Attention Research Update

October 2013

"Helping parents, professionals and educators stay informed about new research on ADHD"

David Rabiner, Ph.D.  Research Professor, Duke University


                        Using Dogs to Improve Treatment for ADHD - Intriguing Findings?

Is ADHD treatment going to the dogs?  Literally?  Sorry for the terrible pun but results of a recently published study in the Journal of Attention Disorders [Schuck et al., (2012). Canine-assisted therapy for children with ADHD: Preliminary findings from the positive assertive cooperative kids study. Journal of Attention Disorders, DOI: 10.1177/1087054713502080] suggest that involving dogs in ADHD treatment may yield significant benefits.

There is a substantial history of using therapy dogs in psychosocial treatment settings for children along with anecdotal evidence that it is beneficial.  Results from initial studies also suggest that incorporating interaction with dogs into psychosocial interventions - referred to as Caninie-assisted intervention (CAI) - are beneficial to children with neurodevelopmental disorders such as autism specturm disorders and Down's Syndrome.  However, there have been no randomized trials examining this possibility in children with ADHD.

CAI involves interaction between patients and a trained animal, along with its human owner or handler, with the aim of helping individuals make progress towards achieving therapeutic goals.  In CAI for children with ADHD, children spend time reading to dogs in a structured manner and practice teaching dogs new skills through the use of commands and praise. Interacting with dogs places significant demands on children's attention, and if the child's attention wanders, the dog's behavior draws the child back into actively engaging.  Thus, the child must remain focused - or quickly refocus - attention to the task at hand.  According to the authors, structured interactions with dogs thus  provides an attention training experience for children.

This is an interesting idea, but is there any evidence that it works?  That is what the authors sought to find out.

Participants were 24 7-9-year old children (85% boys) diagnosed with the combined type of ADHD, i.e., they had both inattentive and hyperactive-impulsive symptoms. All participants received 12 weeks of social skills training intended to help them develop and practice the skills required to make and maintain friendships.  Their parents received 24 hours of behavioral parent training in which they learned the use of behavioral principles to encourage prosocial behavior and discourage problematic behavior.  You can find a general overview of behavioral treatment for ADHD at http://www.helpforadd.com/add-behavioral-treatment/

In addition to these treatments, half the participants were randomly assigned to received CAI during a portion of the social skills training sessions.  As noted above, during CAI children spent time reading to dogs in a structured manner and teaching dogs new skills through the use of commands and praise. This was done with certified therapy dogs and facilitated by the dogs' handlers.  The programs used were developed by the American Humane Association and the Intermountain Therapy Animals' Reading Education Program - for a description of this interesting organization, visit http://www.therapyanimals.org/R.E.A.D.html

An interesting design element is that while one group worked with real dogs, the other group performed the same activities with dog puppets.  The authors predicted greater gains for children interacting with real dogs because this places significant demands on children's attention, i.e., if the child's attention wanders, the dog's behavior draws the child back into actively engaging.  This would obviously not be true for dog puppets.  Thus, children working with real dogs experienced greater attentional demands which became an attention training opportunity for them.


Measures

Assessments of children's core ADHD symptoms, social skills and problem behaivors were obtained from parents using standardized rating forms before treatment began, at bi-weekly intervals during treatment through 10 weeks.   


Results

As predicted, both groups of children showed significant and meaningful declines in ADHD symptoms and improvements in social skills over time.  Thus, there was evidence that the combination of social skills training and behavioral parent training was effective.  For both groups, the benefits associated with treatment were substantial.

Of particular interest were difference found between CAI and non-groups.  For the social skills outcome, there was no evidence that children working with real dogs demonstrated greater gains than those working with dog puppets. 

For core ADHD symptoms, however, the CAI group showed significantly greater symptom reductions over time.  Group differences were evident by the 4th week of treatment and remained evident after 10 weeks.


Summary and Implications

Results from this study provide preliminary but intriguing evidence that interacting with therapy dogs in structured ways may help alleviate core ADHD symptoms in children with ADHD.  The authors suggest this occurs because the focus and attention required to teach skills to real dogs provides a novel type of attention training experience for children.  The fact that group differences were found only for core ADHD symptoms, but not for problem behaviors or social skills (where both groups showed equal improvements) is consistent with this idea.

Clearly, this is a very preliminary result.  The sample was small and the only outcome data was provided by parents who were not blind to condition.  Parental bias as an explanation for the results is inconsistent with the CAI effect emerging for ADHD symptoms only, however, as one would expect bias to extend to all domains that were rated.  Nonetheless, the study would have been stronger if ratings were also obtained from teachers who were unaware of children's treatment and/or by blind observers.  The authors readily acknowledge this and have a larger trial underway to examine this interesting intervention approach in a more rigorous manner.

Readers will certainly vary as to whether they find the idea behind CAI for children with ADHD to be compelling.  Nonetheless, I think the authors deserve kudos for investigating a novel treatment approach in a scientific manner.  Whether this approach turns out to be helpful is an empirical question and I look forward to learning the results of subsequent research that the authors undertake.


(c) 2013 David Rabiner, Ph.D.

Information presented in Attention Research Update is for informational purposes only, and is not a substitute for professional medical advice.  Although newsletter sponsors offer products and services that I believe will be of interest to subscribers, sponsorship of Attention Research Update does not constitute a specific endorsement or guarantee of any company's product or services.