001 (ball); t(449) = 4.33, p < .001 (stuffed dog). Children were also more likely to comply with a request by saying yes when in the dog condition than in the stuffed-dog condition, t(449) = 2.57, p < .01, and they were less likely to ignore a question and follow with an unrelated statement in the dog condition than in the stuffed-dog condition, t (449) = 2.09, p < .038.

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

October 2002, Vol. 24, No. 6

667

DISCUSSION

Although the sample size of this study prohibits extensive generalization, the results nonetheless provide some tentative support for the efficacy of AAT for children with PDD. Behaviors of the children varied as a function of experimental condition, and interaction with dogs appeared to have some positive benefits. These findings support the work of Redefer and Goodman (1989) and lend merit to the assertion that AAT may be beneficial for this population (Law & Scott, 1995; Nathanson et al., 1997). Children laughed more and gave treats more often in the dog condition, implying a happier, more playful mood and an increase in energy. This increase in energy seems to have been appropriately channeled as evidenced by the fact that childrens attention was primarily centered on the dog and not on distracters unrelated to the protocol. For instance, children were more likely to keep their gaze focused on the dog than on the ball or the stuffed dog and they appeared to be less easily distracted in the dog condition, looking around the room less in this condition. Children were also more likely to talk to the dog, initiating numerous conversations and exchanges. They were more likely to engage the therapist in discussions regarding the dog than discussions regarding the ball. Further support that dogs may aid in maintaining the interest and focus of children with PDD is evidenced by the fact that children spoke less about topics unrelated to the therapeutic protocol in the dog condition than in either of the other conditions. Compared to the stuffed-dog condition, children were also more apt to agree to a request from the therapist. They were less inclined to disregard questions from the therapist by talking about unrelated subjects (as compared to the stuffed-dog condition). For example, the therapist asking, What color is the ball? and the child answering, The rug is dirty would be considered ignoring a question followed by an unrelated statement (see Table 2). This may be a particularly powerful finding, as this category may best represent the typical interactions of children with PDD, interactions that are one-sided and which fail to integrate others communications and perspectives. That children were less inclined to disregard therapist questions with irrelevant answerscombined with frequent talking to the dog and less frequent discussions about topics unrelated to protocol indicates that using a therapy dog may increase meaningful, focused discussions. Although these results are promising, some of the findings run counter to the general hypothesis. For example, children responded to questions with

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

668

Western Journal of Nursing Research

detailed explanations less often in the dog condition. They were also less likely to initiate conversations about themselves or conversations about the therapist. One explanation for this may be that children talked more about the dog and to the dog, thus allowing less time to talk about other topics. Children looked at the therapist less often in the dog condition compared to the two other conditions, perhaps because they looked at the dog more often. Children touched the dog less often than the ball or the stuffed dog. This may be explained by the fact that the children would place the ball or the stuffed dog on their laps and forget about themwhich would be impossible to do with a live, active dog. Another unexpected result was that children exhibited more hand flapping in the presence of the dog. Although hand flapping is usually considered a stereotyped behavior and therefore viewed as undesirable, we believe that in this study, hand flapping was a mode of expressing excitement and exhilaration. In a therapeutic context, it could be the job of the therapist to help children moderate these undesirable behaviors and to transform this excitement into something more appropriate, but this task was beyond the scope of this research. Although the results are certainly encouraging, this study does not evaluate AAT per se. Therapists used a research protocol, not a therapy protocol. They did not try to modify the behavior of the children; they only tried to elicit prosocial behaviors. The primary reason for using a research protocol was to enable examination of differences between conditions or, in other words, to determine whether children may be more primed for therapy when in the presence of a dog. We wanted to examine the foundation of AATthe human-animal bond. In this way, extraneous variables were minimized, allowing us to focus on the fundamental interaction occurringchild and animal. With this research, we now have some quantitative indication that interaction with dogs may have a positive effect on the behaviors of children with PDD. The next step is to see if and how it can be used in a clinical setting and to verify if these positive effects can be generalized to other spheres of the childrens lives. It is also important to know whether all of these effectsor anywould be maintained outside therapy sessions. Taken together, this research provides some evidence that AAT may be an effective form of treatment for children with PDD and ameliorates our previous understanding of the potential benefits of AAT for this population. Perhaps the most important aspect of this research is that it is one of the first studies to quantify the effects of interaction with dogs on this population in a scientific and controlled manner. With the knowledge obtained from this

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

October 2002, Vol. 24, No. 6

669

study, it is possible to begin to further test the implications of the findings, particularly as they apply in clinical settings. By building on the results of this research, both researchers and clinicians can start to delineate the most effective methods of serving clients with PDD through AAT.

NOTE
1. This research was made possible in part by the Pet Care Trust Foundation, Washington, D.C. We wish to acknowledge the contributions of Daun Martin, Camille McElwain, Willow Gormley, Tony Ezetta, Cline Cazorla, and Kristie Morse in this research.

REFERENCES
Aman, M. G., & Langsworthy, K. S. (2000). Pharmacotherapy for hyperactivity in children with autism and other pervasive developmental disorders. Journal of Autism and Developmental Disorders, 30, 451-459. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Anderson, W. P., Reid, C. M., & Jennings, G. L. (1992). Pet ownership and risk factors for cardiovascular disease. Medical Journal of Australia, 157, 298-301. Barker, S. B., & Dawson, K. S. (1998). The effects of animal-assisted therapy on anxiety ratings of hospitalized psychiatric patients. Psychiatric Services, 29, 797-801. Cole, K. M., & Gawlinski, A. (2000). Animal-assisted therapy: The human-animal bond. American Association of Critical-Care Nurses Clinical Issues, 11, 139-149. Conner, K., & Miller, J. (2000). Animal-assisted therapy: An in-depth look. Dimensions of Critical Care Nursing, 19, 20-28. Dawson, G., & Watling, R. (2000). Interventions to facilitate auditory, visual, and motor integration in Autism: A review of the evidence. Journal of Autism and Developmental Disorders, 30, 415-421. Dempsey, I., & Foreman, P. (2001). A review of educational approaches for individuals with Autism. International Journal of Disability, Development and Education, 48, 103-116. Friedmann, E., Katcher, A. H., Lynch, J. J., & Thomas, S. A. (1980). Animal companions and one-year survival of patients after discharge from a coronary care unit. Public Health Reports, 95, 307-312. George, H. (1988). Child therapy and animals. In C. E. Schaefer (Ed.), Innovative interventions in child and adolescent therapy (pp. 400-418). New York: John Wiley. Goldstein, H. (2000). Commentary: Interventions to facilitate auditory, visual, and motor integration: Show me the data. Journal of Autism and Developmental Disorders, 20, 423-425. Hansen, K. M., Messinger, C. J., Baun, M. M., & Megel, M. (1999). Companion animals alleviating distress in children. Anthrozos, 12, 142-148. Katcher, A. H. (2000). The future of education and research on the human-animal bond and animal-assisted therapy. Part B: Animal-assisted therapy and the study of human-animal relationships: Discipline or bondage? Context or transitional object? In A. Fine (Ed.), Handbook

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009

670

Western Journal of Nursing Research

on animal-assisted therapy: Theoretical foundations for guidelines and practice (pp. 461473). San Diego: Academic Press. Katcher, A. H., & Wilkins, G. G. (1998). Animal-assisted therapy in the treatment of disruptive behavior disorders in children. In L. Ante (Ed.), The environmental and mental health: A guide for clinicians. Mahwah, NJ: Lawrence Erlbaum. Kogan, L. R. (2000). Effective animal-intervention for long term care residents. Activities, Adaptation, & Aging, 25, 31-45. Law, S., & Scott, S. (1995). Tips for practitioners: Pet Care: A vehicle for learning. Focus on Autistic Behavior, 10, 17-18. Limond, J. A., Bradshaw, J. W. S., & Cormack, K. F. M. (1997). Behavior of children with learning disabilities interacting with a therapy dog. Anthrozos, 10, 84-89. Mallon, G. P. (1992). Utilization of animals as therapeutic adjuncts with children and youth. Child Care and Youth Forum, 21, 53-67. Melson, G. F. (2000). Companion animals and the development of children: Implications of the biophilia hypothesis. In A. Fine (Ed.), Handbook on animal-assisted therapy: Theoretical foundations for guidelines and practice (pp. 376-382). San Diego: Academic Press. Miller, J., & Ingram, L. (2000). Perioperative nursing and animal-assisted therapy. Association of Operating Room Nurses Journal, 19, 477-483. Muris, P., Steerneman, P., & Ratering, E. (1997). Interrater reliability of the Psychoeducational Profile. Journal of Autism & Developmental Disorders, 27, 621-626. Nathanson, D. E. (1998). Long-term effectiveness of dolphin-assisted therapy for children with severe disabilities. Anthrozos, 11, 22-32. Nathanson, D. E., de Castro, D., Friend, H., & McMahon, M. (1997). Effectiveness of short-term dolphin-assisted therapy for children with severe disabilities. Anthrozos, 10, 90-100. Redefer, L. A., & Goodman, J. F. (1989). Brief report: Pet-facilitated therapy with autistic children. Journal of Autism and Developmental Disorders, 19, 461-467. Schopler, E., Reicher, R. J., & Renner, B. R. (1990). Individualized assessment and treatment for autistic and developmentally disabled children. Vol. 1: Psychoeducational Profile revised. Austin, TX: Pro-ed. SPSS Inc. (1999). SPSS 10.0 for Windows [Computer software]. Chicago, IL: Author. Taylor, E., Maser, S., Yee, J., & Gonzalez, S. M. (1993). Effects of animals on eye contact and vocalizations of elderly residents in long term care facilities. Physical & Occupational Therapy in Geriatrics, 11, 61-71. Triebenbacher, S. L. (2000). The companion animals within the family system: The manner in which animals enhance life within the home. In A. Fine (Ed.), Handbook on animal-assisted therapy: Theoretical foundations for guidelines and practice (pp. 357-373). San Diego: Academic Press. Van Berckelaer-Onnes, I., & Van Duijn, G. (1993). A comparison between the Handicaps Behaviour and Skills Schedule and the Psychoeducational Profile. Journal of Autism and Developmental Disorders, 23, 263-272. Voelker, R. (1995). Puppy love can be therapeutic, too. Journal of the American Medical Association, 274(24), 1897-1899. Volkmar, F. R. (2001). Pharmacological interventions in autism: Theoretical and practical issues. Journal of Clinical Child Psychology, 30, 80-87. Walsh, P. G., & Mertin, P. G. (1994). The training of pets as therapy dogs in a womans prison: A pilot study. Anthrozos, 7, 124-128. Winnicott, D. W. (1986). Transitional objects and transitional phenomena. In P. Buckley (Ed.), Essential papers on object relations (pp. 254-271). New York: New York University Press.

Downloaded from http://wjn.sagepub.com by guest on July 14, 2009