Therapy Dogs Serve Children with Autism

The beginning

She padded into the room and sat by the old man's bed. He was very frail and could no longer raise his head or move. His skin was thin and transparent. Seated facing the man, Katie looked back over her shoulder at me for approval. I nodded. Then I watched in wonder as she carefully placed her front paws on the side of the bed and slowly, with great care, simultaneously spread her paws as she raised herself on her back legs. Now her head was very close, but not touching his. She was where she wanted to be. Their eyes met. "Hello Friend. I have come to visit you."

Katie taking a break during
a therapy work session

That was more than 15 years ago. Katie was my one-year-old black standard poodle. Since that moment in the nursing home with her, I have been in love with therapy dog work.

Katie introduced me to therapy dog work and Molly helped me develop it. Molly was an outstanding therapy dog. Together we turned the corner from therapy dog volunteer work to working with a dog in the provision of therapy. With her by my side at work, I felt blessed as I witnessed the power of the primal human-animal bond and the intelligence and sensitivity of my poodle. Molly is almost 15 years old now and is semi-retired. Even though two other therapy dogs, Delilah and Spring, now do most of our work, I carry an enduring sense of gratitude to my "Miss Molly."

I retired from the public school system in June 2011, but for almost 20 years I worked as a school psychologist for a county special education cooperative. It is comprised of a number of school districts and provides educational programming and services for students whose educational needs cannot be addressed within their home districts. As a school psychologist, I worked with children with special needs. For 16 years of my career I worked in an early childhood special education program. In the last 18 years one disability's incidence, autism, has dramatically increased. The Centers for Disease Control and Prevention (CDC) estimates that an average of one in every 110 children is affected by autism.

One of the first therapeutic approaches to autism to come to the forefront was methodology from the field of applied behavior analysis. Ivar Lovaas and colleagues, UCLA, provided evidence that with intensive intervention the functioning of kids with autism could be substantially improved. Parents began asking, with varying degrees of insistence, for schools to provide this discrete trial teaching, or what many called ABA Therapy. Some situations escalated to lawsuits demanding that school districts provide the service. A district near us was one of them and lost the lawsuit. I went to New York to receive training in applied behavior analysis as a way to teach students with autism and other disabilities.

Around the same time, other approaches to treating and educating children with autism emerged toward mainstream. Our program began to offer a combination of approaches that together satisfied our parents that their beloved preschool children were getting what they needed at school. So, in addition to my regular responsibilities as a school psychologist, I began to provide one-on-one ABA therapy to some of our students. I did this for seven years. One of the first kids with whom I worked was named AJ. He was four years old and nonverbal when we started working together. He was receiving an array of services including speech and occupational therapy. Six weeks after we started working with him our team held a meeting to report his progress. As I was going over what AJ and I had been working on together, his mom interrupted, "He called me Mommy! I never thought he would call me Mommy!" Everyone around the table had tears in their eyes. I still tear up as I remember it now. AJ was on his way!

A milestone

Molly greeting AJ at school

The following summer I asked AJ's mom if she would be interested in AJ trying some animal-assisted therapy. I wanted him to have a relationship with a friend in which he would have all the language he would need to communicate. I wanted him to experience the interactive reciprocity that could come from learning how to give cues to a dog. I suspected that if he could be the teacher, the instruction-giver, he would be a better learner, a better instruction-receiver. I had noticed in my work with kids with autism that there came a point in the progression of discrete trial teaching where the students began to imitate being the teacher. If I allowed some time for this role reversal, then the kids became more engaged and invested in the process. So, I began to think of ways to give them more of these kinds of experiences. I wondered if learning to give cues to a trained therapy dog would improve their communication and social skills.

AJ was learning such things as the value of greeting others as he and Molly met for the first time each week. He learned the importance of eye contact as he practiced asking Molly to "Watch me." He experienced the power of choice as he decided what cues he wanted to give and what he wanted to do during his breaks. He leaned that he had the power to influence others and felt the security of a predictable routine. One of the most unexpected outcomes was that AJ imagined an ongoing relationship with the dog for a long time after the sessions were completed. He told his Mom that the dog guarded him at night. This was extraordinary considering that children with autism typically have limited imaginative play.

Later, AJ's mother wrote a letter of recommendation for me. She felt AJ had not only improved in his ability to take instruction, but that he was following directions involving more steps. His language had improved. He had begun to engage willingly in discrete trial teaching with his mom at home, something she had been trying to do with him for years.

In less than a year, AJ had gone from nonverbal to spontaneously describing experience. A relationship with a nonverbal creature had helped him learn to speak.In less than a year, AJ had gone from nonverbal to spontaneously describing experience. A relationship with a nonverbal creature had helped him learn to speak.

The start of a dream come true

Years later, I left the early childhood program and began working with older children in our county special education programs. One of the classrooms I covered, a middle school program for kids with autism, had a teacher who understood intuitively the value of partnering with dogs in working with students with autism. She welcomed the opportunity for her students to work with my therapy dog. The following year we were assigned to a new high school program for kids with autism. The time for a formal, systematic, professional program of animal-assisted intervention had come; my dream was beginning to come true.

The high school class was designed to meet the needs of students with autism. It also serves students with other disabilities who need the structure and supports that an autism program provides. It's called PALS (Providing Alternative Learning Systems).

In Illinois, the educational definition of autism is:

Autism is a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three that adversely affects a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child's educational performance is adversely affected primarily because the child has an emotional disturbance.

It is a broad definition, distinct from the medical definition, and reflecting a range in degree of impairment and symptomology that is referred to as the autism spectrum. Students with autism are referred to as on the spectrum. In designing programming for students on the autism spectrum we are legally required to consider and support a variety of needs in the areas of communication, social interaction, sensory regulation, resistance to change in environment and/or routine, and repetitive, stereotypical, or any behavior requiring intervention and/or that impacts progress in the general curriculum. It's a tall order, and in many cases requires creative thinking and problem-solving by a multidisciplinary team. So how can a psychologist and a poodle partner help? Let me share some of our experiences related to the variety of needs experienced by autistic children.

Communication

"Molly Dog Miss Pat Trevor"

These are the words we heard from a high school student with autism as he watched himself on video working with Molly. It's a poignant moment for staff. For many of our autistic students, spontaneous attempts to describe experience are uncommon or nonexistent. We were thrilled.

In educating or providing therapy for children with autism, or any other student, the overarching challenge becomes how to connect with them in a way that makes sense to them. Unlike the majority of students who are auditory learners, students with autism are usually visual learners. Hearing and understanding verbal language for them can be like listening to a radio broadcast that is full of static. It's a struggle to make sense out of it, and it's irritating. Autistic students need visual directions, visual sequencing of tasks, and visual schedules. We need to communicate with them nonverbally as much or more than they need to learn how to communicate with us verbally.

Speech therapists lead us in helping students to develop verbal language. The entire staff has to focus on communicating nonverbally. This involves minimizing talking—probably the most difficult challenge for everyone the staff! Everyone, that is, except for the therapy dogs. To the students' relief, the dogs never talk. They are natural nonverbal communicators!

In her book, Animals in Translation, Using the Mysteries of Autism to Decode Animal Behavior, co-author and person with autism Temple Grandin, PhD, states, "Autism made school and social life hard, but it made animals easy." Dr. Grandin has a special connection with animals that she attributes to her autism. She believes that, "Autistic people are closer to animals than normal people are," in terms of how they perceive the world.

So, fostering this special connection by partnering with an intelligent dog like a poodle makes sense when working with students with autism. It brings the potential for connection that may not occur without the animal. I have not only observed my Molly prompt a student to continue an activity that was part of a sequence, I have seen her and the student maintain prolonged eye contact. Kids with autism seldom make eye contact with people, much less sustain it. I wonder how Molly knew how to prompt the student appropriately? Why did the student choose to make and keep eye contact with her? The dog and child "get" each other in a way that I am not a part of, and when I observe it I feel privileged.

One day we were working with a student in the class who is blind. The student, who I will call Shelly, was playing ball with Molly. It would start with Molly positioning herself in front of Shelly in a seated position. I would say, "Ready, set, go" and Shelly would throw the ball. Molly would run and retrieve it. We did this over and over. Then something amazing happened. Shelly threw the ball directly into Molly's mouth five times in a row! It was not a chance happening. Somehow they each had figured out how to position themselves to make it work. It was communication. It was reciprocal social interaction.

Social interaction

Reading and responding to other people's behavior with social skill is, by definition, a challenge for students on the autism spectrum. In my opinion, it's not that students with autism don't want to connect with others. It's that they don't know how to go about it or they are overwhelmed in a situation or preoccupied internally. We teach social skills directly and try to provide opportunities for the students to use the skills. And, because our students are visual learners, teaching them has involved the construction of visual instructional materials.

One of the first materials I made was in pursuit of a way to guide the students to greet Molly and then choose which, if any, type of interaction they would like to have with her. A combination of pictures, words, and Braille, the tool is a small, spiral bound book with laminated pages. The cover has a black line-drawing of a stick figure waving Hi and a head shot of Molly. Each subsequent page pictures a type of activity and an affirmative sentence such as, I would like to pet Molly or I would like to play ball with Molly. Two small different-colored squares, one with Yes, one with No, are attached with Velcro above the page so that the student can pick off a square and place it in a designated answer spot to indicate his or her choice. The book helps students start an interaction and then choose if and how they would like to participate.

I have seen a student who had been afraid to be near Molly choosing, through use of the book, to touch her for the first time. Most of the students go through the pages and pick out what they want to do. Their choices are honored, even if they choose not to engage. I believe that when we honor their choices consistently, students will at some point choose to engage. In my experience, that's what usually happens.

Molly and Delilah getting photos
taken for students' visual schedules

Several years ago Delilah, a black standard poodle, became a member of our family. Soon afterward, she began the training process to become a therapy dog. She earned her CGC and was going through the evaluation process to become certified when we visited some young patients in a psychiatric ward. Deli, as the kids now call her, passed that part of the evaluation with flying colors. She was calm, gentle, and very interested in making friends with each child. After the general ward visit, we entered a locked wing to visit a child with autism. With the help of the choice book, Molly began to show Deli how it's done!

The child chose not to touch Molly initially, but by the time we were finished she had initiated two interactions with us. She handed me pictures she had drawn and offered Molly a french fry from her lunch. In a short time, with the presence of the dogs and minimal use of the choice book, she had grown from a child who repeatedly ran away into her room to a child offering us gifts. The observing hospital staff members were very surprised.

Sensory regulation

Imagine what it might be like to have excessive sensory experiences! The lights are too bright, sounds are too loud. You get the willies when you touch things like glue or dough. Common foods smell, taste, or feel uncomfortable in your mouth so you don't want to eat them. Now imagine having insignificant sensations. Your pain threshold is so high you hold on to hot things and burn your skin. You feel agitated because normal amounts of movement don't keep you calm. You crave or avoid physical pressure or movement or sights, sounds, or smells.

Many people with autism have to deal with these kinds of experiences. They may differ in kind and degree, but sensory regulation problems tend to come with autism. Some students enjoy the feel of soft, clean poodle hair, but some don't. Most students find walking the dogs calming. Sometimes it's stimulating. If a student has withdrawn into his autism, a walk can center and bring forth engagement. I have one student who sings when he walks dogs. We are still exploring the ways in which the dogs can help the students' sensory needs.

Resistance to change

One of our students occasionally soiled his pants and typically resisted getting up and going to the bathroom. His teacher said it could be "an all-day process to get him up and to the bathroom." As this was going on one day, I held Molly's lead toward the student and asked if he wanted to take her for a walk. He immediately got up and walked Molly to the bathroom door. We waited outside the bathroom, and when the student was finished he walked Molly back to his classroom. This strategy to help overcome his resistance to transition to the restroom was used whenever Molly and I were there and the need arose. It worked the majority of the time.

One day Molly and I came to school to find out it was "picture day" and we needed to take the students to the auditorium to have a group photo taken. This not only meant a change in routine, but also a transition to an unfamiliar room. We arrived at the auditorium with minimal incident and all of the students, except one, stepped up to the stage with little trouble. One student entered the auditorium, sat down about two-thirds of the way from the stage, and refused to get up. When offered the opportunity to walk Molly to the stage, he got up right away, walked up and on the stage, and held Molly's leash while the class photo was taken. The photo was in the yearbook!

Trevor and Molly posing
for a yearbook photo.
Molly keeps an eye
on her friend.

Another day one of the classroom assistants hurried into the room and said, "Richard is in the hall and he won't come back into the classroom." Molly and I stepped into the hall. Richard saw us and asked, "Walk Molly?" A short walk later, the student returned to the classroom.

Our students can also have difficulty transitioning from one emotional state to another. At times they seem to get stuck in a feeling and their discomfort can be prolonged. For example, following a gentle verbal reprimand by a classroom assistant, one of our students seemed to feel very deeply hurt. He cried and cried with such sorrow that we became concerned. We had no verbal way to help him gain perspective and calm down. So, we offered him Molly's leash. He, his aide, Molly, and I took a few laps around the room and he calmed.

Behavior

When students don't have much language or skill socially, it's sometimes very difficult for them to manage strong emotions. Adolescent feelings, in particular, can change and intensify rapidly. High-school boys are rapidly becoming young men and are growing big and strong. This is a critical time to teach them strategies to manage angry feelings.

We had one student who was especially in need of such help. When he was upset, it was frightening. His teacher and I came up with a strategy. I made a laminated card not much larger than a playing card. On one side it said, in black-line drawings and words: 1. Stop, 2. Step Back 3. Breathe.

On the other side was a picture of the student with Molly. The photo had been taken right after he had walked her for the first time. I hoped the vision of a peaceful, happier time would function as a neurological bridge back to calmer, more rational behavior. The teacher wore the card on her lanyard with other frequently used visual instructions. She discovered that it worked! And, more than a year later and after some staff changes including that teacher, the card was still in use. When paired with gentle visual guidance, the image of a trusted canine friend can bring peace.

Moving forward

The puzzle of autism continues to provide challenges. There are many dedicated people around the world searching for effective ways to research, diagnose, treat, and educate people with autism. Research demonstrates that partnering with canines is one valuable method of helping those with autism; Katie, Molly, Delilah, Spring, and I have been happy to be part of that success.Research demonstrates that partnering with canines is one valuable method of helping those with autism; Katie, Molly, Delilah, Spring, and I have been happy to be part of that success.

We are moving forward with our work by starting regular visits to an autism ward at a behavioral health hospital. I also opened a small dog training company called "We Just Click!" where my dogs and I train others to work with therapy dogs. In addition, in January 2012, Special Kids & Dogs begins—a class for kids with special needs who want to learn how to train dogs. My therapy dogs will be their initial students. From there, my hope is that some will go on to train their own dogs. Perhaps some will train their dogs to be therapy dogs and help others.

My dogs and I have experienced many challenges, and many happy victories, with autistic students. Dogs of all breeds and breed combinations have the potential to be wonderful therapy dogs. But, if you ask me, when it comes to therapeutic canines, the poodle is just the best!

About the author

Patricia Stokely, KPA CTP, combined her skills as an educator and dog trainer, and her love for children and dogs, into a remarkable career as a school psychologist with a focus on autism and animal-assisted therapy programs. Her mission continues to be fostering the human-animal bond and sharing the perspective and joy of clicker training.