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Assistance Dogs and Autism Ranking: Insufficient/Mixed evidence

Assistance dog

Assistance dogs (also known as service dogs) are dogs that are specifically trained to help individuals with various types of disability. In many countries assistance dogs have special access rights, to ensure their owners are not discriminated against.

Their use has now been extended to individuals on the autism spectrum.

Some assistance dogs (autism assistance dogs) are dogs that are specially trained to assist in the day to day life of the family with a child on the autism spectrum.  It is important that the dog is recognised as a 'working dog'. Because of this the dog will work in a special harness that connects it to both the parent and the child.

The dogs are trained to lead from the front, acting on instructions from the parent, while the child is usually encouraged to walk alongside the dog using a lead attached to the dog. The child may also be in a harness.

The use of autism assistance dogs is based on the idea that the dogs offer greater independence to the child and parent. They ensure that the child is kept safe by preventing the child from running away. They also provide other benefits associated with dog ownership such as regular routines and social support.

Some people think that, in some circumstances, the dogs may also offer other benefits, such as encouraging the child to communicate and to be more sociable or enhancing the opportunities for the inclusion of the child and the family.

Our Opinion

There is a limited amount of low-quality research evidence (three group studies and three single-case design studies with three or more participants) into the use of assistance dogs for children and young people on the autism spectrum. There is no research on the use of assistance dogs with adults on the autism spectrum.

This research suggests that assistance dogs may provide a few benefits to children and young people on the autism spectrum, and their parents and carers. Those benefits include increased safety, reduction of parental stress, an increased tolerance of dogs and greater opportunities for social inclusion.

However, because the quality of that research is so poor, we cannot determine whether assistance dogs provide any benefits to anyone on the autism spectrum, or their parents and carers. We must wait for further research of sufficiently high quality to be completed.

There is a need for small-scale research that uses quantitative methodologies (such as experimental trials) rather than qualitative methodologies (such as parental satisfaction surveys).  That research should investigate whether assistance dogs are more or less effective than other interventions designed to provide the same benefits, and whether specific individuals are more likely to benefit from assistance dogs than other individuals. If this small-scale research demonstrates benefits, further, large-scale research may be justified.

Disclaimer

Please read our Disclaimer on Autism Interventions


Audience

Some people think that assistance dogs may be appropriate for anyone on the autism spectrum who can cope with an active, lively animal day in, day out for many years.

However, some organisations which train and provide assistance dogs are more cautious. They may have specific child age limits and most importantly, will assess the family as a whole for the suitability of having a dog. For example, the charity Dogs for Good’s website, accessed on 29 June 2018, provides several eligibility criteria.

“1. Your child is aged between 3 and 10. 2. Your child must have an autism spectrum disorder diagnosis. 3. The dog will support only one child diagnosed on the autistic spectrum within the household. 4. Your child must be physically mobile. 5. You must be physically capable of handling a dog. 6. It is essential that you attend an information day at a venue of the Charity’s choosing. 7. If you live in rented accommodation, you will need to provide written evidence from your landlord/housing association that you are permitted to keep an assistance dog on the premises. 8. You must have access to a secure outdoor area at ground level that can be allocated to use for a dog’s toileting purposes. i. If you live in a property with a communal garden and propose to use that for the dog’s toileting purposes, you must have written permission to put in place a toileting pen 6ft x 6ft (minimum) for the purpose of toileting a dog.”

Aims and Claims

Aims

According to Irish Guide Dogs for the Blind website, accessed on 12 June 2015,
 
“The primary function of the assistance dog is to provide safety to a child with autism and their family. Due to the high level of obedience and training that an assistance dog receives, they are trained to stand when they feel a strain on the attachment from the child to the dog. This in turn will hold the child in place for a few moments allowing the parent time to deal with the situation and not have their child in any immediate danger. The child cannot get any further than the length of the attachment lead, thus increasing the safety for the child and reducing the stress levels for the parent/guardian. The dog is like a moving anchor and a source of security for both parent and child.”
 
Some people think that assistance dogs can also be trained to help with other problems, such as difficulties with temperament, social communication and social interaction. They also think that the dogs can be used to teach responsibility and commitment, as well as problem-solving skills. It is also suggested that dogs can be used to teach the individual to overcome a fear of dogs and other animals.
 
There are different explanations as to why assistance dogs may help some people on the autism spectrum. However, it is likely that the reasons may vary from one family to another. Possible reasons for any benefits include:
  • The dog acts as a psychological and physical anchor, helping to reduce the risk of the child running off.
  • The dog offers companionship, social support and uncritical acceptance.
  • The dog may act as a means of facilitating social communication - a social 'bridge'.
  • Dogs may be more tolerant, so the person feels less anxious or pressurised.
  • Dogs are interesting and the child may be instinctively drawn to them.
  • The child learns a range of skills from interacting with the dog which can be transferred to other situations.

Claims

There have been various claims made for the use of assistance dogs for people on the autism spectrum. For example, Irish Guide Dogs for the Blind claim that assistance dogs “help to control and improve the behaviour of a child with autism by promoting calmness and acting as a safety aid to the parents”.
 
Other organisations have made additional claims. For example, the Autism Assistance Dogs Ireland website, accessed on 29 June 2018, claimed that an assistance dog can
  • “Distract a child who becomes distressed by nose nudging and pawing so that the child does not hurt them self or others, and so learns to use the dog as a coping mechanism
  • Eases difficult transitions to places that would normally be anxiety provoking, such as the supermarket, school, any place outside the child's home
  • Holds position in dangerous situations so that the child cannot bolt. The child is attached to the dog via a belt which is then linked to the dog’s jacket. The parent then takes control of the dog by the lead to ensure that the child who is at risk of bolting, remains in a safe place, e.g. can no longer run out into oncoming traffic
  • Can improve a child's communication and concentration skills as they are no longer highly anxious and distraught, and so the child can focus on their surroundings, process and learn
  • Provides pressure contact and comfort to child who needs tactile support in stressful situations
  • Helps to locate a child who might have disappeared, is nonverbal and cannot respond to their own name
  • 'Meltdowns' reduce as the child now feels safe and has a constant companion
  • Enables family to bring their child out and do normal, everyday things, with full public access. Families no longer live in isolation and avoidance of places that once caused their child such distress
  • Educates society, helping people to understand that this wonderful child has a disability and needs our support and not our criticism."

Key Features

Assistance dogs (also known as service dogs) are dogs that are specifically trained to help individuals with various types of disability. In many countries assistance dogs have special access rights, to ensure their owners are not discriminated against. Their use has now been extended to individuals on the autism spectrum.

Some assistance dogs (autism assistance dogs) are dogs that are specially trained to assist in the day to day life of the family with a child on the autism spectrum.  It is important that the dog is recognised as a 'working dog'. Because of this the dog will work in a special harness that connects it to both the parent and the child.

The dogs are trained to lead from the front, acting on instructions from the parent, while the child is usually encouraged to walk alongside the dog using a lead attached to the dog. The child may also be in a harness.

Different providers of assistance dogs have different methods but some people believe that careful breeding, careful puppy selection and establishing correct behaviour patterns early on are believed to reduce training time and increase safety.

  • Some providers place fully trained dogs with their human partners when the dogs are approximately two years of age. Others place untrained puppies with the human partner
  • The family may attend a training class that teaches them how to look after and manage the dog.
  • In some cases, the dog may be harnessed to the child for outdoor activities, while the parent holds the leash. In some cases, the child may hold the leash.
  • The dog may be taught to respond to specific actions. For example, some dogs may be taught to respond to problem behaviours, such as repetitive and restricted behaviours.

Please note: An assistance dog is not the same as a therapy dog or a pet dog. A therapy dog is trained to provide comfort and affection to people in long-term care, hospitals, retirement homes, schools, mental health facilities, and other stressful situations to include disaster areas. Pet dogs may be trained or untrained and do not attract the accessibility benefits of an assistance dog.

Cost and Time

Cost

Some organisations (such as Dogs for Good) provide assistance dogs free to the user (although there may be a waiting list). Other organisations ask users to contribute towards the costs which can be anything between £9,000 and £20,000.

There is then the cost of looking after the dog (feeding, equipment, exercise area, vets' fees etc.) during the life of the dog, which could be up to fifteen years or more.

According to the Dogs for Good website, accessed on 29 June 2018, it costs approximately £1,100 a year to keep an assistance dog, which includes food, health and insurance costs.

Time

The time required to use an assistance dog is considerable because the dog lives as part of the family for many years and requires training, feeding, grooming, toileting, exercising and so on during its working life and beyond.  According to National Service Dogs, an assistance dog has a working life of about eight to ten years, although many families will keep the dog as a family pet once it 'retires'.

According to Burrows et al (2008),

"For parents who were already highly stressed, the service dog could add to their workload as another body in the family that requires feeding, grooming, exercising, and toileting. However, most parents quickly learned how to integrate the dog into their daily schedule. Parents with unreasonable expectations as to what the dog could do were less likely to realize the benefits the dog could provide. It is important for any parent interested in pursuing a service dog for their child to realize that the training of these dogs is ongoing, and failure to maintain the dog's training both in and out of harness can affect the success of the placement."

Risks and Safety

Hazards

There are some possible hazards involved in the use of assistance dogs, some of which are more likely to occur than others. These include

  • Injury to the child or family usually through biting or scratching but also psychological trauma if the child has a dog phobia or the use of the dog is uncontrolled.
  • Injury or psychological trauma to the dog by the child or family.

Because of this, some people advocate careful breeding of assistance dogs, using breeds which are known for their intelligence and placidity. Supervision is also essential in creating a placement that is safe and effective. It is important for the carers of any child to understand that their role is to ensure that the relationship between child and dog is consistently gentle and mutually enjoyable.

Irish Guide Dogs for the Blind recommends that children should not be left alone with a dog unsupervised.

Contraindications

There are some contraindications (something which makes a particular treatment or procedure potentially inadvisable) for assistance dogs. 

For example, assistance dogs may not be appropriate for some individuals and families who

  • Are allergic to dogs.
  • Have a phobia of dogs.
  • May hurt or frighten dogs, however inadvertently.
  • Cannot cope with the demands of dog ownership including costs, the effort and the logistics required to train and look after a dog on a long-term basis.

Placement within a family that already owns another dog, may be more complicated and requires specific care.

Suppliers and Availability

Suppliers 

There are some organisations in the UK, Ireland and the USA which can provide specially trained assistance dogs but in most cases there is a very long waiting list.

Credentials

Some providers of assistance dogs are members of coalition organisations that operate at national and international levels. For example, Assistance Dogs International (ADI) sets the standards for the production and care of assistance dogs. 

Related Suppliers and Availability


History

Guide dogs for blind people were first used in Germany to help soldiers blinded during the First World War.  The use of guide dogs to help visually impaired people then spread to other countries such as the UK and the USA.

In the 1970's people in the USA and other countries began to use assistance dogs to help people with physical disabilities and mental health problems.

Various providers in the UK (such as Dogs for Good and Support Dogs) began to use assistance dogs to help people on the autism spectrum during the 2000's.

 

Current Research

Description of Studies

We have identified six articles* published in English-language, peer-reviewed journals which evaluate the efficacy of assistance dogs as an intervention for children and young people on the autism spectrum.  

The studies we identified included almost 400 children and young people on the autism spectrum aged from one year old to 14 years old. Individuals with specific diagnoses included people with autistic disorder, Asperger syndrome or pervasive developmental disorder - not otherwise specified.  

Some of the children and young people were verbal, some were non-verbal. Some of them had one or more additional conditions such as mild-to-moderate learning difficulties, attention deficit hyperactivity disorder, asthma and epilepsy.

All of the studies looked at the use of an assistance dog as a standalone intervention, with the exception of the study by Groomes et al (2014). This study compared two social skills groups, one of which provided access to a single assistance dog if it was needed. In all of the other studies, the assistance dog lived with the family in the family home. 

In the family studies, the family had normally had the dog for several months, the length of time ranging from 6 to 36 months. The exception was in the study by Viau et al (2010) where the family had the dog for four weeks and it was then withdrawn to see what effect this would have on the family.

Most of the dogs were provided by specialist organisations, who also provided training and instruction to the family on how to look after and use the dogs. Some of the studies specified the breed of dog used but in most cases they did not nor did any of them specify the age of the dogs.

It is not clear from most of the studies whether the participants were receiving any other interventions (such as speech and language therapy or medication) at the same time as they had an assistance dog.

Three of the studies used a group design, which compared a group of people with an assistance dog to a different group without a dog. The other three studies used a single-case design, where there was no group who did not have a dog.

*Please note: We have not included articles with fewer than three participants on the autism spectrum, articles which did not examine the efficacy of assistance dogs as an intervention for people on the autism spectrum, or articles on the use of dogs in pet therapy (because this is a different kind of intervention).

Study Outcomes

  • The study by Burgoyne et al (2014) reported on a survey of 164 parents/guardians of children on the autism spectrum, half of whom had an assistance dog and half of whom were on a waiting list for an assistance dog. The parents who had a dog believed their child was significantly safer from environmental dangers, perceived that the public acted more respectfully and responsibly towards their child, and felt more competent about managing their child.
  • The study by Burrows et al (2008) was a small qualitative study of 10 parents of children on the autism spectrum who had an assistance dog. The parents felt the dog protected their child from danger, made public outings and family activities easier, and helped to improve their social recognition and status.
  • The study by Groomes et al (2014) was a small randomised, controlled trial with 14 participants. It compared adolescents on a social skills course with other adolescents on a social skills course who also had access to the same assistance dog. It reported that the assistance dog might have helped adolescents on the autism spectrum and other family members to improve their social skills and increase their emotional well-being.
  • The study by Fecteau et al (2017) was a large, controlled trial of 98 families of children on the autism spectrum who had an assistance dog or were waiting to receive an assistance dog. It reported that the presence of a service dog in the family had an effect on parenting stress, as well as on their wakening and morning cortisol levels (a marker for stress). 
  • The study by Smyth and Slevin (2010) was a small survey which reported on the day-to-day experiences of seven parents living with an assistance dog for their autistic child, and that of the whole family. It reported a range of different benefits for the children including improved safety, companionship, positive social acknowledgement and development of motor skills. Benefits for parents and family included decreased anxiety about the child’s safety, increased family outings and positive social acknowledgement.
  • The study by Viau et al. (2010) was an alternating trial of the effects of assistance dogs on the cortisol levels (a marker for stress) and behaviours of 42 children on the autism spectrum. It reported that the average cortisol levels did not change when assistance dogs were introduced but that the cortisol awakening response levels decreased significantly. It also reported that the number of problematic behaviours reported by parents decreased after the introduction of the dogs.

Status Research

There are a number of limitations to each of the research studies published to date.  For example, 

Type of study

Some studies used relatively weak methodologies or did not adequately describe the methodologies they used. For example

  • Three of the studies (Burgoyne et al, 2014; Burrows et al, 2008; Smyth and Slevin, 2010) used qualitative, non-experimental methodologies. That is, they did not control the introduction of the dogs to the families nor did they use any kind of pre-post-test to assess whether there was a measurable difference before and after the dogs were introduced. 
  • Three of the studies (Burrows et al, 2008; Smyth and Slevin, 2010; Viau et al, 2010) used single-case designs, that is, they did not have a control group of participants who did not receive an assistance dog.
  • Neither of the two randomised studies (Fecteau et al, 2017; Groomes et al, 2014) described the randomisation process. This means that we do not know if the participants in these studies were randomised or if they were randomised in an adequate manner.
  • None of the group studies were blinded, which means that the participants in each group knew whether they had an assistance dog, which could have affected the results of the study.

Participants

Some studies had limited numbers of participants, selected participants in ways that could have biased the outcomes or did not adequately describe the participants or how they were selected. For example

  • Two of the studies had very few participants.  For example, the study by Smyth and Slevin (2010) had only seven participants, the study by Burrows et al (2008) had only 10 participants and the study by Groomes et al (2014) had only 14 participants. 
  • All of the studies were restricted to specific groups of autistic participants, such as children and young people (although this may be reasonable given that assistance dogs are not normally available to adults on the autism spectrum).
  • Most of the studies did not independently verify the diagnosis of autism using established tools like the ADOS.  
  • Most of the studies did not provide enough details about the participants (such as the ratio of males to females, their intellectual and verbal abilities, their ethnicity, or whether they had any co-occurring conditions that could have affected the outcomes).
  • Most of the studies did not clearly state all the inclusion and exclusion criteria for participants (such as age, coexisting conditions, coexisting treatments etc.).

Intervention/s

Some of the researchers delivered the interventions in ways that could have biased the outcomes or did not adequately describe how the interventions were delivered. For example,

  • Some of the studies did not provide enough information about the assistance dogs and how they were used, so that other researchers could understand what was being delivered and how. For example, some studies did not describe the age or breed of dog, did not describe the training that the dogs undertook before they were placed with the family, did not describe the training that the parents undertook before they received the dog etc.
  • Some of the studies ran for relatively short periods of time. For example, the study by Viau et al (2010) ran for only four weeks and the study by Groomes et al (2014) ran for only six weeks.
  • Some of the studies ran for a relatively long period (over a year) meaning that any changes in the participants could have been due to their natural development rather than the intervention.
  • Some of the studies included participants who probably received one or more other interventions (such as speech and language therapy or a medication) at the same time as they had the dog but did not describe or allow for these.

Comparators

Some group studies did not compare like with like or did not provide enough detail about any differences in the experimental and control groups and the interventions each received. For example,

  • The study by Groomes et al (2014) did not provide enough details about the participants in the control group (such as the ratio of males to females, their intellectual and verbal abilities, their ethnicity, or whether they had any co-occurring conditions that could have affected the outcomes).
  • The same study did not provide enough details about the intervention (social skills training programme) received by the control group.  (In fact, the experimental group also received this programme, in addition to having access to an assistance dog, but it was not clearly described for either group.)
  • The other two group studies (Burgoyne et al, 2014; Fecteau et al, 2017) used a wait-list control group (who received nothing) rather than an active control group (who would have received an active intervention of some kind, such as a robotic dog).

Outcomes and Measures

Some researchers did not use the most appropriate outcome measures or did not adequately describe those outcome measures and any limitations they might have had. For example,

  • Some of the studies did not provide enough detail for us to be able to make a considered assessment of their efficacy. For example, the study by Groomes et al (2008) stated that assistance dogs “may provide a means of helping adolescents and family members to employ pro-social behaviors” but they did not state what those pro-social behaviours were.
  • The same study stated that it used a range of outcome measures inc. the Multidimensional Anxiety Scale for Children, the Adaptation to Disability Scale-Revised and the Autism Social Skills Profile (ASSP) but failed to provide any data from those measures. 
  • One of the studies (Fecteau et al, 2017) used the Childhood Autism Rating Scale to assess the behaviours of the children at the beginning of the study but did not use it to assess the children at the end of the study, which would have been quite useful, as it could have shown if the dogs had produced any effect in the children.
  • Some of the studies (such as Burgoyne et al, 2014) used self-reports and parents’/guardians’ personal perceptions rather than any kind of objective measures.
  • One of the studies (Viau et al, 2010) used an objective outcome measure (cortisol awakening response, a marker for stress) but noted that it was unclear what changes in the marker meant in practice. 
  • None of the studies appeared to use any kind of adverse effect measure to test whether the dogs produced any adverse effects.

Data Analysis

Some researchers did not use the most appropriate statistical tools and techniques to analyse the data from their studies or did not adequately describe those tools and techniques and any limitations these may have had.

  • Some of the studies had incomplete data. For example, Viau et al (2010) noted that there were some difficulties in collecting some of the saliva samples resulting in a loss of data.  
  • Some of the studies did not provide any kind of statistical analysis of the outcomes (such as the statistical significance) and none of the studies provided any data on the effect sizes. 
  • The study by Groomes et al (2008) stated that the results approached statistical significance but did not provide any data to demonstrate this.
  • Some of the studies did not record if the assistance dogs had any beneficial or harmful effects in the medium (three to six months) or longer term (six months or longer).

Other

Some research studies included other flaws that could have biased the outcomes. For example,

  • None of the studies appeared to involve people on the autism spectrum in the design, development and evaluation of those studies.
  • The study by Burrows et al (2008) was funded in part by National Service Dogs (a supplier of assistance dogs) and the study by Viau et al (2010) was funded by La Fondation MIRA (a supplier of assistance dogs). The researchers involved may therefore have been biased towards the assistance dogs, however unconsciously.

For a comprehensive list of potential flaws in research studies, please see ‘Why some autism research studies are flawed’

Ongoing Research

We have been unable to identify any studies into assistance dogs and autism that are currently underway.  If you know of any other studies we should include please email info@researchautism.net with the details. Thank you.

Future Research

Summary of Existing Research

There is a limited amount of low-quality research evidence (three group studies and three single-case design studies with three or more participants) into the use of assistance dogs for individuals on the autism spectrum. There is no research on the use of assistance dogs with adults on the autism spectrum.

This research suggests that assistance dogs may provide several benefits to children and young people on the autism spectrum, and their parents and carers. Those benefits include increased safety, reduction of parental stress, an increased tolerance of dogs and greater opportunities for social inclusion.

However, because the quality of that research is so poor we cannot determine whether assistance dogs actually provide any benefits to any children and young people on the autism spectrum, or their parents and carers. We must wait for further research of sufficiently high quality to be completed.

Recommendations for Future Research

There is a need for small-scale research that uses quantitative methodologies (such as experimental trials) rather than qualitative methodologies (such as parental satisfaction surveys). 

That research should 

  • Compare assistance dogs with other interventions, such as therapy dogs, which are designed to provide the same benefits.
  • Identify if specific groups on the autism spectrum are more likely to benefit from assistance dogs than other groups on the spectrum.
  • Identify if assistance dogs have any beneficial or harmful effects in the medium to long term.
  • Involve people on the autism spectrum (and parents and carers) in the design, development and evaluation of those studies.

If this small-scale research demonstrates benefits, further, large-scale research may be justified.

Studies and Trials

This section provides details of scientific studies into the effectiveness of this intervention for people with autism which have been published in English-language, peer-reviewed journals.

If you know of any other publications we should include please email info@researchautism.net with the details. Thank you.

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Studies and Trials


Other Reading

This section provides details of other publications on assistance dogs.

You can find other publications on dogs in our publications database.

If you know of any other publications we should include please email info@researchautism.net with the details. 

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Other Reading


Additional Information

According to Irish Guide Dogs for the Blind website, accessed on 12 June 2015,

“Each family will gain something from the dog but what they gain may be completely different. The dogs are very different, the children are very different and the handlers (parent/guardian) are very different. So it is important not to compare yourself to another family and not expect the same results as another family. Some children will develop a bond with the dog but others won't. The only thing we guarantee is the safety aspect and everything outside of that is a bonus.”

 

Related Additional Information


Updated
31 Jan 2019
Last Review
01 Jan 2019
Next Review
01 Jan 2022