Journal of Pediatric Nursing (2014) 29, 114–123
Pet Dog Ownership Decisions for Parents of Children With Autism Spectrum Disorder1 Gretchen K. Carlisle PhD, MEd, RN ⁎ University of Missouri, Columbia, MO
Key words: Autism; Pets; Children; Dogs; Human–animal interaction
This study aimed to examine the role of pet dogs in families of children with autism. Sixty-seven percent of families owned dogs and 94% reported that their children were bonded to their dogs. Parents described previous experience with dogs and beliefs in their benefits as influential in their dog ownership decision-making process. Children living with dogs interacted with them in play and/or sharing personal space. Sensory issues of the children impacted their interaction with dogs inside and outside the home. Time and cost of care were identified burdens of dog ownership. Benefits were the opportunity to learn responsibility and companionship. © 2014 Elsevier Inc. All rights reserved.
THE DIAGNOSIS OF autism spectrum disorder (ASD) is marked by deficits with communication and social skills, along with the presence of restrictive and repetitive behaviors, and symptoms range from mild to severe (American Psychiatric Association, 2013). The widely heterogeneous symptomology of those with ASD has led to a variety of approaches for addressing the challenges of individual children. Pet dogs are common among families of typically developing children, and this type of human animal interaction may play a unique role for children with ASD.
Theoretical Framework Human–animal interaction has been examined through the lens of attachment theory, which was first proposed by Bowlby (1960). Attachment theory describes the bond of infants to their mothers for comfort and security (Bowlby, 1961), and has been further advanced to provide an understanding of the transfer of that attachment by children 1 Poster presentation on March 9 2013 at Midwest Nursing Research Society Conference in Chicago Illinois. ⁎ Corresponding author: Gretchen K. Carlisle, PhD, MEd, RN. E-mail address: [email protected].
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to bonds with other family members and peers over time as the children develop (Ainsworth, 1989). Melson (1990) applies attachment theory to describe children's relationships to their pets. This attachment includes the relationship components of spending time together, interacting together and the children's thoughts about the relationship (Melson, 1990). The activities of playing and caring for their pets have been associated with stronger bonds to their pets, for typically developing children (Melson, Peet, & Sparks, 1991). Children describe their pets as members of the family, sources of security and as friends (Triebenbacher, 1998). The strength of these human animal relationships may play a role in the outcome of the interactions. School aged children who were more attached to their pets were found to demonstrate greater empathy with others (Daly & Morton, 2006; Poresky, 1996). Less is known about the relationships and interactions between children with ASD and pets; however, there has been an increase in the use of trained dogs with children with ASD through animal assisted therapy (AAT) and the use of service dogs. Children with ASD exhibit a common deficit in the ability to establish social relationships. The ability to establish a secure attachment with a dog may increase the ability of these children to seek social relationships with others (Carlisle, 2012). Studies to date suggest the presence of social benefits from the interaction and relationship with
Pet Dog Ownership of Children with Autism Spectrum Disorder specially trained dogs, indicating a possibility of similar benefits for children with ASD and their pet dogs.
Literature Review Children with ASD have been identified as having the ability to form secure attachments; however, they may be less organized attachments than those of typically developing children (Naber et al., 2007). The ability to form a strong attachment with a primary caregiver, may impact the potential for the development of friendships with peers (Bauminger, Solomon, & Rogers, 2010). The difficulty children with ASD demonstrate in establishing relationships has been described as related to a deficit in theory of mind, which is the inability to comprehend the thoughts of others (Bar-On & Cohen, 1995). Dogs lack the complex facial features and body language common to humans. It has been proposed that the lack of necessity to identify what a dog may be thinking, in order to have a social interaction, may provide a rationale for the ability of children with ASD to interact with dogs (Solomon, 2012). Cortisol, the biological indicator of stress, has been found to be increased when children with ASD interact with peers (Corbett, Schupp, Simon, Ryan and Mendoza, 2010), yet decreased when children with ASD have been paired with a service dog (Viau et al., 2010). The calming effect may aid children with ASD in developing relationships with dogs. Studies investigating the interaction of trained dogs and children with ASD have been conducted. The benefit of the inclusion of dogs as a therapeutic aid in the psychological counseling of typically developing children is not a novel concept (Levinson, 1962). The investigation of children with ASD and dogs is less established. A meta-analysis of studies investigating AAT found that its use was associated with moderate effect sizes for improving the behavioral symptoms of children with ASD, and dogs were identified as the type of animals consistently associated with benefits (Nimer & Lundahl, 2007). In one study, when compared to a stuffed dog or toy ball, the presence of a live dog during a therapy session was associated with increased conversational engagement and focused eye gaze for children with pervasive developmental disorder, which is a form of ASD (Martin & Farnum, 2002). Another study conducted during occupational therapy sessions found that when a therapy dog was present, children with ASD had increased social interactions (p b .01), when compared to sessions with no dog (Sams, Fortney, & Willenbring, 2006). In the case of service dogs, benefits have also been found. Following receipt of a service dog in their home, children with ASD have been shown to have significantly fewer problem behaviors (n = 42, p b .001), than before the arrival of the dog (Viau et al., 2010). Problem behaviors may be an important factor in the development of relationships. A study of 109 children found that greater
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numbers of problem behaviors predicted poorer total social skills (β = .96, p b .01) (Matson, Hess, & Mahan, 2013). In another study, children who received a service dog, compared to a control group that did not receive a dog, had significant increases in social reciprocity (N = 20, p b .02) (Wild, 2012). In an additional study (N = 10), parents reported decreased levels of anxiety in their children, with increased overall happiness, following placement of a service dog in their home (Burrows, Adams, & Millman, 2008). Typically, the consistent characteristics of these trained dogs include a calm temperament and obedient behavior. The characteristics of pet dogs are more widely variable; however, benefits have been identified for typically developing children, including close relationships and attachment to their dogs. The arrival of a pet has been associated with an increase in interactions among family members and greater family happiness, in families of typically developing children (Cain, 1985). Preschool and school age school age children (N = 174) credited their pets with acting as emotional supports and social catalysts (Triebenbacher, 1999). When compared with children who did not live with a pet, children living with a pet were found to have increased levels of self-esteem, social competence and empathy (Daly & Morton, 2006; Endenburg & van Lith, 2011). This support extends through the transitional periods of development, which are often difficult for children. Dogs may serve as a confidant during these periods, with one study finding that children seek out their dogs for comfort and may be more likely to share confidences with their dog than with a friend or family member (McNicholas & Collis, 2000). Although a variety of pets are acknowledged, 51% of children (N = 213) identified dogs as their favorite pet, while 27% named cats (Bryant, 1990). These reported experiences among typically developing children demonstrate consistent benefits related to their relationships with pets. Only one study of children with ASD and pet ownership has been found in the literature. In that study, two groups of children were examined. One group of children (n = 8) who had always lived with a pet was compared with a control group of children (n = 8) who had never lived with a pet. The second group of children (n = 12) included those children who lived with a pet that was acquired after the children were aged five, compared with a control group of children (n = 12) who had never lived with a pet (Grandgeorge et al., 2012). In the first group of children always living with a pet, 50% of the children had tactile interactions with one of their pets, but none of the children were reported by parents to play with or care for their pets, and only two were described as having a privileged relationship with their pets. In the second group of children who acquired their pet after the age of 4 to 52 years, 75% of the children had tactile interactions, 58% played with their pet, 50% cared for their pet, and 58% were described as having a privileged relationship with their pet. Six of the families in this second group acquired their pet specifically for their child with ASD. The pets included dogs,
116 cats, one rabbit and one hamster. This preliminary evidence demonstrates the potential for attachment of children with ASD and pets, and suggests possible benefits from this type of attachment. Pets are common in the United States with 66% of families reporting pet ownership (American Veterinary Medical Association, 2012). Acquiring a pet includes the process of decision-making, which allows individuals to justify their decisions and communicate their interpretation of experiences. One study (N = 312) found that the primary reasons reported for acquiring a pet were child request (25%) and teaching child responsibility and care (22%) (Fifield & Forsyth, 1999). In the families that chose not to own a pet, reasons included allergies (20%), restrictions of family life (16%), time (14%) and cost (13%) (Fifield & Forsyth, 1999). There are many anecdotal reports of parents acquiring pet dogs for their child with ASD, related to the perception of the benefits, but an examination of this was not found in the literature. An examination of dog acquisition decisions and interactions of children with ASD and pet dogs may provide illumination.
Sample Participants were recruited from an ASD diagnostic and treatment center in the Mid-western United States that served a diverse geographic population of urban and rural families. Approval for the study was received through the associated academic institutional review board (IRB) and the research committee of the ASD center. The ASD center maintained a potential participant data-base, including 953 children identified with ASD, whose caregivers consented to contact for consideration of participation in research (Carlisle, 2012). Parents of children meeting the following criteria were included: age of 8–18 years, intelligence quotient (IQ) score of greater than 70 and a diagnosis of one of the autism spectrum disorders, including: autistic disorder, Asperger's syndrome, pervasive developmental disorder-not otherwise specified or autism spectrum disorder (hereafter referred to collectively as ASD). These criteria were met by 285 children in the data-base and attempts were made to contact each of these households. A request was made to speak with the primary caregivers (hereafter referred to collectively as parents) of these children and enrollment was offered to those individuals. The final sample included 70 parents of children with ASD (Carlisle, 2012). The data collected from three parents were excluded, based on the highly unique circumstances of their children's exposure to dogs. One parent owned dogs, but the dogs were reportedly isolated in an outdoor kennel with no exposure to children, due to their aggressive behavior. A second parent, who did not own a dog, provided frequent dogsitting care in her home for the dogs of friends, allowing for extensive interaction with dogs for her child with ASD. The
G.K. Carlisle third parent reported that they did not currently own a dog, but had owned a dog since their child was born until their dog's recent death, and they were planning to acquire another dog soon. The exceptional circumstances of these children were not consistent with those of other children in the study; therefore, their data were excluded.
Design and Data Collection The aim of this study was to identify the decision-making process regarding dog ownership in families of children with ASD, along with the parents' perceived benefits and burdens of dog ownership. The study also sought to describe the interaction of children with ASD who lived with pet dogs, as well as the interaction of children with ASD who did not live with dogs, but encountered them in the community. A cross-sectional descriptive design was used for the collection of data through a telephone interview. Data collection included a demographic questionnaire followed by structured open-ended questions, related to the research questions of the study. Questions were focused on gaining an understanding of the parents' decision-making process regarding dog ownership, descriptions of their children's interaction with dogs in their family or outside their home, if the family did not live with a dog, and perceptions of benefits/burdens of dog ownership (Carlisle, 2012). In cases where parents identified other pets that their child interacted with, they were encouraged to describe those interactions. Interviews ended with an offer to parents to share any additional thoughts or information regarding their children and animals. Based on the richness of their responses, additional probing follow-up questions were asked. The goal was to encourage parents to describe their experiences and for the investigator to participate as an active listener (Richards & Morse, 2007). Parent interviews were recorded to enable transcription of detailed responses. Parents were offered a $10 gift card as compensation for their time.
Analysis Demographic data were entered twice and a verification procedure was used in SAS 9.3 to identify discrepancies (SAS 9.3 Software | SAS, 2011). Simple descriptive statistics were used to compare dog and non-dog groups for demographic variables. Content analysis was conducted, following the utilization of attachment theory to develop the interview questions and for analysis of the data (Carlisle, 2012). Field notes were taken immediately following each interview and parent responses were transcribed within 24 hours (Carlisle, 2012). During transcriptions, individual interviews were reviewed at least twice to ensure accuracy of the process. Once accurate transcriptions were ensured, field
Pet Dog Ownership of Children with Autism Spectrum Disorder Table 1 Reasons for Decision Regarding Dog Ownership (N = 70) (Carlisle, 2012, p. 66).
“Always had a dog,” grew up with dogs Parents like/love dogs Teach children responsibility Good for children Children wanted dog Companion for children Good for children with ASD Teach compassion/calm child Too much work Too much cost Child afraid/doesn't like dogs Don't want any pets Prefer cats Allergies
Dog (n = 47)
No Dog (n = 23)
24 18 15 15 13 13 12 9 0 0 0 0 0 0
0 0 0 0 0 0 0 0 10 7 7 5 4 3
notes were reviewed with each transcription to identify unique data properties and to address any relationships between the research questions and the findings (Yin, 2011). Deconstruction of the data was conducted by categorizing parent responses based on the research questions of dog ownership decision-making, child–dog interactions and parents' perceptions of the benefits/burdens of dog ownership. Division by dog ownership or non-dog ownership was identified for each category. After reading and re-reading the data, with comparison to field notes, frequencies in the content were identified by focusing on what was occurring from the parents' perspectives (Corbin, Strauss, & Strauss, 2008). Content was then organized using a concept mapping system (Public Cmap Tools Client Software, 1998). Concept mapping provided a tool to analyze data in new ways through reconstruction of the data, which aided in illuminating parents' perceptions regarding their children and dogs. Several steps were taken to increase scientific rigor of the study. Attempts were made to contact all potential participants from the data-base who met the inclusion criteria, to ensure the broadest sample of participants. In addition to this, parent responses were not limited by time and those with lengthy and detailed responses were included. Ongoing review of the field notes, taken throughout the data collection process, allowed monitoring of the process to ensure procedural consistency and immersion in the data. At the critical point of concept development, consultation was sought from an expert in qualitative analysis, Dr. Lawrence Ganong, to provide an objective review of the analytic process. These steps allowed for the identification of content from the data.
Results The mean parent age was 42 years with 61 females and 9 males (Carlisle, 2012). Sixty-one parents described them-
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selves as Caucasian, two Asian, two Hispanic, two Native American, one African American and two as “other.” Seventy-nine percent of parents had post-secondary education. Twenty parents reported incomes of b $30,000, 36 reported incomes of ≥ $ 30,000 and b $ 90,000, and 11 reported incomes of N $90,000. Three parents declined to report their income. The mean age of children enrolled was 13 years. The mean number of children in the families was 2.9, with six children living in only child families. Sixty-five children were male and five female. The male to female ratio in the present study did not compare to the five to one ratio reported by the United States Centers for Disease Control and Prevention, for children with ASD (Prevalence of Autism Spectrum Disorders—Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008, n.d.). Forty-seven families owned dogs and 81% (n = 57) owned some type of pet (Carlisle, 2012). All parents described some type of interaction of their children with dogs, including those that did not own dogs, but encountered dogs in the community. In dog owning families, the mean age of the dogs was 4.4 years and the reported time children spent in direct interaction with their dog was an average of 1.5 hours/day.
Research Question #1 The first research question asked, “How do families of children with ASD make decisions regarding dog ownership?” The reasons parents reported for deciding to own or not to own a dog are illustrated in Table 1 (Carlisle, 2012). Dog Owners In families that owned dogs, a variety of reasons were given for their decision. In dog owning families, positive reflections on dog ownership were given. Three parents described their dogs as having a closer relationship to them, than their child (Carlisle, 2012). When asked about his reasons for deciding to own a dog, one parent (ID #109) said, “Companionship for my wife, primarily. That's the main reason.” Another (ID #78) said, We just really all love dogs and yes, it is a comfort thing for all of us. And this particular dog we picked her out because of the breed. She, um (sic), well, the other dog we had was a dachshund and she was very hyper and that sort of added to the chaotic household and this dog is just as sweet as she can be. That's exactly what we wanted. She's very loving and not barky, and, ah, just likes all the visitors, everything like that. She's more of a comfort than a circus like the other dog was. She just really adds a lot to our house.
In other families, their decision was related to their child's diagnosis. One parent (ID #107) said, I had read some stuff that children with autism or pervasive developmental disorder, that don't show emotion, um (sic), a dog would be there for him, be easier for him to talk. That's why I got the dog.
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Another parent (ID #187) said, I just thought it would be really good for him. I mean to have a companion to some degree…She's little (dog). I mean there's something about being with an animal that maybe you can't get anywhere else. I mean you can stroke a dog and you don't have to tell them all your stuff, but you just feel understood in a nonverbal way. They can sense a lot of things about you, like if you're sad.
A third parent (ID #170) said, “the reason we did get her (dog) was because both our children don't have many friends and so our dog's definitely their best friend.” A fourth (ID #76) said, “She's (daughter) autistic, so we thought it (dog ownership) would be good for responsibility, you know, caring for the dog and all those things.” More than half of the parents (51%) who owned dogs had a personal history of dog ownership and described this as very influential in their decision to own a dog at the time of the survey. Non-Dog Owners For those who decided against dog ownership, the work of caring for a dog was the most commonly reported reason (21% of parents). One parent (ID #120) stated, I just cannot imagine having the responsibility of a dog, because they have to be taken out, they have to be fed. I just don't want that responsibility and I don't know how hard it would be to find one that would be good with him (child with ASD).
Another parent (ID #64) said, “I can't afford to take care of one and he can't take care of one by himself.” A mother (ID #128) who described herself as single said, “it's hard enough to take care of two boys, let alone providing for a dog. Taking care of a dog is a lot of responsibility and I already have enough responsibility.” The theme of lack of time to care for a dog was woven throughout many parents' reports of reasons to not own a dog. In other families, the child with ASD was described as being afraid of dogs, but more accepting of other pets such as cats or Table 2 Children's Interactions With Dogs (N = 70) (Carlisle, 2012, p. 72). Dog No Dog (n = 47) (n = 23) Talks to “Loving/likes dogs” Dog listens/calms Play, wrestle, tricks Pets Snuggle, sit together, hang out Responsible for care, walks Sensory problems (jumping, barking, licking) Afraid, doesn't like
22 0 7 44 35 39 24 9
4 16 0 0 8 0 0 11
0
4
rabbits (Carlisle, 2012). Parents reported the perception of a decreased likelihood of those animals to be actively demanding interaction, like a dog would do. In a family that owned a cat, the mother (ID #269) said, “he's always been more relaxed around cats, so that seemed like a more natural introduction to pets in the home, because of their personality.” Another parent (ID #262) said, “With his autism and ADHD, it won't work. We had a puppy once and it didn't work.” A third parent (ID #120) echoed a common theme saying, “I don't know how hard it would be to find one (dog) that would be good with (child with ASD).” Sensory issues of the children with ASD, which inhibited dog ownership, were described related to the loud barking, smell, jumping up and other behaviors of dogs.
Research Question #2 The second research question asked, “How do children with ASD interact with pet dogs?” The frequencies of interaction types are found in Table 2 (Carlisle, 2012). Dog Owners All but three of the children in dog-owning families were described by parents as interacting with their dogs through some type of play (Carlisle, 2012). The play included wrestling on the floor, tricks, fetch or other activities. The interaction of one girl and her dog was described by her mother (ID #27) as follows, “She (child with ASD) likes to play with her (dog) on the floor. She likes to get down and pet her and talk to her. Usually, she'll do that anywhere from 30 minutes to an hour a day.” Another mother (ID #246) described her son's interaction, “They like to play a lot and run around the house like crazy, and then he'll snuggle with him (dog). Sometimes he'll play fetch and sometimes he'll give him treats and try to get his dog to do tricks.” Quiet activities were reportedly practiced by many children, including sitting together while playing video games or watching television. In one case (ID #109), the mother stated her son “Loves his dog. He plays with him. He takes him to bed every night. He [dog] helps him [child] go to sleep.” These children were described as being attached to their dogs by the parents. Sensory issues related to dogs were described as a problem for some children in dog owning families. These children were reported to have developed avoidance behaviors. One mother (ID #199) described the following issue: Yesterday they were playing. He likes the dog, but she's too energetic. He wanted the dog to go outside and play, but not to get on him our touch him and the dog wanted to be with him. The dog always wants to play with him a lot. Our son will tolerate that for a few minutes and then he's like (sic) no. Our dog is really bouncy and active and jumps up and licks his face, and he doesn't really like that. The other children like our dog. If he (child) sees another dog he tries to avoid it. Our neighbors have dogs and he doesn't like them. They bark a lot and he doesn't like loud noises.
Pet Dog Ownership of Children with Autism Spectrum Disorder In another case, the parent (ID #190) described her child's interaction with their dog, He has a sensory issue with (the dog's) hair. He likes the dog, but just the touch with him, he (child) doesn't always tolerate that. When he's sad he will call (the dog) to sit near him on the chair or pet him, but its more having him nearby.
In addition to situations in which children disliked characteristics or behaviors of dogs, the behavior of four children in the study presented safety concerns for the dogs. In each of these cases, the parents reported that their children's interaction with their dogs required monitoring, to ensure the safety of the dog. In the first case, a child was responsible for taking the dog outside to eliminate, but the child had developed an exact timing for the task that was inadequate for the dog's needs (Carlisle, 2012). The parent discussed the problem this created for the dog and was able to negotiate a longer time period with the child. In a second situation the parent (ID #109) said her son liked their dog, but said she was concerned by some of her child's actions, Sometimes he's a little bit aggressive towards him. I don't know how to say it. If he wants the dog to do something, he'll pull him by the collar a little more than I think he should. Never to a point where he hurts the dog.
In a third family, the mother (ID #236) reported, Occasionally, if he's (child) really bad (upset or angry), you know then he might yell at his dog and make him go away, cuz [sic] he just doesn't want to be touched or anything, but if he's sad then he wants to be near him, he wants to cuddle with him. (Carlisle, p. 72–73, 2012)
119 Table 3 p. 75).
Benefits of Dog Ownership (N = 70) (Carlisle, 2012,
Teaches responsibility Companionship Calming/stress relief Entertainment/happiness Unconditional love Promotes social interaction Teaches empathy/tolerance Protection/safety None
Dog (n = 47)
No Dog (n = 23)
24 22 14 16 12 7 7 7 0
15 20 0 0 5 0 0 0 2
Children were reported to exhibit a range of negative responses to dogs, related to specific dog behaviors that they disliked. A parent (ID #239) who did not own a dog described her child's response to dogs, He generally is very shy of dogs. He doesn't like to be jumped on or licked by them. He will definitely shy away from them. He will even hide behind myself or my husband, to try to get away from dogs, especially if they bark or try to jump on him. He's fearful. He does like cats a little better.
These sensory issues were reported to include touch (jumping, licking or fur), smell (dog or dog waste), sound (barking or whining) and sight (large sized dogs). While these issues were described by some dog-owning parents, their presence was reported to be prohibitive for dog ownership by other parents.
Research Question #3 In the fourth case, the parent (ID #255) verbalized the following concerns, Sometimes he's a little over the top with the dogs. He might get up in the dogs face. He'll walk up and try to pry the dog's mouth open. We have to constantly watch him. You know, him not wanting to let the dog eat sometimes. (Carlisle, p. 73, 2012)
Research question #3 asked, “What are the benefits/ burdens of dog ownership for families of children with autism?” The perceived benefits of owning a dog were described by dog-owning and non-dog owning parents (Table 3) (Carlisle, 2012).
These unique situations demonstrated the willingness of the parents to monitor the interactions of their child and their dog.
Dog Owner Benefits Parents described many benefits of dog ownership for their children with autism and their families. One dogowning parent (ID #78) said,
Non-Dog Owners In families that did not own dogs, all their children were reported to have had some encounter with dogs outside their homes. A mother (ID #150), who said her son likes dogs, described his interactions with dogs as follows:
He's (child) a little bit hyper and he'll cuddle up with her (dog) and she'll fall asleep with him, and he'll just instantly kind of calm down. It's really been good for him, really, really, really been good. We couldn't have picked a better dog. (Carlisle, p. 74, 2012)
If it's an unfamiliar dog and it backs off, he has a tendency to back off too and become fearful, but mostly he likes to be attentive and loving. I could see if he were attracted to the dog, or if he thought it was cool [sic] looking, like an interesting dog, then he might approach the individual because he was curious about the dog, more than somebody without a pet.
Another parent (ID #55) described the benefits for her son as follows: Basically just for companionship. Helps teach a little bit of responsibility. Just having the daily chore of feeding him (dog), that's one thing we gave to him (child), was taking care of the pets.
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Forty-seven percent of parents named companionship as a benefit and one parent (ID #170) summarized this along with stress relief, saying, “I think that if you've had a bad day, the dog is always there that you can play with and love. To get through and tell what's bothering you.” Forty-five percent of parents that owned dogs described benefits for themselves, including companionship.
Non-Dog Owner Benefits In non-dog owning families, all but two parents reported there would be benefits to owning a dog. One parent (ID #247) said, “I am sure there would be benefits for the children, but I don't think it would be a benefit for me.” Another parent (ID #210) said, Children can have a lot of benefits, like sometimes children can express themselves better with a pet than with other people. It's quite a sense of feeling loved because dogs love their owners so much.
An increase in physical activity was described by one parent (ID #143), who stated, (A dog would be) someone to greet you when you come home. A smiling face, automatically, they miss you no matter what. Um, gosh [sic], I guess it would give the kids a chance to play outside, even if they didn't really want to. Um [sic], it would give them more responsibility at home, to look after someone else other than themselves.
Table 4 p. 76).
Burdens of Dog Ownership (N = 70) (Carlisle, 2012,
Cost of care Time for care Travel limitations Must be right dog for right family None Destruction Neighborhood, housing restrictions Child may hurt dog Dog may hurt child Child afraid/doesn't like dog Must be right dog for right family
Dog (n = 47)
No Dog (n = 23)
21 18 16 7 7 4 0 0 0 0 0
9 20 3 0 1 0 11 3 2 2 1
He's afraid of them (dogs), and we just don't want one. We feel like he gets the companionship from his rabbit. Later, I plan to get a cat because he does like cats, and I feel like it will increase his chores by adding another pet.
In addition, some parents reported that their current housing situation limited their ability to own a dog, either from no dog housing policies or the parents' belief that they did not own enough land or have a large enough fenced yard to adequately keep a dog.
Discussion Dog Owner Burdens Some of the same burdens of dog ownership were described by dog owners and non-dog owners, with cost and time to care for dogs identified as challenges (Table 4) (Carlisle, 2012). Arranging for pet care when families travel was described by a parent (ID #279) who said, The only thing is we have a hard time if we go on a family trip. We have to get a dog sitter, because I'm not going to take her (dog) on a family trip. We have to give her medicine so we don't have a flea and tick problem and that gets a little expensive.
Fifteen percent of parents described the importance of choosing a dog that would be a good match for their family and their child with ASD (Author). For example, a family had once owned a dog with calm behavior that their child with ASD liked, but when that dog died they acquired a large breed dog whose reported destructive and rambunctious behavior led their child to avoid the new dog.
Non-Dog Owner Burdens Non-dog owning parents chose to have alternative pets in 14% of families (Author). When asked about potential burdens of dog ownership, one parent (ID #95) said,
There are similarities regarding dog ownership among parents of typically developing children and parents of children with ASD; however, recognition of the differences may aid parents of children with autism in making a dog ownership decision. In families of typically developing children, the responsibilities of caring for a pet have been reported as a concern which can be burdensome (Fifield & Forsyth, 1999). Parents of children with ASD have unique demands on their time and report more stress, when compared to parents of typically developing children or those with special health care concerns (Schieve et al., 2011). Consideration of who will be the primary caretaker of a pet may play a role in this process. The mother of the family was identified in one study (N = 612) as the most influential person regarding the decision to acquire a pet (Albert & Bulcroft, 1988). Eighty-seven percent of the self-described primary caregivers of the children (parents) in the present study were female, and several reported close personal attachment to their dogs, while one father stated they acquired their dog for his wife (Carlisle, 2012). There may be benefits of dog ownership for these parents; however, consideration of the benefit/burden balance may be critical to successful decision regarding dog ownership for each family. Another factor may be personal pet ownership history. Growing up with a pet was identified as a strong predictor of future pet ownership, for mothers of typically developing
Pet Dog Ownership of Children with Autism Spectrum Disorder children, according to one study (N = 13,577) in the United Kingdom (Westgarth et al., 2010). In the present study, almost half of parents owning dogs reported that one or both parents had grown up with dogs (Carlisle, 2012). Given that 38% of dog-owning parents reported that they liked/loved dogs, it may be that their own positive experience with a dog and/or perceived benefits for themselves impacted their decision to own a dog, apart from or along with perceived benefits for their children. Nearly all the children in this study living with dogs were described as having some type of interaction with their dogs, including active play, petting the dogs or simply sitting near one another. Typically developing children have described their interaction with their dogs as among their closest relationships, with their dogs often acting as confidants (Bryant, 1990; Melson, & Swarz, 1994). In this study, 47% of children living with dogs talked to their dogs and 17% of children in non-dog owning families were described as talking to dogs outside their homes (Carlisle, 2012). In a population of children that have deficits in communication and social interaction, dogs may provide a unique benefit for these children through enhancement of these abilities. It is widely acknowledged that many parents believe typically developing children can benefit from dog ownership. In this study parents identified specific benefits of dogs related to challenges of children with ASD including stress relief, increased social interaction, empathy and companionship (Carlisle, 2012). Twenty-six percent of dog owning parents said that the benefits for their child with autism were a part of the reason they decided to own a dog. In this study, dog owners and non-dog owners identified the time and cost of caring for a dog as a primary burden of dog ownership. It may be that the additional responsibility of caring for a child with ASD influences parents' decisions regarding dog ownership. In addition to this, 19% of dog owning parents (n = 9) and 48% of non-dog owning parents (n = 11) reported that their children had sensory issues related to dogs, including hypersensitivities to the touch, sound, and/or smell of dogs (Carlisle, 2012). Parents owning dogs vocalized the need to monitor their children's interactions with their dog closely due to the sensory issues, and 15% of parents (n = 7) noted the need for a good match between the characteristics of their child and a dog, for the successful integration of that dog into their home. The ownership of rabbits and cats were alternative pets that parents described as providing the benefits of a pet, without the burden of sensory overload their children experienced when interacting with a dog. An area of concern, the safety of their children and/or the safety of a dog, was described by 13% of parents related to their children's behavior, and was labeled as at least part of the reason some chose to not own a dog (Carlisle, 2012). The American Veterinary Medical Association (2010) recommends that typically developing children reach the age of four years before families consider dog ownership, due to the risk of a dog bite for infants and young children. The
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incidence of dog bites is unknown among children with ASD; however, the reported experiences of parents in this study indicate that monitoring the interactions between children with autism and dogs may be particularly important. Given these additional challenges of dog ownership, yet the high incidence of ownership in this study, other factors may play a role in the dog ownership decision-making process for these families. Several limitations are acknowledged in this study. The data-base included non-working phone numbers from 126 of the participants, eliminating the possibility of their inclusion (Carlisle, 2012). An additional 61 parents did not respond to messages left on answering machines requesting their return call for consideration of participation in a research study. A final 24 potential participants refused participation. These enrollment factors may have influenced the prevalence of dog ownership identified in the study and/or the type of responses received. The high prevalence of dog ownership among families with children, limited the enrollment of parents without dog ownership experiences. Parent perceptions of personal benefits of dog ownership may also have influenced the study. Mothers have been found to be the member of the household most likely to make the decision regarding pet ownership (Albert & Bulcroft, 1988). If more fathers had been enrolled in this study (n = 9), their responses may have been different than those of the responding mothers. Additionally, the male to female ratio of children in the present study did not compare to the five to one ratio of children with ASD reported by the United States Centers for Disease Control and Prevention (“Prevalence of Autism Spectrum Disorders—Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008,” n.d.). It is possible that this may have been due the study's small sample size and this may have influenced the results. None of the safety concerns noted by parents in the present study were associated with female children. Finally, this study excluded younger children and those with moderate to severe intellectual ability, and responses of parents of these children may have been different than those who were included.
Conclusions Dog ownership is common among families of children with ASD, and parents describe similar reasons for their decision to acquire a dog, as do parents of typically developing children. Many parents perceive their children with ASD as being capable of developing an attachment to their dogs; however, a symbiotic integration of a dog into these families may rely on careful consideration of several factors. The time parents have to care for a dog may play a role, in addition to the selection of a dog with characteristics that provide a good match for the individual sensory issues of each child (Carlisle, 2012). For some children, alternative pets may provide the benefits of a pet without the sensory
122 overload some children were reported to experience with dogs. Other families may not benefit from pets at all, based on parent attitudes about pets or their child's sensory issues. Given the unique family dynamics present for families of children with ASD, further research is needed to examine the characteristics and types of pets providing children with the greatest benefits, as well as the role pets may play in providing benefits for the parents of children with ASD.
Acknowledgments This study was supported with a grant from Sigma Theta Tau–Alpha Iota Chapter. The author would like to acknowledge the support of her dissertation committee members, Dr. Rebecca A. Johnson, Dr. Lawrence Ganong, Dr. Debra Gayer and Dr. Micah Mazurek.
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Pet Dog Ownership Decisions for Parents of Children With Autism Spectrum Disorder1 Gretchen K. Carlisle PhD, MEd, RN ⁎ University of Missouri, Columbia, MO
Key words: Autism; Pets; Children; Dogs; Human–animal interaction
This study aimed to examine the role of pet dogs in families of children with autism. Sixty-seven percent of families owned dogs and 94% reported that their children were bonded to their dogs. Parents described previous experience with dogs and beliefs in their benefits as influential in their dog ownership decision-making process. Children living with dogs interacted with them in play and/or sharing personal space. Sensory issues of the children impacted their interaction with dogs inside and outside the home. Time and cost of care were identified burdens of dog ownership. Benefits were the opportunity to learn responsibility and companionship. © 2014 Elsevier Inc. All rights reserved.
THE DIAGNOSIS OF autism spectrum disorder (ASD) is marked by deficits with communication and social skills, along with the presence of restrictive and repetitive behaviors, and symptoms range from mild to severe (American Psychiatric Association, 2013). The widely heterogeneous symptomology of those with ASD has led to a variety of approaches for addressing the challenges of individual children. Pet dogs are common among families of typically developing children, and this type of human animal interaction may play a unique role for children with ASD.
Theoretical Framework Human–animal interaction has been examined through the lens of attachment theory, which was first proposed by Bowlby (1960). Attachment theory describes the bond of infants to their mothers for comfort and security (Bowlby, 1961), and has been further advanced to provide an understanding of the transfer of that attachment by children 1 Poster presentation on March 9 2013 at Midwest Nursing Research Society Conference in Chicago Illinois. ⁎ Corresponding author: Gretchen K. Carlisle, PhD, MEd, RN. E-mail address: [email protected].
0882-5963/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pedn.2013.09.005
to bonds with other family members and peers over time as the children develop (Ainsworth, 1989). Melson (1990) applies attachment theory to describe children's relationships to their pets. This attachment includes the relationship components of spending time together, interacting together and the children's thoughts about the relationship (Melson, 1990). The activities of playing and caring for their pets have been associated with stronger bonds to their pets, for typically developing children (Melson, Peet, & Sparks, 1991). Children describe their pets as members of the family, sources of security and as friends (Triebenbacher, 1998). The strength of these human animal relationships may play a role in the outcome of the interactions. School aged children who were more attached to their pets were found to demonstrate greater empathy with others (Daly & Morton, 2006; Poresky, 1996). Less is known about the relationships and interactions between children with ASD and pets; however, there has been an increase in the use of trained dogs with children with ASD through animal assisted therapy (AAT) and the use of service dogs. Children with ASD exhibit a common deficit in the ability to establish social relationships. The ability to establish a secure attachment with a dog may increase the ability of these children to seek social relationships with others (Carlisle, 2012). Studies to date suggest the presence of social benefits from the interaction and relationship with
Pet Dog Ownership of Children with Autism Spectrum Disorder specially trained dogs, indicating a possibility of similar benefits for children with ASD and their pet dogs.
Literature Review Children with ASD have been identified as having the ability to form secure attachments; however, they may be less organized attachments than those of typically developing children (Naber et al., 2007). The ability to form a strong attachment with a primary caregiver, may impact the potential for the development of friendships with peers (Bauminger, Solomon, & Rogers, 2010). The difficulty children with ASD demonstrate in establishing relationships has been described as related to a deficit in theory of mind, which is the inability to comprehend the thoughts of others (Bar-On & Cohen, 1995). Dogs lack the complex facial features and body language common to humans. It has been proposed that the lack of necessity to identify what a dog may be thinking, in order to have a social interaction, may provide a rationale for the ability of children with ASD to interact with dogs (Solomon, 2012). Cortisol, the biological indicator of stress, has been found to be increased when children with ASD interact with peers (Corbett, Schupp, Simon, Ryan and Mendoza, 2010), yet decreased when children with ASD have been paired with a service dog (Viau et al., 2010). The calming effect may aid children with ASD in developing relationships with dogs. Studies investigating the interaction of trained dogs and children with ASD have been conducted. The benefit of the inclusion of dogs as a therapeutic aid in the psychological counseling of typically developing children is not a novel concept (Levinson, 1962). The investigation of children with ASD and dogs is less established. A meta-analysis of studies investigating AAT found that its use was associated with moderate effect sizes for improving the behavioral symptoms of children with ASD, and dogs were identified as the type of animals consistently associated with benefits (Nimer & Lundahl, 2007). In one study, when compared to a stuffed dog or toy ball, the presence of a live dog during a therapy session was associated with increased conversational engagement and focused eye gaze for children with pervasive developmental disorder, which is a form of ASD (Martin & Farnum, 2002). Another study conducted during occupational therapy sessions found that when a therapy dog was present, children with ASD had increased social interactions (p b .01), when compared to sessions with no dog (Sams, Fortney, & Willenbring, 2006). In the case of service dogs, benefits have also been found. Following receipt of a service dog in their home, children with ASD have been shown to have significantly fewer problem behaviors (n = 42, p b .001), than before the arrival of the dog (Viau et al., 2010). Problem behaviors may be an important factor in the development of relationships. A study of 109 children found that greater
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numbers of problem behaviors predicted poorer total social skills (β = .96, p b .01) (Matson, Hess, & Mahan, 2013). In another study, children who received a service dog, compared to a control group that did not receive a dog, had significant increases in social reciprocity (N = 20, p b .02) (Wild, 2012). In an additional study (N = 10), parents reported decreased levels of anxiety in their children, with increased overall happiness, following placement of a service dog in their home (Burrows, Adams, & Millman, 2008). Typically, the consistent characteristics of these trained dogs include a calm temperament and obedient behavior. The characteristics of pet dogs are more widely variable; however, benefits have been identified for typically developing children, including close relationships and attachment to their dogs. The arrival of a pet has been associated with an increase in interactions among family members and greater family happiness, in families of typically developing children (Cain, 1985). Preschool and school age school age children (N = 174) credited their pets with acting as emotional supports and social catalysts (Triebenbacher, 1999). When compared with children who did not live with a pet, children living with a pet were found to have increased levels of self-esteem, social competence and empathy (Daly & Morton, 2006; Endenburg & van Lith, 2011). This support extends through the transitional periods of development, which are often difficult for children. Dogs may serve as a confidant during these periods, with one study finding that children seek out their dogs for comfort and may be more likely to share confidences with their dog than with a friend or family member (McNicholas & Collis, 2000). Although a variety of pets are acknowledged, 51% of children (N = 213) identified dogs as their favorite pet, while 27% named cats (Bryant, 1990). These reported experiences among typically developing children demonstrate consistent benefits related to their relationships with pets. Only one study of children with ASD and pet ownership has been found in the literature. In that study, two groups of children were examined. One group of children (n = 8) who had always lived with a pet was compared with a control group of children (n = 8) who had never lived with a pet. The second group of children (n = 12) included those children who lived with a pet that was acquired after the children were aged five, compared with a control group of children (n = 12) who had never lived with a pet (Grandgeorge et al., 2012). In the first group of children always living with a pet, 50% of the children had tactile interactions with one of their pets, but none of the children were reported by parents to play with or care for their pets, and only two were described as having a privileged relationship with their pets. In the second group of children who acquired their pet after the age of 4 to 52 years, 75% of the children had tactile interactions, 58% played with their pet, 50% cared for their pet, and 58% were described as having a privileged relationship with their pet. Six of the families in this second group acquired their pet specifically for their child with ASD. The pets included dogs,
116 cats, one rabbit and one hamster. This preliminary evidence demonstrates the potential for attachment of children with ASD and pets, and suggests possible benefits from this type of attachment. Pets are common in the United States with 66% of families reporting pet ownership (American Veterinary Medical Association, 2012). Acquiring a pet includes the process of decision-making, which allows individuals to justify their decisions and communicate their interpretation of experiences. One study (N = 312) found that the primary reasons reported for acquiring a pet were child request (25%) and teaching child responsibility and care (22%) (Fifield & Forsyth, 1999). In the families that chose not to own a pet, reasons included allergies (20%), restrictions of family life (16%), time (14%) and cost (13%) (Fifield & Forsyth, 1999). There are many anecdotal reports of parents acquiring pet dogs for their child with ASD, related to the perception of the benefits, but an examination of this was not found in the literature. An examination of dog acquisition decisions and interactions of children with ASD and pet dogs may provide illumination.
Sample Participants were recruited from an ASD diagnostic and treatment center in the Mid-western United States that served a diverse geographic population of urban and rural families. Approval for the study was received through the associated academic institutional review board (IRB) and the research committee of the ASD center. The ASD center maintained a potential participant data-base, including 953 children identified with ASD, whose caregivers consented to contact for consideration of participation in research (Carlisle, 2012). Parents of children meeting the following criteria were included: age of 8–18 years, intelligence quotient (IQ) score of greater than 70 and a diagnosis of one of the autism spectrum disorders, including: autistic disorder, Asperger's syndrome, pervasive developmental disorder-not otherwise specified or autism spectrum disorder (hereafter referred to collectively as ASD). These criteria were met by 285 children in the data-base and attempts were made to contact each of these households. A request was made to speak with the primary caregivers (hereafter referred to collectively as parents) of these children and enrollment was offered to those individuals. The final sample included 70 parents of children with ASD (Carlisle, 2012). The data collected from three parents were excluded, based on the highly unique circumstances of their children's exposure to dogs. One parent owned dogs, but the dogs were reportedly isolated in an outdoor kennel with no exposure to children, due to their aggressive behavior. A second parent, who did not own a dog, provided frequent dogsitting care in her home for the dogs of friends, allowing for extensive interaction with dogs for her child with ASD. The
G.K. Carlisle third parent reported that they did not currently own a dog, but had owned a dog since their child was born until their dog's recent death, and they were planning to acquire another dog soon. The exceptional circumstances of these children were not consistent with those of other children in the study; therefore, their data were excluded.
Design and Data Collection The aim of this study was to identify the decision-making process regarding dog ownership in families of children with ASD, along with the parents' perceived benefits and burdens of dog ownership. The study also sought to describe the interaction of children with ASD who lived with pet dogs, as well as the interaction of children with ASD who did not live with dogs, but encountered them in the community. A cross-sectional descriptive design was used for the collection of data through a telephone interview. Data collection included a demographic questionnaire followed by structured open-ended questions, related to the research questions of the study. Questions were focused on gaining an understanding of the parents' decision-making process regarding dog ownership, descriptions of their children's interaction with dogs in their family or outside their home, if the family did not live with a dog, and perceptions of benefits/burdens of dog ownership (Carlisle, 2012). In cases where parents identified other pets that their child interacted with, they were encouraged to describe those interactions. Interviews ended with an offer to parents to share any additional thoughts or information regarding their children and animals. Based on the richness of their responses, additional probing follow-up questions were asked. The goal was to encourage parents to describe their experiences and for the investigator to participate as an active listener (Richards & Morse, 2007). Parent interviews were recorded to enable transcription of detailed responses. Parents were offered a $10 gift card as compensation for their time.
Analysis Demographic data were entered twice and a verification procedure was used in SAS 9.3 to identify discrepancies (SAS 9.3 Software | SAS, 2011). Simple descriptive statistics were used to compare dog and non-dog groups for demographic variables. Content analysis was conducted, following the utilization of attachment theory to develop the interview questions and for analysis of the data (Carlisle, 2012). Field notes were taken immediately following each interview and parent responses were transcribed within 24 hours (Carlisle, 2012). During transcriptions, individual interviews were reviewed at least twice to ensure accuracy of the process. Once accurate transcriptions were ensured, field
Pet Dog Ownership of Children with Autism Spectrum Disorder Table 1 Reasons for Decision Regarding Dog Ownership (N = 70) (Carlisle, 2012, p. 66).
“Always had a dog,” grew up with dogs Parents like/love dogs Teach children responsibility Good for children Children wanted dog Companion for children Good for children with ASD Teach compassion/calm child Too much work Too much cost Child afraid/doesn't like dogs Don't want any pets Prefer cats Allergies
Dog (n = 47)
No Dog (n = 23)
24 18 15 15 13 13 12 9 0 0 0 0 0 0
0 0 0 0 0 0 0 0 10 7 7 5 4 3
notes were reviewed with each transcription to identify unique data properties and to address any relationships between the research questions and the findings (Yin, 2011). Deconstruction of the data was conducted by categorizing parent responses based on the research questions of dog ownership decision-making, child–dog interactions and parents' perceptions of the benefits/burdens of dog ownership. Division by dog ownership or non-dog ownership was identified for each category. After reading and re-reading the data, with comparison to field notes, frequencies in the content were identified by focusing on what was occurring from the parents' perspectives (Corbin, Strauss, & Strauss, 2008). Content was then organized using a concept mapping system (Public Cmap Tools Client Software, 1998). Concept mapping provided a tool to analyze data in new ways through reconstruction of the data, which aided in illuminating parents' perceptions regarding their children and dogs. Several steps were taken to increase scientific rigor of the study. Attempts were made to contact all potential participants from the data-base who met the inclusion criteria, to ensure the broadest sample of participants. In addition to this, parent responses were not limited by time and those with lengthy and detailed responses were included. Ongoing review of the field notes, taken throughout the data collection process, allowed monitoring of the process to ensure procedural consistency and immersion in the data. At the critical point of concept development, consultation was sought from an expert in qualitative analysis, Dr. Lawrence Ganong, to provide an objective review of the analytic process. These steps allowed for the identification of content from the data.
Results The mean parent age was 42 years with 61 females and 9 males (Carlisle, 2012). Sixty-one parents described them-
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selves as Caucasian, two Asian, two Hispanic, two Native American, one African American and two as “other.” Seventy-nine percent of parents had post-secondary education. Twenty parents reported incomes of b $30,000, 36 reported incomes of ≥ $ 30,000 and b $ 90,000, and 11 reported incomes of N $90,000. Three parents declined to report their income. The mean age of children enrolled was 13 years. The mean number of children in the families was 2.9, with six children living in only child families. Sixty-five children were male and five female. The male to female ratio in the present study did not compare to the five to one ratio reported by the United States Centers for Disease Control and Prevention, for children with ASD (Prevalence of Autism Spectrum Disorders—Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008, n.d.). Forty-seven families owned dogs and 81% (n = 57) owned some type of pet (Carlisle, 2012). All parents described some type of interaction of their children with dogs, including those that did not own dogs, but encountered dogs in the community. In dog owning families, the mean age of the dogs was 4.4 years and the reported time children spent in direct interaction with their dog was an average of 1.5 hours/day.
Research Question #1 The first research question asked, “How do families of children with ASD make decisions regarding dog ownership?” The reasons parents reported for deciding to own or not to own a dog are illustrated in Table 1 (Carlisle, 2012). Dog Owners In families that owned dogs, a variety of reasons were given for their decision. In dog owning families, positive reflections on dog ownership were given. Three parents described their dogs as having a closer relationship to them, than their child (Carlisle, 2012). When asked about his reasons for deciding to own a dog, one parent (ID #109) said, “Companionship for my wife, primarily. That's the main reason.” Another (ID #78) said, We just really all love dogs and yes, it is a comfort thing for all of us. And this particular dog we picked her out because of the breed. She, um (sic), well, the other dog we had was a dachshund and she was very hyper and that sort of added to the chaotic household and this dog is just as sweet as she can be. That's exactly what we wanted. She's very loving and not barky, and, ah, just likes all the visitors, everything like that. She's more of a comfort than a circus like the other dog was. She just really adds a lot to our house.
In other families, their decision was related to their child's diagnosis. One parent (ID #107) said, I had read some stuff that children with autism or pervasive developmental disorder, that don't show emotion, um (sic), a dog would be there for him, be easier for him to talk. That's why I got the dog.
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Another parent (ID #187) said, I just thought it would be really good for him. I mean to have a companion to some degree…She's little (dog). I mean there's something about being with an animal that maybe you can't get anywhere else. I mean you can stroke a dog and you don't have to tell them all your stuff, but you just feel understood in a nonverbal way. They can sense a lot of things about you, like if you're sad.
A third parent (ID #170) said, “the reason we did get her (dog) was because both our children don't have many friends and so our dog's definitely their best friend.” A fourth (ID #76) said, “She's (daughter) autistic, so we thought it (dog ownership) would be good for responsibility, you know, caring for the dog and all those things.” More than half of the parents (51%) who owned dogs had a personal history of dog ownership and described this as very influential in their decision to own a dog at the time of the survey. Non-Dog Owners For those who decided against dog ownership, the work of caring for a dog was the most commonly reported reason (21% of parents). One parent (ID #120) stated, I just cannot imagine having the responsibility of a dog, because they have to be taken out, they have to be fed. I just don't want that responsibility and I don't know how hard it would be to find one that would be good with him (child with ASD).
Another parent (ID #64) said, “I can't afford to take care of one and he can't take care of one by himself.” A mother (ID #128) who described herself as single said, “it's hard enough to take care of two boys, let alone providing for a dog. Taking care of a dog is a lot of responsibility and I already have enough responsibility.” The theme of lack of time to care for a dog was woven throughout many parents' reports of reasons to not own a dog. In other families, the child with ASD was described as being afraid of dogs, but more accepting of other pets such as cats or Table 2 Children's Interactions With Dogs (N = 70) (Carlisle, 2012, p. 72). Dog No Dog (n = 47) (n = 23) Talks to “Loving/likes dogs” Dog listens/calms Play, wrestle, tricks Pets Snuggle, sit together, hang out Responsible for care, walks Sensory problems (jumping, barking, licking) Afraid, doesn't like
22 0 7 44 35 39 24 9
4 16 0 0 8 0 0 11
0
4
rabbits (Carlisle, 2012). Parents reported the perception of a decreased likelihood of those animals to be actively demanding interaction, like a dog would do. In a family that owned a cat, the mother (ID #269) said, “he's always been more relaxed around cats, so that seemed like a more natural introduction to pets in the home, because of their personality.” Another parent (ID #262) said, “With his autism and ADHD, it won't work. We had a puppy once and it didn't work.” A third parent (ID #120) echoed a common theme saying, “I don't know how hard it would be to find one (dog) that would be good with (child with ASD).” Sensory issues of the children with ASD, which inhibited dog ownership, were described related to the loud barking, smell, jumping up and other behaviors of dogs.
Research Question #2 The second research question asked, “How do children with ASD interact with pet dogs?” The frequencies of interaction types are found in Table 2 (Carlisle, 2012). Dog Owners All but three of the children in dog-owning families were described by parents as interacting with their dogs through some type of play (Carlisle, 2012). The play included wrestling on the floor, tricks, fetch or other activities. The interaction of one girl and her dog was described by her mother (ID #27) as follows, “She (child with ASD) likes to play with her (dog) on the floor. She likes to get down and pet her and talk to her. Usually, she'll do that anywhere from 30 minutes to an hour a day.” Another mother (ID #246) described her son's interaction, “They like to play a lot and run around the house like crazy, and then he'll snuggle with him (dog). Sometimes he'll play fetch and sometimes he'll give him treats and try to get his dog to do tricks.” Quiet activities were reportedly practiced by many children, including sitting together while playing video games or watching television. In one case (ID #109), the mother stated her son “Loves his dog. He plays with him. He takes him to bed every night. He [dog] helps him [child] go to sleep.” These children were described as being attached to their dogs by the parents. Sensory issues related to dogs were described as a problem for some children in dog owning families. These children were reported to have developed avoidance behaviors. One mother (ID #199) described the following issue: Yesterday they were playing. He likes the dog, but she's too energetic. He wanted the dog to go outside and play, but not to get on him our touch him and the dog wanted to be with him. The dog always wants to play with him a lot. Our son will tolerate that for a few minutes and then he's like (sic) no. Our dog is really bouncy and active and jumps up and licks his face, and he doesn't really like that. The other children like our dog. If he (child) sees another dog he tries to avoid it. Our neighbors have dogs and he doesn't like them. They bark a lot and he doesn't like loud noises.
Pet Dog Ownership of Children with Autism Spectrum Disorder In another case, the parent (ID #190) described her child's interaction with their dog, He has a sensory issue with (the dog's) hair. He likes the dog, but just the touch with him, he (child) doesn't always tolerate that. When he's sad he will call (the dog) to sit near him on the chair or pet him, but its more having him nearby.
In addition to situations in which children disliked characteristics or behaviors of dogs, the behavior of four children in the study presented safety concerns for the dogs. In each of these cases, the parents reported that their children's interaction with their dogs required monitoring, to ensure the safety of the dog. In the first case, a child was responsible for taking the dog outside to eliminate, but the child had developed an exact timing for the task that was inadequate for the dog's needs (Carlisle, 2012). The parent discussed the problem this created for the dog and was able to negotiate a longer time period with the child. In a second situation the parent (ID #109) said her son liked their dog, but said she was concerned by some of her child's actions, Sometimes he's a little bit aggressive towards him. I don't know how to say it. If he wants the dog to do something, he'll pull him by the collar a little more than I think he should. Never to a point where he hurts the dog.
In a third family, the mother (ID #236) reported, Occasionally, if he's (child) really bad (upset or angry), you know then he might yell at his dog and make him go away, cuz [sic] he just doesn't want to be touched or anything, but if he's sad then he wants to be near him, he wants to cuddle with him. (Carlisle, p. 72–73, 2012)
119 Table 3 p. 75).
Benefits of Dog Ownership (N = 70) (Carlisle, 2012,
Teaches responsibility Companionship Calming/stress relief Entertainment/happiness Unconditional love Promotes social interaction Teaches empathy/tolerance Protection/safety None
Dog (n = 47)
No Dog (n = 23)
24 22 14 16 12 7 7 7 0
15 20 0 0 5 0 0 0 2
Children were reported to exhibit a range of negative responses to dogs, related to specific dog behaviors that they disliked. A parent (ID #239) who did not own a dog described her child's response to dogs, He generally is very shy of dogs. He doesn't like to be jumped on or licked by them. He will definitely shy away from them. He will even hide behind myself or my husband, to try to get away from dogs, especially if they bark or try to jump on him. He's fearful. He does like cats a little better.
These sensory issues were reported to include touch (jumping, licking or fur), smell (dog or dog waste), sound (barking or whining) and sight (large sized dogs). While these issues were described by some dog-owning parents, their presence was reported to be prohibitive for dog ownership by other parents.
Research Question #3 In the fourth case, the parent (ID #255) verbalized the following concerns, Sometimes he's a little over the top with the dogs. He might get up in the dogs face. He'll walk up and try to pry the dog's mouth open. We have to constantly watch him. You know, him not wanting to let the dog eat sometimes. (Carlisle, p. 73, 2012)
Research question #3 asked, “What are the benefits/ burdens of dog ownership for families of children with autism?” The perceived benefits of owning a dog were described by dog-owning and non-dog owning parents (Table 3) (Carlisle, 2012).
These unique situations demonstrated the willingness of the parents to monitor the interactions of their child and their dog.
Dog Owner Benefits Parents described many benefits of dog ownership for their children with autism and their families. One dogowning parent (ID #78) said,
Non-Dog Owners In families that did not own dogs, all their children were reported to have had some encounter with dogs outside their homes. A mother (ID #150), who said her son likes dogs, described his interactions with dogs as follows:
He's (child) a little bit hyper and he'll cuddle up with her (dog) and she'll fall asleep with him, and he'll just instantly kind of calm down. It's really been good for him, really, really, really been good. We couldn't have picked a better dog. (Carlisle, p. 74, 2012)
If it's an unfamiliar dog and it backs off, he has a tendency to back off too and become fearful, but mostly he likes to be attentive and loving. I could see if he were attracted to the dog, or if he thought it was cool [sic] looking, like an interesting dog, then he might approach the individual because he was curious about the dog, more than somebody without a pet.
Another parent (ID #55) described the benefits for her son as follows: Basically just for companionship. Helps teach a little bit of responsibility. Just having the daily chore of feeding him (dog), that's one thing we gave to him (child), was taking care of the pets.
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Forty-seven percent of parents named companionship as a benefit and one parent (ID #170) summarized this along with stress relief, saying, “I think that if you've had a bad day, the dog is always there that you can play with and love. To get through and tell what's bothering you.” Forty-five percent of parents that owned dogs described benefits for themselves, including companionship.
Non-Dog Owner Benefits In non-dog owning families, all but two parents reported there would be benefits to owning a dog. One parent (ID #247) said, “I am sure there would be benefits for the children, but I don't think it would be a benefit for me.” Another parent (ID #210) said, Children can have a lot of benefits, like sometimes children can express themselves better with a pet than with other people. It's quite a sense of feeling loved because dogs love their owners so much.
An increase in physical activity was described by one parent (ID #143), who stated, (A dog would be) someone to greet you when you come home. A smiling face, automatically, they miss you no matter what. Um, gosh [sic], I guess it would give the kids a chance to play outside, even if they didn't really want to. Um [sic], it would give them more responsibility at home, to look after someone else other than themselves.
Table 4 p. 76).
Burdens of Dog Ownership (N = 70) (Carlisle, 2012,
Cost of care Time for care Travel limitations Must be right dog for right family None Destruction Neighborhood, housing restrictions Child may hurt dog Dog may hurt child Child afraid/doesn't like dog Must be right dog for right family
Dog (n = 47)
No Dog (n = 23)
21 18 16 7 7 4 0 0 0 0 0
9 20 3 0 1 0 11 3 2 2 1
He's afraid of them (dogs), and we just don't want one. We feel like he gets the companionship from his rabbit. Later, I plan to get a cat because he does like cats, and I feel like it will increase his chores by adding another pet.
In addition, some parents reported that their current housing situation limited their ability to own a dog, either from no dog housing policies or the parents' belief that they did not own enough land or have a large enough fenced yard to adequately keep a dog.
Discussion Dog Owner Burdens Some of the same burdens of dog ownership were described by dog owners and non-dog owners, with cost and time to care for dogs identified as challenges (Table 4) (Carlisle, 2012). Arranging for pet care when families travel was described by a parent (ID #279) who said, The only thing is we have a hard time if we go on a family trip. We have to get a dog sitter, because I'm not going to take her (dog) on a family trip. We have to give her medicine so we don't have a flea and tick problem and that gets a little expensive.
Fifteen percent of parents described the importance of choosing a dog that would be a good match for their family and their child with ASD (Author). For example, a family had once owned a dog with calm behavior that their child with ASD liked, but when that dog died they acquired a large breed dog whose reported destructive and rambunctious behavior led their child to avoid the new dog.
Non-Dog Owner Burdens Non-dog owning parents chose to have alternative pets in 14% of families (Author). When asked about potential burdens of dog ownership, one parent (ID #95) said,
There are similarities regarding dog ownership among parents of typically developing children and parents of children with ASD; however, recognition of the differences may aid parents of children with autism in making a dog ownership decision. In families of typically developing children, the responsibilities of caring for a pet have been reported as a concern which can be burdensome (Fifield & Forsyth, 1999). Parents of children with ASD have unique demands on their time and report more stress, when compared to parents of typically developing children or those with special health care concerns (Schieve et al., 2011). Consideration of who will be the primary caretaker of a pet may play a role in this process. The mother of the family was identified in one study (N = 612) as the most influential person regarding the decision to acquire a pet (Albert & Bulcroft, 1988). Eighty-seven percent of the self-described primary caregivers of the children (parents) in the present study were female, and several reported close personal attachment to their dogs, while one father stated they acquired their dog for his wife (Carlisle, 2012). There may be benefits of dog ownership for these parents; however, consideration of the benefit/burden balance may be critical to successful decision regarding dog ownership for each family. Another factor may be personal pet ownership history. Growing up with a pet was identified as a strong predictor of future pet ownership, for mothers of typically developing
Pet Dog Ownership of Children with Autism Spectrum Disorder children, according to one study (N = 13,577) in the United Kingdom (Westgarth et al., 2010). In the present study, almost half of parents owning dogs reported that one or both parents had grown up with dogs (Carlisle, 2012). Given that 38% of dog-owning parents reported that they liked/loved dogs, it may be that their own positive experience with a dog and/or perceived benefits for themselves impacted their decision to own a dog, apart from or along with perceived benefits for their children. Nearly all the children in this study living with dogs were described as having some type of interaction with their dogs, including active play, petting the dogs or simply sitting near one another. Typically developing children have described their interaction with their dogs as among their closest relationships, with their dogs often acting as confidants (Bryant, 1990; Melson, & Swarz, 1994). In this study, 47% of children living with dogs talked to their dogs and 17% of children in non-dog owning families were described as talking to dogs outside their homes (Carlisle, 2012). In a population of children that have deficits in communication and social interaction, dogs may provide a unique benefit for these children through enhancement of these abilities. It is widely acknowledged that many parents believe typically developing children can benefit from dog ownership. In this study parents identified specific benefits of dogs related to challenges of children with ASD including stress relief, increased social interaction, empathy and companionship (Carlisle, 2012). Twenty-six percent of dog owning parents said that the benefits for their child with autism were a part of the reason they decided to own a dog. In this study, dog owners and non-dog owners identified the time and cost of caring for a dog as a primary burden of dog ownership. It may be that the additional responsibility of caring for a child with ASD influences parents' decisions regarding dog ownership. In addition to this, 19% of dog owning parents (n = 9) and 48% of non-dog owning parents (n = 11) reported that their children had sensory issues related to dogs, including hypersensitivities to the touch, sound, and/or smell of dogs (Carlisle, 2012). Parents owning dogs vocalized the need to monitor their children's interactions with their dog closely due to the sensory issues, and 15% of parents (n = 7) noted the need for a good match between the characteristics of their child and a dog, for the successful integration of that dog into their home. The ownership of rabbits and cats were alternative pets that parents described as providing the benefits of a pet, without the burden of sensory overload their children experienced when interacting with a dog. An area of concern, the safety of their children and/or the safety of a dog, was described by 13% of parents related to their children's behavior, and was labeled as at least part of the reason some chose to not own a dog (Carlisle, 2012). The American Veterinary Medical Association (2010) recommends that typically developing children reach the age of four years before families consider dog ownership, due to the risk of a dog bite for infants and young children. The
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incidence of dog bites is unknown among children with ASD; however, the reported experiences of parents in this study indicate that monitoring the interactions between children with autism and dogs may be particularly important. Given these additional challenges of dog ownership, yet the high incidence of ownership in this study, other factors may play a role in the dog ownership decision-making process for these families. Several limitations are acknowledged in this study. The data-base included non-working phone numbers from 126 of the participants, eliminating the possibility of their inclusion (Carlisle, 2012). An additional 61 parents did not respond to messages left on answering machines requesting their return call for consideration of participation in a research study. A final 24 potential participants refused participation. These enrollment factors may have influenced the prevalence of dog ownership identified in the study and/or the type of responses received. The high prevalence of dog ownership among families with children, limited the enrollment of parents without dog ownership experiences. Parent perceptions of personal benefits of dog ownership may also have influenced the study. Mothers have been found to be the member of the household most likely to make the decision regarding pet ownership (Albert & Bulcroft, 1988). If more fathers had been enrolled in this study (n = 9), their responses may have been different than those of the responding mothers. Additionally, the male to female ratio of children in the present study did not compare to the five to one ratio of children with ASD reported by the United States Centers for Disease Control and Prevention (“Prevalence of Autism Spectrum Disorders—Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008,” n.d.). It is possible that this may have been due the study's small sample size and this may have influenced the results. None of the safety concerns noted by parents in the present study were associated with female children. Finally, this study excluded younger children and those with moderate to severe intellectual ability, and responses of parents of these children may have been different than those who were included.
Conclusions Dog ownership is common among families of children with ASD, and parents describe similar reasons for their decision to acquire a dog, as do parents of typically developing children. Many parents perceive their children with ASD as being capable of developing an attachment to their dogs; however, a symbiotic integration of a dog into these families may rely on careful consideration of several factors. The time parents have to care for a dog may play a role, in addition to the selection of a dog with characteristics that provide a good match for the individual sensory issues of each child (Carlisle, 2012). For some children, alternative pets may provide the benefits of a pet without the sensory
122 overload some children were reported to experience with dogs. Other families may not benefit from pets at all, based on parent attitudes about pets or their child's sensory issues. Given the unique family dynamics present for families of children with ASD, further research is needed to examine the characteristics and types of pets providing children with the greatest benefits, as well as the role pets may play in providing benefits for the parents of children with ASD.
Acknowledgments This study was supported with a grant from Sigma Theta Tau–Alpha Iota Chapter. The author would like to acknowledge the support of her dissertation committee members, Dr. Rebecca A. Johnson, Dr. Lawrence Ganong, Dr. Debra Gayer and Dr. Micah Mazurek.
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