ArticlePDF Available

Brief Report: Above and Beyond Safety: Psychosocial and Biobehavioral Impact of Autism-Assistance Dogs on Autistic Children and their Families


Abstract and Figures

Autism-Assistance Dogs (AADs) are highly-skilled service animals trained primarily to ensure the safety of an autistic child by preventing elopement and mitigating ‘meltdowns’. Although anecdotal accounts and case-studies have indicated that AADs confer benefits above and beyond safety, empirical support anchored in validated clinical, behavioral, and physiological measures is lacking. To address this gap, we studied children and their families before and after receiving a well-trained AAD using a within-subject, repeated-measures design. Notably, this study is the first to assess change in a biomarker for chronic stress in both autistic children and their parents. Final analyses included pre-/post-AAD data from 11 triads (parent/handler-dog-child) demonstrating significantly positive psychosocial and biobehavioral effects of AADs.
Content may be subject to copyright.
1 3
Journal of Autism and Developmental Disorders
Brief Report: Above andBeyond Safety: Psychosocial
andBiobehavioral Impact ofAutism‑Assistance Dogs onAutistic
Children andtheir Families
Accepted: 14 December 2021
© The Author(s) 2022
Autism-Assistance Dogs (AADs) are highly-skilled service animals trained primarily to ensure the safety of an autistic child
by preventing elopement and mitigating ‘meltdowns’. Although anecdotal accounts and case-studies haveindicated that
AADs confer benefits above and beyond safety, empirical support anchored in validated clinical, behavioral, and physiologi-
cal measures is lacking. To address this gap, we studied children and their families before and after receiving a well-trained
AAD using a within-subject, repeated-measures design. Notably, this study is the first to assess change in a biomarker for
chronic stress in both autistic children and their parents. Final analyses included pre-/post-AAD data from 11 triads (parent/
handler-dog-child) demonstrating significantly positive psychosocial and biobehavioral effects of AADs.
Keywords Autism-assistance dogs· Canine assistance· Service dogs· Psychosocial effects· Chronic cortisol
concentration· Parent/child stress
Autism spectrum disorder (ASD), a heterogeneous neu-
rodevelopmental disorder (NDD) comprising lifelong chal-
lenges in social, communication, and behavioral domains,
has reached an unprecedented prevalence estimate of 1-in-
54 in the United States (Maenner etal., 2020). Frequently,
treatment plans not only need to address core ASD symp-
toms, but also a variety of co-occurring developmental,
psychiatric, neurologic, or medical diagnoses that further
impact daily functioning and quality of life (Masi etal.,
2017). One approach with the potential to address a number
of concerns for autistic individuals and their families is the
incorporation of animal-assisted interventions (AAIs)1 into
home, school, and hospital settings (Dimolareva & Dunn,
2020; Esposito etal., 2011; Johnson etal., 2002); several
studies have reported positive effects when human-animal
interactions (HAI) have been integrated into ASD therapies
(Dimolareva & Dunn, 2020; Droboniku & Mychailyszyn,
2021; Funahashi etal., 2014; OHaire etal., 2013). Anec-
dotal accounts have also accrued attesting to the benefits
of well-trained autism-assistance dogs (AADs) who engage
with their human partners on a daily basis. Yet, despite
rising interest in the field, the evidence-base for AAIs for
ASD remains limited—due, in large part, to considerable
variability in research methodologies, implementation, and
reporting (Kazdin, 2017; O’Haire, 2013, 2017). Even sparser
still are systematic evaluations of whether and how well-
trained AADs can impact the lives of autistic children and
their families (Butterly etal., 2013).
The primary trained duties of an AAD stemmed from a
critical need to prevent child elopement; a foremost con-
cern for many parents of autistic children is that their child
may bolt or wander and “expose him or herself to potential
danger by leaving a supervised, safe space or the care of
a responsible person” (Anderson etal., 2012). One study
collected data on missing person cases in the US involving
elopement by individuals with ASD across a 5-year period
(2011–2016) and reported that, of the 808 cases evaluated,
17% resulted in death, 13% required medical attention, 38%
carried a heightened risk of bodily harm (i.e., “close calls),
* Angela Tseng
1 Department ofPsychiatry & Behavioral Sciences,
University ofMinnesota, 717 Delaware St. SE, Minneapolis,
MN55414, USA
1 For the sake of clarity, the term “animal(s)” will be used to signify
“non-human animal(s)” throughout the manuscript.
Journal of Autism and Developmental Disorders
1 3
and 1% were still considered missing (McIlwain & Fournier,
2017). Trained AAD teams increase a child’s safety by
working as a triad; in public, the child may wear a specially
designed belt that connects to the dog’s vest while an adult
handler holds the dog’s leash. AADs are taught to resist
passively with their body weight if their child attempts to
bolt and the tethering system keeps the child with their dog.
Caregiver and case study reports have related that AADs
can prevent elopement effectively while providing a sense of
security for both parents and children (Burgoyne etal., 2014;
Burrows etal., 2008). In fact, this trained ability to prevent
a child with autism from wandering away confers ‘service
animal’ status to AADs, defined by the US Department of
Justice as a dog that is individually trained to do work or per-
form tasks directly related to a person’s disability. Service
dogs are permitted to accompany people with disabilities
in all areas where members of the public are allowed to go
(ADA, 2010).
Another troubling issue affecting families of autistic chil-
dren is the health and well-being of parents/caregivers who
report experiencing higher physiological stress, parenting-
related stress, and fatigue than parents of typically-devel-
oping (TD) children and children with other NDDs (Baker-
Ericzén etal., 2016; Estes etal., 2013; Fecteau etal., 2017;
Smith etal., 2009); these experiences may increase parental
risk for mental (e.g., anxiety, depression) and physical health
(e.g., adrenal, cardiovascular) problems (Foody etal., 2014;
Seymour etal., 2012). Myriad factors including child char-
acteristics and behavioral challenges (Olson etal., 2021),
as well as sociocultural and economic circumstances (e.g.,
access to resources, stigma associated with mental health,
financial burden of care), can compound to distress parents
and affect both child and overall family outcomes by means
of transactional pathways (Bonis, 2016; Iadarola etal., 2019;
Rodriguez etal., 2019).
Encouragingly, reports of collateral benefits have emerged
from families with AADs trained chiefly for safety. One
seminal study noted that the contribution of service dogs to
family outcomes extended beyond physical welfare to behav-
ioral and psychosocial domains; parents reported that they
experienced improved quality of sleep and a greater sense of
independence while their children exhibited fewer negative
behaviors (e.g., “meltdowns”, “tantrums”, “bolting”) and
families overall experienced an increase in social acknowl-
edgement and a decrease in embarrassment or shame in
public (Burrows etal., 2008). AADs have also been trained
to disrupt potentially harmful repetitive or self-stimulating
behaviors as well as provide a modified form of pressure
touch therapy practiced by occupational therapists to help
autistic individuals reduce levels of arousal and anxiety
(Bestbier & Williams, 2017; Grandin, 1992; Krauss, 1987).
Further, because simple language is used to work with
AADS, children may gain rewarding interactive experiences
that then scaffold socialization with other humans (Solomon,
2010). Broadly, these dogs may serve as social catalysts
for their human partners by enhancing social interactions,
increasing social networks, and reducing instances of social
discrimination (Becker etal., 2017; Camp, 2001; Carlisle,
2015; Mader etal., 1989; McNicholas & Collis, 2000).
Yet, while the positive, multidimensional impact of these
AADs has been oft reported in anecdotal accounts and case
studies, empirical research substantiating these gains is
limited. Moreover, documentation is sparse specifying how
service dog providers collect outcome data when evaluat-
ing the success of their canine placements (Butterly etal.,
2013). In order to strengthen the evidence-base for this field,
systematic pre-/post-AAD assessments employing validated
instruments are warranted. Also, although a handful of stud-
ies have been published on the effects of assistance dogs
on human psychosocial health and well-being (See Rod-
riguez etal., 2020 for review), few have focused on dogs
trained expressly for ASD.Whereas mostadult handler-dog
teams (e.g., mobility, seeing, hearing, diabetes)are dyadic,
to evaluate the benefits of AADs, we must consider the
unique dynamics of the handler-dog-child triad in conjunc-
tion withthe vast heterogeneity of ASD diagnoses which
are often comorbid with other NDDs. Finally, the use of
biological measures when possible may provide key objec-
tive insights into the long-term effects of having an AAD.
To date, however, few studies have included a biomarker
measure in their evaluations of AAD success. A review of
the extant literature revealed only two such investigations
that measured changes in cortisol (salivary), the primary
glucocorticoid produced by the activation of the hypotha-
lamic pituitary adrenal (HPA) axis in response to a stressor.
Specifically, both studies examined the cortisol awakening
response (CAR), a core biomarker of HPA axis regulation
related to psychosocial stress and stress-related psychiatric
disorders (Fries etal., 2009), and reported decreases of CAR
for both parents and children after they receiving trained
service dogs (Fecteau etal., 2017; Viau etal., 2010).
The overarching objective of the present study has been
to investigate empirically the impact of AADs by collecting
psychosocial and biobehavioral data by means of validated
instruments designed to betterunderstand the functioning of
children and families affected by ASD. In addition to assess-
ment data collected via parent-report (child) and self-report
(parent), we included a biological measure of chronic stress
in both parents and children to augment our understanding of
how AADs may affect physiological health. Chronic cortisol
concentrations (CCC) assayed from a single collection of a
keratinized matrix (e.g., hair/nails) sample have been shown
to represent an accumulation of cortisol secretions over a
time frame of months (Meyer & Novak, 2012; Phillips etal.,
2021). In contrast, cortisol samples collected from saliva
or urine are limited in time (< a few days) and can require
Journal of Autism and Developmental Disorders
1 3
repeated measurements across 24-hours over several days to
obtain average chronic concentrations (Wosuet al., 2013).
Comparative studies examining the correspondence of CCC
obtained from scalp-near hair segments to 30-day (3 × daily)
average salivary cortisol area-under-the curve levels demon-
strated strong associations between CCC and prior 30-day
integrated cortisol production measures (Fries etal., 2009;
Short etal., 2016). Thus, the use of CCC can also reduce
the burden of data collection for participants, particularly
vulnerable populations, in addition to providing a gauge of
chronic stress retrospectively.
To our knowledge, the present study is among the first to
assess CCC in autistic children and the only investigation
to examine CCC in both parents and children with ASD.
Additionally, no previous reports of the effects of AAD have
incorporated CCC measures. Critically, we collected data
both before and after participants received their dogs so that
we would be able to evaluate outcomes within-subjects.
Our study objectives were thus to contribute both quantita-
tive and qualitative data from well-validated instruments to
address the question of whether children and their families
benefit from these human-canine partnerships across mul-
tiple domains.
All study procedures were approved by the University of
Minnesota’sInstitutional Review Board and all parents
completed informed consent procedures. Participants were
informed that their decision to participate would have no
bearing on their current or future relationships with the uni-
versityor the canine training program.
Using non-probability, purposive sampling, we recruited
families from the top of a regional assistance dogtrain-
ing program’s(Can Do Canines, New Hope, MN, USA)
3–5-year-long waiting list of applications to receive an AAD.
Can Do Canines
Can Do Canines (https:// cando canin es. org/) is an interna-
tionally recognized, Assistance Dogs International (ADI)
accredited, nonprofit organization that trains assistance dogs
for hearing loss, mobility challenges, seizure disorders, Type
1 Diabetes, as well as ASD in children. Families are pro-
vided with the dogs free-of-charge and the economic bur-
den and time-investment for each certified handler/dog team,
combined with the assiduous training and placement stand-
ards enforced by the organization, limits severely the num-
ber of dogs placed each year. Clients of the assistance dog
provider receive AADs whose temperaments/talents were
carefully matched to families by highly-experienced train-
ers. Trainers are able select for certain characteristics (e.g.,
hypoallergenic breeds) and tailor final training to meet the
needs of individual families. To apply for an AAD, children
(Ages: 2–7years when applying) must have a confirmed
ASD diagnosis, live within the state, and families must be
physically and financially able to take full responsibility for
the dog after certification (See Fig.1 for Study Flow Dia-
gram). An age restriction was established to accommodate
the lengthy waitlist and the fact that size must be considered
if dogs will be trained to prevent child elopement. By the
time they are ready for final training, potential AADs may
have already had more than 18months of socialization, gen-
eral training, assessments, and intensive training specific to
their assistance dog careers. Once the match is made, one
caregiver undergoes training to become the primary dog
handler and works with trainers and the AAD without their
child present. When they are ready to have the dog move
into the home, trainers then work with the triad (handler-
dog-child) together to build their partnerships and skills
in everyday life. These AAD teams require approximately
8–12weeks to complete team training and certification.
Participant Characteristics
Since our potential participant pool was limited to the fami-
lies who would be receiving an AAD during our period of
data collection, our only criteria for inclusion beyond those
of the training program were that parents/caregivers be able
to provide informed consent and complete questionnaires
in English. In total, we enrolled 13 families to participate in
the study. Final analyses included data from 11 teams; we
were unable to collect post-AAD data from one family and
one team experienced a change in family circumstances and
had to return their dog. Mean AAD age was 2.9 ± 0.5years
when matched with a family, 45.5% were females, and
mean weight was 62.2 ± 7.1 pounds. With the exception of
one Standard Poodle, all AADs were Labrador Retrievers,
Golden Retrievers, or Labrador/Golden crosses. The desig-
nated adult dog handler was the primary parent participant;
100% were mothers, 27% families identified as single-parent
households. Secondary parent/caregiver data were collected
when possible but were insufficiently powered for further
analysis. Formal diagnosis of ASD was confirmed through
parent-provided records by the assistance dog organization
while additional medical history, including diagnoses of
co-occurring neurodevelopmental conditions, was collected
via parent-report. All children had a confirmed diagnosis of
ASD and 45.5% were non-verbal. Detailed parent and child
characteristics are reported in Table1.
Journal of Autism and Developmental Disorders
1 3
Given that we would not be able to control for hetero-
geneity in family characteristics and child medical his-
tory and treatment, we implemented a repeated measures
design that would allow us to examine changes over time
within each family. We did, however, ask parents to report
ongoing treatments at each assessment and no significant
changes in ASD-related treatments between pre-/post-
AAD measures were recorded; 36.3% were receiving
therapy (e.g., occupational, speech and language, physi-
cal, applied behavioral analysis,), 45.5% were receiv-
ing therapy and medications, and 18.1% were receiving
therapy and “other” treatments (e.g., assistive technology,
adaptive sports). We should also note that one common
factor amongst the families who chose to remain on the
3–5-year long waitlist for an AAD is a willingness and
commitment to bringing an AAD into their lives and the
belief that an AAD might be beneficial. Further, fami-
lies would not likely apply for an assistance dog if their
child had known sensory aversions to canines (Grandin
etal., 2010) that would preclude meaningful interaction.
Applicants were able to make special requests for hypoal-
lergenic breeds but those limitations could lengthen wait-
times substantially.
Fig. 1 Study-flow diagram
Journal of Autism and Developmental Disorders
1 3
Study Design
Our assessment battery consisted of parent-report (child)
and self-report (parent) questionnaires as well as CCC
sample (parent and child) collection. We asked partici-
pants to complete pre-AAD (T1) measures after being
taken off the waitlist and before receiving their dogs. A
follow up assessment (post-AAD; T2) was administered
8–12weeks after teams were certified. Participants were
given the option of completing measures remotely or in-
person. Paper questionnaires and consent forms were con-
verted to REDCap (Research Electronic Data Capture),
a secure, web-based software platform designed to sup-
port data capture for research studies (Harris etal., 2009,
2019). Participants were also given the option to have the
researcher collect hair/nail samples in-person or self-col-
lect at home and submit to our laboratory by mail.
Two post-intervention time points were included in the
original study design. However, due to institutional research
and canine training facility restrictions during the COVID-
19 pandemic, we were unable to complete all planned data
collection. Moreover, we were concerned that results might
be confounded bythe considerable stress and changes in rou-
tine brought on by the pandemic alongside concurrentcivil
unrest in our regional community. Consequently, we lim-
ited our final data set to teams who completed both of their
pre-and post-AAD assessments either before (N = 7) or after
Spring 2020 (N = 4). In other words, although we contin-
ued to collect follow-up data remotely when possible, we
decided to only include data in our final analysis if families
completed T2 before March 2020 or if they enrolled after
Spring 2020. Ultimately, because the training facility was
also required to shut down for a period of time, we did not
enroll the next new participant family until October 2020.
While participants had been given the option to complete
procedures remotely/online before pandemic restrictions
were put in place, the latter group of participants were
offered the remote/online option only. We report herein on
data collected from families before receiving their AAD and
8–12weeks following team certification.
Table 1 Participant
a Confirmed ASD diagnosis required to apply for AAD
A. Child B. Parent (AAD handler)
Age (years) Age (years)
Mean 9.1 Mean 41.3
SD 1.5 SD 4.6
Sex (%) Sex (%)
Female 16.7 Female 100.0
Ethnicity (%) Ethnicity (%)
Hispanic/Latino 9.1 Hispanic/Latino 9.1
Race (%) Race (%)
American Indian/Alaska native 9.1 American Indian/Alaska native 0.0
Asian 9.1 Asian 0.0
Black/African American 9.1 Black/African American 9.1
White/Caucasian 81.8 White/Caucasian 81.8
Other/more than one race 18.2 Other/More than One Race 9.1
Neurodevelopmental disorders (%) Highest level of education (%)
Anxiety 90.9 Did not graduate from high school 9.1
Attention-deficit/hyperactivity 36.4 Some college 27.3
Autism spectrum 100.0aCollege graduate 36.4
Conduct 27.3 Graduate degree(s) 27.3
Global developmental delay 27.3 Annual household income (%)
Intellectual disability 63.6 $31,000–$40,000 18.2
Motor 18.2 $41,000–$50,000 0.0
Obsessive–compulsive 18.2 $51,000–$60,000 9.1
Seizure 27.3 $61,000–$70,000 18.2
Sleep 72.7 $71,000–$80,000 9.1
Speech and language 45.5 $81,000–$90,000 9.1
$91,000 + 36.4
Journal of Autism and Developmental Disorders
1 3
Behavioral/Psychosocial Measures
Behavioral features of children were assessed by having
parents complete a pre-/post-AAD battery of question-
naires (see Table2 for descriptions) including the Social
Responsiveness Scale—2nd Edition (SRS-2) (Constantino
& Gruber, 2012), the Child Behavior Checklist (CBCL)
(Achenbach & Rescorla, 2001), and the Autism Spectrum
Quotient—Child (AQ-Child) (Baron-Cohen etal., 2001).
In order to gather information about parent/family experi-
ences and concerns, parents also completed the Autism
Parenting Stress Index (APSI) (Silva & Schalock, 2012),
State-Trait Anxiety Inventory (STAI) (Spielberger, 1989),
the Autism Family Experience Questionnaire (AFEQ)
(Leadbitter etal., 2018), and the Perceived Stress Scale
(PSS) (Cohen etal., 1983). At the second time point, we
also asked parents for canine signalment and to respond
briefly to some open-ended questions about the AAD’s
integration into their household.
Biological Measures
To explore AAD impact using a biological measure of
chronic stress, we collected samples of scalp hair (posterior
vertex) or nail clippings from parents and children for corti-
sol extraction and analysis by enzyme immunoassay (Cooper
etal., 2012; Meyer & Novak, 2012). Although we planned to
measure hair cortisol concentration (HCC) only originally,
hair collection from some of our initial participants proved
to be prohibitively difficult and/or not possible due to lack
of scalp hair. Subsequently, participants were also given the
option to submit fingernail clippings (Phillips etal., 2021)
as an alternative method (Liu & Doan, 2019). Participants
provided the same (hair or nail) samples for their pre- and
Table 2 Parent (self-report) and child (parent-report) measures
AFEQ (Leadbitter etal., 2018); APSI (Silva & Schalock, 2012); PSS (Cohenet al., 1983); STAI (Spielberger, 1989); AQ-Child (Baron-Cohen
etal., 2001); CBCL (Achenbach etal., 2001); SRS-2 (Constantino & Gruber, 2012)
Name Description Retest Reliability Time (minutes)
Parent (Self-report)
Demographics form Includes questions about household composition,
socio-economic status, family medical history
including neurodevelopmental disorders
~ ~ 10–15
Autism Family Experience Questionnaire (AFEQ) 48-item questionnaire that assesses family quality
of life, includes 4 domains: experience of being a
parent; family life; child development and social
relationships; child's feelings and behavior
0.83 10
Autism Parenting Stress Index (APSI) 13 items grouped into 3 categories (core social dis-
ability, difficult-to-manage behavior, and physical
issue) designed to measure aspects specific to
families of children with an ASD diagnosis
0.88 5
PerceivedStress Scale (PSS) 10-item instrument that measures degree to which
situations in one’s life are appraised as stressful.
Items query how unpredictable, uncontrollable, and
overloaded respondents find their lives
0.85 5
State-Trait Anxiety Inventory (STAI) 40-item instrument designed to assess levels of state
anxiety and trait anxiety; state anxiety defined as a
transient momentary emotional status that results
from situational stress while trait anxiety represents
a predisposition to react with anxiety in stressful
0.69–0.89 5
Child (parent-report)
Autism Spectrum Quotient- children’s version (AQ-
50-item parent-report questionnaire designed to
measure autism trait severity (4–11years old)
0.85 10
Child Behavior Checklist/6–18 (CBCL) 113-item questionnaire addressing child’s competen-
cies and problem behaviors, including internalizing
and externalizing behaviors
0.80–0.94 15–20
Social Responsiveness Scale, second edition (SRS-2) 65-item rating scale measuring deficits in social
behavior associated with ASD, total score reflects
social deficit severity with five treatment subscale
scores (Social Awareness, Social Cognition, Social
Communication, Social Motivation, Restricted
Interests & Repetitive Behavior)
0.88–0.95 10–15
Journal of Autism and Developmental Disorders
1 3
post-AAD measures. Parents were also asked to complete a
questionnaire for each hair or nail sample to capture data on
hair care and medication use that may affect cortisol assay
results (Doan etal., 2018; Hamel etal., 2011). Ultimately,
we had to limit our final analysis to the subset of participants
from whom we received both pre-/post-AAD samples (Par-
ent, N = 6; Child, N = 5); inclusion/collection of complete
datasets was hindered by difficulty with collection, low sam-
ple weight, and the presence of steroid medications that may
have inflated final concentrations.
Data Analysis
Using SPSS 25.0 (Statistical Package for Social Sciences,
Version 25) we conducted Shapiro–Wilk tests to assess data
for normality and Wilcoxon signed-rank tests to assess pre-/
post-AAD changes. Both full scale and subscale scores were
included when applicable. We used raw scores rather than
t-scores for the CBCL and SRS-2 because, at the high end
of the distribution, raw scores may be more precise than
t-scores (Achenbach & Rescorla, 2001; Constantino &
Gruber, 2012). Significance levels were set at alpha = 0.05
(two-tailed). We also examined associations between parent
and child data on change in stress and cortisol levels using
Pearson correlations.
Chronic Cortisol Concentration
We collected 20–50mg of scalp hair from the posterior ver-
tex region and stored samples at room temperature in dry
and dark conditions (Cooper etal., 2012); hair was then wet-
ted with isopropanol, minced into 2mm pieces, and washed
four times with 0.5mL of isopropanol at room temperature
for 30s to remove external contamination. For fingernail
samples, clippings were collected from all ten fingers and
then stored and processed using an analogous protocol.
Samples were dried under a nitrogen stream and weighed.
Cortisol was extracted with 1mL of methanol overnight at
55°C, 1mL acetone for 5min, and then 1mL of methanol
overnight at 55°C one more time (Slominski etal., 2015).
Pooled solvent fractions were removed under a nitrogen
stream. 1mL of acetone was added and evaporated under a
nitrogen stream to chase off the solvents' remnants. Samples
were then dissolved in in an assay diluent, randomly distrib-
uted on different plates to avoid a batch effect, and analyzed
in duplicate using Salimetrics cortisol enzyme-linked immu-
nosorbent assay (ELISA) (Miller etal., 2013). If readings
for a sample differed by more than 10% or if readings were
too high due to high concentration, the measurements were
repeated; also, 5% of samples were randomly reanalyzed to
ensure reproducibility.
Using within-subjects contrasts, we compared measures col-
lected before families received their AAD (T1) and after they
had time to complete training and integrate the AAD into their
daily lives (T2). Overall, we found significant, positive changes
over time for parent, child, and family measures. Complete
results are reported in Table3 and Figs.2, 3, 4.
Given the small size of our sample, we employed Shap-
iro–Wilk tests to assess normality and found that, overall,
our data were not normally distributed. Hence, we opted
to use non-parametric tests to compare pre- and post-AAD
measures. Specifically, Wilcoxon signed-rank tests revealed
reductions in levels of experienced and perceived stress on
the: PSS, Z = − 2.361, p = 0.018; APSI, Z = -2.255, p = 0.024;
STAI (State), Z = − 2.045, p = 0.041; STAI (Trait), Z = − 2.398,
p = 0.016; and the AFEQ (Total Score) Z = − 2.936, p = 0.003.
We also found significant improvements in parent-reports
of child behavior and ASD symptomatology: AQ-Child,
Z = − 2.503, p = 0.012; CBCL (Total Problems), Z = − 2.603,
p = 0.009; SRS-2 (Total), Z = − 2.003, p < 0.045.
We also analyzed CCC levels for both parents and children
in the subset of participants who provided both pre- and post-
AAD hair/nail samples using Wilcoxon signed-rank tests and
found that CCC levels were lower at T2 than at T1 in Parents,
F(1,5) = 20.852, p = 0.006 and Children, F(1,4) = 30.600,
p = 0.005. Inter-plate variability was 2.2% and high, median,
low values for final cortisol concentration (%RSD) were
20.35pg/mg (5.87), 6.85 pg/mg (1.77), and 2.54 pg/mg
(0.265), respectively.
For the parent and child dyads with complete cortisol data,
we detected a correlation in concentration change (T1-T2) sig-
nificant at the 0.05 level (1-tailed), r(0.822), p = 0.044 indicat-
ing a reduction in cortisol levels for both parents and children.
We also found a significant correlation (1-tailed) for T1-T2
parental cortisol levels and parental PSS scores, r (0.814),
p = 0.047, indicating that reductions in chronic cortisol levels
corresponded with reductions in parent perceived stress levels.
Also, T1-T2 child cortisol levels were even slightly more cor-
related (1-tailed) with T1-T2 parental PSS scores, r (0.852),
p = 0.034.
Finally, we asked parents to describe briefly their child’s
relationship with their AAD. While we did not collect enough
text to conduct thematic analysis, comments were notably
positive and highlighted individual differences in each team.
Some examples of parental observations are included below.
Journal of Autism and Developmental Disorders
1 3
Table 3 Pre-/Post-AAD results
Pre-AAD (T1) Post-AAD (T2) ZarAsymp. Sig.
Exact Sig. (2-tailed)
Mean SD Median Mean SD Median
A. Parent (self-report) and child (parent-report) measures
AFEQ (N = 11)
Child development, understanding, social relationships 50.82 6.76 27.00 44.55 4.72 22.00 − 2.675 0.807 0.007** 0.005**
Child symptoms (feelings and behavior) 35.91 3.05 60.00 34.55 3.27 58.00 − 2.952 0.890 0.003** 0.001**
Experience of being a parent of a child with autism 33.91 3.70 33.00 31.91 3.75 32.00 − 1.636 0.493 0.102 0.109
Family life 27.64 3.32 25.00 24.36 4.20 21.00 − 2.398 0.723 0.016* 0.014**
AFEQ total 148.27 9.55 149.00 135.36 10.11 132.00 − 2.936 0.885 0.003** 0.001**
APSI (N = 10b) 21.80 5.81 24.00 17.40 4.33 16.50 − 2.255 0.713 0.024* 0.023*
PSS (N = 11) 21.45 6.96 23.00 17.55 5.43 16.00 − 2.361 0.712 0.018* 0.016*
STAI (N = 11)
State anxiety 46.36 13.57 48.00 40.64 9.79 40.00 − 2.045 0.617 0.041* 0.043*
Trait anxiety 49.64 12.18 54.00 44.45 10.29 46.00 − 2.398 0.723 0.016* 0.014**
AQ-child (N = 11) 50.91 13.97 54.00 45.55 13.19 51.00 − 2.503 0.755 0.012** 0.012**
CBCL (N = 11)
Anxious/Depressed subscale 6.00 4.47 6.00 3.82 3.19 4.00 − 2.273 0.685 0.023* 0.023*
Withdrawn/Depressed subscale 3.91 0.94 4.00 3.64 1.43 4.00 − 0.796 0.240 0.426 0.410
Somatic Complaints subscale 3.18 3.46 1.00 2.27 2.65 1.00 − 1.613 0.486 0.107 0.172
Social problems 6.64 3.01 7.00 5.09 2.39 5.00 − 2.582 0.779 0.010** 0.010**
Thought problems 9.64 2.66 9.00 9.18 2.68 9.00 − 0.621 0.187 0.535 0.580
Attention problems 12.73 3.04 12.00 11.27 3.13 11.00 − 2.676 0.807 0.007** 0.007**
Rule-breaking behavior 2.64 1.91 2.00 2.18 1.40 2.00 − 0.741 0.223 0.458 0.547
Aggressive behavior 12.00 5.31 12.00 7.82 4.00 6.00 − 2.454 0.740 0.014** 0.012**
Internalizing problems 13.09 7.08 12.00 9.73 5.31 8.00 − 2.680 0.808 0.007** 0.004**
Externalizing problems 14.64 6.83 14.00 10.00 4.94 9.00 − 2.315 0.698 0.021* 0.019*
CBCL Total problems 27.73 12.62 26.00 19.73 9.11 21.00 − 2.603 0.785 0.009** 0.006**
SRS-2 (N = 11)
Social awareness 15.73 2.80 16.00 15.45 2.84 16.00 − 0.051 0.015 0.959 1.000
Social cognition 22.73 3.50 23.00 20.45 3.47 21.00 − 2.149 0.648 0.032* 0.035*
Social communication 39.27 7.67 38.00 35.55 8.38 35.00 − 2.347 0.708 0.019* 0.016*
Social motivation 18.09 4.11 19.00 15.73 5.12 18.00 − 2.363 0.712 0.018* 0.016*
Restricted interests and repetitive behavior 21.18 3.92 22.00 21.09 4.46 22.00 − 0.211 0.064 0.833 0.844
SRS total 117.00 15.92 121.00 108.27 19.20 111.00 − 2.003 0.604 0.045* 0.048*
Journal of Autism and Developmental Disorders
1 3
Parent 1: “Child1 takes AAD1 to school every day. The tether system
has stopped Child1's elopement. AAD1 can help Child1 calm down
when upset and ease his anxiety. Child1's peers like AAD1 so they
interact more with Child1 than they did in the past. Child1 feeds
AAD1 and will throw a tennis ball for him. Child1 gives AAD1
some instructions but does not initiate a lot of play or petting.
Child1 will pet or hug AAD1 when prompted. They sleep in the
same room but not the same bed because Child1 does not appreci-
ate AAD1's kisses (licking his face).”
Parent 2: “AAD2 and Child2 are best buddies. AAD2 helps Child2
manage his anxiety, stay safe in public places, and allows our fam-
ily to access our community in a way that we've never been able to
do. Awesome!”
Parent 3: “You wouldn't necessarily know by interaction how impor-
tant AAD3 is to [non-verbal] Child3 but Child3 loves AAD3 and he
is very important to him. AAD3 sleeps with Child3 and assists when
we are out in the community.
Our primary study objective was to assess the multidimen-
sional impact of well-trained AADs on autistic children and
their families across key domains of function. By recruiting
from the top of a wait-list for AADs, we were able to enroll
participants shortly before they received their dog, thus
allowing us to collect pre-/post-AAD data using a battery
of psychosocial and biobehavioral assessments. Our find-
ings provide substantive support for the positive effects of
AADs above and beyond their duties as a child’s “sentinel
of safety” (Burrows etal., 2008).
The observed benefits of AADs may not be surprising
since young children, as early as 9-months of age, have
demonstrated an attraction to animals, often preferring them
to inanimate objects (DeLoache etal., 2011; Kahn, 1997;
Lobue etal., 2013; Ricard & Allard, 1993). Positive inter-
species interactions have also been associated with increased
concentrations of oxytocin and decreased cortisol levels in
both humans and canines (Handlin etal., 2015; Nagasawa
etal., 2015; Odendaal & Meintjes, 2003). During medical
procedures, the presence of a companion animal has been
shown to reduce a child’s physiological arousal and behav-
ioral distress (Nagengast etal., 1997; Vagnoli etal., 2015).
Correspondingly, during a laboratory-based stressor, rise in
perceived stress for TD children (7–12years) was buffered
significantly by the presence of the family pet dog, relative
to children who were alone or with a parent (Kertes etal.,
2017). As invaluable sources of socio-emotional support
(Melson, 2003), animals may also serve as transitional
objects, through which children can transfer their established
bonds to humans (Martin & Farnum, 2002). For children
especially, dogs provide multisensory experiences and direct
feedback in the context of nonverbal actions that may be
a Wilcoxon signed ranks test: based on positive ranks
b Missing data in responses from one Pre-AAD APSI
**p ≤ 0.01
*p ≤ 0.05
p ≤ 0.10
Table 3 (continued)
Pre-AAD (T1) Post-AAD (T2) ZarAsymp. Sig.
Exact Sig. (2-tailed)
Mean SD Median Mean SD Median
B. Cortisol concentration measures
Chronic cortisol concentration (pg/mg)
Parent (N = 6) 10.255 6.098 7.710 6.127 4.176 3.975 − 2.201 0.898 0.028* 0.031*
Child (N = 5) 9.164 2.774 8.400 5.526 1.518 4.910 − 2.023 0.905 0.043* 0.063†
Journal of Autism and Developmental Disorders
1 3
more easily deciphered at early developmental stages (Pro-
thmann etal., 2009; Redefer & Goodman, 1989).
Prior research has suggested that dogs are particularly
adroit at eliciting prosocial behavior, acting as social
catalysts with humans, as well as reducing physiological
arousal and stress in children and adults (Fecteau etal.,
2017; McNicholas & Collis, 2000; Viau etal., 2010). Con-
sistent with these findings, our data show significant pre-/
post-AAD improvements for children on the AQ-Child, the
CBCL (CBCL Total Problems; Anxious/Depressed, Social
Problem, and Attention Problem Subscales; Internalizing
and Externalizing Problem Composites), and the SRS-2
(SRS Total; Social Cognition, Social Communication, and
Social Motivation Subscales). Parents self-reported signifi-
cantly reduced stress and anxiety on the APSI, PSS, and
STAI (State and Trait) and significantly improved fam-
ily experiences overall on the AFEQ (AFEQ Total; Child
Development, Understanding, & Social Relationships; Child
Symptoms—Feelings & Behavior; Family Life Subscales).
Both parents and children with pre-/post-AAD CCC data
showed a reduction on our objective physiological measure
of chronic stress. However, while the majority of outcome
measures indicated significant pre-/post-AAD improve-
ments, it is worthwhile to consider those areas that yielded
Fig. 2 Pre-/Post-AAD mean
score differences on parent self-
report measures demonstrating:
A improved family experiences
on the AFEQ, B reduction of
parenting stress on the APSI,
C reduction of perceived stress
on PSS; and D reduction of
anxiety on the STAI (*p 0.05;
**p ≤ 0.01)
Journal of Autism and Developmental Disorders
1 3
trend improvements on the AFEQ (Experience of Being a
Parent of a Child with Autism Subscale, p = 0.102) and the
CBCL (Somatic Complaints Subscale, p = 0.107) and t hose
measures that returned non-significant results on CBCL
Subscales (Withdrawn/Depressed, Rule-Breaking Behavior,
Thought Problems) and SRS-2 Subscales (Social Awareness,
RRBs). By differentiating between domains that are more
or less susceptible to the presence of an AAD, we may be
afforded insight into the potential mechanisms of actions
subserving the dynamic, ongoing relationships within par-
ent/handler-dog-child triads.
In evaluating how the integration of a well-trained AAD
can result in long-term changes in the lives of autistic chil-
dren and their families, adopting a dynamic biopsychosocial
perspective may be useful to contextualize the role of AADs
(Gee etal., 2021; Lehman etal., 2017). Within this frame-
work, the AAD’s role in preventing a child’s elopement may
be construed as a continuous interplay between biological,
psychological, and social factors within a non-static envi-
ronment. For example, by consistently and effectively pre-
venting a child from eloping, the AAD helps alleviate some
of the acute safety concerns reported by parents/caregiv-
ers of autistic children (Bonis, 2016; Burrows etal., 2008;
Rodriguez etal., 2019). Over time the increased sense of
security and social acknowledgment afforded by the AAD
may reduce chronic physiological and psychological stress
in parents, improving overall quality of life for the family
(Eddy etal., 1988; Mader etal., 1989). Further, parents have
reported that having the AAD to support their child enables
them to go on family outings, feel more independent, and
Fig. 3 Pre-/Post-AAD mean score differences on parent-report measures demonstrating improvements (decrease in problem scores or reduction
in challenges) on the A, B CBCL, C SRS-2, D AQ-Child (*p ≤ 0.05; **p ≤ 0.01)
Journal of Autism and Developmental Disorders
1 3
be more connected socially, processes that can also serve to
augment mental health and well-being more broadly (Bur-
goyne etal., 2014; Smyth & Slevin, 2010).
While findings from this investigation provide significant
support for the benefits of AADs, the data are limited in a
number of ways.
First, we must note the conclusions drawn from these
AAD-teams should be considered in view of their highly-
specialized training and stringent certification criteria and
may not be generalized across animals described as emo-
tional support, therapy, comfort, or companion animals who
have not received comparable levels of training.
Second, we did not include a wait-list control group
(families who applied for an AAD but did not receive a dog
during the same period of time) or a non-wait-list control
group (families from the community who had not applied
for an AAD). Given the highly multifactorial nature of each
family’s individual characteristics, the unpredictable length
of time each family might be on the wait-list, and the lim-
ited number of AADs available, we decided to constrain
the study to a single group, repeated measures design. The
additional variability introduced by families who had not
applied for an AAD (non-wait-list controls) would render
comparison data even more difficult to interpret. Addi-
tionally, including a control group from further down the
wait-list would require participant families to remain on the
wait-list for the duration of the study collection period and
we did not wish to interfere with standard operating pro-
cedures of the training program. In particular, we did not
want study participation to be a factor if an AAD candidate
proved to be a good match for a control-family as collect-
ing an appropriately-timed T2 assessment would delay the
process of getting the AAD team started. Moreover, families
unlikely to receive a dog during our collection period (i.e.,
bottom of the 3–5year wait-list) would include a younger
cohort of autistic children who would be poorly matched to
the active group if we implemented a cross-sectional design.
Further, families on the wait-list could not be restricted from
introducing, discontinuing, or modifying therapies/medica-
tions during the study period; yet, these alterations would
inexorably confound comparisons to the active group. While
families who did receive an AAD were also not constrained
from altering their treatment plans, the training process of
becoming an AAD team is quite involved and we surmised
that families would not have the time to modify their existing
treatment plans substantially; we did not note any significant
alterations in child therapies/medications pre-post-AADs in
our sample but we could have factored in those changes to
our final analysis as needed.
Third, due to the high demand and low supply of qualified
AADs, our sample size was expectedly quite small. In antici-
pation of this limitation, we chose a within-subject design to
examine pre-/post-AAD changes for each family; we were
able to demonstrate significant, quantifiable changes from
T1 to T2. Also, because we were unable to collect all data
from the third time point as originally planned, we were
precluded from gauging if improvements were maintained
long-term. Additional data points could have provided
insight into whether continued interaction with AADs would
lead to sustained and/or greater/fewer changes over time.
For example, while we posit that some AAD effects follow
a more protracted time course through indirect pathways,
these may not be evident until more time has passed. One
putative mechanism entails the proximal reduction of physi-
ological arousal stress and an increase in feelings of physical
safety with the AAD that may impact sleep quality distally in
time. Several parent participants reported that their children
have difficulty sleeping which, in turn, affected their own
sleep quality. Sleep deprivation indubitably plays a role in
mental health and well-being, which can then impact multi-
ple levels of family systems and behavior (Mihaila & Hart-
ley, 2018). However, several families noted that with the
AAD’s presence, their children began sleeping through the
night, perhaps due to an increased sense of security or their
canine’s de-arousing capabilities.
Next, we could not control for the myriad variables that
may have contributed to changes over the study timeline.
For example, we cannot rule out the impact of developmen-
tal change over the study months and families maintained
their ongoing treatment and medication schedules while par-
ticipating. Although our T2 data demonstrated significant
improvements in participants relative to their T1 data, we
Fig. 4 Pre-/Post-AAD differences in chronic cortisol concentration
levels for parents and children (*p ≤ 0.05)
Journal of Autism and Developmental Disorders
1 3
cannot be certain that changes were not due to variables
such as maturation, concurrent treatments, or unknown envi-
ronmental factors. Also, most measures were parent-report
and parent-self report assessments, which may be subject
to response bias. Yet, given that the autistic children in our
study were quite young, heterogeneous in their presentation,
and all had co-occurring challenges (e.g., non-verbal, co-
morbid NDDs), it was not feasible to administer an objective
task-based or observational measure that would be develop-
mentally appropriate for all participants. We were, however
cautiously selective in the measures chosen for inclusion in
our assessment battery; all instruments were validated, reli-
able (see Table2), behavioral and psychosocial instruments
that have been developed for and used widely to evaluate
child functioning and development.
Finally, we experienced difficulty when collecting sam-
ples for cortisol assay because several participants had very
short or no scalp hair. Similar issues when collecting finger-
nail samples arose because some individuals bit their finger-
nails or kept their nails quite short. An alternative option that
may offset some of these issues in future studies might be
the use of toenail clippings to ascertain cortisol concentra-
tion. Overall, considering the heterogeneity of our partici-
pantfamilies, we are reasonably confident that receiving an
AAD, the one consistent change for all families during the
study collection period, was a driving factor in positive out-
comes. Nevertheless, findings based on our limited sample
size must be interpreted with caution.
To our knowledge, the present study is the first to examine
psychosocial and biobehavioral effects of assistance dogs
trained specifically for ASD using validated and standard-
ized measures of family experience, parental stress, autism
symptom severity, and child behavior; these data are also
the first to evaluate a biological marker for chronic stress in
both children and parents/caregivers. Our findings augment
significantly our evidence-base for the benefits of AADs on
autistic children and their families across multiple domains.
At present, well-trained assistance dogs, particularly
those for ASD, remain a highly limited ‘commodity’,
requiring considerable, often prohibitively high, investment
of resources by families and service dog providers. Aver-
age wait times for well-trained AADs can exceed 3years
and the estimated total cost to raise and train just one dog
can surpass $55,000 (Cooper, 2021; Ensminger, 2010;
Konrad, 2009). Further, after team certification, families
must assume all financial responsibilities for canine care.
Currently, no health insurance policies cover any of these
expenses beyond the possible application of pre-tax health-
care accounts, (Internal Revenue Service, 2020), and most
service dog providers require that families contribute at least
part of the costs themselves. Additionally, while US federal
law mandates access for service animals to all public areas
including schools, the Americans with Disabilities Act also
requires that the animal be under the handler's control at
all times (ADA, 2010). However, because public facilities
are not themselves responsible for service animals, schools
do not have to provide handlers. AADs are trained to work
as part of a triad, and unless an adult dog-handler is avail-
able, the child is still prohibited from bringing their AAD to
school. Given that these considerable financial and regula-
tory barriers remain, further work is needed to broaden the
scope of our research to more service dog providers and
autistic individuals both within the US and internationally.
An enhanced understanding of factors contributing to the
effectiveness of AADs will serve to refine canine placement
procedures and training approaches, with the ultimate goal
of increasing availability and accessibility of AADs for fam-
ilies who may benefit substantially from these specialized
human-canine partnerships.
Acknowledgments This research was supported by a Grant from the
Frank J. and Eleanor A. Maslowski Charitable Trust. We are most
grateful to members of the Project to Assess Assistance Dogs (PAAD)
Study (https:// paad. umn. edu/) and to Can Do Canines in New Hope,
MN (https:// cando canin es. org/) for their partnership and support
throughout this project. Special acknowledgment to Alan Peters (Can
Do Canines' Founder) for his leadership and vision, and to Can Do
Canines’ extraordinary team of staff and volunteers for their dedication
and commitment to enhancing quality of life for people with disabili-
ties. We are humbled by the strength and resilience of our participant
families and their hard-working canine partners, without whom this
work would not have been possible. We thank our collaborator, Dr.
Kestutis Bendinskas, and his research group in the Department of
Chemistry at the State University of New York at Oswego for perform-
ing all cortisol extraction and measurement procedures.
Author Contribution AT conceived of the study and performed all
aspects of study design, data collection, data analysis, and manuscript
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article's Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article's Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.
Journal of Autism and Developmental Disorders
1 3
Achenbach, T. M., & Rescorla, L. (2001). Manual for the ASEBA
school-age forms & profiles : An integrated system of multi-
informant assessment. ASEBA.
ADA. (2010). American disability act requirements: Service animals.
U.S. department of justice, civil rights division, disability rights
section. RetrievedSeptember 27, 2021 from http:// www . ada. gov/
servi ce_ anima ls_ 2010. htm
Anderson, C., Law, J. K., Daniels, A., Rice, C., Mandell, D. S., Hago-
pian, L., & Law, P. A. (2012). Occurrence and family impact of
elopement in children with autism spectrum disorders. Pediatrics,
130(5), 870–877. https:// doi. org/ 10. 1542/ peds. 2012- 0762
Baker-Ericzén, M. J., Brookman-Frazee, L., & Stahmer, A. (2016).
Stress levels and adaptability in parents of toddlers with and with-
out autism spectrum disorders. Research and Practice for Persons
with Severe Disabilities, 30(4), 194–204. https:// doi. org/ 10. 2511/
rpsd. 30.4. 194
Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley,
E. (2001). The autism-spectrum quotient (AQ): Evidence from
asperger syndrome/high-functioning autism, males and females,
scientists and mathematicians. Journal of Autism and Develop-
mental Disorders, 31(1), 5–17. https:// doi. org/ 10. 1023/a: 10056
53411 471
Becker, J. L., Rogers, E. C., & Burrows, B. (2017). Animal-assisted
social skills training for children with autism spectrum disorders.
Anthrozoös, 30(2), 307–326. https:// doi. org/ 10. 1080/ 08927 936.
2017. 13110 55
Bestbier, L., & Williams, T. I. (2017). The immediate effects of deep
pressure on young people with autism and severe intellectual
difficulties: demonstrating individual differences. Occupational
Therapy International, 2017, 7534972. https:// doi. org/ 10. 1155/
2017/ 75349 72
Bonis, S. (2016). Stress and parents of children with autism: A review
of literature. Issues in Mental Health Nursing, 37(3), 153–163.
https:// doi. org/ 10. 3109/ 01612 840. 2015. 11160 30
Burgoyne, L., Dowling, L., Fitzgerald, A., Connolly, M., Browne, J. P.,
& Perry, I. J. (2014). Parents’ perspectives on the value of assis-
tance dogs for children with autism spectrum disorder: A cross-
sectional study. British Medical Journal Open, 4(6), e004786.
https:// doi. org/ 10. 1136/ bmjop en- 2014- 004786
Burrows, K. E., Adams, C. L., & Spiers, J. (2008). Sentinels of safety:
Service dogs ensure safety and enhance freedom and well-being
for families with autistic children. Qualitative Health Research,
18(12), 1642–1649. https:// doi. org/ 10. 1177/ 10497 32308 327088
Butterly, F., Percy, C., & Ward, G. (2013). Brief report: Do service dog
providers placing dogs with children with developmental disabili-
ties use outcome measures and if so, what are they? Journal of
Autism and Developmental Disorders, 43(11), 2720–2725. https://
doi. org/ 10. 1007/ s10803- 013- 1803-1
Camp, M. M. (2001). The use of service dogs as an adaptive strategy: A
qualitative study. The American Journal of Occupational Therapy,
55(5), 509–517. RetrievedApril 29, 2021 from http:// www. ncbi.
nlm. nih. gov/ pubmed/ 14601 810
Carlisle, G. K. (2015). The social skills and attachment to dogs of
children with autism spectrum disorder. Journal of Autism and
Developmental Disorders, 45(5), 1137–1145. https:// doi. org/ 10.
1007/ s10803- 014- 2267-7
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure
of perceived stress. Journal of Health and Social Behavior, 24(4),
385–396. RetrievedOctober 1, 2020 from https:// www. ncbi. nlm.
nih. gov/ pubmed/ 66684 17
Constantino, J. N., & Gruber, C. P. (2012). Social responsiveness scale:
SRS-2 (Second). Western Psychological Services.
Cooper, E. (2021, August 4). An autism assistance dog is improving
six-year-old Lucas's life but the fight for funding took years. ABC
News. RetrievedSeptember 27, 2021 from https:// www. abc. net.
au/ news/ 2021- 08- 04/ autism- assis tance- dog- impro ves- lucas- life-
after- ndis- fight/ 10034 8082
Cooper, G. A., Kronstrand, R., Kintz, P., Society of Hair T. (2012).
Society of hair testing guidelines for drug testing in hair. Forensic
Science International, 218(1–3), 20–24. https:// doi. org/ 10. 1016/j.
forsc iint. 2011. 10. 024
DeLoache, J. S., Pickard, M. B., & LoBue, V. (2011). How very young
children think about animals. InP. McCardle,S. McCune, J. A.
Griffin, & V. Maholmes (Eds.),How animals affect us: Examining
the influences of human–animal interaction on child development
and human health (pp. 85–99).American Psychological Associa-
tion.https:// doi. org/ 10. 1037/ 12301- 004
Dimolareva, M., & Dunn, T. J. (2020). Animal-assisted interventions
for school-aged children with autism spectrum disorder: A meta-
analysis. Journal of Autism and Developmental Disorders. https://
doi. org/ 10. 1007/ s10803- 020- 04715-w
Doan, S. N., DeYoung, G., Fuller-Rowell, T. E., Liu, C., & Meyer, J.
(2018). Investigating relations among stress, sleep and nail corti-
sol and DHEA. Stress, 21(2), 188–193. https:// doi. org/ 10. 1080/
10253 890. 2018. 14293 98
Droboniku, M. J., & Mychailyszyn, M. P. (2021). Animal interaction
affecting core deficit domains among children with autism: A
meta-analysis. Journal of Autism and Developmental Disorders.
https:// doi. org/ 10. 1007/ s10803- 021- 04891-3
Eddy, J., Hart, L. A., & Boltz, R. P. (1988). The effects of service dogs
on social acknowledgments of people in wheelchairs. Journal of
Psychology, 122(1), 39–45. https:// doi. org/ 10. 1080/ 00223 980.
1988. 10542 941
Ensminger, J. J. (2010). Service and therapy dogs in American society :
Science, law and the evolution of canine caregivers. Charles C
Esposito, L., McCune, S., Griffin, J. A., & Maholmes, V. (2011). Direc-
tions in human-animal interaction research: Child development,
health, and therapeutic interventions. Child Development Perspec-
tives, 5(3), 205–211. https:// doi. org/ 10. 1111/j. 1750- 8606. 2011.
Estes, A., Olson, E., Sullivan, K., Greenson, J., Winter, J., Dawson, G.,
& Munson, J. (2013). Parenting-related stress and psychological
distress in mothers of toddlers with autism spectrum disorders.
Brain & Development, 35(2), 133–138. https:// doi. org/ 10. 1016/j.
brain dev. 2012. 10. 004
Fecteau, S. M., Boivin, L., Trudel, M., Corbett, B. A., Harrell, F. E.,
Jr., Viau, R., Champagne, N., & Picard, F. (2017). Parenting stress
and salivary cortisol in parents of children with autism spectrum
disorder: Longitudinal variations in the context of a service dog’s
presence in the family. Biological Psychology, 123, 187–195.
https:// doi. org/ 10. 1016/j. biops ycho. 2016. 12. 008
Foody, C., James, J. E., & Leader, G. (2014). Parenting stress, sali-
vary biomarkers, and ambulatory blood pressure: A comparison
between mothers and fathers of children with autism spectrum
disorders. Journal of Autism and Developmental Disorders, 45(4),
1084–1095. https:// doi. org/ 10. 1007/ s10803- 014- 2263-y
Fries, E., Dettenborn, L., & Kirschbaum, C. (2009). The cortisol awak-
ening response (CAR): Facts and future directions. International
Journal of Psychophysiology, 72(1), 67–73. https:// doi. org/ 10.
1016/j. ijpsy cho. 2008. 03. 014
Funahashi, A., Gruebler, A., Aoki, T., Kadone, H., & Suzuki, K.
(2014). Brief report: The smiles of a child with autism spectrum
disorder during an animal-assisted activity may facilitate social
positive behaviors–quantitative analysis with smile-detecting
interface. Journal of Autism and Developmental Disorders, 44(3),
685–693. https:// doi. org/ 10. 1007/ s10803- 013- 1898-4
Journal of Autism and Developmental Disorders
1 3
Gee, N. R., Rodriguez, K. E., Fine, A. H., & Trammell, J. P. (2021).
Dogs supporting human health and well-being: A biopsychosocial
approach. Frontiers in Veterinary Science. https:// doi. org/ 10. 3389/
fvets. 2021. 630465
Grandin, T. (1992). Calming effects of deep touch pressure in patients
with autistic disorder, college students, and animals. Journal of
Child and Adolescent Psychopharmacology, 2(1), 63–72. https://
doi. org/ 10. 1089/ cap. 1992.2. 63
Grandin, T., Fine, A. H., & Bowers, C. M. (2010). The use of therapy
animals with individuals with autism spectrum disorders. Hand-
book on animal-assisted therapy (pp. 247–264). Elseiver.
Hamel, A. F., Meyer, J. S., Henchey, E., Dettmer, A. M., Suomi, S. J.,
& Novak, M. A. (2011). Effects of shampoo and water washing
on hair cortisol concentrations. Clinica Chimica Acta, 412(3–4),
382–385. https:// doi. org/ 10. 1016/j. cca. 2010. 10. 019
Handlin, L., Nilsson, A., Ejdebäck, M., Hydbring-Sandberg, E., &
Uvnäs-Moberg, K. (2015). Associations between the psychologi-
cal characteristics of the human-dog relationship and oxytocin
and cortisol levels. Anthrozoös, 25(2), 215–228. https:// doi. org/
10. 2752/ 17530 3712x 13316 28950 5468
Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M.,
O’Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J.,
& Duda, S. N. (2019). The REDCap consortium: Building an
international community of software platform partners. Journal of
Biomedical Informatics. https:// doi. org/ 10. 1016/j. jbi. 2019. 103208
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde,
J. G. (2009). Research electronic data capture (REDCap)—a
metadata-driven methodology and workflow process for provid-
ing translational research informatics support. Journal of Bio-
medical Informatics, 42(2), 377–381. https:// doi. org/ 10. 1016/j.
jbi. 2008. 08. 010
Iadarola, S., Perez-Ramos, J., Smith, T., & Dozier, A. (2019). Under-
standing stress in parents of children with autism spectrum dis-
order: A focus on under-represented families. Int J Dev Disabil,
65(1), 20–30. https:// doi. org/ 10. 1080/ 20473 869. 2017. 13472 28
Internal Revenue Service. (2020). Publication 502: Medical and dental
expenses. U.S. Department of the Treasury. RetrievedSeptem-
ber 27, 2021 from https:// www. irs. gov/ forms- pubs/ about- publi
cation- 502
Johnson, R. A., Odendaal, J. S., & Meadows, R. L. (2002). Animal-
assisted interventions research: issues and answers. Western
Journal of Nursing Research, 24(4), 422–440. RetrievedApril
29, 2021 from http:// www. ncbi. nlm. nih. gov/ pubmed/ 12035 914
Kahn, P. H. (1997). Developmental psychology and the biophilia
hypothesis: children’s affiliation with nature. Developmental
Review, 17(1), 1–61. https:// doi. org/ 10. 1006/ drev. 1996. 0430
Kazdin, A. E. (2017). Strategies to improve the evidence base of ani-
mal-assisted interventions. Applied Developmental Science, 21(2),
150–164. https:// doi. org/ 10. 1080/ 10888 691. 2016. 11919 52
Kertes, D. A., Liu, J., Hall, N. J., Hadad, N. A., Wynne, C. D. L., &
Bhatt, S. S. (2017). Effect of pet dogs on children’s perceived
stress and cortisol stress response. Social Development, 26(2),
382–401. https:// doi. org/ 10. 1111/ sode. 12203
Konrad, W. (2009, Aug 21). An aide for the disabled, a companion,
and nice and furry. The New York Times. RetrievedSeptember
27, 2021 from https:// www. nytim es. com/ 2009/ 08/ 22/ health/ 22pat
ient. html
Krauss, K. E. (1987). The effects of deep pressure touch on anxiety.
American Journal of Occupational Therapy, 41(6), 366–373.
https:// doi. org/ 10. 5014/ ajot. 41.6. 366
Leadbitter, K., Aldred, C., McConachie, H., Le Couteur, A., Kapa-
dia, D., Charman, T., Macdonald, W., Salomone, E., Emsley, R.,
Green, J., PACT Consortium. (2018). The autism family expe-
rience questionnaire (AFEQ): An ecologically-valid, parent-
nominated measure of family experience, quality of life and pri-
oritised outcomes for early intervention. Journal of Autism and
Developmental Disorders, 48(4), 1052–1062. https:// doi. org/ 10.
1007/ s10803- 017- 3350-7
Lehman, B. J., David, D. M., & Gruber, J. A. (2017). Rethinking
the biopsychosocial model of health: Understanding health as a
dynamic system. Social and Personality Psychology Compass.
https:// doi. org/ 10. 1111/ spc3. 12328
Liu, C. H., & Doan, S. N. (2019). Innovations in biological assessments
of chronic stress through hair and nail cortisol: Conceptual, devel-
opmental, and methodological issues. Developmental Psychobiol-
ogy, 61(3), 465–476. https:// doi. org/ 10. 1002/ dev. 21830
Lobue, V., Bloom Pickard, M., Sherman, K., Axford, C., & DeLoache,
J. S. (2013). Young children’s interest in live animals. British
Journal of Developmental Psychology, 31(Pt 1), 57–69. https://
doi. org/ 10. 1111/j. 2044- 835X. 2012. 02078.x
Mader, B., Hart, L. A., & Bergin, B. (1989). Social acknowledegments
for children with disabilities: Effects of service dogs. Child Devel-
opment, 60(6), 1529–1534. https:// doi. org/ 10. 1111/j. 1467- 8624.
1989. tb040 23.x
Maenner, M. J., Shaw, K. A., Baio, J., Washington, A., Patrick, M.,
DiRienzo, M., Christensen, D. L., Wiggins, L. D., Pettygrove,
S., Andrews, J. G., Lopez, M., Hudson, A., Baroud, T., Schwenk,
Y., White, T., Rosenberg, C. R., Lee, L.-C., Harrington, R. A.,
Huston, M., … Dietz, P. M. (2020). Prevalence of autism spectrum
disorder among children aged 8 years—autism and developmen-
tal disabilities monitoring network, 11 sites, United States, 2016.
MMWR Surveillance Summaries, 69(4), 1–12. https:// doi. org/ 10.
15585/ mmwr. ss690 4a1
Martin, F., & Farnum, J. (2002). Animal-assisted therapy for chil-
dren with pervasive developmental disorders. Western Journal
of Nursing Research, 24(6), 657–670. https:// doi. org/ 10. 1177/
01939 45023 20555 403
Masi, A., DeMayo, M. M., Glozier, N., & Guastella, A. J. (2017). An
overview of autism spectrum disorder, heterogeneity and treat-
ment options. Neuroscience Bulletin, 33(2), 183–193. https://
doi. org/ 10. 1007/ s12264- 017- 0100-y
McIlwain, L., & Fournier, W. (2017). Mortality & risk in ASD wan-
dering/elopement 2011–2016. RetrievedSeptember 16, 2021
from https:// natio nalau tisma ssoci ation. org/ wp- conte nt/ uploa ds/
2017/ 04/ NAAMo rtali tyRis kASDE lopem ent. pdf
McNicholas, J., & Collis, G. M. (2000). Dogs as catalysts for social
interactions: Robustness of the effect. British Journal of Psy-
chology, 91(Pt 1), 61–70. https:// doi. org/ 10. 1348/ 00071 26001
Melson, G. F. (2003). Child development and the human-companion
animal bond. American Behavioral Scientist, 47(1), 31–39. https://
doi. org/ 10. 1177/ 00027 64203 255210
Meyer, J. S., & Novak, M. A. (2012). Minireview: Hair cortisol: A
novel biomarker of hypothalamic-pituitary-adrenocortical activ-
ity. Endocrinology, 153(9), 4120–4127. https:// doi. org/ 10. 1210/
en. 2012- 1226
Mihaila, I., & Hartley, S. L. (2018). Parental sleep quality and behavior
problems of children with autism. Autism, 22(3), 236–244. https://
doi. org/ 10. 1177/ 13623 61316 673570
Miller, R., Plessow, F., Rauh, M., Groschl, M., & Kirschbaum, C.
(2013). Comparison of salivary cortisol as measured by different
immunoassays and tandem mass spectrometry. Psychoneuroen-
docrinology, 38(1), 50–57. https:// doi. org/ 10. 1016/j. psyne uen.
2012. 04. 019
Nagasawa, M., Mitsui, S., En, S., Ohtani, N., Ohta, M., Sakuma, Y.,
Onaka, T., Mogi, K., & Kikusui, T. (2015). Social evolution
oxytocin-gaze positive loop and the coevolution of human-dog
bonds. Science, 348(6232), 333–336. https:// doi. org/ 10. 1126/
scien ce. 12610 22
Nagengast, S. L., Baun, M. M., Megel, M., & Leibowitz, J. M. (1997).
The effects of the presence of a companion animal on physiologi-
cal arousal and behavioral distress in children during a physical
Journal of Autism and Developmental Disorders
1 3
examination. Journal of Pediatric Nursing, 12(6), 323–330.
RetrievedApril 29, 2021 from http:// www. ncbi. nlm. nih. gov/
pubmed/ 94203 70
Odendaal, J. S., & Meintjes, R. A. (2003). Neurophysiological cor-
relates of affiliative behaviour between humans and dogs. The
Veterinary Journal, 165(3), 296–301. https:// doi. org/ 10. 1016/
s1090- 0233(02) 00237-x
O’Haire, M. E. (2013). Animal-assisted intervention for autism spec-
trum disorder: A systematic literature review. Journal of Autism
and Developmental Disorders, 43(7), 1606–1622. https:// doi. org/
10. 1007/ s10803- 012- 1707-5
O’Haire, M. (2017). Research on animal-assisted intervention and
autism spectrum disorder, 2012–2015. Applied Developmental
Science, 21(3), 200–216. https:// doi. org/ 10. 1080/ 10888 691. 2016.
12439 88
OHaire, M. E., McKenzie, S. J., Beck, A. M., & Slaughter, V. (2013).
Social behaviors increase in children with autism in the presence
of animals compared to toys. PLoS ONE, 8(2), e57010. https://
doi. org/ 10. 1371/ journ al. pone. 00570 10
Olson, L., Chen, B., Ibarra, C., Wang, T., Mash, L., Linke, A., Kinnear,
M., & Fishman, I. (2021). Externalizing behaviors are associated
with increased parenting stress in caregivers of young children
with autism. Journal of Autism and Developmental Disorders.
https:// doi. org/ 10. 1007/ s10803- 021- 04995-w
Phillips, R., Kraeuter, A. K., McDermott, B., Lupien, S., & Sarnyai,
Z. (2021). Human nail cortisol as a retrospective biomarker of
chronic stress: A systematic review. Psychoneuroendocrinology,
123, 104903. https:// doi. org/ 10. 1016/j. psyne uen. 2020. 104903
Prothmann, A., Ettrich, C., & Prothmann, S. (2009). Preference for,
and responsiveness to, people, dogs and objects in children with
autism. Anthrozoos: A Multidisciplinary Journal of The Interac-
tions of People & Animals, 22(2), 161–171. https:// doi. org/ 10.
2752/ 17530 3709x 434185
Redefer, L. A., & Goodman, J. F. (1989). Brief report: Pet-facilitated
therapy with autistic children. J Autism Dev Disord, 19(3), 461–
467. RetrievedApril 29, 2021from http:// www. ncbi. nlm. nih. gov/
pubmed/ 27937 90
Ricard, M., & Allard, L. (1993). The reaction of 9- to 10-month-old
infants to an unfamiliar animal. Journal of Genetic Psychology,
154(1), 5–16. https:// doi. org/ 10. 1080/ 00221 325. 1993. 99147 16
Rodriguez, Hartley, S. L., & Bolt, D. (2019). Transactional relations
between parenting stress and child autism symptoms and behavior
problems. Journal of Autism and Developmental Disorders, 49(5),
1887–1898. https:// doi. org/ 10. 1007/ s10803- 018- 3845-x
Rodriguez, K. E., Greer, J., Yatcilla, J. K., Beck, A. M., & O’Haire, M.
E. (2020). The effects of assistance dogs on psychosocial health
and wellbeing: A systematic literature review. PLoS ONE, 15(12),
e0243302. https:// doi. org/ 10. 1371/ journ al. pone. 02433 02
Seymour, M., Wood, C., Giallo, R., & Jellett, R. (2012). Fatigue, stress
and coping in mothers of children with an autism spectrum dis-
order. Journal of Autism and Developmental Disorders, 43(7),
1547–1554. https:// doi. org/ 10. 1007/ s10803- 012- 1701-y
Short, S. J., Stalder, T., Marceau, K., Entringer, S., Moog, N. K., Shirt-
cliff, E. A., Wadhwa, P. D., & Buss, C. (2016). Correspondence
between hair cortisol concentrations and 30-day integrated daily
salivary and weekly urinary cortisol measures. Psychoneuroen-
docrinology, 71, 12–18. https:// doi. org/ 10. 1016/j. psyne uen. 2016.
05. 007
Silva, L. M., & Schalock, M. (2012). Autism parenting stress index:
Initial psychometric evidence. Journal of Autism and Devel-
opmental Disorders, 42(4), 566–574. https:// doi. org/ 10. 1007/
s10803- 011- 1274-1
Slominski, R., Rovnaghi, C. R., & Anand, K. J. (2015). Methodological
considerations for hair cortisol measurements in children. Thera-
peutic Drug Monitoring, 37(6), 812–820. https:// doi. org/ 10. 1097/
FTD. 00000 00000 000209
Smith, L. E., Hong, J., Seltzer, M. M., Greenberg, J. S., Almeida, D.
M., & Bishop, S. L. (2009). Daily experiences among mothers of
adolescents and adults with autism spectrum disorder. Journal of
Autism and Developmental Disorders, 40(2), 167–178. https:// doi.
org/ 10. 1007/ s10803- 009- 0844-y
Smyth, C., & Slevin, E. (2010). Experiences of family life with an
autism assistance dog. Learning Disability Practice, 13(4), 12–17.
https:// doi. org/ 10. 7748/ ldp20 10. 05. 13.4. 12. c7758
Solomon, O. (2010). What a dog can do: Children with autism and
therapy dogs in social interaction. Ethos, 38(1), 143–166. https://
doi. org/ 10. 1111/j. 1548- 1352. 2010. 01085.x
Spielberger, C. D. (1989). State-trait anxiety inventory : a compre-
hensive bibliography (2nd ed.). Consulting Psychologists Press.
Vagnoli, L., Caprilli, S., Vernucci, C., Zagni, S., Mugnai, F., & Mes-
seri, A. (2015). Can presence of a dog reduce pain and distress in
children during venipuncture? Pain Management Nursing, 16(2),
89–95. https:// doi. org/ 10. 1016/j. pmn. 2014. 04. 004
Viau, R., Arsenault-Lapierre, G., Fecteau, S., Champagne, N., Walker,
C. D., & Lupien, S. (2010). Effect of service dogs on salivary
cortisol secretion in autistic children. Psychoneuroendocrinol-
ogy, 35(8), 1187–1193. https:// doi. org/ 10. 1016/j. psyne uen. 2010.
02. 004
Wosu, A. C., Valdimarsdóttir, U., Shields, A. E., Williams, D. R., &
Williams, M. A. (2013). Correlates of cortisol in human hair:
Implications for epidemiologic studies on health effects of chronic
stress. Annals of Epidemiology, 23(12), 797-811.e792. https:// doi.
org/ 10. 1016/j. annep idem. 2013. 09. 006
Publisher's Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
... According to Tseng [51], assistance dogs may help to alert and/or interrupt potentially problematic repetitive or self-stimulating behaviors in children with ASD. In addition, dogs can apply pressure stimulation to the children that resembles patterns of touch therapy that are commonly practiced by occupational therapists with the aim of alleviating arousal and anxiety [51,52]. ...
... According to Tseng [51], assistance dogs may help to alert and/or interrupt potentially problematic repetitive or self-stimulating behaviors in children with ASD. In addition, dogs can apply pressure stimulation to the children that resembles patterns of touch therapy that are commonly practiced by occupational therapists with the aim of alleviating arousal and anxiety [51,52]. Dogs may provide a calming presence and decrease the numbers of disruptive behaviors including tantrums [53,54]. ...
... A recent assessment of chronic cortisol in hair or nail specimen points at reduction in cortisol levels for both parents and children. Reduced chronic cortisol concentrations were further paralleled by reductions in stress levels as perceived by the parents [51]. ...
Full-text available
The prevalence of mental health disorders, driven by current global crises, is notably high. During the past decades, the popularity of dogs assisting humans with a wide spectrum of mental health disorders has significantly increased. Notwithstanding these dogs’ doubtless value, research on their legal status, certification processes, training and management practices, as well as their welfare status, has been scarce. This scoping review highlights that in contrast to other assistance dogs such as guide dogs, there exists no consistent terminology to mark dogs that assist humans with impaired mental health. Legal authorities monitoring the accreditation process, training and tracking of mental health supporting dogs are broadly lacking, with only few exceptions. This review emphasizes the need to address several topics in the promotion of progress in legal and welfare issues related to assistance dogs as well as emotional support dogs for humans with a mental health disorder. The current body of knowledge was assessed in three different areas of focus: (1) the legal dimension including definitions and certification processes; (2) the dimension of performed tasks; and (3) the dog welfare dimension including aspects of the relationship with the handler and risks associated with children recipients. Considering the challenges associated with a mental health diagnosis, collaborations of dog provider organizations and health care professionals would be desirable to continuously assess the efficiency of the human-dog dyad regarding their overall compatibility, general satisfaction and mutual well-being.
... Research on the success of mitigated elopement performed by autism assistance dogs has primarily engaged in anecdotal case studies on autistic child safety from the perspective of parents (see Burgoyne et al, 2014). However, Tseng (2022) has identified a need for more empirical, clinically validated measures that address autism assistance dogs' impact on chronic stress in autistic individuals and their family members, rather than focusing on safety only. While Tseng's report centers on autistic children and their families and does not include autistic adolescents and adults, it raises the issue of examining an assistance dog's role in mitigating chronic stress above that of lowering the risk of elopement. ...
... This would suggest that dogs are singled out for their ability to be trained to assist with desired behavior and to ameliorate sensory integration issues in individuals with autism, irrespective of age. Tseng (2022) also found that through remediation of certain behaviors, autism assistance dogs enable families of autistic individuals to experience more independence and social connectivity which can then improve mental health. Building on these findings, we propose the following questions to first be discussed with respect to autistic individuals and stimming behaviors: ...
1 Working Abstract Autism assistance dogs are trained to perform a variety of tasks, including searches for a lost individual, safety interventions for the individual, interruptions of the individual's repetitive or destructive behavior, and tasks designed to mitigate anxiety for the individual for whom they are trained to assist. In this paper, we focus on the latter two-interruption of repetitive behaviors (also referenced as stimming or stims) and mitigation of anxiety and discomfort. Currently, no scholarly literature is available on specific stimming behaviors that assistance dogs are trained to disrupt. This paper therefore aims to promote a closer examination of which behaviors, particularly repetitive stims, constitute a need for intervention, and how dogs are trained to recognize and intervene in repetitive versus destructive stimming behavior. We also examine ways in which dogs' welfare is considered in the intervention of dangerous behaviors. Finally, we present literature on the autonomy of autistic individuals and their need to engage in certain stimming behaviors without disruption and endeavor to promote a more nuanced dialogue about the welfare of both assistance dogs and the autistic individuals they are trained to assist. Lay Abstract Autism assistance dogs perform diverse tasks that involve protecting the physical and psychological safety of the individual whom they are trained to assist. This includes interrupting certain behaviors that could be harmful to the autistic individual or to those around them and helping to reduce stress that the individual might feel in certain environments that can trigger anxiety. Specific repetitive behaviors associated with autism, such as rocking back and forth, picking the skin, and flapping the arms, are some commonly observed forms of self-soothing or self-stimulation (also called stims) that dogs may be trained to interrupt for the purpose of discouraging the individual from engaging in such behaviors. In this paper, we closely examine the purpose, benefits, and potential drawbacks of training dogs to interrupt these and other stim behaviors. We also discuss the welfare of the dogs trained in this role and present documented views of autistic individuals who raise concerns about their right to engage in certain stimming behaviors that non-autistic individuals may not understand. We seek greater attention to autistic individuals' emotional wellbeing equally alongside their physical wellbeing in addition to the wellbeing of the dogs trained to assist them.
... En lien avec la réduction de certaines problématiques chez l'enfant (e.g. diminution/disparition des réveils nocturnes, diminution des crises, facilitation des sorties, les parents peuvent ici voir leur qualité de vie s'améliorer, ce qui contribuerait par conséquent à l'amélioration de leur bien-être (Tseng, 2022). Certaines études rapportent par ailleurs que comparativement à des familles sans animal de compagnie, celles en possédant ont un meilleur fonctionnement familial (Leung et al., 2022 ;. ...
Persons with posttraumatic stress disorder (PTSD) frequently experience relationship failures in family and occupational domains resulting in loss of social supports. Prior research has implicated impairments in social cognition. The Reading the Mind in the Eyes Test (RMET) measures a key component of social cognition, the ability to infer the internal states of other persons based on features of the eyes region of the face; however, studies administering this popular test to persons with PTSD have yielded mixed results. This study assessed RMET performance in 47 male U.S. military Veterans with chronic, severe PTSD. Employing a within-subjects design that avoided selection biases, it aimed specifically to determine whether components of RMET performance, including accuracy, response latency, and stimulus dwell time, were improved by the company of a service dog, an intervention that has improved social function in other populations. RMET accuracies and response latencies in this PTSD sample were in the normal range. The presence of a familiar service dog did not improve RMET accuracy, reduce response latencies, or increase dwell times. Dog presence increased the speed of visual scanning perhaps consistent with reduced social fear.
Full-text available
Parents of children diagnosed with autism spectrum disorder (ASD) report higher levels of stress than parents of typically developing children. Few studies have examined factors associated with parental stress in early childhood. Even fewer have investigated the simultaneous influence of sociodemographic, clinical, and developmental variables on parental stress. We examined factors associated with stress in parents of young children with ASD. Multiple regression models were used to test for associations between socioeconomic indices, developmental measures, and parental stress. Externalizing behaviors, communication, and socialization skills accounted for variance in parental stress, controlling for ASD diagnosis. Results highlight the importance of interventions aimed at reducing externalizing behaviors in young children as well as addressing stress in caregivers of children with ASD.
Full-text available
Humans have long realized that dogs can be helpful, in a number of ways, to achieving important goals. This is evident from our earliest interactions involving the shared goal of avoiding predators and acquiring food, to our more recent inclusion of dogs in a variety of contexts including therapeutic and educational settings. This paper utilizes a longstanding theoretical framework- the biopsychosocial model- to contextualize the existing research on a broad spectrum of settings and populations in which dogs have been included as an adjunct or complementary therapy to improve some aspect of human health and well-being. A wide variety of evidence is considered within key topical areas including cognition, learning disorders, neurotypical and neurodiverse populations, mental and physical health, and disabilities. A dynamic version of the biopsychosocial model is used to organize and discuss the findings, to consider how possible mechanisms of action may impact overall human health and well-being, and to frame and guide future research questions and investigations.
Full-text available
Canine-assisted interventions (CAI) are becoming more popular in hospital settings, representing a crucial intersection between animals, veterinary medicine, and society. However, standardized policies and procedures to minimize risk and maximize benefit to vulnerable humans and protect therapy dog welfare are lacking, posing a challenge to safe practice. Few intervention programs are evaluated to document efficacy compounding the potential risk. This paper presents a rationale for CAI in hospitals and describes the evidence, issues, and challenges to establishing and maintaining safe and effective programs for humans and animals. Recommendations are made for best practices based on the existing scientific evidence and a model program in place in a major medical center for 19 years. Scientific and practical implications are considered.
Full-text available
Animal-assisted intervention (AAI) has garnered public interest and has been implemented for youth with autism spectrum disorders—a practice supported by anecdotal evidence. While investigations of AAI for children with autism have been conducted, the extant literature is characterized by significant variability in methodology and practice. The present meta-analysis examines the aggregated effects of equine AAI on adaptive functioning among children with autism. Results indicated that interacting with an equine specifically during AAI produced small-to-medium effects (g = 0.40) on the adaptive functioning of children with autism. Recommendations are made for future research on this topic.
Full-text available
Beyond the functional tasks that assistance dogs are trained for, there is growing literature describing their benefits on the psychosocial health and wellbeing of their handlers. However, this research is not only widely disparate but, despite its growth, has not been reviewed since 2012. Our objective was to identify, summarize, and methodologically evaluate studies quantifying the psychosocial effects of assistance dogs for individuals with physical disabilities. Following PRISMA guidelines, a systematic review was conducted across seven electronic databases. Records were independently screened by two authors. Studies were eligible for inclusion if they assessed outcomes from guide, hearing, medical, or mobility service dogs, if they collected original data on handlers’ psychosocial functioning, and if the outcome was measured quantitatively with a validated, standardized measure. Studies on psychiatric service dogs, emotional support dogs, and pet dogs were excluded. Of 1,830 records screened, 24 articles were identified (12 publications, 12 theses) containing 27 studies (15 cross-sectional, 12 longitudinal). Studies assessed the effects of mobility (18), hearing (7), guide (4), and medical (2) assistance dog partnerships with an average sample size of N = 83. An analysis of 147 statistical comparisons across the domains of psychological health, quality of life, social health, and vitality found that 68% of comparisons were null, 30% were positive in the hypothesized direction, and 2% were negative. Positive outcomes included significant effects of having an assistance dog on psychological wellbeing, emotional functioning, self-esteem, and vitality. However, it is of note that several methodological weaknesses of the studies make it difficult to draw any definitive conclusions, including inadequate reporting and a failure to account for moderating or confounding variables. Future research will benefit from stronger methodological rigor and reporting to account for heterogeneity in both humans and assistance dogs as well as continued high-quality replication.
Full-text available
Research has indicated beneficial effects of Animal-Assisted Interventions (AAIs) for children with Autism. However, there is a dearth of meta-analyses and findings are often contradictory. The current meta-analysis assesses the effectiveness of AAIs on social interaction, communication and global Autism symptoms. A total of 1447 studies were returned, of which 16 (n = 489) met the inclusion criteria. The meta-analyses indicated small effect sizes related to improvements in social interaction and communication and reduction in Autism Spectrum Disorder symptoms. Additionally, there was little evidence for a relationship between dosage and effect size. In conclusion, AAIs appear to offer small improvements in social interaction and communication for children with Autism, which may be comparable to activities used in active control conditions.
Full-text available
Problem/condition: Autism spectrum disorder (ASD). Period covered: 2016. Description of system: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years whose parents or guardians live in 11 ADDM Network sites in the United States (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). Surveillance is conducted in two phases. The first phase involves review and abstraction of comprehensive evaluations that were completed by medical and educational service providers in the community. In the second phase, experienced clinicians who systematically review all abstracted information determine ASD case status. The case definition is based on ASD criteria described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Results: For 2016, across all 11 sites, ASD prevalence was 18.5 per 1,000 (one in 54) children aged 8 years, and ASD was 4.3 times as prevalent among boys as among girls. ASD prevalence varied by site, ranging from 13.1 (Colorado) to 31.4 (New Jersey). Prevalence estimates were approximately identical for non-Hispanic white (white), non-Hispanic black (black), and Asian/Pacific Islander children (18.5, 18.3, and 17.9, respectively) but lower for Hispanic children (15.4). Among children with ASD for whom data on intellectual or cognitive functioning were available, 33% were classified as having intellectual disability (intelligence quotient [IQ] ≤70); this percentage was higher among girls than boys (40% versus 32%) and among black and Hispanic than white children (47%, 36%, and 27%, respectively). Black children with ASD were less likely to have a first evaluation by age 36 months than were white children with ASD (40% versus 45%). The overall median age at earliest known ASD diagnosis (51 months) was similar by sex and racial and ethnic groups; however, black children with IQ ≤70 had a later median age at ASD diagnosis than white children with IQ ≤70 (48 months versus 42 months). Interpretation: The prevalence of ASD varied considerably across sites and was higher than previous estimates since 2014. Although no overall difference in ASD prevalence between black and white children aged 8 years was observed, the disparities for black children persisted in early evaluation and diagnosis of ASD. Hispanic children also continue to be identified as having ASD less frequently than white or black children. Public health action: These findings highlight the variability in the evaluation and detection of ASD across communities and between sociodemographic groups. Continued efforts are needed for early and equitable identification of ASD and timely enrollment in services.
Cortisol is the primary glucocorticoid produced by the activation of the hypothalamic pituitary adrenal (HPA) axis after a psychological or physiological stressor. The dysregulation of the HPA axis by chronic stress has been associated with psychiatric disorders. Although hair is currently the main validated source of chronic cortisol concentrations, cortisol is also bound to human nails, another keratinised matrix. Therefore, nail cortisol has the potential to be an alternative retrospective chronic measure of HPA activation. The aim of this systematic review was to assess the temporal resolution, methodological issues, HPA correlates, and target populations in nail cortisol investigations. A qualitative synthesis was performed to assess current literature exploring cortisol concentrations from human nails. A total of 18 eligible human studies extracted from Medline (PubMed and Ovid), ProQuest (PsycINFO), and Scopus found that immunoassays and mass spectrometry were the two primarily methods of analysis. However, methodological variability remained evident between studies. Nail cortisol correlated with saliva and hair in some studies and was investigated across multiple developmental periods. Finally, when applied as an outcome measure in health disorders, higher nail cortisol concentrations have been shown to be associated with acute coronary syndrome and depression. In conclusion, nail cortisol may serve as a retrospective biomarker of chronic stress; however, the ability to track how much cortisol is accumulating within nail clippings is complex and may represent a large timespan. Further, very few studies have reported effect sizes and investigated the effects of covariates, such as age, sex, ethnicity, and nail characteristics, which limits the validation of this measure. Further studies are required to validate the utility of nail cortisol as a biomarker of chronic stress across the human lifespan.
The Research Electronic Data Capture (REDCap) data management platform was developed in 2004 to address an institutional need at Vanderbilt University, then shared with a limited number of adopting sites beginning in 2006. Given bi-directional benefit in early sharing experiments, we created a broader consortium sharing and support model for any academic, non-profit, or government partner wishing to adopt the software. Our sharing framework and consortium-based support model have evolved over time along with the size of the consortium (currently more than 3200 REDCap partners across 128 countries). While the "REDCap Consortium" model represents only one example of how to build and disseminate a software platform, lessons learned from our approach may assist other research institutions seeking to build and disseminate innovative technologies.
Much of the existing research on biological mechanisms underlying the stress experience has focused largely on moment‐to‐moment stress, rather than on chronic stress, an arguably more powerful predictor of long‐term outcomes. Recent methodological innovations have paved the way for new lines of research on chronic stress, with promising implications for developmental researchers and for those who study health and adversity. In particular, there are increasing studies that have focused on chronic stress assessments by relying on cortisol derived from hair and nails as a biomarker for chronic stress. In this paper, we provide an overview of their use, describe how hair and nail cortisol ought to be conceptualized differently across the lifespan, how developmental factors may impact its interpretation, and the circumstances under which its use may be more methodologically sensible. The purpose of this review is to provoke further discussion and encourage careful research designs that utilize hair and nail cortisol for understanding the effects of chronic stress exposure from the early developmental period, across adverse contexts, and in association with psychological and physical health outcomes.