*Renata Bociarska1, Beata Janina Olejnik2, Monika Chorazy3, Katarzyna Snarska4, Jolanta Lewko5
The use of dog therapy in the treatment and rehabilitation of children with autism
Terapia z udziałem zwierząt w leczeniu i rehabilitacji dzieci z autyzmem
1Graduate of the Department of Health Sciences, Medical University of Bialystok, Poland
2Department of Developmental Age Medicine and Paediatric Nursing, Medical University of Bialystok, Poland
3Department of Neurology, Medical University of Bialystok, Poland
4Department of Clinical Medicine, Medical University of Bialystok, Poland
5Department of Integrated Medical Care, Medical University of Bialystok, Poland
Streszczenie
Wstęp. Dogoterapia ma znaczący wpływ w procesie rozwojowym dziecka. Szczególną grupę podatną na działania terapeutyczne z udziałem psa stanowią dzieci z przewlekłymi schorzeniami, wymagające długotrwałego leczenia i rehabilitacji.
Cel pracy. Ocena wpływu dogoterapii na leczenie i rehabilitację dzieci z autyzmem oraz wpływu terapii z udziałem psa na zmianę zachowań i postaw u tych dzieci.
Materiał i metody. Badaniem objęto grupę 50 dzieci z orzeczeniem autyzmu, które korzystają z dogoterapii jako formy wspomagającej leczenie, pod kierunkiem terapeuty. Respondentami byli rodzice/opiekunowie dzieci. Zastosowano metodę sondażu diagnostycznego z wykorzystaniem autorskiego kwestionariusza ankiety, składającej się z 22 pytań dotyczących m.in. korzyści i zmian odnoszących się do sfery fizycznej, psychicznej i zachowań społecznych dziecka, będących efektem zastosowanej dogoterapii.
Wyniki. Znaczna część grupy wykazała pozytywne zmiany w zachowaniu, odnoszące się do każdej ze sfer funkcjonowania. U 70% badanej grupy zaobserwowano mniejszy poziom lęku w kontaktach z otoczeniem, większą otwartość i zaufanie, a także większą inicjatywę i motywację w podejmowanych różnego rodzaju działaniach edukacyjnych i leczniczych.
Wnioski. Aktywny udział psa w procesie rozwojowym dziecka jest formą terapii i rehabilitacji, dotąd jeszcze niedostatecznie poznaną i docenianą. Pies korzystnie wpływa na rozwój dziecka, wzmacnia procesy kognitywne i mobilizację, aktywizuje, poprawia funkcjonowanie psychospołeczne, a także redukuje stereotypie i inne objawy osiowe autyzmu. Subiektywna ocena i uzyskane wyniki badań wskazują na wysoką skuteczność dogoterapii jako metody wspomagającej. Zachodzi potrzeba korzystania z tej alternatywnej formy w życiu człowieka i jej ewaluacji.
Summary
Introduction. Dog therapy has a significant impact on the child’s development. Children suffering from chronic diseases requiring long-term treatment and rehabilitation are particularly responsive to therapeutic modalities involving dogs.
Aim. The aim of the study was to evaluate the impact of dog therapy on the treatment and rehabilitation of children with autism and to assess the influence of dog therapy on behaviour and attitude changes in such children.
Material and methods. The study included a group of 50 children diagnosed with autism who received dog therapy as a auxiliary treatment modality. Respondents were the children’s parents/guardians. The diagnostic survey method including an original questionnaire consisting of 22 questions relating, among other things, to the benefits and changes in the physical, psychological and social behaviour of the child resulting from the applied therapy was utilised.
Results. A significant number of study participants showed positive changes in behaviour regarding each sphere of functioning. In 70% of the studied children, a decreased level of anxiety was observed in contacts with their surroundings, greater openness and trust as well as higher motivation and greater initiative in a variety of educational and therapeutic activities.
Conclusions. The active involvement of a dog in the child’s development is a form of therapy and rehabilitation which has not been fully explored and appreciated. Dogs exert a positive impact on the child’s development, enhance cognitive processes and motivation, inspire the child, improve their psychosocial functioning as well as reduce stereotyped behaviours and other axial symptoms of autism. Subjective assessment and the objective results obtained in the study indicate high efficacy of dog therapy as an auxiliary method. There is a need to use and evaluate this auxiliary treatment modality in human life.
Introduction
Advances in medicine regard the development of many disciplines relating to the diagnosis and treatment of disease as well as the therapy and rehabilitation of patients. Dog therapy is a method known since antiquity and used in the treatment of a wide spectrum of disorders. It utilises the presence of a dog as a natural human companion. However, despite being widely used, it is not a fully recognised auxiliary modality in the treatment and rehabilitation of a number of disorders and dysfunctions. Dog therapy is of particular significance in the treatment of children. Thanks to a wide range of competences of the therapist, the dog, any individual can be a recipient of this form of therapy. Scientific reports and research findings confirming the efficacy of dog therapy allow us to state that the involvement of a dog in the life of a human being is invaluable.
In a number of countries worldwide, dog therapy is recommended by psychologists, counsellors, therapists and medical professionals for all children, particularly those with various deficits, at all levels of education and development (1). In Poland, only few centres are attempting to introduce elements of dog therapy into educational establishments and medical institutions. Performing initial comprehensive evaluations of the evolution and application of this form of therapy is a key issue. In 2014 the profession of a dog therapist (No. 323007) was officially registered on the Polish labour market, which has raised hopes for a more widespread use of this natural method of therapy (2).
Since ancient times the importance of dogs has been illustrated by their portrayal as healers, guides or faithful companions (3). First scientific reports regarding the therapeutic use of dogs come from 1792, when they were used in the treatment of the mentally disabled (4). In the twentieth century, dog therapy has flourished as a treatment modality used in medicine, psychology and social sciences. Numerous organisations promoting animal-based therapies, i.e. SEPMAE in France or PAT in Great Britain, were established, uniting volunteers with dogs who visited hospitals, nursing homes or hospices (5). The most significant are the experiences of Boris Levinson, referred to as “the father of dog therapy”, who noticed the impact of his own dog on the autistic paediatric patients he was treating (6).
Dog therapy is now widely used in a large number of countries as part of the Visiting Pet Program-animals visiting patients in their homes (7). There are numerous organisations and associations which offer dog therapy and provide training in this field.
In Poland, dog therapy has been known for over 30 years. Maria Czerwinska, on whose initiative the Foundation for Friendship of People and Animals – “CZE-NE-KA” was established in 1998, is considered its precursor (8). In subsequent years, more foundations such as “Friend” in Warsaw, “Dogtor” in the Tri-City (Gdansk, Sopot, Gdynia), “Ama Canem” and others were set up (9).
Contemporary dog therapy as a auxiliary treatment modality can be used to treat a wide gamut of conditions. It is particularly useful in the treatment of disorders whose clinical picture includes an intellectual, somatic and psychomotor disability. Autism should be included in this group of disorders. According to the ICD-10 Classification of Mental and Behavioural Disorders used in Poland “autism (F84.0) is included in the group of pervasive developmental disorders” (10). At present, diagnosis is established on the basis of the presence of abnormal and/or impaired development which is manifest before the age of 3 years, and abnormal functioning in all three areas of social interaction, communication, and restricted, repetitive behaviour (Autistic Triad of Impairments) (11).
Autism is a spectrum disorder whose incidence is on the increase. Year on year, the number of reported cases of autism spectrum disorder (ASD) is growing at a alarming rate and this fact illustrates the considerable significance of the social problem (12). It is estimated that currently 1 in 75 people worldwide suffers from autism, including 1 in 45 children. In Poland, the condition may affect approximately 17,000 children and adolescents. There is a higher incidence of autism in boys in comparison to girls and, importantly, the condition predominantly affects children from families with a high socioeconomic status (13).
Autism is a neurodevelopmental disorder, which means that its clinical picture, course or character may change as the child grows. The main signs and symptoms of autism include impaired social interaction and communication, and stereotyped behaviours. Perception in autistic individuals is also impaired, which becomes apparent before the age of 3 years. Children experience difficulty with establishing, maintaining and understanding social relations. They also display creativity deficits in thought processes, difficult and unusual behaviours, disturbances in sensory processing and sensory functioning (14).
Autism is a pervasive developmental disorder and thus requires a holistic approach. Deficits are addressed through symptomatic treatment. Treatment methods are adapted to the character and severity of the disorder as well as the presence of comorbidities (eg. epilepsy). The therapist’s attitude to the parents/guardians of autistic patients requires great caution and tact as sometimes parents’ expectations regarding treatment efficacy are so high that they may even hope for a complete cure. It should be emphasised that the treatment is not expected to produce outstanding outcomes, but multiple therapeutic attempts (15).
A wide range of available treatment modalities for autism enables the therapist to select the most appropriate, patient-tailored methods. The goal of each intervention in autism patients is to eliminate deficits, improve their quality of life and functioning, and stimulate development. One of the most commonly used treatment modalities, which is gaining scientific recognition, is dog therapy. Dog therapy, which does not produce any adverse effects and has no contraindications, exerts a direct beneficial impact on the functioning of an autistic child (16).
While the use of other forms of therapy recommended in the treatment of autism may produce detectable changes in the child’s behaviour, dog therapy has a positive impact on the disease as a whole. Continuous contact with a dog, not only in a therapeutic setting, but also in the family environment, plays an important educational role. Stigmatization of autistic individuals by society results in their withdrawal, which further intensifies their social isolation. Therefore, dog therapy frequently proves to be the only effective method of “opening” individuals with autism. A dog becomes their most faithful friend and partner, whose nature and character traits help autistic children overcome their difficulties, strengthen motivation and activate. Despite the fact that the therapeutic process sometimes, making further attempts to treat autistic individuals using dog therapy is recommended. However, it should be emphasised that the process requires time and attentiveness, both on the part of the parent and the therapist.
There is scientific evidence confirming that not only children affected by autism, but also healthy children, raised with animals demonstrate more empathy, are more sensitive to the needs of others and show a higher IQ (17).
Aim
The aim of the study was to evaluate the impact of dog therapy on the treatment and rehabilitation of children with autism and to assess the influence of dog therapy on behaviour and attitude changes in such children.
Material and methods
The study utilised a diagnostic survey method comprising an original questionnaire consisting of 22 questions. The first part of the survey contained questions relating to research group characteristics (gender, age, time of diagnosis, attendance at an outpatient autism clinic and use of other, alternative treatment methods). The second part of the survey contained questions regarding forms and methods of dog therapy used, treatment duration and setting as well as the resulting changes in the behaviour and functioning of the child. The questions concerned improvements in physical fitness, motor accuracy, motivation to learn, acquisition of knowledge, a sense of security and trust in others, relationships with family and those around, as well as the ability to express feelings, socially appropriate behaviours and attitudes.
The study was conducted among parents/guardians of 50 children (30 boys and 20 girls) diagnosed with autism who used dog therapy as an auxiliary treatment modality administered by a qualified therapist. The children studied were aged 2.5-18 years. The median age was 6.5. Children aged 4-8 years constituted the largest group of study participants. A significant number of the children (68%) were diagnosed with autism between the ages of 1 and 3 years. 88% of study participants were under the care of an outpatient autism clinic.
When considering the age at which diagnosis was made, a significant number of study participants, 68%, were diagnosed with the disease between the ages of 1 and 3 years while only 4% were diagnosed after the age of 6 years. 14% of study participants were diagnosed with the condition below the age of 1 year and 14%, a group statistically similar in size, were diagnosed between the ages of 3 and 6 years.
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