∗ , Aubrey H. Fine, EdD † , Christine M. Bowers, BA †
∗Colorado State University
†California State Polytechnic University
Walter is now eight years old. He has been visiting the office for over a year. He sits on the floor with his legs crossed as he feeds a treat to his canine co-therapist. “Here you go, girl,” he says as he flaps his hands in excitement.
It was not too long ago that Walter would just rock, shriek and simply ignore the warm hearted golden retriever as she approached. If she got too close, he would stiffen to demonstrate his displeasure. Walter has autism.
According to the Autism Society of America, autism is a “complex developmental disability that typically appears during the first three years of life and affects a person’s ability to communicate and interact with others.” Autism spectrum disorders (ASD) lie on a spectrum that ranges from mild to very severe. Asperger’s syndrome is a milder variant on the autism spectrum. There has been a dramatic increase in the identification of persons with ASD over the past few decades (Autism Society of America, 2006). For example, 40 years ago, it was estimated that one out of every 2,500 children born was diagnosed with autism. The latest figures reported estimate prevalence rates to be one in 150 children born (Centers for Disease Control and Prevention (CDC), 2007) with autism currently affecting between 1 and 1.5 million people in America (United States Census Bureau, 2000). The CDC (2009) acknowledges the recent data released by the Health Resources and Services Administration which places ASD prevalence rates at about one in 91 children ages 3 to 17, and is currently preparing an updated prevalence rate report. Additionally, autism is four times more likely to be diagnosed in boys than girls.
In general, persons with ASD are broadly recognized as having impairments in social functioning and communication, as well as displaying repetitive or stereotyped behaviors (American Psychiatric Association, 2000). ASD are extremely variable and can vary in degrees of impairment. Some persons classified with ASD have profound challenges and will remain non-verbal, while others will demonstrate traits of brilliance. For example, it has been long accepted that Einstein and Mozart would probably have been diagnosed with either high functioning autism or Asperger’s syndrome. Science suggests that ASD are due to abnormalities in brain development and formation (Courchesne, 2004).
Some of the major symptoms of ASD are limited or perhaps abnormal speech, impairments in reciprocal social interactions, lack of eye contact, sensory oversensitivity, and repetitive behaviors. Often persons with ASD have a markedly constrained repertoire of activities, which can also be developmentally inappropriate. The key to understanding the disorder is recognizing the variability that may be observed. Impaired social functioning appears to be one of the most salient characteristics within the disorder. Symptoms may include weak or no eye contact, failure to develop peer relationships, and lack of social reciprocity. When interacting with someone with ASD, they are aware of another’s presence, but often will not acknowledge that person. Communication impairments within this population include slow or limited verbal language, mimicking language, echolalia, and delays in pragmatics. Many persons with ASD have the inability to initiate and sustain conversations. Finally, several persons who have disorders within the spectrum have repetitive and stereotyped behavior. These behaviors are most often recognized through repetitive motor movements, preoccupation with certain objects, and inflexible adherence to routines (APADSM-IV-TR, 2000).
The most functional variation of ASD is Asperger’s syndrome. Individuals with Asperger’s syndrome are verbal, but generally have difficulties with social pragmatics, social interaction skills, eye contact and reading non-verbal behavior and gestures. Many persons with Asperger’s syndrome also have a strong need for sameness and may have limited interests. On the other hand, there are large groups of persons with ASD who have also been diagnosed with mental retardation. These individuals usually do not develop verbal language, and have pervasive developmental delays that tremendously impact their functional self-help or social skills (Kutscher, 2006).
It is important to note that the Neurodevelopmental Disorders Work Group for the DSM-V is suggesting some possible changes for the new edition concerning ASD. There are currently three major suggestions. The first suggestion includes utilizing a single diagnosis for ASD, thus eliminating the separate categories of autism, Asperger’s syndrome, and PDD-NOS. A second recommendation is changing the current three-symptom domain to two: social communication deficits and fixated interests/repetitive behaviors. The third suggestion is to define ASD symptoms along a continuum that includes normal traits, subclinical symptoms, and three different severity levels for the disorder (Swedo, 2009). Although final decisions have not been made for the upcoming DSM-V, clinicians need to realize that ASD will undergo categorical changes, which will have an impact on how we define the disorder. Nevertheless, our general understanding of the symptoms will remain the same and should not change how we problem-solve the roles that animals have in these individuals’ lives.
At this time there is not a cure for those with ASD, but there is some evidence of certain therapies that have promise in helping to treat the disorder. The scientific community is in agreement that early intervention can help foster growth and development. Within this chapter, the authors will provide an argument for how animals may be incorporated with this population. Attention will be given to understanding why persons with ASD may or may not relate to animals. Suggestions will also be given to help the reader to better understand the underlying processes that impact persons with ASD in their relations with various species of animals. Significant attention will also be given to the roles that service animals and therapeutic riding may have.
13.2 Animals and individuals with ASD
For some children or adults with ASD or other developmental disorders, either a service dog or other animal-assisted interventions (AAI), including therapeutic riding, can have great benefits. Nevertheless, the first author has discovered, through conversations with parents of children with ASD, that there are several variables that need to be considered. The use of animals as part of a therapy or activities program may be very beneficial for some with ASD, but may not be beneficial for others.
It is clear that there has been a recent interest in the roles that animals have in the lives of persons with ASD. Several trade books and scholarly articles have been written attempting to document the value of animals in the lives of a person with ASD. Martin and Farnum (2002) suggest that animals may be extremely valuable to the cognitive and social lives of children as a whole. Katcher and Wilkins (2000), in a previous edition of this Handbook, reports that children may, at times, use animals as initial transitional objects that may eventually lead to relationships with others. Since many persons with ASD struggle with sustaining and developing relationships, animals may act as an initial catalyst to support social interactions. This position has been often documented in the literature (Fine, 2006). It appears that animals may act as a social catalyst and seem to engage the person in becoming more comfortable within the therapeutic environment.
On the other hand, there have been a handful of studies in the last decade that have demonstrated that AAI could be useful in supporting persons with ASD with many of their developmental needs. Ming-Lee Yeh (2008) suggested several interesting outcomes from her three years of research on evaluating a canine animal-assisted therapy (AAT) treatment for children with ASD in Taiwan. The study followed 33 paired autistic children, whose ages averaged 5.89 years old. Children in the control group were observed in regular living activities, while those in experimental treatment were treated with AAT activities in semi-structured small groups (5–8 persons), lasting 40 minutes, twice a week. Her study followed the impact on the clients after the 8-week study was concluded. All canine animals in this research were trained and qualified therapeutic dogs. The Vineland Adaptive Behavior Scale (VABS, Chinese version) and individual treatment goal attainment scales (GAS) were used for evaluating the effectiveness of the AAT. Ming-Lee Yeh (2008) reported significant improvements for the children who received the AAT treatment on the social skills subscale and total score on the VABS. She also reported that after playing with dogs, children revealed significant improvements on GAS in various dimensions of communication and language as well as increasing their on-task behavior. She concluded by suggesting that her findings supported that AAT was helpful to the children in recognizing their environments as well as practicing higher level interpersonal skills.
Celani (2002) in another study found that children with ASD appeared to prefer drawings of animals to those pictures illustrating humans and interpersonal interactions. Additionally, Martin and Farnum (2002) noted several improvements in children with ASD when they interacted with therapy dogs. They observed improvements in their playful moods, and better attentiveness as a direct consequence of being around the dogs.
Several popular press books, such as a Rupert Isaacson’s (2009) The Horse Boy and Nuala Gardner’s (2008) a friend like henry, have chronicled the unique relationships that have been established with their children with ASD and various animals. Isaacson (2009) in his book The Horse Boy describes how his young son Rowan diagnosed with severe autism related to horses. The Horse Boy traces Rowan’s early difficulties with severe behavioral deficits and speech delays, and highlights the discovery of the innate value of horseback riding. On horseback, Isaacson reported that his son was calm, gave verbal directives to the horse and expressed joy. Both riding and interaction with horses on the ground was beneficial. On the other hand, Gardner (2008) recounts how the strong relationship between her son Dale and a golden retriever named Henry seemed to produce the strong breakthroughs needed in helping her son open up to the world around him. Both authors emphasize the strong bond that was established between their sons and the animals.
13.3 Why people with autism relate with animals
Grandin and Johnson (2005) hypothesize that one of the reasons why some children and adults with ASD relate really well to animals is due to sensory-based thinking. They suggest that animals do not think in words. Both their memories and their experiences are filled with detailed sensory information. A dog’s world is filled with pictures, little smells, sounds and physical sensations instead of words.
The first author often gets asked, “How do you know that animals think in pictures and other sensory information?” The things that animals become afraid of are one indication that they store memories as pictures or sounds. The first author met a horse that was terrified of black cowboy hats. White cowboy hats caused no reaction. The horse’s fear of black cowboy hats developed after a veterinary procedure where alcohol was thrown in his eyes. When this occurred, he was looking right at the person’s black cowboy hat. Animals often associate frightening or painful experiences with something that they were seeing or hearing the moment it occurred. Often, it is a large visual feature on a person, such as a beard or a lab coat. Specific sounds may also trigger a fear reaction. For example, one elephant was known to fear diesel powered engines, but gas powered engines caused no reaction. The distinctive sound of a diesel engine was associated with a frightening past experience. In non-verbal individuals with ASD, similar “fear memories” that are linked to sensory stimuli may occur. Scientific studies have also shown that animals store information as either pictures or sounds. Birds are able to remember where they stored food and migrating birds remember visual landmarks (Grandin and Johnson, 1995). Even ants remember visual images (Judd and Collett, 1998).
There is neurological evidence that language may cover up the sensory-based thinking which is present in all people. In some cases, frontal-temporal lobe dementia (a type of Alzheimer’s disease) destroys the frontal cortex and the language areas of the brain. In some patients, artistic and musical abilities will emerge in an individual who had no previous interest in art or music (Miller et al., 1998).
13.4 Sensory oversensitivity
One of the reasons why AAT is successful for some children and adults with ASD and not successful for others is due to sensory oversensitivity. A person with ASD may not be able to tolerate the smell of a dog. Another may have auditory oversensitivity and the sound of a dog barking may hurt his/her ears. When the first author was a child, the sound of a school bell felt like a dentist drill hitting a nerve. Even if the dog is trained not to bark, the individual may fear the dog will bark. Sensory oversensitivity is extremely variable. One may gag when s/he smells a dog and another may like the smell. A dog barking will not bother some and others will run screaming away from it. Persons with ASD who actively avoid dogs often do so because they have extreme sensitivity to either sound or smell.
For years, autobiographies by people with ASD have reported problems with hypersensitivity. Grandin (1995) in her book, Thinking in Pictures, quotes many of the early self reports. One person reported that rain sounded like gunfire. Researchers have now documented that problems with sensory oversensitivity are real (Crane et al., 2009; Davis et al., 2006; Gomes et al., 2008; Leekam et al., 2007; Wiggins et al., 2009). Both reports in the scientific literature and practical experience have shown that individuals with many other diagnoses such as ADHD, dyslexia, learning problems, and head injuries may also have problems with sensory oversensitivity (Ghanizadeh, 2009; Romanos et al., 2008; Shochat et al., 2009). Grandin (2008) reviewed additional research on sensory oversensitivity. Some children and adults with ASD cannot tolerate fluorescent lights. They can see the 50 or 60 cycle flicker. This makes them feel like they are in a disco with a strobe light. The small compact fluorescent light bulbs that screw into a lamp may also flicker and cause problems. One study showed that children with ASD had more repetitive behaviors in a room with fluorescent lights (Coleman et al., 1976). Some individuals on the spectrum have problems with fluorescent lights and others do not. If a person with ASD was introduced to a therapy dog in a room that caused sensory overload, s/he may not have a good reaction to the dog simply because of the room. To accurately judge how a person with ASD will react to a dog, the individual needs to be in a quiet place away from fluorescent lights or other sensory distractions.
13.5 Factors that worsen sensory problems
Sensory problems often get worse when an individual with ASD gets tired. A child who can tolerate a crowded supermarket in the morning when they are rested may not be able to tolerate it when they are tired. When the individual gets tired, they may feel like they are inside the speaker at a rock concert. People with ASD call this sensory overload. When sensory overload occurs, the individual may start screaming or they may just shut down and not respond. No learning can occur when overload happens. To recover, the individual has to get away from the overstimulation and calm down in a quiet place. One of the difficulties when doing research on sensory oversensitivity is its variability. This is because one person with ASD may react badly to a stimulus when others do not.
13.6 People with autism and sensory-based thinking
Many people with ASD are sensory-based thinkers. Grandin (1995), in an earlier publication, revealed that she thinks in pictures. Words narrate the pictures that pop up into her imagination. She suggested that her mind works like the Google Internet search engine for Images. She explained that all her thoughts are in photo realistic pictures (Grandin, 1995). This really helped her in her work with animals. For example, she explains that in her early work with cattle, she got in the vaccinating chute to see what the animals were seeing. She did this to determine why they often balked and refused to move through the chute. She discovered that they were afraid of shadows, dangling chains, reflections, and other distractions (Grandin, 1980; Grandin and Johnson, 2005). When she first started doing this, many feedlot managers could not understand what she was looking for. It was difficult for them to understand because they thought in words, instead of detailed visual, auditory, tactile, and smell sensations. The first author believes that for herself, vision is her preferred sense. For different individuals with ASD, the other sensory systems may be used as they perceive the world. Tito Mukhopadhyay, in his book How Can I Talk if my Lips Don’t Move? and Donna Williams in her numerous books, describe how they are auditory thinkers. Hearing is their preferred sense because their visual system provided unreliable and distorted information. Williams (1996) described walking through a yellow kitchen that had fluorescent lights. She stated, “I saw shapes and colors as it whooshed by.”
Some non-verbal individuals are tactile and smell thinkers. The circuits in the brain that process sight and hearing may be providing them with distorted information. Several individuals have reported that their hearing would fade in and out (White and White, 1987). It may be like trying to use a mobile phone with a really weak signal that keeps “breaking up.” Professionals who work with individuals with ASD who are non-verbal have told the first author they believe that smell and touch may be the only senses that provide their clients with accurate and reliable information. Even though these people are not blind and are not deaf, their brain may process tactile sensations and smells more clearly than auditory or visual ones. The first author has observed that some non-verbal individuals may tap many objects and smell things. For example, she recently watched one non-verbal teenager tap everything around him. His motions were similar to a blind person who is really skilled with the white cane. He tapped and smelled objects in order to perceive them. This would explain why some non-verbal individuals, when they are first introduced to a therapy animal, may want to explore it through smell and touch. One individual with very severe visual processing problems told the first author that he had to touch every part of a dog and its leash to fully determine what it was. He had to feel the entire leash and feel how it was attached to the dog to understand what the leash was for. He also had to touch the collar and unfasten it to determine that the leash and the collar were not a permanent part of the dog.
Prothmann et al. (2009) initiated a study to assess the preference for and the responsiveness to dogs by persons with ASD. The researchers concluded that animals, specifically dogs, might make their behavioral intentions more easily understandable to persons with ASD because they do not communicate both verbally and non-verbally. They inferred that one of the major deficits in persons with ASD is their inability to combine the coordinated and parallel understanding of verbally transmitted emotion-related information and non-verbally transmitted emotion-related information. In essence, a dog’s communication is not bundled with verbal and non-verbal intricacies. Dogs communicate non-verbally and portray their intentions with their body language. This is why it may be much easier for persons with ASD to understand them.
Over twenty years ago, Baron-Cohen et al. (1985) introduced the theory of mind hypothesis to explain the main symptoms that characterize the neurodevelopmental deficiencies that accompany autism. Baron-Cohen furthered the work on theory of mind in his book Mindblindness (Baron-Cohen, 1995). According to Lantz (2009):
Theory of mind is the ability to attribute [these] mental states to self and others in order to understand and predict behavior. It involves making the distinction between the real world and mental representations of the world. Individuals with autism spectrum disorder tend to be less proficient “mind readers” compared to people who are typical.