Abstract

Introduction

Children with autism spectrum disorder (ASD) in inclusion classrooms tend to be rejected and victimized by their peers, which can lead to social isolation, anxiety, and problem behaviors.¹ These stressful school experiences often carry over into maladaptive and difficult behaviors at home.² Lack of peer social support and friendships can lead to impaired mental and physical health; therefore, it is important to find new ways to improve social functioning for children with ASD in inclusion classrooms.

Currently, the main avenue of intervention for children with ASD is through the education system.^3,4 Unfortunately, the most successful treatments to date are expensive and time-consuming and require highly trained staff to implement.⁴ One viable addition to current practices may be the inclusion of an animal in the classroom.

Preliminary evidence suggests that individuals with ASD may seek out interaction with animals^5,6 and acquire social benefits from them.^7,8 The field of Human–Animal Interaction (HAI), or Anthrozoology, provides theoretical support for beneficial interactions between individuals with ASD and animals.⁹ HAI social support theory suggests that animals can enhance social support both directly, as a source of comfort, and indirectly, as a facilitator of human interactions.¹⁰ In addition, HAI attachment theory suggests that animals may provide a source of comfort and safety for children, as transitional objects that can alleviate distress and may reduce problem behaviors.^11–13 These theoretical underpinnings have spurred a growing field of inquiry into the practice of Animal-Assisted Intervention (AAI).

AAI is an umbrella term, encompassing both Animal-Assisted Therapy (AAT) and Animal-Assisted Activities (AAA).¹² AAT is defined as a goal-directed intervention facilitated by trained personnel, in which an animal is an integral part of the treatment process. In contrast, AAA is defined as activities with animals that provide opportunities for motivational, educational, recreational, and/or therapeutic benefits without the presence of specified treatment goals or objectives. It does not have to be implemented by trained personnel, and session content is spontaneous.¹⁴

The emerging research on AAI for ASD has focused largely on AAT, rather than AAA.^15–17 However, a recent AAA study demonstrated that the mere presence of a guinea pig encouraged increased social behaviors in children with ASD, compared to the presence of toys.¹⁸ The current study builds upon this work by evaluating the impact of animal (guinea pig) presence and interaction over time through an 8-week, classroom-based AAA program. We assessed generalized changes in social behaviors both in the school classroom (teacher-reported) as well as at home (parent-reported) following an 8-week waitlist period, as well as following an 8-week AAA program. On the basis of HAI theory and previous AAI research, we hypothesized that participants with ASD would demonstrate increases in social functioning from before to after the AAA program, but not during the waitlist period.

Materials and Methods

Participants

Sixty-four (64) children with ASD (50 male; 14 female) aged 5.2–12.8 years (M=8.9; SD=2.2) participated. They were spread across 41 kindergarten through seventh-grade classrooms in 15 different schools throughout the greater Brisbane area in Australia. All had a previous, independent diagnosis of ASD (n=25), Asperger's Disorder (n=21), Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS; n=10), or Autistic Disorder (n=8). A subset of participants also participated in an 8-week waitlist control condition before starting the AAA program. Demographic data for both the waitlist and non-waitlist groups are presented in Table 1.

Table 1.

Demographic and Baseline Measures of Target Participants with Autism Spectrum Disorder

	Group
	All (n=64)	Waitlist (n=37)	Non-waitlist (n=27)	Waitlist vs. non-waitlist
Variable	n (%)	n (%)	n (%)	p
Demographics
Sex (male)	50 (78.1%)	28 (75.7%)	22 (81.5%)	NS
Pet owners	45 (70.3%)	29 (78.4%)	16 (59.3%)	NS
Current ASD treatment	35 (54.7%)	20 (54.1%)	15 (57.7%)	NS

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	M (SD)	M (SD)	M (SD)
Age (years)	8.9 (2.2)	9.5 (2.4)	8.2 (1.7)	NS
Grade	3.6 (2.4)	4.0 (2.6)	3.0 (1.9)	NS
Parent measures
n	57	33	24
PDDBI Social Approach Behaviors	67.8 (13.2)	67.6 (14.2)	68.0 (12.0)	NS
PDDBI Social Withdrawal Behaviors	27.3 (10.2)	26.7 (10.6)	28.0 (9.9)	NS
SSRS Social Skills	76.5 (15.3)	76.0 (17.2)	77.3 (12.5)	NS
SSRS Problem Behaviors	120.5 (14.4)	121.6 (14.1)	119.1 (15.0)	NS
Teacher measures
n	61	34	27
PDDBI Social Approach Behaviors	52.6 (15.5)	55.9 (14.8)	48.3 (15.6)	NS
PDDBI Social Withdrawal Behaviors	22.6 (13.2)	21.2 (14.2)	24.3 (12.0)	NS
SSRS Social Skills	84.1 (16.4)	85.7 (15.4)	82.1 (17.7)	NS
SSRS Problem Behaviors	112.0 (13.2)	111.9 (13.2)	112.1 (13.4)	NS

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Pervasive Developmental Disorder Behavior Inventory (PDDBI) values are raw scores and Social Skills Rating System (SSRS) values are standard scores.

Baseline measures are pre-Animal-Assisted Activities (AAA) program assessments during the week prior to the AAA program.

NS, not significant; ASD, autism spectrum disorder.

Procedures

Participant groups and outcome assessment

Participants were cluster-assigned to one of two groups: (1) waitlist group (n=37) or (2) non-waitlist group (n=27) at the school level in order to prevent cross-contamination between groups. The waitlist group completed outcome measures upon entering the study (Time 1), after an 8-week waiting period during the week prior to the AAA program (Time 2), and during the week following the AAA program (Time 3). Participants in the non-waitlist group were assessed at Time 2 and Time 3 only. In order to control for variability across the school year, the study start date was staggered by school over the course of the year. Response rates for teacher questionnaires were 100% (n=37) at Time 1, 95.3% (n=61) at Time 2, and 100% (n=64) at Time 3. Response rates for parent questionnaires were 94.6% (n=35) at Time 1, 89.1% (n=57) at Time 2, and 84.4% (n=54) at Time 3.

AAA program

Guinea pigs were selected as the intervention animal because they have been reported as one of the best choices for young children and as classroom pets because they are diurnal, relatively easy to handle and care for, generally like to be held, and seldom bite.¹⁹ Guinea pigs are social animals that require companionship; therefore, each participating classroom housed one pair of guinea pigs of the same sex to prevent breeding. The animals remained in the classroom during the school week (Monday to Friday) for the duration of the program.

The implementation of the program was coordinated by one of the researchers (MEO) with no clinical background or training. The purpose of enlisting a nonspecialist program facilitator was to present a basic activities program that could potentially be implemented by parents, volunteers, or teachers without clinical background or training. The AAA program consisted of two main components: (1) animal care and (2) animal interaction (Table 2).

Table 2.

Overview of Animal-Assisted Activities Program Components and Participants

		Participants
Program component	Supervisor	All students in class	Study participants only	Description
Animal care
Introductory lesson	Facilitator	x		1×15-minute lesson on guinea pig care
Week (Mon.–Fri.)	Facilitator & teacher	x		Classroom care (feeding, cage cleaning)
Weekend/holiday	Parent	x		Home care by eligible families (transport, feeding)
Post-study	Teacher or parent	x		Adoption of guinea pigs offered to teachers, then parents
Animal interaction
Classroom	Teacher	x		Classroom animal exposure and handling
Sessions	Facilitator		x	16×20-minute AAA sessions outside classroom

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The AAA sessions were conducted in groups of three participants. To simulate peer presence in the classroom during these sessions, we randomly selected two typically developing peers from each child's classroom to partake in the sessions alongside the child with ASD. The sample of typically developing peers included 128 children aged 4.8–12.7 years (M=8.6; SD=2.3).

The purpose of the AAA sessions was to ensure that study participants had at least 40 minutes of contact time with the guinea pigs per week (two 20-minute sessions) as well as to collect basic data about the types of activities children chose to engage in with guinea pigs. Materials were provided for all activities in every session, as described in Table 3. A detailed description of the AAA program and procedures can be found elsewhere.²⁰

Table 3.

Description of Animal-Assisted Activities and Their Mean Occurrence Across Groups

		% Occurrence across groups
Activity	Description Picture activity card (materials)	M (SD)	Range
Holding	Holding guinea pig in arms or lap “Hold” (towels)	100.0% (0.0%)	100.0%
Feeding	Preparing fruit/vegetables or hand feeding “Feed” (grass/hay, fruits or vegetables, cutting board, plastic knife)	88.6% (16.6%)	37.5%–100.0%
Floor time	Sitting in a circle, allowing guinea pigs to roam freely in center “Floor” (blanket, towels)	70.9% (21.8%)	12.5%–100.0%
Visual art	Drawing pictures or taking photographs of guinea pigs “Draw” (markers, pencils, paper, blank notebook) “Camera” (photo camera)	42.9% (24.0%)	6.3%–100.0%
Health monitoring	Weighing, measuring, recording physical and behavioral characteristics “Weigh” (kitchen scale) “Measure” (measuring tape) “Record” (health checklist, blank notebook)	37.1% (24.1%)	6.3%–87.5%
Construction	Building housing additions, shelters, mazes, or animal toys “Build” and “Maze” (recycled materials such as cardboard or tissue boxes, scissors, glue, string)	30.3% (21.6%)	6.3%–87.5%
Grooming	Brushing coat or bathing “Brush” (baby brush and comb) “Bath” (small-animal shampoo, bathing tub, towels, hairdryer)	26.9% (16.4%)	6.3%–75.0%
Cage cleaning	Emptying cage to clean and provide fresh bedding “Clean” (cleaning solution, paper towels, trash bags, fresh bedding)	17.6% (18.3%)	0.0%–56.3%

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Results

Discussion

An 8-week AAA program for 64 children with ASD in 41 inclusion school classrooms demonstrated increases in ASD-diagnosed children's social functioning. Specifically, both teachers and parents reported increases in social approach behaviors, decreases in social withdrawal behaviors, and increases in social skills following the program. These outcomes were independent of a child's school, teacher, grade, pet ownership, or outside treatment.

All participating classrooms completed the 8-week AAA program, demonstrating feasibility of the protocol. Over half of teachers opted to keep the guinea pigs in the classroom following the program. The remaining animals were adopted by families of participants.

Over half of parents reported that their child demonstrated an increased interest in attending school during the time the guinea pigs were in the classroom. Previous research has documented that the inclusion classroom can be a stressful and lonely environment for children with ASD.^28–30 HAI studies have revealed that the simple presence of an animal can enhance people's perception of social scenes, making them appear happier and less threatening.^31–33 The presence of the guinea pigs may have enhanced the atmosphere of the classroom, leading to increases in the children's motivation to attend.

The key finding of the study was that on the primary social functioning outcome measures, there was significant improvement following the AAA program, but not the waitlist period. These positive changes in the children's behavior were perceived by both parents and teachers. These effects may have been related to the ability of an animal's presence to facilitate social interaction between people³⁴ and provide social support in stressful social situations.³⁵

Despite positive outcomes in the current study, several limitations should be noted. First, the use of a waitlist control rather than an attention control precludes concluding that outcomes were due to the animal itself rather than the program as a whole. Further studies should enlist attention controls such as a program focused on plant care or engaging toys to determine whether the animal is indeed an essential ingredient of the program. Component analyses of the AAA program, itself, are also warranted to determine which elements were effective (e.g., animal care instruction versus animal interaction, animal presence in the classroom versus time outside of the classroom with the animals and peers). Second, teachers and parents were not blinded to participant conditions, which could have biased their ratings, especially if they had high expectations or desire for change from the AAA program. Third, limited data were collected regarding participant characteristics such as verbal ability, IQ, level of assistance in the classroom, or independent confirmation of ASD diagnoses. Given the significant variability in outcomes at the individual level and the broad spectrum of ASD traits, the collection of these items as potential moderators of program effects is warranted in further studies. Finally, although the program facilitator had no clinical training or experience, the use of only one facilitator for all sessions limits the ability to determine whether obtained effects are truly attributable to the program, or whether they are instead the result of interacting with that individual. Further studies should use multiple facilitators and carefully measure treatment fidelity.

Conclusions

In summary, findings from the current study largely support the hypothesis that the AAA program would increase social functioning in children with ASD. This outcome appears to confirm previous theoretical and anecdotal literature highlighting the capacity of animals to draw children with ASD out of the “autistic bubble” and connect them socially with others.⁹ It suggests that appropriately designed AAI in inclusion classrooms may be a feasible and effective way to engage and improve the social functioning of children with ASD.

References