In puppy love: How an assistance dog can enhance the life of a child with a disability

By K. Nattrass, AB, B. W. Davis, BS, Sheila O'Brien, MEd, Gary Patronek, VMD, PhD, and Mia MacCollin, MD

The role of dogs in the care of children is surprisingly broader today than just the familiar guide animals for the blind. Do you have a patient whose autism or ADHD or other disability might benefit from "paws-on" attention?

Anna* wakes each morning to a cold nose in her face. It's Shasta,* her service dog, who helps Anna out of bed and into her wheelchair while her parents go about their morning routine. As Anna's mother calls upstairs for the children to hurry, Shasta, a golden retriever, retrieves clothes from a pile set out the night before and helps Anna dress.

One of Shasta's most important jobs comes later, during evening homework. Before Shasta came to stay here, Anna would intentionally drop her pencil to delay doing her homework until her mother, busy with the other children, could bend to pick it up. But an excuse like that doesn't work with Shasta around. Now, should Anna drop her pencil, Shasta picks it up and returns it to her without being asked.

Except for school hours, Shasta is always by Anna's side. And, although Shasta is trained to facilitate the girl's physical independence, Anna sees her more as a best friend. There are other benefits, too: "Now, instead of seeing the girl in the wheelchair," Anna says, "they see the girl with the cool dog."

Shasta is a new kind of assistance dog: She has been specially trained to work with a child. The work of these dogs is often misunderstood; what they do differs in several important ways from what so-called therapy dogs do. A therapy dog works under its owner or a trained therapist to provide therapy in a medical setting. An assistance dog lives and works with its owners to provide constant physical, mental, and emotional benefits (see "A glossary of the assistance dog").

Professional training of assistance dogs began in the 1920's with guide dogs for the blind. In the 1970's, the definition of assistance dogs was expanded to include hearing dogs for the deaf and service dogs for the physically disabled. The 1990 Americans with Disabilities Act (ADA) extended legal protection to dogs specifically trained for service to a disabled person. Since then, the realm of assistance dogs has been expanding steadily to include seizure alert and response dogs and social dogs for people with a mental or emotional disability, to name two examples of the variety of services that a dog can be trained to perform for a person with a disability.

Not until recently, however, did children begin to consistently receive assistance dogs. The reason? These animals require a great deal of attention and responsibility, not to mention care and maintenance—something that a disabled child may be unable to cope with alone. As a result, the idea of a facilitated assistance dog was developed, in which child and guardian (usually, a parent) undergo extensive training in how to work with and maintain their assistance dog. Providing service, hearing, and social dogs for children is now a growing part of the work of many assistance dog organizations.

Benefits

Assistance dogs were first developed to provide physical independence to their physically handicapped owners. For service dogs, the innumerable list of tasks might include turning light switches on and off, taking off a jacket, retrieving items from the cupboard, and opening doors. For the owner of a hearing dog, being alerted to his or her name being called and to the alarm clock, oven, microwave, telephone, and fire alarm is an all-important benefit.

But physical benefit is only one, relatively small advantage of having an assistance dog. Over the past several years, we have conducted an outcomes study of children who receive an assistance dog from a single provider (the National Education for Assistance Dogs Services). In this ongoing, unfunded, and unpublished study, we have found that they also provided cognitive benefits, including improved focus, soothing and calming effects, and improvement in the child's mood. For an autistic child, a specially trained dog can precipitate cognitive shifts in understanding and relating to other living beings.

We have also observed a medical benefit in some cases—namely, a reduction in the dosage of medication and the integration of the dog into therapy sessions. For example, Micah, a young adult who received a service dog as a teenager, has been having trouble preparing for life in an independent living center. Working with an occupational therapist, he has devised cue cards with pictures of his dog, Temoku, which incorporate his activities of daily living in real-life situations.

It may be, in some cases, that the potential benefit of an assistance dog is limited by the practitioner's unfamiliarity with these dogs and what they can do. To that, we respond: Be creative! Having the child issue commands to the dog—"Come,"' "Sit"—can be used as speech therapy. Brushing the dog can increase range of motion. And walking with the dog can be used in a therapeutic program of promoting mobility. The possibilities are far-ranging.

Consider the experience of Charlotte, a 12-year-old who has autism-spectrum disorder (ASD). She has enjoyed many of the benefits we've just mentioned by working with Hobbes, her social dog. Charlotte's family has been delighted to find that her moods are easier to handle since Hobbes joined the family, and that motivating Charlotte to leave the house has become less stressful, because "Hobbes is coming, too." Hobbes has helped Charlotte develop a sense of "others" and an understanding that animals, like people, have feelings—a difficult lesson for many autistic persons. Hobbes provides at-home physical therapy and neuromuscular stimulation through tugging and play with Charlotte. He facilitates social interaction by providing a focus when Charlotte's friends from school visit; friends are difficult for an autistic child to make and keep, but interacting with Hobbes keeps Charlotte's friends entertained, and they enjoy visiting in part because of him. The greatest benefit, however, is that including Hobbes in Charlotte's activities has provided stable social support and enriched her highly structured world. By adding Hobbes to the family, "Charlotte's world has expanded by 33%!" her father declares.

An unforeseen, but often noted, benefit of the presence of an assistance dog for an adult is its effect on the whole family. This benefit was magnified in our study of children. "He's like having a friend for me, too," admitted one mother whose child's autism and resulting needs limit her social life.

Often, we've heard families with a disabled child say that can't imagine trying to raise and train a puppy, even if they are aware of the benefits a companion animal might bring their family. As one parent noted, "Sometimes, having an autistic child is like having 18 children!" Yet we have seen—in the parallel experience of adding a well-trained adult assistance dog to the family—how the entire family benefits.

For an adult with a disability, social benefit is often the most cited advantage of owning an assistance dog. We have found similar results in our study of pediatric assistance dogs. Assistance dogs become the social support of chronically ill children. "He's my best friend," was the declaration echoed by several children who have an assistance dog—underscoring the important social role such a dog can play for a child who may be ostracized by peers. For a child with a serious medical condition, this means a friend who is available during long periods of illness and hospitalization; for an autistic child, the dog can provide the kind of security in routine that makes daily tasks easier to cope with. We have found that nearly all families we interviewed thought their child's quality of life had improved since receiving an assistance dog.

Are there risks?

Having an assistance dog carries some potential risk and difficulty.

• Owning a dog is expensive. The family must be made aware of the potential cost. Many organizations subsidize all or part of the initial purchase and training costs, but few help with maintenance—food, veterinary care, and so forth. Some veterinarians offer a discount on office visits or medications for assistance dogs, but they are the exception. When a family isn't certain that they can afford as much as $1,000 or more a year on the care of the dog, they should be asked to reconsider their interest—for the sake of the dog.

• The care of an assistance dog requires a sacrifice of time. The patients and family must spend a great deal of time maintaining their dog's training. Like children, dogs are more likely to develop behavior problems without constant loving adult guidance and training. Patient and family must also understand that, as many families in our study noted, this animal "is just a dog": It isn't a robot, and it will do only what it has been trained, encouraged, and trained again to do. Feeding, grooming, and exercising the dog—all in addition to the time spent maintaining training—may be a burden.

• The family may meet resistance in public. They must realize that, although access to public places with an assistance dog (and with other assistance animals) is protected under the provisions of the ADA, many businesses are ill-informed about those provisions and unfamiliar with the variety of assistance dogs; it is important that you prepare the family for possible resistance.

• Assistance dogs may increase the visibility of a disability and draw the curious. Many respondents to our survey considered this a benefit; they think it helps explain to the public that "not everything is normal." Some, however, were uncomfortable once they realized how obvious their hidden disability became when they were accompanied by a dog in a cape. You can help your clients decide whether they are able to deal with the attention. We have found that assistance dog owners may feel overwhelmed by all the time they spend informing the public about the dogs, although we found that young patients generally enjoyed the attention and the focus on their well-trained dog, instead of on their disability.

• Nothing is forever. People change, and so do dogs. The natural lifespan of a dog or a career-ending change in the disability of a young person may bring a cherished relationship to an end. As with any pet, the family must take into account the inevitability of change and contemplate how they will engage the natural grieving process at the end of this relationship.

Myths about medical risks

Many practitioners are concerned about medical risks—infection, allergy, bites—associated with dogs in public places and patients' homes. Those concerns aren't unfounded, but most are overestimated. Although the risk, especially in a medical setting such as a hospital or physician's office, is always a concern, our study, which included dogs that accompany their owner on medical visits and hospital stays, did not demonstrate transmission of disease. A vaccinated, well-cared-for assistance dog should not be a risk to a healthy person, although it is prudent to limit contact around patients who have an open wound, a known allergy, or fear of dogs (cynophobia).

Dog allergy is common. As is the case when taking in any pet, the patient's family should ensure that the patient and everyone else in the household are not allergic to a dog or that they can be adequately treated for a dog allergy with the dog present.

Dog bites are a concern, of course. But all assistance dogs have undergone extensive evaluation and training, and any that show even a remote sign of aggression are failed. This doesn't mean that accidents never happen, but we are unaware of attacks or even accidental bites by assistance dogs.

Helping your patient choose

With some awareness of the possibilities and realities of owning an assistance dog, you can help your patients and their families decide whether an assistance dog is right for them. Keep in mind that most of your patients have never considered going this route and may be completely unaware of how to get information about what an assistance dog can do for them and how they can begin the application process.

So when you have a patient with a physical, mental, or emotional disability, why not ask whether the family has considered a dog? Assistance dog organizations can be found throughout the United States, and Assistance Dogs International, Inc., offers an up-to-date listing of reputable providers (at www.adionline.org ). Not all of these organizations provide assistance dogs for children at this time, but they may be willing to explore the possibility, or may be able to point the family in the right direction. And offer families a copy of the "Guide for Parents" to help them decide whether assistance dog ownership is right for them.

The parent guide on working with an assistance dog may be photocopied and distributed to families in your practice without permission of the publisher.

SUGGESTED READING

Allen K, Blascovich J: The value of service dogs for people with severe ambulatory disabilities: A randomized controlled trial. JAMA 1996; 275:1001

Hart LA, Zasloff RL, Benfatto AM: The socializing role of hearing dogs. Appl Anim Behav Sci 1996;47:7

Mader B, Hart LA, Bergin B: Social acknowledgments for children with disabilities: Effects of service dogs. Child Dev 1989;60:1529

Valentine DP, Kiddoo M, LaFleur B: Psychosocial implications of service dog ownership for people who have mobility or hearing impairments. Soc Work Health Care 1993; 19:109

MS. NATTRASS was a graduate student at the Center for Animals and Public Policy, Tufts University School of Veterinary Medicine, North Grafton, Mass., when this article was written. She is now an intern at the International Foundation for Animal Welfare, Boston.

MS. DAVIS was a graduate student at the Center for Animals and Public Policy, Tufts University School of Veterinary Medicine, when this article was written. She is now program coordinator for Phinney's Friends/Massachusetts Society for the Prevention of Cruelty to Animals, Boston.

MS. O'BRIEN is executive director of National Education for Assistance Dogs Services, West Boylston, Mass.

DR. PATRONEK was director of the Center for Animals and Public Policy at Tufts University School of Veterinary Medicine when this article was written, where he also held the Agnes Varis University Chair in Science and Society and was assistant professor of environmental and population health. He is now a clinical assistant professor at the Center for Animals and Public Policy.

DR. MacCOLLIN is a fellow at the Center for Animals and Public Policy, Tufts University School of Veterinary Medicine, and assistant professor of pediatrics and neurology at Harvard Medical School, Cambridge, Mass. She welcomes correspondence from readers at maccollin@helix.mgh.harvard.edu.

The authors have nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article.

*The names of all patients and assistance dogs mentioned here have been changed.

A glossary of the assistance dog

The official umbrella definition

Service animal—In the language of the Americans with Disabilities Act, "any guide dog, signal dog, or other animal individually trained to provide assistance to individuals with a disability."

Types of assistance dogs used by children

Facilitated assistance dog—A dog that is part of a team with a third-party facilitator (such as a parent), due to the child's inability—because of age or lack of cognitive or physical skill—to be the sole caretaker of the dog.

Hearing/signal alert dog—A dog trained to perform specific tasks for a hearing-impaired child.*

Service dog—A dog trained to perform specific tasks for a mobility-impaired child.* The dog's tasks may include, but aren't limited to, carrying a backpack, picking up objects from the floor or other surfaces, turning on a light switch, and pulling a manual wheelchair.

Social dog—A dog that primarily addresses the cognitive, emotional, and psychological needs of a child. The dog may be trained to assist with physical tasks but its principal role should be to provide emotional support and facilitate external social relationships.

Specialty dog—A dog trained to perform functions from two or more of the categories described above (e.g., a hearing/service or a service/social dog).

*Can also serve as a "facilitated" dog in the model described under "facilitated assistance dog."

A parting thought

You have the opportunity and ability to become a voice of guidance and advocacy in the emerging field of providing child-health service animals. Two examples:

• Providers of assistance dogs need advice from pediatricians about how a child's need for an assistance dog differs from an adult's need.

• Many assistance dog organizations provide trained facility dogs, as they are called, to accompany practitioners and therapists on daily rounds. (Interested in taking your involvement a step further? Assistance dogs can be incorporated into the work of a medical practice!)

The possibilities are many. The result may be worth the cost of a few lint brushes.