Assignment: Prospective Case Control Study

Assignment: Prospective Case Control Study
Assignment: Prospective Case Control Study
H. F. Wright1 • S. Hall1 • A. Hames1 • J. Hardiman1,4 • R. Mills2,3 •
PAWS Team4 • D. S. Mills1
Published online: 2 April 2015
? The Author(s) 2015. This article is published with open access at
Abstract This study describes the impact of pet dogs on
stress of primary carers of children with Autism Spectrum
Disorder (ASD). Stress levels of 38 primary carers ac-
quiring a dog and 24 controls not acquiring a dog were
sampled at: Pre-intervention (17 weeks before acquiring a
dog), post-intervention (3–10 weeks after acquisition) and
follow-up (25–40 weeks after acquisition), using the Par-
enting Stress Index. Analysis revealed significant im-
provements in the intervention compared to the control
group for Total Stress, Parental Distress and Difficult
Child. A significant number of parents in the intervention
group moved from clinically high to normal levels of
Parental Distress. The results highlight the potential of pet
dogs to reduce stress in primary carers of children with an
Keywords ASD ? Autism ? Child ? Family ? Carer ? Dogs ? Intervention
Autism spectrum disorder (ASD) is a heterogeneous con-
dition defined by the DSM-5 as a person experiencing
persistent difficulties in social interaction in a range of
contexts and as showing restricted, repetitive behaviours.
These problems must have been evident in early childhood,
cause significant impairment in functioning and not be
explainable by intellectual disorders or developmental de-
lays (DSM-5, APA 2013). Parenting children with devel-
opmental disorders, such as ASD is associated with higher
levels of stress, anxiety and negative outcomes (such as
depression and social isolation) when compared to par-
enting typically developing children, or children with other
non-developmental disabilities (Dunn et al. 2001; Koegel
et al. 1992; Weiss et al. 2013; Wolff et al. 1989). High
levels of stress impact not only on the health and wellbeing
of the carers themselves, but can also limit the effective-
ness of the outcomes of ASD interventions (Robbins et al.
1991; Osborne et al. 2008). As such the assessment of
interventions and lifestyle choices that effectively reduce
carer stress is a critically important area for research in
ASD treatment programmes.
The availability of social support and levels of stress
experienced have been associated with successful adapta-
tion of the carer (Koegel et al. 1992; Konstantareas and
Homatidis 1989; Weiss et al. 2013). It has been suggested
that the type of social support may relate to the effective-
ness of stress buffering, with more informal social support
(e.g. spouse, family, friends) acting as a more effective
stress buffer compared to formal or structured social sup-
port (e.g. parenting support groups) (Boyd 2002). Given
that informal social support may be an effective reme-
diation tool for reducing stress in carers it is appealing to
investigate the potential of companion animals, such as pet
Richard Mills was affiliated to the National Autistic Society, London,
UK, while the time of this study.
& H. F. Wright
1 School of Life Sciences, Joseph Banks Laboratories,
University of Lincoln, Lincoln LN6 7DL, UK
2 Research Autism, Adam House, 1 Fitzroy Square,
London W1T 5HE, UK
3 Department of Psychology, University of Bath, Bath, UK
4 Dogs for the Disabled, Frances Hay Centre,
Banbury, Oxfordshire OX17 2BS, UK
J Autism Dev Disord (2015) 45:2531–2540
DOI 10.1007/s10803-015-2418-5
dogs to provide informal social support for parents of
children with ASD.
It could be proposed that because carers already expe-
rience high levels of physical and emotional demands, the
demands of acquiring a pet might increase rather than re-
duce stress. However, there is increasing evidence to sup-
port stress reducing and health enhancing benefits of pets
on individuals and families (Allen et al. 2001; Friedman
and Thomas 1995). Dog ownership has been found to be a
positive factor in supporting individuals in difficult times,
including children affected by serious illness and death of a
parent (Raveis et al. 1993) and in reducing the symptoms
of physical and psychological illness in women coping
with the loss of a loved one (Barker and Barker 1988).
Furthermore, companion animals have been shown to re-
duce the onset and severity of stress-related conditions
(Wilson 1991). Additionally, there is evidence to support
the utility of trained assistance dogs as therapy for children
with ASD (Solomon 2010; Berry et al. 2013), with benefits
such as enhancing family freedom (Burrows et al. 2008),
reducing child stress (Viau et al. 2010) and improving the
effectiveness of therapy sessions (Silva et al. 2011). These
effects are remarkable in themselves for the benefits they
provide for the child with ASD, but they may also induce a
wider positive impact upon parental stress levels, par-
ticularly in circumstances where the dog lives as part of the
family as opposed to being a part of structured therapy
sessions. Indeed, a study by Burgoyne et al. (2014) report
an increase in caregiver competence, although not care-
giver strain, in families living with a trained assistance dog.
The limited number of studies which have explored the
effects of pet dogs in families with children with ASD,
have primarily focused on outcomes related to the child
with the ASD diagnosis. For instance, a recent study by
Grandgeorge et al. (2012) showed that parents reported an
increase in prosocial behaviours in their child with ASD
and a reduction in anxiety with the acquisition of a pet
(including cat, dog and small furry animal). Such beneficial
effects in child behaviours may improve parental stress.
Alternatively, because pet dogs interact with the entire
family unit it is also possible that the dog may elicit similar
stress reducing effects directly in the parent. The only other
(known) study looking at the effects of pet (as opposed to
service/assistance) dogs reports parental opinions on their
perceived benefits and limitations of acquiring a dog in the
family (Carlisle 2014). Indeed, it is important that parents
acquire a dog after careful consideration of both the po-
tential benefits and negative implications of dog ownership.
Due to both the individual nature of ASD and the charac-
teristics of dogs as unique living species it is unlikely that
dog ownership will benefit all families in the same way.
Therefore, whilst the purpose of this paper is to report data
illustrating positive effects of pet dogs for parents of
children with ASD we are keen to point out pet dogs as
effective ASD therapy is still in its infancy and requires
greater scientifically robust evaluations. Our research team
has investigated parental expectations of acquiring a pet
dog and observed some noticeable disparities between
expectations and reality which are important for practi-
tioners and parents to consider when thinking about dog
ownership (Wright, Hall, Hames, Hardiman, Burgess, Mills
and Mills, under review).
As previously mentioned parental stress levels are
thought to be important determiners in the success of ASD
therapy programmes (Robbins et al. 1991; Osborne et al.
2008), therefore, one important stage in developing un-
derstanding of animal companionship in ASD therapy is to
investigate the impact of dog ownership on parent stress.
Given the potential combined benefits for the parent, child
and whole family, pet dogs may be a widely acceptable and
flexible lifestyle change which reduces stress in the carers
of children with ASD. Furthermore, there are many po-
tential benefits of dogs as an intervention in this context;
they are accessible, socially valid and acceptable in most
western cultures, therefore, the aim of this study was to
assess the impact of acquiring a family pet dog on the stress
of carers of a child with ASD.
The research process was approved by the University of
Lincoln’s ethics committee.
Participants were recruited to take part in the study if their
child had a confirmed diagnosis of autism spectrum dis-
order. Because of the heterogeneous nature of ASD we did
not include a strict exclusion criterion for participation, in
order to obtain a sample that reflected the disparity of
characteristics of families in the general population. The
stipulations for participation were that the child was aged
between 2 and 16 years and had had received a clinical
diagnosis of ASD through Children and Adolescent Mental
Health Services (CAMHS), ASD diagnosis was confirmed
verbally by the parents. Parents looking to acquire a family
pet dog were recruited on a voluntary basis via Dogs for the
Disabled’s PAWS (Parents Autism Workshops and Sup-
port) network (Dogs for the Disabled 2013). The PAWS
program involves a series of three professional workshops
that educate parents about dog behaviour, welfare, and
training, whist advising on the suitability of, and integra-
tion of pet dogs into families with children with ASD. In
addition, postings on websites and social networks related
to Dogs for the Disabled and the National Autistic Society
2532 J Autism Dev Disord (2015) 45:2531–2540
(NAS), and word of mouth were used to increase the
number of participants. Demographic data relating to the
child, dog and family were collected. A control group of
parents who did not acquire dogs were recruited through
PAWS and local networks and sampled at matched time-
scales. All parents confirmed they were the primary carer
of the child. All parents in the intervention group acquired
a dog during the study (from Baseline to Post-Interven-
tion), all parents in the control group did not acquire a dog,
or live with a dog during any of the sampling points within
the study.
Intervention Group Participants (Families with a Child
with ASD Acquiring a Pet Dog)
Ninety-three carers were initially recruited into the inter-
vention group; of these, 82 completed the baseline sample
data. Eight of the 11 that dropped out before this time
reported that they had decided not to get a dog within the
timescale of the study (five of these transferred to the
control group), two acquired a dog prior to baseline and so
were excluded; the remaining carer was un-contactable.
Sixty carers provided data in both the baseline (BL) and
post-intervention (PI) samples. Of the 22 that dropped out
between BL and PI, 11 reported that they would not be
acquiring a dog within the study timescale (one of these
transferred to the control group), two were outside of the PI
sampling window, two requested to drop out of the re-
search, four were un-contactable, one got a trained assis-
tance dog and two acquired dogs but subsequently re-
homed them prior to the PI sample (reasons: carer #038
reported that the dog was biting the children, carer #079
was allergic to the dog).
Forty-two carers provided data at all three sample points
(baseline, post-intervention and follow-up); 18 dropped out
between PI and follow up (FU). Of these eight re-homed the
dogs (six due to child-dog issues, one due to child problems
unrelated to the dog, one due to dog training problems un-
related to the child), one requested to drop out of the re-
search, one was not contactable, and seven were outside of
the study timescale (i.e. the date of dog acquisition meant
that it was too late to include them in the follow up sample).
In line with the instructions in the PSI manual (Abidin
1995), four carers were removed from the data set as they
had extremely low ‘Defensive Responding’ scores, indi-
cating that their responses may be strongly biased to pre-
sent a favourable impression.

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