Changes in Sleep of Families After the Arrival of an Autism Service Dog.

This study aimed to investigate the changes in sleep quality and quantity among families following the arrival of an autism service dog. We hypothesized that the sleep of the child or adolescent with autism spectrum disorder (assessed objectively with actigraphy and subjectively with a parent-reported sleep diary), and of both parents (assessed by self-reported diaries) would improve after the dog's arrival. The sleep of 18 youths (15 boys) aged from 5 to 16 years (M = 8.86), and of their parents (14 mothers, 11 fathers) was assessed for a 5- to 7-day period before (pretest) and eight to ten weeks after the dog's arrival (posttest). A designated parent (the same at the pretest and posttest) completed the sleep diary of the child, who wore an actiwatch in the meantime. Significant improvement in most sleep parameters was observed from pretest to posttest for the child and the mother, as reported in the sleep diaries. However, there was no improvement in the child's sleep when assessed objectively. Fathers' sleep duration increased after the dog's arrival, when adjusting for the child's age. All significant effects had medium to large sizes. This study provides the first quantitative evidence of the positive effect of autism service dogs on the sleep of families. These findings suggest that the dog's presence may increase the sense of safety for the child, who would resume sleeping faster or stay in the bedroom after nocturnal awakenings, leading to improved parents' sleep.

The Cost-Effectiveness of Seizure Dogs for Persons Living With Severe Refractory Epilepsy: Results From the EPISODE Study.

OBJECTIVES: The Epilepsy Support Dog Evaluation study was commissioned by the Dutch Ministry of Health, Welfare and Sports to inform a reimbursement decision on seizure dogs. The randomized trial found that seizure dogs reduce seizure frequency and improve health-related quality of life of persons with severe refractory epilepsy (PSREs). This article examined the cost-effectiveness (CE) of adding seizure dogs to usual care for PSREs in The Netherlands. METHODS: A microsimulation model was developed, informed by generalized linear mixed models using patient-level trial data from the Epilepsy Support Dog Evaluation study. The model adopted a 10-year time horizon and took a societal perspective. Seizure frequency was predicted as a function of time with the seizure dog. Patient utilities, caregiver utilities, and costs were predicted as a function of seizure frequency and time with the seizure dog. RESULTS: Quality-adjusted life-years (QALYs) of PSREs with a seizure dog and usual care alone were estimated at 6.28 and 5.65, respectively (Δ 0.63). For caregivers, estimated QALYs were 6.94 and 6.52, respectively (Δ 0.42). Total costs were respectively €228 691 and €226 261 (Δ €2430). Intervention costs were largely offset by savings in informal care and healthcare. The incremental CE ratio was €2314/QALY. Probabilistic sensitivity analysis indicated a 91% probability of seizure dogs being cost-effective at the €50 000/QALY threshold. The incremental CE ratio fell well below this threshold in scenario analyses. CONCLUSIONS: Seizure dogs are likely to be a cost-effective addition to usual care for PSREs in The Netherlands.

The effects of service dogs for children with autism spectrum disorder and their caregivers: a cross-sectional study.

Introduction: Service dogs are an increasingly popular complementary intervention for children with autism spectrum disorder. However, despite increasing demand, there remains a lack of empirical research on their potential benefits. The purpose of this study was to evaluate the effects of service dogs on children with autism and their caregivers. Methods: A total of N = 75 families of children with autism were recruited from a non-profit service dog provider in the US, including n = 39 families previously placed with a service dog and n = 36 families engaging in usual care while on the waitlist. Caregivers completed an online survey containing both self- and proxy-report standardized measures of child, caregiver, and family functioning. Linear regressions modeled the relationship between service dog presence and survey outcomes, controlling for relevant child and caregiver covariates. Results: Results indicated that having a service dog was associated with significantly better child sleep behaviors, including better sleep initiation and duration and less sleep anxiety/co-sleeping with medium effect sizes. However, service dog presence was not significantly related to child withdrawal, negative emotionality, emotional self-control, hyperactivity, irritability, and lethargy with small effect sizes. For caregivers, having a service dog was not significantly related to standardized measures of caregiver strain, sleep disturbance, depression, or the impact of the child's condition on family functioning with small effect sizes. Supplemental matched case-control analyses confirmed these findings. Discussion: In conclusion, service dogs were found to positively impact sleep behaviors among children with autism, but may not uniformly relate to other areas of child and caregiver wellbeing. Prospective longitudinal designs, larger sample sizes able to detect small effects, and studies that measure sleep using objective methods are needed to build on these findings.

Roles and usages of neuro service dogs for caregivers living at home with persons with dementia: An exploratory comparative case study.

The goal of the present study was to examine how canine assistance may support family caregivers and persons with dementia and to document and compare two modalities of home care support. An exploratory comparative case study research design was conducted. Three cases correspond of dyads of a caregiver, a person with mild to moderate dementia, and either a neuro service dog (NSD), a companion dog or no dog. Hypotheses are formulated to capture differences between cases. Recruitment was done in a service dog organisation, through Canadian Alzheimer associations and in records of a hospital. Data were collected through 45-60 minutes telephone interviews that included completion of the Caregiver's Burden Scale and sociodemographic questions. We used an inductive approach with qualitative data. There were five caregivers (mean age 54.8 years) who had an NSD, 28 caregivers (63.6 years) who had a companion dog, and 23 caregivers (63.8 years) without dog. In the category of roles and usages of the dog, 'Socialisation' and 'Help with a sense of direction' were the most addressed roles for dyads with the NSD. For dyads with companion dog and without dog, 'Engagement-and-meaning of life' as well as 'Physical activity with the dog' were the most discussed roles. The 'Sleep or wake up' role was the least discussed role across three cases. In the other categories, they were seven advantages and 10 inconvenients that were mentioned for canine assistance. For home care support, the presence of NSD has more positive impacts on both the person with dementia and their caregiver compared to the presence of a companion dog; the presence of a NSD results in the person with dementia accessing more indoor and outdoor public sites than with a companion dog; and dyads with a dog are informally socially engaged more frequently than those with no dog.

Neuro Service Dogs Impacts on Community-Dwelling Persons with Mild to Moderate Dementia and Their Caregiver.

Since there were no research data on the use of neuro service dogs (NSD) in 2018, a comparative case study research design was done. The cases comprised of a caregiver with a person with mild to moderate dementia, and either an NSD (n=5), a companion dog (n=28), or no dog (n=23). Monitor activity and online questionnaires were administrated. Interesting qualitative data on the roles of a NSD, advantages and inconvenients were fully described and published. Quantitative data could not confirm that NSD is benefit-cost, neither that it increases quality of sleep or level of exercise, compared to companion dogs.

Exploring the Experiences of Volunteer Assistance Dog Puppy Raisers from the Same Program at Two Australian University Campuses.

Assistance dogs are beneficial; however, accessing one can be challenging due to the time, cost, and high failure rates associated with training. A major factor contributing to a high failure rate appears to be the competency of volunteer puppy raisers (PRs), with returning PRs typically more effective than first-time PRs. However, there remains a gap in the literature dedicated to examining PRs' experiences and how they are affected by the raising programs. This study analysed two groups of PRs (N = 16) from the same university-based program in different Australian regions (i.e., one regional and one suburban). Semi-structured interviews were conducted and analysed both inductively and deductively. The inductive approach identified four major themes that helped to understand the PRs experiences throughout the program: expectations as a PR, organisational and environmental support and suitability, the intensity of PR workload, and practical support. The deductive analysis identified four functions of volunteerism relevant to PRs' motivations: altruism (values), egoism (enhancement), interacting with others (social), and learning new skills (understanding). Overall, the results obtained from the two groups were consistent with past findings suggesting the benefits of organisational and practical support. These findings further develop our understanding of how to enhance puppy-raising experiences.

Service Dogs and Persons with Disabilities: When COVID-19 Lockdown Changes Their Relationship.

Persons with disabilities, who own service dogs, develop strong relationships with them. Since the COVID-19 pandemic decreased the possibility of social contact and modified human relationships, we hypothesized that the COVID-19 lockdown would influence people with disabilities-service dog relationships. An online survey was conducted during the first COVID-19 lockdown in France and included information (e.g., MONASH score) both in the general context prior to and during the COVID-19 lockdown. Seventy owners participated. Compared to the general context, scores for the Perceived Emotional Closeness and Perceived Costs subscales were significantly higher during the COVID-19 lockdown, while scores for the Dog-Owner Interaction subscale were significantly lower during the COVID-19 lockdown. Our study confirmed that service dogs, like other pets, were a source of emotional support for their owners during the COVID-19 lockdown. However, people with disabilities found their relationship with their service dog costlier (e.g., my dog makes too much mess). Our study highlights that, in extreme situations, characteristics of a human-animal relationship can be exacerbated in both positive and negative ways.

Current Perspectives on the Challenges of Implementing Assistance Dogs in Human Mental Health Care.

The prevalence of mental health disorders, driven by current global crises, is notably high. During the past decades, the popularity of dogs assisting humans with a wide spectrum of mental health disorders has significantly increased. Notwithstanding these dogs' doubtless value, research on their legal status, certification processes, training and management practices, as well as their welfare status, has been scarce. This scoping review highlights that in contrast to other assistance dogs such as guide dogs, there exists no consistent terminology to mark dogs that assist humans with impaired mental health. Legal authorities monitoring the accreditation process, training and tracking of mental health supporting dogs are broadly lacking, with only few exceptions. This review emphasizes the need to address several topics in the promotion of progress in legal and welfare issues related to assistance dogs as well as emotional support dogs for humans with a mental health disorder. The current body of knowledge was assessed in three different areas of focus: (1) the legal dimension including definitions and certification processes; (2) the dimension of performed tasks; and (3) the dog welfare dimension including aspects of the relationship with the handler and risks associated with children recipients. Considering the challenges associated with a mental health diagnosis, collaborations of dog provider organizations and health care professionals would be desirable to continuously assess the efficiency of the human-dog dyad regarding their overall compatibility, general satisfaction and mutual well-being.

The Role and Relevance of Hearing Dogs from the Owner's Perspective: An Explorative Study among Adults with Hearing Loss.

This study aimed to explore perceptions and experiences about how owning a hearing dog can influence the functioning and the autonomy of people with hearing loss. Three adults participated in a semi-structured interview. The interviews were video recorded, transcribed, and coded. A procedure combining qualitative content analysis and interpretative phenomenological analysis was used. The study shows how specific aspects of hearing dogs are associated with increased autonomy and sense of security among owners. The attentive dog-owner pairing, the outstanding training and the companion role of the hearing dog are the main elements supporting the high satisfaction related by all the participants. In regard of the location context (Quebec, Canada), ongoing challenges for owners are reflected in the lack of visibility of this rehabilitation means and its poor recognition from the society, resulting in the constant burden to explain the dog's work to others. For adults with hearing loss, the hearing dog is a relevant way of offering both the benefits of functional assistance and the psychosocial support of a pet. The association between owning a hearing dog and improved overall well-being suggests that this form of rehabilitation should be considered as a pertinent option by hearing health professionals.

Hair Cortisol in Service Dogs for Veterans with Post-traumatic Stress Disorder Compared to Companion Dogs (Canis Familiaris).

Service dogs are trained to assist humans. This assistance potentially exposes them to stressors To investigate if service dogs are exposed to more stressors than companion dogs we questioned whether hair cortisol levels differed between both groups. We studied this by cutting a tuft of hair from the neck of 19 companion and 11 service dogs. Cortisol levels were subsequently analyzed via immunoassay and compared via a simple linear regression model. The influence of coat color, season, sex, other dogs, pets, or mental health diagnoses in the household was also checked . Results showed that cortisol values did not differ between service and companion dogs. Furthermore, none of the additional variables had an influence on cortisol levels. This lead to the conclusion that the service dogs in this study did not have higher hair cortisol levels than companion dogs Further study should be conducted as to why no difference did occur between groups and if this difference is persistent over time given that we only studied a period of up to two months' worth of hair cortisol.

Emotion Facial Processing in Children With Autism Spectrum Disorder: A Pilot Study of the Impact of Service Dogs.

Processing and recognizing facial expressions are key factors in human social interaction. Past research suggests that individuals with autism spectrum disorder (ASD) present difficulties to decode facial expressions. Those difficulties are notably attributed to altered strategies in the visual scanning of expressive faces. Numerous studies have demonstrated the multiple benefits of exposure to pet dogs and service dogs on the interaction skills and psychosocial development of children with ASD. However, no study has investigated if those benefits also extend to the processing of facial expressions. The aim of this study was to investigate if having a service dog had an influence on facial expression processing skills of children with ASD. Two groups of 15 children with ASD, with and without a service dog, were compared using a facial expression recognition computer task while their ocular movements were measured using an eye-tracker. While the two groups did not differ in their accuracy and reaction time, results highlighted that children with ASD owning a service dog directed less attention toward areas that were not relevant to facial expression processing. They also displayed a more differentiated scanning of relevant facial features according to the displayed emotion (i.e., they spent more time on the mouth for joy than for anger, and vice versa for the eyes area). Results from the present study suggest that having a service dog and interacting with it on a daily basis may promote the development of specific visual exploration strategies for the processing of human faces.

The Impact of Service Dogs on Military Veterans and (Ex) First Aid Responders With Post-traumatic Stress Disorder.

Due to its novelty and lack of empirical study it remains unclear if a service dog truly mitigates the burden of post-traumatic stress disorder (PTSD) symptoms. To cross sectionally investigate the effect of service dogs on veterans and first aid responders with PTSD, we studied subjective and physiological parameters in 65 individuals divided over four groups. These groups were: veterans and first aid responders with PTSD and a service dog (n = 20), with PTSD and a companion dog (n = 10), with PTSD without a dog (n = 12) and a group without PTSD (n = 23). We found that veterans and first aid responders with PTSD who had a service dog showed significantly less PTSD related symptoms, better sleep quality, and better wellbeing experience, than those with a companion dog. Those with a service dog additionally experienced fewer PTSD related symptoms than those without a service dog and tended to walk more than individuals without PTSD. No differences were found in cortisol levels between groups though and changes in both salivary cortisol and activity were not linked to improved welfare experience. Though the use of physiological measurement methods thus warrants more research, our study indicates that the subjective experience of wellbeing, sleep quality and PTSD related symptoms is improved by the presence of a service dog.

Understanding the participation outcomes for persons with disability when partnered with assistance dogs: A scoping review.

INTRODUCTION: Assistance dogs are trained to support persons living with disability and mitigate limitations that hinder their participation in everyday activities. Despite participation being a frequent challenge for people with disabilities, evidence linking assistance dog provision to improved participation outcomes is underdeveloped. This scoping review aimed to improve understanding by mapping the participation outcomes claimed in research on assistance dogs using the International Classification of Functioning (ICF), Disability and Health framework. METHODS: Using the Arksey and O'Malley's six-step framework, this scoping review searched six databases. Data were collected, mapped and summarised in accordance with the domains outlined in the ICF. RESULTS: In total, 38 studies across 41 papers met the inclusion criteria. Included studies investigated assistance dogs who were partnered with people living with physical disabilities, mental illness, autism and chronic conditions that require alerting (e.g., epilepsy and diabetes). Mapping of participation outcomes suggested that assistance dogs can have a positive impact on participation in many areas of daily life. CONCLUSION: Findings can assist practitioners, funders and policymakers to recognise the value of assistance dogs as a support for people with disability. However, further research is needed to address limitations regarding study designs, for example, the outcome measures used.

Outcomes of assistance dog placement in the home for individuals with autism spectrum disorder and their families: A pilot study.

INTRODUCTION: Evidence indicates that assistance dogs placed in the home are effective in supporting individuals with Autism Spectrum Disorder (ASD) by increasing social and community participation and promoting quality of life. This study aimed to examine the outcomes of assistance dog placement on quality of life, independence, and participation of families including individuals with ASD placed with an assistance dog compared to families on the waiting list for an autism assistance dog and to evaluate the feasibility of the design for future studies. METHODS: A cross-sectional comparative study was conducted. The Adaptive Behaviour Analysis System, Social Responsiveness Scale, Autism Treatment Evaluation Checklist, Canadian Occupational Performance Measure, and Autism Family Experience Questionnaire were used to evaluate adaptive skills, behaviour, social difficulties, daily functioning, and family quality of life. RESULTS: Six families who had an autism assistance dog placed with them, and 12 families who were on the waiting list were recruited using purposeful sampling. The pilot data found no significant differences between the two groups. However, trends were observed which suggested that assistance dogs can increase desired social behaviours, decrease ASD severity, and improve family wellbeing. For families with an assistance dog, more positive outcomes were observed for families who were partnered with an assistance dog for longer. Parents (and sometimes individuals with ASD) were able to complete and return the outcome measures via mail to collect the outcome data for the study. CONCLUSION: These study findings add to the developing evidence about the use of assistance dogs with this population. A larger sample size may have allowed for significant associations to be detected. The methods used were feasible to be applied in a larger study. These results may assist health professionals advocate for funding for assistance dog placement to individuals with ASD and their families.

Interactions between the Public and Assistance Dog Handlers and Trainers.

This research aimed to explore the experiences of handlers and trainers of disability assistance dogs in terms of the types of interactions they had with members of the Aotearoa NZ (NZ) public and how these interactions were perceived, interpreted, and managed. A qualitative method, guided by an interpretive approach and social constructionism, was utilised to collect data via semi-structured interviews with six handlers and six trainers of assistance dogs. Data were analysed using thematic analysis with the social model of disability as the theoretical base. Findings indicated that participants regularly faced a complex range of unique interactions due to various factors such as the public's lack of knowledge and understanding of the dog's role and right of access to public places. While participants encountered brief friendly comments about the dog and its role, other encounters involved long conversations, invasive personal questions, interference with their dogs, and denied access to businesses, cafés, restaurants, and public transport. These findings underpin the need to provide more education to the public on the etiquette of engaging with handlers and their assistance dogs and more support for businesses to understand the legal rights of handlers. Through education and support to change societal attitudes and remove structural barriers, disabled people using assistance dogs may be able to independently participate in community life and be fully included without hindrance.

Visual Exploration and Observation of Real-Life Interactions Between Children with ASD and Service Dogs.

Two original studies explored relationships between visual attention of children with ASD (candidates for receiving a service dog) and their behaviors during their first interaction with a service dog. The first study consisted in video behavioural analyses of 16 children with ASD interacting with a service dog. During the interaction with a service dog, the time children with ASD spent looking towards social items vs objects was associated with how they interacted with the service dog. The second study was exploratory (i.e. 6 children), using the same behavioural approach but coupled with eye-tracking data. The more children with ASD looked at both their parent and the evaluator, as opposed to inanimate items, the more they interacted with the service dog.

Current Rules and Regulations for Dogs Working in Assistance, Service, and Support Roles.

The legal landscape for dogs working in assistance, service, and support roles is complicated and contradictory. Regulations permit access to public places, allow subsets of dogs' emergency transport and treatment, provide elevated protections for K-9s and assistance animals from criminal acts, and make it a crime to fraudulently represent a service animal. Federal and state agencies provide different regulations for dogs to access public places. Identification and verification of the working animal are not standardized. Working dog legislation is a changing landscape that requires veterinarians to be up to date on laws and regulatory guidance.

Facilitators and Barriers to Assistance Dog Puppy Raisers' Engagement in Recommended Raising Practices.

Many assistance dog providers use volunteer raisers to manage each puppy's learning and daily experiences, which partly determines the puppy's behavioural development. Therefore, it is important that raisers engage in recommended practices. Three common recommendations from the literature include frequent socialisation and consistent training for the puppies, and effective training for the raisers. However, what facilitates or hinders raisers' engagement in these practices remains unclear. To understand this, we interviewed eight raisers (three men and five women) every month during their year-long puppy raising program, and pseudo-randomly selected 16 from 48 interviews for data analysis. Thematic analyses revealed several facilitating and/or hindering factors corresponding to each of the three recommended practices. Frequent socialisation was influenced by the raisers' availability, sharing of puppy raising responsibility with others, support from their workplace, and the puppy's behaviours (e.g., soiling indoors, jumping). Consistent training was challenged by the presence of everyday distractors, accessibility to timely advice, perceived judgement from others, and the puppy's undesirable behaviours. Effective learning was facilitated by having information available in raisers' preferred learning modality, opportunities for peer-learning, and willingness to seek help. Future research should examine these factors quantitatively, which will enable more robust evaluation of programs aimed at supporting puppy raisers.

Barriers to inclusion: Service dog handlers in science laboratories.

Despite institutional claims of the importance of diversity, equity, and inclusion in STEM, people with disabilities remain under-represented. Current policies neglect to explicitly address inclusion of the growing population of students with disabilities who rely on service dogs, specifically in accessing teaching and research laboratories. With the increase in students registering for post-secondary disability services, the science community has outgrown general policies that primarily outline steps for exclusion of student service dog handlers. Here we discuss barriers and areas in need of improvement and then outline explicit guidelines for inclusion that are currently absent from existing policies. Particular concerns arise in teaching and research laboratories where live animals are present, and we recommend further research is needed to make informed decisions. In order to realize our vision of a diverse STEM workforce, academic institutions and professionals need to recognize barriers to inclusion and consider their role in making science accessible.