The effects of Animal Assisted Therapy on autonomic and endocrine activity in adults with autism spectrum disorder: A randomized controlled trial.

OBJECTIVE: Stress and its sequelae are very common in adults with autism spectrum disorder (ASD) without an intellectual disability (ID). Animal-assisted therapy (AAT) has shown physiological stress-reductive effects in children with ASD. The aim of the current study was to examine the acute psychophysiological response to an AAT session, and to examine the longer-term stress-physiological effects of the intervention, up until 10 weeks post-treatment, in comparison to waiting-list controls. METHOD: A randomized controlled trial with pre-intervention (T0), post-intervention (T1: 10 weeks) and follow-up (T2: 20 weeks) measurements of neuroendocrine and cardiovascular measures, was conducted in 53 adults with ASD (N = 27 in intervention arm; N = 26 in control arm). Within the intervention group, stress-physiological data were collected during the 5th therapy session (acute effects). Data were analyzed with mixed models for outcome measures cortisol, alpha-amylase, heart rate variability and sympathetic activity. RESULTS: The AAT interventional session was significantly associated with reduced cortisol levels (ß = -0.41, p = .010), while parasympathetic and sympathetic cardiovascular activity remained unaltered. No significant changes were found for stress-physiological measures at post-treatment time points. CONCLUSIONS: Acute stress reduction, reflected in significant reduction in cortisol levels, was found during an AAT session in adults with ASD, without ID. More research is needed to explore to what extent the specific factors of AAT have contributed to the decrease in cortisol and whether stress reduction is possible for the longer-term.

Social Development of Adults with Autism Spectrum Disorder During Dog-Assisted Therapy: A Detailed Observational Analysis.

Social communication and self-esteem are often affected in adults with autism spectrum disorder. Implementation and evaluation of interventions targeting social skills are challenged due to specific characteristics of autism. Intensive, valid evaluation of social skills programs is needed. In this explorative multiple case study, we examined effects and working mechanisms of dog-assisted therapy on social communication and self-esteem, by analyzing detailed observations with Monte Carlo permutation tests (testing against 10,000 random samples) and using self- and other-reports in N=6 high-functioning adults with ASD. Results showed significant positive effects on secure body posture. There was an indication of improved self-esteem and more spontaneous touching of the dog, while no convincing increase was found for verbal initiatives. Cross-correlation analyses revealed that touching the therapy dog may be an important determinant to elicit social development in Animal Assisted Therapy (AAT). Considering preliminary results, we recommend exploring underlying mechanisms more thoroughly with real-time observations, accounting for possible gender-effects.

Effects of Dog Assisted Therapy for Adults with Autism Spectrum Disorder: An Exploratory Randomized Controlled Trial.

Effective treatments of highly prevalent stress-related outcomes such as depression and anxiety are understudied in adults with autism spectrum disorder (ASD). A randomized controlled trial with baseline, post-intervention, and 10-week follow-up, that explores the effects of animal assisted therapy (AAT) was conducted. In total, 53 adults with ASD with normal to high intelligence were randomized in an intervention (N = 27) versus waiting list control group (N = 26). The remarkable adherence to the therapy program by study participants and the program's clinically relevant effects indicate that AAT with dogs can be used to reduce perceived stress and symptoms of agoraphobia, and to improve social awareness and communication in adults with ASD with normal to high intelligence.

Process Evaluation of Animal-Assisted Therapy: Feasibility and Relevance of a Dog-Assisted Therapy Program in Adults with Autism Spectrum Disorder.

(1) Background: Randomized controlled trials (RCTs) are considered the gold standard for evaluating a treatment. However, the results of an RCT may remain meaningless for clinical practice in cases of poor intervention feasibility or fidelity (the extent to which the protocol was executed), or when health care professionals or patients experience the intervention as irrelevant or unpleasant. Feasibility and relevance of psychosocial interventions are highly understudied in adults with autism spectrum disorder (ASD). In order to put the effects revealed in an RCT on an animal-assisted therapy (AAT) program in adults with autism spectrum disorder (ASD) into the context of clinical practice and to formulate guidelines for potential improvements and further implementation of the therapy, the aim of this process evaluation was to gain insight into the relevance and feasibility of the intervention and barriers and facilitators to its implementation. (2) Methods: Data were collected from 27 participants with ASD and three therapists using questionnaires, semi-structured interviews, and treatment reports. Reach, adherence, program fidelity, and program appraisal were evaluated, and barriers and facilitators to recruitment and implementation of the AAT program were explored. (3) Results: The participants were satisfied with the program and evaluated it as feasible and relevant for adults with ASD. The participants documented improving self-insight, joy, relaxation, and physical contact with a therapy dog as the reason of their positive appraisal of the therapy. Documented aspects that may influence feasibility and appraised relevance were the participants' therapy attitude, skills for generalization, and severity of contextual problems (e.g., problems at work, relationship problems). Regarding the sample quality, females and dog owners were slightly over-represented in the RCT. (4) Discussion: Considering the positive evaluation of the intervention and its positive effects revealed in the RCT, the AAT program can be added to the treatment repertoire to reduce stress and improve social communication in adults with ASD. More research in larger samples is needed for better understanding the generalization of the intervention effects, especially in male patients and those who do not have a dog at home.