Introduction
Children with Autism Spectrum Disorder (ASD) often experience rejection by their peers, which could result in problem behaviours and over time, impact their physical and mental health. One treatment practice for children with ASD involves the use of animals in therapeutic activities known as animal-assisted intervention. According to the human-animal interaction social support theory, animals provide social support as they act as a source of comfort and facilitate social interactions. Additionally, the human-animal interaction attachment theory suggests that animals can act as a source of comfort and safety for children, which could alleviate distress and reduce problem behaviours. Consistent with these theories, recent research appears to find preliminary support for the ability of animals to connect with children with ASD, facilitate social interactions and improve social functioning over time. Although there may be physical and psychological risks in involving animals in treatment, incidences are rare and the benefits may outweigh the risks.
The Effectiveness of Animal-Assisted Intervention in the treatment of Children with Autism Spectrum Disorders
Children with Autism Spectrum Disorder (ASD) often experience rejection and victimisation by their peers, which could result in social isolation, anxiety and problem behaviours at home (O'Haire, McKenzie, McCune, & Slaughter, 2014). Over time, these experiences could impact the physical and mental health of the child (O'Haire et al., 2014). Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ASD is characterized by persistent impairment in social functioning, and restricted, repetitive patterns of behavior (American Psychiatric Association, 2013).
These symptoms are present from early childhood and have the potential to impair everyday functioning (American Psychiatric Association, 2013). As such, it is vital that effective treatment practices are available for children with ASD. One treatment practice adopted by professionals involves the use of animals in therapeutic activities known as animal-assisted intervention. Animal-assisted intervention is a term used to encompass both animal-assisted therapy and animal-assisted activities.
While animal-assisted therapy refers to an interventional strategy that involves an animal, is goal-directed and is facilitated by a trained professional, animal-assisted activities are activities with animals that create opportunities for educational, recreational or therapeutic benefits without being goal directed or facilitated by a professional (O’Haire et al., 2014).
According to the human-animal interaction social support theory, animals have the ability to enhance social support as they act as a source of comfort and facilitate social interactions (McNicholas & Collis, 2006). Additionally, the human-animal interaction attachment theory suggests that animals can act as a source of comfort and safety for children, which could alleviate distress and reduce problem behaviours (Kruger & Serpell, 2006). While these theoretical underpinnings have led researchers to theorise that animals offer a unique outlet for social engagement (O’Haire, 2013), others have contended that social aversion amongst individuals with ASD may be specific to the human species and may not extend to animals (Johnson, 2003).
In this paper, the effectiveness of animal-assisted intervention in the treatment of children with ASD will be discussed. Although a large body of research has shown that the use of animals in animal-assisted intervention have numerous health benefits (Lanning, Baier, Ivey-Hatz, Krenek, & Tubbs, 2014; O’Haire et al., 2014), there are several physical and psychological risks (Cherniack & Cherniack, 2014). Nonetheless, research indicates that animal-assisted intervention is effective in the treatment of children with ASD.
Several researchers contend that the success of animal-assisted therapy in improving physical and mental health of patients is due to the unique human-animal attachment (Beck & Madresh, 2008; Geist, 2011). According to Bowlby’s (1969) attachment theory, attachment refers to an emotional bond that involves closeness-seeking behaviour, intimate interactions and support in relationships. These emotional bonds between humans and animals has been found to provide individuals with a sense of security, emotional support and even relief in difficult times (Beck & Madresh, 2008). However, researchers have also reported differences in the strength of the emotional bond between a pet and its owner, and the bond that is created in a therapeutic environment. In the latter, the interaction with the animal is restricted to the interactions during therapeutic sessions (Balluerka, Muela, Amiano, & Caldentey, 2014). Hence, it may be more accurate to regard animals as an assistant therapist, as they work together with the psychologist, the lead therapist, to develop key elements of a therapeutic process such as a therapeutic alliance and trust (Melson & Fine, 2010).
Consistent with the human-animal interaction theory, research has shown that animal-assisted activities are effective in improving social functioning, including increases in social approach behaviours and social skills in children with ASD (Lanning et al., 2014; O'Haire et al., 2014). In the study conducted by O’Haire et al. (2014), sixty-four children between the ages of 5 and 12 who had been diagnosed with ASD participated an animal-assisted activity programme. One of the researchers with no clinical training facilitated the animal care and interaction programme which included sixteen 20- minute sessions of contact time with guinea pigs as well as 8 weeks of animal exposure in a classroom.
Guinea pigs were selected as the 
intervention animal in the programme as they seldom bite, are easy to handle in a classroom setting and are social animals. The researchers reported that the children who participated in the animal-assisted activity programme demonstrated significant improvements in social functioning from before to after the programme. These findings indicate that animal-assisted activities may be effective in the treatment of children with ASD. Additionally, the results demonstrate that the use of guinea pigs in the classroom is a cost-effective method of enabling educators to improve the social functioning of children with ASD (O'Haire et al., 2014). Nonetheless, this study was not without limitations.
While the findings of this study is consistent with a large pool of empirical evidence which also reports the benefits of the inclusion of animals in therapeutic activities such as increases in social interaction and communication and decreases in autistic stress and problem behaviours, many of these findings should be interpreted with caution due to methodological limitations (O’Haire, 2013).
Firstly, the accuracy of the findings of O’Haire et al. (2014) may have been subject to bias as teachers and parents were not blinded to the participant conditions as they may have had expectations for change after the programme. Additionally, as only one facilitator was used for the programme, the obtained improvements in the children could be attributed to the interactions with the facilitator and not truly attributable to the programme. Moreover, as with many studies in the field of animal-assisted intervention, the relatively small sample size of this study limits the generalisability of the results and the ability to investigate treatment outcomes based on individual differences (O’Haire, 2013).
Lastly, after a review of fourteen studies that were published in peer-reviewed journals, O’Haire (2013) states that there has been a lack of universal terminology used in previous research concerning animal-assisted intervention, resulting in the variability of animal-assisted interventional strategies at a basic definitional level. As such, it is imperative that researchers continue to refine concepts and carry out more rigorous research to develop standardized procedures in animal-assisted intervention that are effective for children with ASD (O’Haire, 2013). Nevertheless, these findings appear to confirm previous theoretical and empirical work, indicating preliminary support for the ability of animals to connect with children with ASD, facilitate social interactions and improve social functioning over time (O'Haire et al., 2014).
Whilst the use of animals in interventional strategies for children with ASD has numerous empirically supported benefits, it should be noted that there are some health risks involved. Animals can be complex to care for as they require adequate food, hygiene, veterinary care (Beck & Katcher, 2003). If not properly cared for, animals could potentially cause human infection and injuries as there are infections that can be transmitted from animals to humans (Guay, 2001). However, the incidences of such diseases in individuals who have participated in animal assisted interventional strategies has not been documented (Cherniack & Cherniack, 2014).
In addition to physical health risks, animals may also cause psychological harm to children as humans can develop strong attachments and bonds with their pets. While these strong emotional bonds between humans and animals have the ability to provide individuals with a sense of security, emotional support and facilitate psychological treatment (Beck & Madresh, 2008), individuals may experience grief reactions similar to those after the loss of a loved one following the death of the animal (Beck & Katcher, 2003). Despite these risks involved, incidences are rare and are even less well documented thatn the benefits (Cherniack & Cherniack, 2014).
In conclusion, consistent with the human-animal interaction social support and attachment theories, recent research appears to indicate that animal-assisted intervention is effective in the treatment of children with ASD. However, many of these findings should be interpreted with caution due to methodological limitations such as small sample sizes that limit the generalisability of the results.
Additionally, bias of parents and teachers who report improvements in the social functioning of children with ASD could have affected the accuracy of the results. Moreover, there has been a lack of universal terminology used in previous research concerning animal-assisted intervention, resulting in variability of animal-assisted interventional strategies at a basic definitional level. Several researchers have also noted potential physical and psychological risks involved in the inclusion of animals in interventional strategies.
However, the incidences of these risks are rare, possibly indicating that the benefits largely outweigh the risks. Hence, findings of recent research appear to find preliminary support for the ability of animals to connect with children with ASD, facilitate social interactions and improve social functioning over time (O'Haire et al., 2014). Future researchers should continue to refine concepts and carry out more rigorous research in the future to determine the types of animal-assisted intervention practices which are most effective for different groups of children.
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