This talk was presented at the conference "Autism in the Family: Can Dogs Help" held in London on the 22nd June 2013. Professor Daniel Mills is the UK's first Professor of Veterinary Behavioural Medicine and is based in the School of Life Sciences at the University of Lincoln. His research has focused on human –animal interactions, the assessment of emotion in companion animals and the use of semiochemicals to manage pet behavioural problems. He is a member of the Companion Animal Welfare Society. He has been the lead researcher on the ‘Pet Dogs for Children with Autism’ research project for the past 3 years.

1. PROF DANIEL S. MILLS BVSC PHD CBIOL FSBIOL FHEA CCAB
DIP ECAWBM(BM) MRCVS
EUROPEAN & RCVS RECOGNISED SPECIALIST IN
VETERINARY BEHAVIOURAL MEDICINE
DR HANNAH WRIGHT BSC ( HONS) PHD
S C H O O L O F L I F E S C I E N C E S
U N I V E R S I T Y O F L I N C O L N
R I S E H O L M E P A R K
L I N C O L N L N 2 2 L G
Pet Dogs for Children with
Autism Research
1

2. Overview
 Autism Spectrum Disorder and its impact
 Meeting current needs
 Identifying effective interventions
 Dog related interventions for ASD
 Assistance Dogs vs the PAWS programme
 Initial results from PAWS research programme
 Can a pet dog enhance the quality of life for families with a child
with autism?
 What aspects of the dog‟s behaviour trigger desirable behaviour
and interactions with autistic children?
 Is greater benefit obtained in populations with certain
demographic characteristics?
2

3. ASD in society
 Estimated prevalence 1 in 100 children, UK
 Lifetime cost to the state estimated at £3m / child
 Care
 Lost income
 Effect on contacts
 Parents
 Siblings
 Wider family
 Local community
3

4. Effect on family
Family organisation/planning (Heiman & Berger, 2008)
Family resilience, coping strategies (Bayat, 2007; Hastings et
al, 2005)
Family cohesion (Estes et al, 2009)
Parental & siblings quality of life (Mungo et al, 2007)
Parental stress/psychological illness > stress proliferation (Bouma &
Schweitzer, 1990; Hoffman et al, 2008)
Sibling relationship quality (Orsmond et al, 2009)
Parents marital relationship (Brobst et al, 2009)
Expressed Emotion (Hastings & Lloyd, 2007)
Friendship & social support (Dyson, 1997)
Employment (Montes & Halterman, 2008)
Outside access (Fox et al, 2002)
4

5. Meeting the current need
5

6. Interventions:
Treatments, Therapies & Services
 Over 800 listed by Research Autism
 Most lack scientific support
 Treatment
 PKU
 Comorbid conditions
 Requirements
 Individualised
 Persistent
 Structured
6

7. Intervention challenges
Family variation
Autism Spectrum Disorders
Variability - number, presentation and severity of
symptoms
Effect every child (& family) differently
"If you've met one child with Autism….. you've met one child with
Autism"
Families affected in different ways
oNeed to fit into family way of being
What is the treatment goal?
The process of establishing an evidence base
7

8. Establishing an evidence base
 Focus on goals that are easy to measure
 Focus on short term effects
 Prefer homogeneous interventions
 Limitation of RCTs
 Focus on single treatment variables
 Population matching given heterogeneity
 Poor quality models vs personalised medicine
Mesibov and Shea 2010
8

9. Dog related interventions for
ASD
9

10. Autism Assistance Dog
 Full public access.
 Children 3 - 10 years old.
 Part of a team, with the
parent and child.
 Child wears a discreet
belt
 Attached to the assistance
dog and also holds on to a
harness.
 Commands and directions
are given to the dog by
the parent
10

11. Autism Assistance Dogs
 Dogs socialised and trained to remain calm in busy environments
 Calming focus
 Increase access and engagement with activities previously
impossible.
 Preventing tantrums through calming effect
 A constant focus for child in unfamiliar environments
 Safer environment for the child, increased security
 Increased child and parent independence
 Introduced routines & structure
 Reducing bolting behaviour
 Interrupting repetitive behaviours & tantrums
 Providing a companion who does not make demands on the child
 Public perception
 At home
 Dog is used to help develop social and emotional learning
 Cost ~£20k/dog
11

12. Assistance Dog numbers in the UK
 GDBA
 Hearing Dogs
 Dogs for the Disabled
Association
 Canine Partners for
Independence
 Support Dogs
 Dog Aid
 4500
 900
 250
 150
 150
 20
~30 for autism
12

13. Autism Assistance dogs
 Many apparent benefits not related to the specific
training
 distracting away from meltdown behaviour
 building language skills
 a more general effect of having a dog in the family
 1300 enquiries in 6 months
 Unable to meet demand
13

14. PAWS (Parents Autism Workshops and
Support)
• Parents attend a series of three, one day
workshops,
• Project workers with a background in Child
Development and Dog Welfare & Training,
give parents an insight into potential
benefits of dog ownership for their child, as
well as the practical and theoretical skills
into positive dog ownership.
o After the series of workshops, parents use
the support of the PAWS team through an
online forum, telephone or email, or through
follow-up workshops to reach their
individual goals.
14

15. Research on dogs and ASD children
 Children showed fewer autistic behaviours and more socially
appropriate ones when a dog was introduced into therapy
sessions (Redefer & Goodman, 1989)
 Effect was not lasting
 Children were more playful, focused, and more aware of their
social environments when in the presence of a calm dog, when
compared to a toy or stuffed dog (Farnum, 2002)
 Cortisol Awakening Response (CAR), but not basal cortisol, was
significantly reduced in children with ASD following the
introduction of a service dog, and subsequently increased after
dogs were removed from the families (Viau et al, 2010)
15

16. “Pet Dogs for Children with Autism”
 Funded by the Big Lottery Fund
 Collaboration between:
 Dogs for Disabled (DFD)
 National Autistic Society (NAS)– Research Autism
 University of Lincoln – Biological Sciences
 3 year project 2010-2013
16

17. The three research questions
 Q1. Can a pet dog enhance the quality of life for
families with a child with autism?
 Q2. What aspects of the dog‟s behaviour trigger
desirable behaviour and interactions with autistic
children?
 Q3. Is greater benefit obtained in populations with
certain demographic characteristics?
17

18. Methods
 Combination of qualitative and quantitative methods
 Thematic analysis of interviews (n=2*20)
 Longitudinal cohort study (93 +33)
 Time control group (33)
 Field observations (20)
 Population survey (641/483 /347)
 Development of new assessment scales to use
alongside established scales
18

19. Scales used
 The Parental Stress Index-Short Form
 36 items derived from the PSI
 Three subscales:
 Parental Distress,
 Difficult Child Characteristics,
 Dysfunctional Parent-Child Interaction
 The Family Assessment Measure -III
 Three components:
 General Scale - overall family health;
 Dyadic Relationship Scale - how a family member views his or her
relationship with another
 Self-Rating Scale – self rating of own functioning within the family
19

20. Scales used
 Spence Children‟s Anxiety Scale (Pre-school, Parent
Report)
 28 frequency rated anxiety items
 6 subscales
 Panic attack / agoraphobia
 Generalized anxiety
 Social anxiety
 Obsessive compulsive disorder
 Physical injury fears
 Separation anxiety
20

21. Scales Used: PAWSs
 PAWS 1
 Family Normalcy Scale developed by Richard Mills
 10 items:
 child behaviour, self care, supervision, enjoyment of life, mobility,
financial, general impact, social relations, community relations,
coping
 Comprehension analysis
 Reliability analysis – Time control group
 PAWS 2
 32 Behaviours and activities of importance identified
from interviews :
 child independence, social interactions, imagination,
walking, enjoyment, empathy, tantrums, repetitive
behaviour, bolting, impacts on family, response to dogs
21

22. Q1. Can a pet dog enhance the quality of
life for families with a child with autism?
 Pre/post intervention + follow up study
 Treatment Group – mainly families on PAWS workshops
 Time Control Group – Dr Annette Hames
 Clinical scales
 PSI Short Form
 FAM-III General Scale (Family Functioning)
 Spence Children‟s Anxiety Scale
 PAWS#1: Child Provisional Normalcy Rating Scale
 PAWS#2 items
22

23. Intervention study
 Treatment group: n=93 families contacted
 5 moved to the control group after the baseline interview
 22 families dropped out before second interview
 66 with two interviews (n=45 with all three interviews)
(10 rehomed dogs = 15% of those acquiring a dog)
 Control group: n=33 families recruited
 n=5 drop outs (n=28 all three interviews)
BASELINE (PRE) FOLLOW UP
(25-35 WEEKS PI)
POST-INTERVENTION
(4-10 WEEKS PI)
MINIMUM 20 WEEK INTERVALMAX 6 MONTHS
23

24. Matching of treatment and control groups :
Interview timings:
Baseline-Post-intervention
Treatment: 4-36w (mean=12)
Control: 7-24w (mean=11)
Post-int -Follow-up
21-35w (mean=27)
7-30w (mean=26)
Baseline-Follow-up
25-49 (mean=38)
22-40 (mean=37)
Gender of interviewee (parent):
Treatment Control
Male 7% 7%
Female 93% 93%
Gender of child:
Treatment Control
Male 75% 82%
Female 25% 18%
24

25.  Child Age:
 Speech level:
Treatment Control
Full Sentences 29 52% 16 57%
Simple phrases/sentences 11 20% 2 7%
Single words/gestures 8 14% 7 25%
Non-Verbal 5 9% 3 11%
Unknown 4 5% 0
Treatment Control
Average age and range 8.5 3-15 8.5 2-16
2 years and under 0 0% 1 3%
3-6 years 16 29% 7 25%
7–10 years 27 48% 12 43%
11-14 years 12 21% 5 18%
15+ 1 2% 3 11%
Matching of treatment and control groups :
25

26. 100
102
104
106
108
110
112
114
116
118
1 2 3
TS
TS
BASELINE POST-INTERVENTION FOLLOW UP
TotalStress(TS)score
High
scores
(>86)
Treatment
Control
•Significant reduction in treatment group (RM-ANOVA n=45, F=19.582, p<0.001)
•BL-PI (post-hoc Bonferroni, p=0.014)
•BL-FU (post-hoc Bonferroni, p=0.009)
•No significant change PI-FU (post-hoc Bonferroni, p=0.859)
PSI – total scores
*Sig <0.0125 after correction for multiple tests

27. 40
41
42
43
44
45
46
47
48
1 2 3
DC
DC_C
BASELINE POST-INTERVENTION FOLLOW UP
High
scores
(>33)
DifficultChild(DC)subscalescore
Treatment
Control
•Significant reduction in treatment group (RM-ANOVA n=45, F=12.967, p<0.001)
•BL-PI (post-hoc Bonferroni, p<0.001)
•BL-FU (post-hoc Bonferroni, p<0.001)
•No significant change PI-FU (post-hoc Bonferroni, p=1.0)
•No significant changes in control group (RM-ANOVA n= 27, F=5.093, p=0.015)
PSI – Child characteristics
*Sig <0.0125 after correction for multiple tests

28. 25
27
29
31
33
35
37
39
1 2 3
PCDI
PCDI_C
BASELINE POST-INTERVENTION FOLLOW UP
Treatment
Control
85th percentile
High
scores
Parent-ChildDysfunctionalInteraction
(P-CD)subscalescore
Treatment
Control
PSI – Parent child interaction
•Significant reduction in treatment group (RM-ANOVA n=45, F=7.401, p=0.001)
•BL-PI (post-hoc Bonferroni, p=0.009)
•BL-FU (post-hoc Bonferroni, p=0.009)
•No significant change PI-FU (post-hoc Bonferroni, p=1.0)
•No significant changes in control group (RM-ANOVA n= 27, F=0.376, p=0.689)
*Sig <0.0125 after correction for multiple tests

29. 25
27
29
31
33
35
37
39
1 2 3
PD
PD_C
BASELINE POST-INTERVENTION FOLLOW UP
85th percentile
Normal
range
High
scores
ParentDistress(PD)subscalescore
Treatment
Control
•Significant reduction in treatment group (RM-ANOVA n=45, F=13.762, p<0.001)
•BL-PI (post-hoc Bonferroni, p<0.001)
•BL-FU (post-hoc Bonferroni, p=0.001)
•No significant change PI-FU (post-hoc Bonferroni, p=1.0)
•No significant changes in control group (RM-ANOVA n=27, F=2.093, p=0.134)
Parenting Stress Index (PSI) – Parent distress
*Sig <0.0125 after correction for multiple tests

30. Parenting Stress Index Results
 Although no significant difference between
Treatment and Control groups in any of the
subscales at the three time points.
 Reductions seen in all areas
 Biggest effect on Parental Distress
 This is of clinical relevance as this reduced from high to normal
range.
 All other subscales remain well within the high ranges.
30

31. Benchmark: PSI data from „Early Bird‟ study
Early Bird:
 Parent focused programme with information, explanations and
practical strategies aimed at increasing parent confidence in
helping their child.
 Eight 3.5 hour session over three months
 Recently diagnosed children
 Follow up +3mo, +9mo
 Full version of PSI
 n=119 vs waiting list control n=24
 Progressive reduction in three PSI measures over time
(child, parent & total stress)
 Control group n/s changes pre EB programme
 During 3mo tx improved PSI total, PSI parent, but not PSI
child
Shields & Simpson 200431

32. FAM-III Family FunctioningTotalScore
45-55=Averagefunctioning
44
45
46
47
48
49
50
51
52
53
BL PI fU
tx
control
•No significant change in treatment group (RM-ANOVA n=43, F=1.321, p=0.272)
•No significant change in control group (RM-ANOVA n=27, F=2.095, p=0.133)
•No significant difference between groups at any time point (t-tests, p>0.05)
32

33. PAWS#1 Family Normalcy
•Significant change in treatment group (RM-ANOVA n=43, F=5.714, p=0.005)
•BL-PI (post-hoc Bonferroni, p=0.031)
•BL-FU (post-hoc Bonferroni, p=0.021)
•No significant change PI-FU (post-hoc Bonferroni, p=1.0)
•No significant change in control group RM-ANOVA n=27, F=0.733, p=0.486
•No significant difference between groups at any time point (t-tests, p>0.05)
30
31
32
33
34
35
36
37
38
39
40
BL PI FU
TotalScore
Treatment
Control

34. Treatment group (n=15) Control Group (n=26)Score(%)
Repeated Measures ANOVA (sig< 0.007) Treatment Group Control Group
Panic Attack/Agoraphobia (♦) F=1.657, p=0.214 F=0.289, p=0.751
Separation Anxiety (■) F=6.064, p=0.006 F=0.479, p=0.662
Physical Injury Fears (▲) F=13.656, p=0.001 F=7.390, p=0.002
Social Phobia (x) F=5.637, p=0.009 F=0.460, p=0.581
Obsessive Compulsive Disorder (x) F=2.738, p=0.082 F=0.062, p=0.892
Generalised Anxiety Disorder (•) F=1.167, p=0.326 F=3.558, p=0.036
Total score (I) F=9.856, p=0.005 F=4.402, p=0.017
*Sig <0.007 after correction for multiple tests

35. Q2. What aspects of the dog‟s behaviour trigger desirable
behaviour and interactions with autistic children?
 Field studies – video child-dog interactions in the home
 Three aspects of behaviour of interest:
1. preceding behaviour (e.g. approach, orientation)
2. dog‟s response to child's action
3. activity resulting in termination of interaction
Methods
 3 different scenarios where dog a perceived benefit (with and without the
dog present)
 Talking to a non-familiar person (with/without dog present)
 Behaviour on a walk (with/without dog present)
 Interaction between child-parent (with/without dog present)
35

36. Field study
 Scenario 1:Talking to a non-familiar person (with/without dog
present)
 Child head orientation
 Child body orientation
 Communication
Single words/short phrases
Sentences
Other vocalisations
Gesture (inc. pointing, signing)
 Fidgeting
36

37. Non-familiar person scenario preliminary
results
n=13 ASD, n=11 (neurotypical controls age and gender matched)
 No significant differences identified in any of the measures:
 Child head orientation, body orientation, Communication
 Single words/short phrases, sentences other vocalisations, gesture (inc.
pointing, signing)
 Individuals responded in different ways
Rate of eye gaze towards stranger in ASD and neurotypical (NT) children
rate/min
dog no dog dog no dog37

38. Field study
 Scenario 2:Walking (with/without dog present)
 Parent walking with child
 Researcher following with camera
 Two walks (one with/one without dog)
 Same route where possible
38

39.  Ethogram for walking scenario:
Proximity of child to parent
<1m,1-3m,>3m
Child contact with parent (e.g. holding hand)
Child position in relation to parent
Level, behind, in front
Motion
Walking, running, still
Response to parent requests
Compliant, refusal
Activity directed towards environment (e.g. plucking
leaves, stamping on bushes)
Pace of walk (parent, child)
39

40. Walking with parent (with/without dog)
Results
n=14 children with ASD: 10m/4f, age 5-16 (mean 9)
Walks took significantly longer with the dog (same route) (t=3.245,
p=0.006)
No significant differences in any of the other measures:
 Distance from parent
 Position in relation to parent
 Speed of movement (stopped/walking/running)
Effects very individual
40

41. Q3. Is a greater benefit obtained from populations
with certain demographic characteristics?
 The influence of a dog on child is unlikely to be
uniform, so need large sizes to pick out these more
variable effects and predictors of these
 Use 28 items derived from initial interview
responses concerning benefits and risks in order to
try to identify significant predictors, e.g.
 Age, Breed, Sex, Source of dog,
 Child characteristics
 Family structure and Experiences
 Survey of a large population (~500) with adog to
establish prevalence of effects and significant
predictive demographic features
41

42. Survey
42

43. Mode =1 (Strongly Agree) Mode=2 (Mainly Agree) Mode=3 (Partly A/Partly D)
↑ child happier in self ↑ tolerate routine changes ↑ independence in self care
↓ conflict with siblings ↑ affection to family ↑ pay attention on tasks
↑ family able to get out ↓ afraid of dogs ↑ empathy for family
↑ willing to walk ↑ engaging with strangers ↑ imagination in social play
↑ independence in home ↓ likely to tantrum
↓ time tantrum recovery ↑ communicate needs
↓ family arguments ↓ Repetitive behaviours
↓ running off/bolting ↑ family flexible routines
↑ social with family
↑ willing in new activities
↑ communicate feelings
↑ parent time to self
↑ cooperation with family
↑ family enjoyment
↑ imagination in own play
↓ hesitant other dogs

44. Grouping of benefits (n=347)
 3 factor structure
1. Tolerance to changes in routine, willingness to do something new,
willingness to go for a walk, independence in self care,
independence within the home, happiness in self, affection to the
family, fear of dogs, tendency to tantrum, recovery from tantrum,
ability to pay attention, repetitive behaviours, empathy,
imagination in social play, imagination in own play, parental time
to self, enjoyableness of family activities – adaptability (34.5%v)
2. Communication of immediate needs, communication of feelings
with family, flexibility in routine, social interactions with family,
co-operation with family, hesitancy with other dogs – social skills
(14.0%v)
3. Conflict with siblings, family arguments, family ability to get out of
house, running off/bolting – conflict management (5.0%v)
Total v. explained : 53.5%
44

45. Mode =1 (Strongly Agree) Mode=2 (Mainly Agree) Mode=3 (Partly A/Partly D)
↑ child happier in self ↑ tolerate routine changes ↑ independence in self care
↑ willing to walk ↑ affection to family ↑ pay attention on tasks
↑ independence in home ↓ afraid of dogs ↑ empathy for family
↓ time tantrum recovery ↑ engaging with strangers ↑ imagination in social play
↓ family arguments ↓ likely to tantrum
↓ running off/bolting ↓ repetitive behaviours
↓ conflict with siblings ↑ family enjoyment
↑ family able to get out ↑ imagination in own play
↑ parent time to self
↑ willing in new activities
↑ communicate feelings
↑ communicate needs
↑ cooperation with family
↑ family flexible routines
↑ social with family
↓ hesitant other dogs

46. Predicting effects
46
 Significant factors retained & positive contribution
 Total score: (R2=11.6%)
 F1 - Adaptability: (R2=11.3%)
 Language ability - greater language ability
 Number of parents in family - 1 parent (vs. 2)
 Regular contact with horses – yes
 Dog is a retriever type (vs other inc crosses & u/k) – yes
 Dog gender – female
 F2 – Social Skills: (R2=1.6%)
 Unpaid support – yes
 F3 – Conflict management: (R2=8.9%)
 Language ability - greater language ability
 Paid support – no
 Dog age – older dog

47. 47
Comparison between survey
and intervention population

48. Mode =Strongly Agree Mode=Mainly Agree Mode=Partly A/Partly D
↓ running off/bolting*s ↓ hesitant other dogs*s ↑ pay attention on tasks*s
↓ conflict with siblings*s ↑ tolerate routine changes*s ↑ independence in self care*
↑ child happier in self*s ↓ tantrum/meltdown*s ↑ empathy for family*
↓ time tantrum recover*s ↑ willing in new activities*s ↑ imagination in social play*
↑ willing to walk*s ↑ parent time to self*s
↑ family able to get out* ↑ cooperation with family*s
↓ family arguments* ↑ family enjoyment*s
↑ independence in home* ↓ repetitive behaviours*s
↑ imagination in own play*s
↑ engaging with strangers*s
↑ family flexible routines*
↑ social interaction w family*
↑ communicate feelings*
↑ communicate needs*
↑ affection to family*
↓ afraid of other dogs*
Key
Green text = significant
changes in intervention
population
Red text = no significant
changes in intervention
population
*= also when child is without
dog
* = only when child is with dog
S = changes occur in short
term & maintained
no changes in control group

49. Summary
 Consistent evidence that pet dogs can help families
with an autistic child
 But specific effects often varied and often hard to predict
 Reductions in PSI measures
 Total Stress (parenting)
 Parent-Child Dysfunctional Interaction
 Difficult Child
 Parental distress (clinically relevant)
 Reduction in Child Anxiety
 Total anxiety
 Separation anxiety
49

50. Summary
 Impact of a dog seems to fall into three main domains
 Adaptability
 Social skills
 Conflict management
 Strongest effect seems to be on conflict management skills, then
social skills, adaptability is more variable
 Effects are very individualistic
 Specific effects are difficult to predict in advance
 Field observations to support the findings are ongoing
 Although the PAWS programme does not enhance the
benefits of having a dog, it provides essential preventive
advice, and will in future include further information on
realistic expectations
50

51. What next
51

52. Acknowledgements
 First and foremost we would like to thank all the
families who took the time to take part in one or
more parts of this work, when you had so many other
demands on your time
 To our collaborators at Dogs for Disabled, National
Autistic Society and colleagues at Lincoln, especially
Dr Annette Hames and Jessica Hardiman
 To our sponsors, especially the BIG lottery Fund for
having the courage to invest in the first major study
of its kind relating to this important condition
 To you all for listening
52

53. Thank you!
53