hai.2022.0010

Human-Animal Interaction Bulletin
Volume 13, No. 1, Pages 75-90
Therapy dogs for children with autism spectrum

disorder: Impacts of active versus passive dog
engagement
Deanna L. Tepper1, Oriane Landry1, Tiffani J. Howell1,

Delwyne Stephens2, Jose Molina2, and Pauleen C. Bennett1
1
School of Psychology and Public Health, La Trobe University, Bendigo,
Australia
2
Irabina Autism Services, Bayswater, Australia
The use of animal-assisted interventions as a method of improving symptoms of autism spectrum

disorder (ASD) is becoming increasingly common, with a significant proportion of available
literature suggesting improvements in social communication and interaction. Less is known about
potential impacts on restricted and repetitive behaviors, motor skills, or executive functions.
Furthermore, it is unknown what level of interaction with an animal, if any, is needed to produce
improvements. In the current study, the behavior and skills of 16 children diagnosed with ASD,
aged 2 to 4 years, were observed when a therapy dog, Muffin, was actively interacting with them,
passively present in a classroom, or absent from the classroom. Contrary to expectations, the
children actively interacted with the dog only infrequently, and there were no differences across
conditions on numerous variables. Muffin’s presence and activity level was only associated with
motor skills in the children, with results indicating that the participants were more likely to remain
stationary than engage in physical activity when the therapy dog was present, perhaps indicating a
global calming effect. The general lack of significant differences suggests that further studies may
be necessary to determine exactly which symptoms of ASD respond to animal-assisted
interventions, and also to determine optimal treatment dosage and frequency. We contend that the
design of animal-assisted intervention may be critical in producing previously reported benefits.
Keywords: Animal-assisted intervention; Human-animal interaction; Dog-assisted therapy; Child

development
Correspondence regarding this article should be addressed to: Deanna L. Tepper,

School of Psychology and Public Health, La Trobe University, P.O. Box 199,
Bendigo, Victoria, 3552, Australia. E-mail: d.tepper@latrobe.edu.au
Conflicts of Interest
DS and JM were employed at Irabina Autism Services at the time the study
commenced, while PB was responsible for breeding the dog. DT, OL, and TH do
not declare a conflict of interest.
Acknowledgements
The researchers express enormous gratitude to the participants and the staff at
Irabina Autism Services. We thank Ms Michelle Ellerbock for her support in
facilitating the observational sessions, and Ms Kelly Deslandes for her assistance
in coding the video recordings. We also thank the two anonymous reviewers whose
helpful comments improved the manuscript.
© CAB International 2022, published under the former journal title of Human-Animal Interaction Bulletin. This article
is licensed under a Creative Commons Attribution 4.0 International License
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Over the last decade, there has been growing interest in the roles that animals may play
in supporting individuals diagnosed with autism spectrum disorder (ASD; Berry et al., 2013).
ASD is a neurodevelopmental condition characterised by impairments in social communication
and interaction, and the presence of restricted or repetitive behaviors (American Psychiatric
Association, 2013). While early childhood behavior interventions have demonstrated positive
long-term outcomes for skill acquisition and the remediation of problem behaviors (Lindgren
& Doobay, 2011), the heterogenous range of symptoms and severity associated with ASD
means treatment is not ‘one size fits all’. As such, the use of complementary and alternative
treatments for ASD is common (Höfer et al., 2016), with animal-assisted interventions (AAIs)
becoming increasingly utilised (Berry et al., 2013).
AAIs is an umbrella term for goal-oriented programs which aim to improve social,
behavioral, physical, or cognitive wellbeing (International Association of Human-Animal
Interaction Organisations, 2018). These programs often employ a ‘therapy animal’, referring
to an animal integrated into such structured programs by a licensed healthcare professional
(Howell et al., 2022). This research area has seen considerable growth in the last two decades,
with reviews suggesting that therapy dogs can improve social and communicative skills (Hardy
& Weston, 2020; Hill et al., 2019). In addition to therapy dogs, reviews have suggested that
therapeutic horseback-riding and interactions with a companion animal are associated with
improvements in socio-communicative skills and improvements in autism symptom severity
(Nieforth et al., 2021; O’Haire, 2017).
However, not all studies have reported such improvements; Anderson and Meints
(2016) found no significant changes in socialisation and communication skills following a five-
week equine-assisted therapy intervention, while a study by Ward et al. (2013) suggested that
improvements in social interaction and symptom severity were not maintained following the
conclusion of a 10-week equine-assisted intervention. Furthermore, a recent meta-analysis (N
= 16) suggested only a small effect size for improvements in social interaction and
communication, with all but one study using either no control or a passive control (e.g., waitlist)
condition (Dimolareva & Dunn, 2021). Due to the emerging interest in AAIs, but inconclusive
and limited findings, further research is necessary to establish the efficacy of AAIs as a method
of improving ASD symptomatology and socio-communication skills.
In addition to deficits in social communication, individuals diagnosed with ASD often
demonstrate impairments in motor ability (Lloyd et al., 2011; Provost et al., 2007). A review
by Ruggeri et al. (2020) has suggested that equine-assisted therapy can improve strength,
agility, and coordination in autistic children, but few studies on this topic have explored
interacting with dogs; nonetheless, it has been suggested that activities such as throwing a ball
and petting and grooming a dog can improve these skills (Smyth & Slevin, 2010). Of the
existing research, an observational within-group study by Petrongelli-Halloran (2010) found
that “reaching out motions” occurred more frequently in a therapy dog condition, compared to
a stuffed toy dog condition (N = 26; 6-19 years, M age = 11.78, SD = 4.30). More recently, a
study by Ben-Itzchak and Zachor (2021) suggested an improvement in motor skill
development, as measured by the Vineland Adaptive Behavior Scales, following a four-month
dog training intervention (N = 73; 2-7 years), while a four-week study by Abadi et al. (2022)
suggested that autistic children (N = 18; M age = 10.1, SD = 2.5) were more active in a physical
activity program when a therapy dog was present. However, as a newer variable of interest,
further research is needed to support these findings and to determine the extent to which
interacting with dogs may improve motor skills for children with ASD.
Children diagnosed with ASD also show impairments in executive functioning (Hill,
2004), referring to the ability to self-regulate behavior, plan, and problem-solve (Diamond,
2013). It has been proposed that interacting with animals may improve executive functioning
(see Diamond & Ling, 2016). An early study by Becker (2014) explored performance on
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executive function tests in the presence of a real therapy dog versus stuffed toy dog control. In
this study, children diagnosed with neurodevelopmental disorders (N = 38; 7-15 years),
including autism, performed significantly better on shifting, inhibition, and attention tasks
when in the presence of the real dog. Research has also explored the use of a short-term
program in improving executive functions, with a study by Tepper et al. (2021) suggesting that
children with poorer executive functions benefitted the most from a four-week dog-training
and reading-to-dog program (N = 63; 6-8 years), however this study did not target children
with ASD. This remains a developing area of research, and it would be beneficial not only to
explore executive functions using neuropsychological assessments, as done in the above
studies, but also to explore the use of everyday executive function skills in the classroom. This
is important as research has suggested that autistic children demonstrate impairments in the use
of “everyday” executive function skills, such as attending to teachers in the classroom,
multitasking, or initiating steps independently (Gioia et al., 2002).
Ultimately, as the use of AAIs continues to increase, it is important to continue to
explore under which circumstances, and for whom, these programs best benefit. While past
research has explored improvements to social and communication skills, further research is
still necessary, while the potential improvements to motor function and executive functions
have been underexplored. Additionally, to date, most studies on AAIs have targeted older
children (Nieforth et al., 2021; O’Haire, 2017), despite research highlighting that behavioral
interventions are more beneficial at an earlier age (Fuller & Kaiser, 2020). This suggests a need
to explore the use of AAIs for younger children. Furthermore, little is known about the level
of human-animal interaction needed to demonstrate positive findings; that is, how important is
the role of the live animal in improving behavior (Marino, 2012). While reviews have explored
‘contact time’, quantified as program duration, frequency, and session length (Nieforth et al.,
2021), it is still unclear what level of interaction occurs in many studies. Specifically, it is
unclear if the mere presence of animals can improve ASD-related behaviors, or if active
interaction with animals is required. As AAIs can be difficult to implement (Johnson et al.,
2002) and potentially compromise the welfare of the animals involved (Ng et al., 2019), it is
worthwhile exploring whether simply having an animal present in the classroom can provide
benefits.
The aim of the present study was to evaluate the impact of an existing AAI program on
social communication skills, executive functions, and motor skills in young children diagnosed
with ASD. Unlike previous studies which have primarily explored change across time, this
study was designed to explore which level of interaction with a dog, if any, was associated with
observed differences in behavior and skills during the course of that interaction. The study
employed an observational research design, exploring the frequency of behaviors when a dog
was present or absent from an early intervention group program at Irabina Autism Services. At
this centre, the dog, Muffin, works as a therapy animal, in both one-on-one therapeutic sessions
and in group programs. For the group programs, Muffin is both passively (e.g., lying down in
the corner of the room) and actively included in activities; she is also sometimes absent.
It was expected that the presence of Muffin, regardless of whether she was passively
present or actively involved, would result in improved behaviors and skills, compared to when
the dog was absent from the classroom. Specifically, it was hypothesised that there would be
greater frequencies of social communicative skills, including increased eye contact, positive
facial affect, positive vocalisations, speech, and social play, when Muffin was present.
Additionally, it was hypothesised that participants would demonstrate more everyday
executive function skills, such as appropriate social attention and appropriate responses to
prompts, when the dog was present compared to absent, while there would be reduced
frequencies of problem behaviors or restricted/repetitive behaviors. Finally, it was
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hypothesised that participants would demonstrate greater use of motor skills when Muffin was
present and actively included in activities.
Method
Participants
Participants were recruited from Irabina Autism Services, an early intervention service
provider located in greater Melbourne, Australia. To access this service, children require an
ASD diagnosis from a paediatrician. An invitation to participate was extended to all 25 families
who had a child participating in a group program at Irabina Autism Services (see below for
program description), with 20 families returning the signed consent form. As sessions were
restricted to a maximum of eight children, it was decided to only code behavior in sessions in
which all eight children in that session had consent to participate; two days per week in which
the program ran were applicable. As such, the final sample size was 16 (n = 9 males, n = 7
females; M age = 3.51, SD = .50, range 2.67- to 4.41-years). No other demographic or
diagnostic information was collected.
Early intervention program description
Irabina Autism Services runs a Global Learning and Development Program (GLaD).
This is an intensive therapy based on behavior intervention models and the Early Start Denver
Model group program (Dawson et al., 2010). GlaD is a play-based early intervention program
which encourages the development of social communication skills. The learning objectives of
GlaD are tailored to the individual strengths and weaknesses of each child, with lessons and
play structured around skills that the child needs to develop. This program incorporates song-
and dance-based group activities, solo play, and play using gymnasium equipment. These types
of play provide the opportunity to exercise expressive and receptive language, and motor, social
communicative, and play skills. Each session was led by a qualified behavioral therapist, with
two to three additional therapists, with backgrounds in speech pathology, occupational therapy,
and psychology, assisting with the delivery. Two 2-hour sessions were observed per week for
a nine-week period over October to December 2018, with a maximum of eight children
participating in each session. The sessions were still observed when there were absences; there
were seven sessions where a child was absent (M attendance = 7.39, SD = .92, range 5-8
participants).
The therapy dog, Muffin, was included in group play at the discretion of the therapists.
Activities with the dog included, but were not limited to: (a) the dog jumping onto a miniature
trampoline and bouncing on it to model the behavior; (b) when asked for a specific body part,
the participants would point to the body part on the dog to demonstrate receptive language,
gesture use and response to prompts; (c) answering questions such as “what is the dog’s
name?”, “what colour is the dog’s fur?”, “is the dog’s fur straight or curly?”; and, (d) pretending
to groom the dog with a plastic hair brush. When participants were engaging in free play or
were in the gymnasium, Muffin roamed the room. The participants were encouraged to
approach the dog and play games such as fetch, with these interactions supervised by a
therapist. Muffin was sometimes engaged in activities elsewhere and was not present during
the group session.
Materials
Behavioral coding. A behavioral checklist was developed by the research team for the
purposes of this study. While some past animal-assisted interventions studies have utilised
observational coding systems (see Guérin et al., 2018; Martin & Farnum, 2002), the
development of a new measure was necessary for this study due to the incorporation of
additional behaviors and skills of interest (e.g., motor skills, executive functions). The
definitions of the behaviors and skills included in analysis are found in Table 1; other behaviors
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of interest (see Appendix A) were initially included in coding sessions but excluded from later
analyses due to low occurrence.
Table 1
Definitions of the behaviors and skills retained for analysis.
Behavior/Skill Definition
Social Communication Skills
Child Affect
Positive Corners of the mouth are turned up, front teeth may be visible
(e.g., smiling).
Negative Corners of the mouth and brow may be turned down (e.g.,
frowning).
Neutral Face is devoid of any visible emotional expression.
Eye Contact
Eye Contact Face must be visible. Individual makes eye contact with peer
or adult.
No Eye Contact Face must be visible. Individual does not make eye contact
with peer or adult.
Child Vocalisations
Vocalisations (+ ve) A sudden, loud vocalisation indicating excitement or
happiness. Not considered a word.
Vocalisations (- ve) A sudden, loud, and/or harsh vocalisation (e.g., scream). Not
considered a word.
Play
Solo Play Child engages in recreational activities on their own.
Play with Peers Child engages in recreational activities with one peer.
Play with Adults Child engages in recreational activities with one caregiver.
Group Play Child engages in recreational activities with two or more
peers/caregivers.
Executive Function Skills
Response to Prompts
Response (+ ve) Appropriate response to prompts from adults (e.g., child
responds with their name when asked ‘What is your name?’).
Response (- ve) Inappropriate response to prompts from adults (e.g.,
screaming).
Social Attention
Social Attention (+ ve) Child focuses attention towards a person that is speaking or
performing actions (e.g., orients body towards talking adult).
Child looks towards adult when name is called. May overlap
with eye contact.
Social Attention (- ve) Child fixates on a person/object when they should be
attending towards another person that is speaking or
performing actions. Child does not respond to adult calling
their name.
Motor Skills
Stationary Child remains stationary for entire observation period.
Moving Child engages in behavior such as walking, running, dancing,
or crawling.
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Equipment and rooms. A Sony Handycam HDR-CX405 was placed in the corner of
an all-purpose activity room (8.30 metres x 4.45 metres) and moved to a gymnasium when
necessary, where additional activities sometimes took place. Intervals were recorded using
Dreamspark Interval Timer on an Android phone, with each interval lasting for two-minutes.
The primary observer monitored a target participant for 20-seconds and then spent the
remainder of the two-minute cycle recording what they had observed during this 20-seconds.
A handheld clock was used to monitor the time of the sessions, and to record specifically when
each interval began. Each participant was allocated an identification number, with the order of
participant observations randomised using Research Randomizer (Urbaniak & Plous, 2013;
https://www.randomizer.org/).
Animal. The therapy dog, Muffin, was a 4-year-old purebred, desexed female Lagotto
Romagnolo. This dog has received public access certification and works as a therapy animal at
Irabina Autism Services. She was actively included in activities at the discretion of the
therapists, or else passively allowed to roam around the therapy room. Interactions between the
participants and the therapy dog were monitored by the therapists. The therapy dog had access
to fresh water and an open crate at all times. Toileting occurred prior to the sessions starting
and once during each session, with the dog removed from the room for a 5- to 10-minute break.
During this break, the dog roamed an outdoor, gated area of grass and was provided the
opportunity to play with a ball with the supervising staff member.
Procedure
All aspects of this study were approved by La Trobe University’s institutional ethics
review committee (Approval Number: HEC18342) and approval to use the site was granted by
the CEO of Irabina Autism Services. Parents and guardians were approached for written
consent on behalf of the child participants. The delivery of the program and wellbeing of the
participants and therapy dog were monitored by the therapists employed at the early
intervention service provider per their usual obligations.
Partial-interval recording time sampling was selected as the observation method. In this
method, an observation session is divided into predetermined intervals, and behaviors, which
have been operationalised a priori, are scored on whether they are present or absent during this
time interval (Ferguson et al., 2018; Martin & Bateson, 2007). A moderate interval length of
20-seconds was used, as this interval length allowed us to capture both short-duration behaviors
(e.g., vocalisations) and behaviors occurring over a longer period (e.g., interaction with peers).
For this study, a ‘X’ on the checklist denoted that the behavior had occurred. A maximum of
eight children participated in each intervention session. The order in which participants were
observed was randomised prior to each session beginning (e.g., Set 1 order: 1, 4, 5, 3, 2, 6, 8,
7). Once data were collected for one child, the primary coder began observations for the next
child, until all eight children had been observed. Once the entire sample was observed, a new
observation period began with another randomised order of participants (e.g., Set 2 order: 3, 2,
4, 6, 5, 7, 8, 1). This pattern continued throughout the intervention session. The observations
were conducted live, with two sessions observed per week over a nine-week period. An average
of 1-hour and 36-minutes of filmed data was collected at each session (Min = 1-hour 16-
minutes, Max = 2-hour 8-minutes), with the dog both present and absent from the sessions.
The primary coder sat in the corner of the all-purpose room or gymnasium and live-
coded behavior. Contact between the researcher and participants was discouraged. A second
observer later coded 10% of the recorded footage. Inter-rater reliability for all behaviors was
estimated using Cohen’s Kappa, which indicated strong agreement between the raters, k = .80,
p < .001 (Cohen, 1960).
Data Analysis. Data were transferred from paper hardcopies to the Statistical Package
for the Social Sciences (SPSS; version 23.0) program, which was used for all subsequent
analyses. For analysis, the ‘X’ notation on the paper hardcopies was converted in a ‘1’
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(“behavior occurred”) in the SPSS files. The data were visually inspected for errors, which
were corrected by reference to the video recording of each session. The total frequency of the
behaviors, measured by observed instances of the behavior occurring, were recorded for each
session. This was then summed for a total occurrence frequency over the entire study duration.
Data were analysed using a series of chi-square tests of independence, to determine any
differences in the frequency of the total observed behavior when the dog was passively present,
actively present, or absent. On an exploratory basis, we also ran a second series of chi-squares
tests of independence, collapsing the frequencies from the ‘active’ and ‘passive’ categories into
a total ‘present’ category. This was to determine if there were any differences in behavior when
the dog was present overall, regardless of activity level, versus absent from the classroom.
To avoid violating the assumption of independence, instances in which individuals
engaged in two or more behaviors in the same category during a 20-second timespan were
excluded (e.g., a participant displayed both positive and neutral affect). Furthermore, some of
the behaviors/skills included in the observational checklist occurred at too low a frequency to
be analysed and were either excluded from subsequent analyses (e.g., all restricted and
repetitive behaviors) or collapsed into a larger, encompassing category (e.g., ‘walk’, ‘run’,
‘dance’ and ‘crawl’ were collapsed into a ‘moving’ category). As such, the behaviors retained
for analyses included facial affect, eye contact, vocalisations and spontaneous speech, response
to prompts, social attention, play behavior, and motor behavior. For a full list of the retained
and excluded skills/behaviors, please see Appendix A.
Results
In total, 820 individual observations were collected; 562 (68.5%) observations were
collected when the therapy dog was passively present in the classroom, while the dog actively
interacted with participants for only 37 (4.5%) of the 820 observations. The dog was absent
from the classroom for 221 (27.0%) observations.
A series of chi-square tests of independence were performed on our retained variables
of interest and the three conditions (i.e., active, passive, and absent). The frequencies in which
the behaviors occurred are presented in Table 2. For facial affect and eye contact, no significant
relationship between variables and condition was found χ2 = (4, n = 549) = 8.11, p = .08 and χ2
= (2, n = 510) = 1.52, p = .47. Similarly, for child vocalisations and spontaneous speech, there
was no statistically significant association χ2 = (2, n = 48) = .07, p = .97 and χ2 = (2, n = 104)
= 0.53, p = .77. We also found no significant associations between response to prompts χ2 =
(2, n = 159) = 3.57, p = .17 and social attention χ2 = (2, n = 216) = 4.16, p = .13. Finally, there
were no statistically significant associations between play type (solo, group, play with peers,
and play with adults) and the animal condition χ2 = (6, n = 686) = 9.36, p = .15.
For motor skills, as shown in Table 2, it appeared that participants were more frequently
stationary than engaging in moving behaviors, regardless of condition. However, the observed
frequencies indicate that participants were more likely to be stationary when the dog was
present, either passively or actively, versus absent. Supporting this, a statistically significant
association was found between these variables χ2 = (2, n = 666), = 7.64, p < .05, Cramer’s V =
.107.
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Table 2
Total frequencies and percentages of behavior when in the three animal-assisted intervention
conditions.
Animal-Assisted Intervention Conditions
Passive Active Absent
n % n % n %
Social-Communication Skills
Child Affect
Positive 87 23.7 11 45.8 46 29.1
Negative 30 8.2 2 8.3 8 5.1
Neutral 250 68.1 11 45.8 104 65.8
Child Eye Contact
Contact 61 17.9 4 12.9 19 13.8
No Contact 280 82.1 27 87.1 119 86.2
Child Vocalisations
Positive 19 59.4 2 66.7 8 61.5
Negative 13 40.6 1 33.3 5 38.5
Child Spontaneous Speech
Directed 39 49.4 1 33.3 12 54.5
Non-Directed 40 50.6 2 66.7 10 45.5
Play
Solo Play 227 48.0 6 31.6 79 40.7
Play with Peers 38 8.0 0 0 21 10.8
Play with Adults 68 14.4 5 26.3 26 13.4
Group Play 140 29.6 8 42.1 68 35.1
Response to Prompts
Positive Response 86 85.1 6 75.0 47 94.0
Negative Response 15 14.9 2 25.0 3 6.0
Social Attention
Positive Attention 127 92.7 12 80.0 61 95.3
Negative Attention 10 7.3 3 20.0 3 4.7
Motor Skills*
Stationary 310 67.5 18 64.3 100 55.9
Moving 149 32.5 10 35.7 79 44.1
Note. * p < .05, with only Motor Skills showing a significant group difference.
Our second series of chi-square tests of independence were performed on our variables
of interest and the collapsed condition (present versus absent), with results shown in Table 3.
Supporting the above analyses, no significant associations were found between the two
conditions and facial affect, eye contact, vocalisations, spontaneous speech, response to
prompts, social attention, or play type. For motor skills, a statistically significant association
was found, χ2 = (1, n = 666) = 7.52, p < .05, Cramer’s V = .106.
Discussion
The aim of the present study was to evaluate an existing animal-assisted intervention
program, by exploring frequencies of target behaviors when the therapy dog was present versus
absent from the classroom. The behaviors of interest reflected social communicative skills
(e.g., eye contact), everyday executive functions (e.g., appropriate or inappropriate responses
to prompts), and motor skills (i.e., stationary versus moving). The occurrence of these
behaviors was coded when the therapy dog was actively interacting with participants, when
passively present in the classroom (e.g., sitting in her crate), and when absent from the
classroom, using a researcher-developed observational tool.
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Table 3
Total frequencies of behavior when collapsing ‘active’ and ‘passive’ conditions into a total ‘present’ category.
Animal-Assisted Intervention Conditions
Present Absent
n % n % χ2(df)
Social Communication Skills
Child Affect
Positive 98 25.1 46 29.1
Negative 32 8.2 8 5.1
Neutral 261 66.8 104 65.8 2.22(2)
Child Eye Contact
Contact 65 17.5 19 13.8
No Contact 307 82.5 119 86.2 1.00(1)
Child Vocalisations
Positive 21 60.0 8 61.5
Negative 14 40.0 5 38.5 0.01(1)
Child Spontaneous Speech
Directed 40 48.8 12 54.5
Non-Directed 42 51.2 10 45.5 0.23(1)
Play
Solo Play 233 47.4 79 40.7
Play with Peers 38 7.7 21 10.8
Play with Adults 73 14.8 26 13.4
Group Play 148 30.1 68 35.1 4.19(3)
Response to Prompts
Positive Response 92 84.4 47 94.0
Negative Response 17 15.6 3 6.0 2.87(1)
Social Attention
Positive Attention 139 91.4 61 95.3
Negative Attention 13 8.6 3 4.7 0.98(1)
Motor Skills
Stationary 328 49.2 159 23.9
Moving 100 15.0 79 11.9 7.52(1)*
* p < .01.
For most skills and behavior, the results did not support our hypotheses; we found no
significant associations between the three animal conditions and social communicative skills,
executive functions, and play type. However, the active incorporation of the therapy dog
occurred at an unexpectedly low frequency, which may have impacted our findings. Only 37
(4.5%) observations occurred when participants were actively interacting with the dog, out of
the 820 collected observations. This low frequency of active interaction was surprising, as past
figures from a review on AAIs for children with ASD suggested an average of 10.1 (SD = 13.9)
contact hours for programs typically ranging from 8- to 12-weeks (O’Haire, 2017), with our
study taking place over a comparable nine-week period. However, for many published papers,
the activities engaged in and the quality of interactions between participants and animals is still
largely unreported, and it is difficult to determine what is meant by ‘contact hours’. While
caution in the interpretation of our results is warranted, we cannot rule out that the level and
quality of animal interaction in our study may not differ from other research in the field. We
also note that it is possible that the animal-assisted intervention was simply not effective in
these examined areas.
The low frequency of active incorporation may reflect how the dog in the current study
is utilised in the partnering organisation’s programs in general. In the group program, the dog
was utilised as a therapy animal that is just one of the many tools at the disposal of the therapists
in the intervention sessions. This differs from many other dog-assisted programs, in which
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external organisations typically bring therapy animals onto the premise, with these animals
then used as the focal point for the therapy. Additionally, it appears that these past programs
often utilise a dedicated handler. For example, in the O’Haire (2017) review, it appears that
most therapy dog programs typically have a ratio of one to two personnel per therapy dog, per
participant. In the current study, three to four therapists assisted with delivering the overall
Global Learning and Development Program (GLaD), with a maximum of eight children in the
classroom, but without a dedicated handler for the dog. As previously discussed, it is difficult
to determine how this current study differs from past research in terms of activities engaged in,
but we speculate that a dedicated dog handler may lead to more active interactions between the
participants and the dog. Additionally, while there were no concerns regarding the welfare of
the dog or the children in this program, we posit that the use of a dedicated handler would better
ensure the safety of both.
In our study, some of our initial variables occurred at too low a frequency to be
analysed. This included some social communicative behaviors, such as sharing and turn-taking,
but it was unexpected that occurrences of restricted and repetitive behaviors were low, as the
presence of these behaviors is a diagnostic criterion for ASD (American Psychiatric
Association, 2013). That these behaviors were not captured may reflect the use of the partial-
interval recording time sampling method, in which one individual was observed at a time; it is
possible that behaviors of interest were exhibited by other participants when the target
individual was being observed. Furthermore, the use of partial-interval recording may have
resulted in missing active interactions between the dog and participants, with the target child
not engaging with the animal while other participants did. However, the partial-interval
recording method does approximate the occurrence of behavior (Ferguson et al., 2018), and as
collecting continuous data was not feasible, it was deemed to be an appropriate observation
technique for this study. We also note that some behaviors of interest are difficult to explore;
for example, children can rapidly move between solitary and cooperative types of play (Yuill,
2021). Our researcher-developed tool explored ‘solo play’, ‘play with peers/adults’ and ‘group
play’, but future uses would benefit from including a parallel play option, defined by children
playing with the same toy or materials (Holmes & Willoughby, 2009; Robinson et al., 2003).
The reason for the low recorded number of restricted and repetitive behaviors, in
addition to abnormal sensory behaviors and problem behaviors, cannot be conclusively
determined. It is possible that these low frequencies reflect the overall effectiveness of the
GLaD program. Similarly, the effectiveness of the program may explain why there were no
significant differences across conditions on most outcome measures used in this study. This
study commenced in October, with many of the participants having engaged in the program
since the beginning of the Australian school year in January. As such, the possible benefits of
engaging in the GLaD program and from interacting with the therapy dog may have reached
ceiling efficacy by the end of the school year, with the children already having met age- and
disability-appropriate milestones for our behaviors of interest. In relation to age, it may also be
possible that younger children, such as the participants in our study, do not benefit as much
from interaction with an animal in comparison to older children (Nieforth et al., 2021; O’Haire,
2017).
Of the variables that we were able to explore, we did find significant results for motor
skills. We predicted that participants would display a higher frequency of motor skills when
actively interacting with the therapy dog, compared to when the dog was passively present or
absent from the classroom. This hypothesis was predicted on an exploratory basis, as the
available research on ASD, motor skills, and therapy dogs is minimal (see Ben-Itzchak &
Zachor, 2021; Martin & Farnum, 2002; Petrongelli-Halloran, 2010). This hypothesis was based
on the idea that interaction with a dog may provide children with the opportunity to practise
motor skills, through activities such as brushing the dog, and throwing a ball for the dog (Smyth
84 | H A I B

& Slevin, 2010). Our chi-square test of independence was significant, indicating that condition
was associated with movement. However, upon inspection of the frequency data, we found an
opposite trend to the predicted hypothesis; participants were more likely to be stationary when
the dog was actively involved in activities or passively present in the classroom, than when she
was absent.
While the statistical association was small, and the overall occurrences of the dog being
incorporated into activities was remarkably low, this result warrants further exploration. It may
be that the presence of the therapy dog, regardless of activity type, had a global calming effect
on the participants. This would be consistent with some previous human-animal research
suggesting that dogs have a calming presence (Kirnan et al., 2018; Wheeler & Faulkner, 2015).
While it cannot be determined conclusively from our study, when the dog was actively
involved, participants may have been more likely to sit or lie down next to the dog, rather than
exercise gross motor skills through activities such as fetch. However, not all research has
suggested the presence of a dog is calming. For example, an observational study by Germone
et al. (2019) coded children with ASD as more overactive when in the presence of a dog versus
control toy condition. As an underexplored area of research, we recommend that future studies
continue to explore the relationship between interaction with dogs and motor skills, but note it
is possible that interaction with dogs will not lead to improvements in these skills.
While we did not find significant outcomes on our other measures, that is not to say
that the inclusion of the dog was not beneficial. Both staff and parents informed the primary
coder, who attended the live sessions, that the presence of Muffin made the participants more
excited to attend therapy at Irabina Autism Services. This was true of the GLaD sessions
themselves, but also for arriving at the centre’s premises, where the therapy dog often
frequented the waiting room where parents signed in. While we can only speculate, it seemed
that the presence of Muffin encouraged participants to attend their therapy sessions, primed the
participants with a positive and excited attitude towards the therapy, and may even have
discouraged participant attrition. A study exploring parent attitudes towards Muffin, including
perceived costs and benefits was planned, but was ultimately deemed beyond the scope of the
current study. In addition, we note that Muffin works as a therapy animal in one-on-one
sessions, with staff reports suggesting positive benefits. This anecdotal evidence suggests that
there are benefits to the animal that we did not explore, and that the advantages of animal-
assisted interventions may not always be overtly noticeable.
Conclusion
Behaviors related to autism spectrum disorder can be difficult to treat or manage, due
to heterogenous severity, symptomatology and comorbidity. In recent years, the use of animal-
assisted interventions to treat ASD has increased, with most studies reporting improvements in
social functioning (O’Haire, 2017). Other variables, such as restricted and repetitive behaviors,
have been analysed, with mixed findings, while areas such as motor skills and executive
functioning have been under-represented in the research. While our study did not find that the
presence of a therapy dog resulted in increased frequencies of positive behaviors, we did find
that participants were more likely to be stationary when interacting with the dog, compared to
when the dog was absent. Determining if the dog had a calming effect was beyond the scope
of this study, but it is recommended that future research explores this, as it would be consistent
with past literature. Additionally, it is recommended that future research continues to explore
social communicative skills, restricted and repetitive behaviors, and executive functioning, due
to the significance of these domains on outcomes across the lifespan. Finally, we believe it is
worthwhile continuing to explore treatment dosage, as it is still difficult to determine what level
of interaction with an animal is required to result in positive behavioral outcomes.
85 | H A I B

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Appendix A
Complete list of initial behaviors and skills used in the researcher developed behavioral checklist.
Behavior of interest n % Was the behavior retained for analyses?
Facial Affect
Positive 144 17.6 Yes
Negative 40 4.9 Yes*
Neutral 365 44.5 Yes
Eye Contact
Eye Contact 84 10.2 Yes
No Eye Contact 426 52.0 Yes
Communication/Social Skills
Vocalisation ( +ve ) 29 3.5 Yes
Vocalisation ( -ve ) 19 2.3 Yes
Laugh 13 1.6 No
Spontaneous verbal/speech (directed) 49 6.0 Yes
Spontaneous verbal/speech (non- 48 5.9 Yes
directed)
Sing 3 0.4 No
Verbal request 12 1.5 No
Non-verbal request 7 0.9 No
Vocal imitation 6 0.7 No
Approach 53 6.5 No
Withdraw 2 0.2 No
Attention ( +ve ) 200 24.4 Yes
Attention ( -ve ) 16 2.0 Yes
Action imitation 41 5.0 No
Prompted sharing 2 0.2 No
Unprompted sharing 18 2.2 No
Prompted turn-taking 16 2.0 No
Unprompted turn-taking 2 0.2 No
Response to prompt 52 6.3 Yes – Collapsed into a total ‘Positive Response to Prompt’ category
( +ve verbal )
89 | H A I B

Response to prompt ( +ve non-verbal) 116 14.1 Yes - Collapsed into a total ‘Positive Response to Prompt’ category
Response to prompt ( -ve verbal ) 3 0.4 Yes - Collapsed into a total ‘Negative Response to Prompt’ category
Response to prompt 22 2.7 Yes - Collapsed into a total ‘Negative Response to Prompt’ category
( -ve non-verbal)
Play
Solo play 312 38.0 Yes
Play with peers 59 7.2 Yes
Play with adults 99 12.1 Yes
Group play 216 26.3 Yes
Motor skills
Stationary 428 52.2 Yes
Walk 186 22.7 Yes – Collapsed into total ‘moving’ category
Run 22 2.7 Yes – Collapsed into total ‘moving’ category
Dance 14 1.7 Yes – Collapsed into total ‘moving’ category
Crawl 17 2.0 Yes – Collapsed into total ‘moving’ category
Restricted/repetitive and sensory
behaviors
Repetitive body movement 5 0.6 No
Repetitive movement of object 0 0 No
Abnormal sensory behaviors 18 2.2 No
Problem behaviors (self-injurious) 1 0.1 No
Problem behaviors (aggression 5 0.6 No
towards others)
Problem behaviors (aggression 3 0.4 No
towards inanimate objects)
Note. * Occurred at a frequency less than five when analysed by the three dog conditions. Retained, but should be interpreted with caution.
90 | H A I B


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Human-Animal Interaction Bulletin

Volume 13, No. 1, Pages 75-90

Therapy dogs for children with autism spectrum

Deanna L. Tepper1, Oriane Landry1, Tiffani J. Howell1,

The use of animal-assisted interventions as a method of improving symptoms of autism spectrum

Keywords: Animal-assisted intervention; Human-animal interaction; Dog-assisted therapy; Child

Correspondence regarding this article should be addressed to: Deanna L. Tepper,

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youth with autism. Autism, 23(7), 1740-1751.

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