Working Towards an Evidence Base: Developing Meaningful Outcome Measures for Animal Assisted Interventions for Children and Young People with Autism.

There is increasing recognition in the literature of the therapeutic function animals can play. Studies have shown pet ownership; reduces depression (Siegel et al. 1999); aids management of mental health issues (Brooks et al. 2018, Beals and Eve, 2009); improves socioemotional outcomes in youths (Jacobson and Chang, 2018); reduces the use of medical services in the elderly (Raina and Parminder,1995).
Autism has a steadily increasing prevalence from 1 in 150 children in 2002 to 1 in 68 in 2012, this strongly heterogeneous, idiosyncratic group features a great diversity of co-morbidities (Politte et al. 2015), and a high prevalence of mental health disorders (Mcleod et al. 2015). Autistic people are marginalised, reporting a lack of social connections (Mcleod et al. 2015), feelings of isolation (Brancroft et al. 2012) with only a 16% full time employment rate (National Autistic Society, 2016). The Lancet Neurology Journal (2017) quotes the cost of Autistic care to be £32 billion annually, and there is a rising awareness of the financial and social cost implications of ASC. In the current socio-economic climate of austerity politics there are manifold drivers to providing effective, efficient and safe ASC interventions. Garnering an evidence base for treatment protocols has become an area of significant focus for further research and study.
Whilst the quality and quantity of research on ASC interventions is improving, there remains a lack of breadth in the current literature. Studies are predominately focused on Applied Behaviour Analysis (ABA), Developmental Social Pragmatic Models (DSPM), or their variants. Despite the supportive empirical base ABA/DSPM are considered by some to be controversial. Accusations of ableism, dehumanisation, even abuse have been made against these therapies and the organisations and policies supporting them such as 'Autism Speaks' and the Autism CARES Act (2014). There is a growing and increasingly vocal opposition to their use from Autistic individuals, advocates and the Neurodiverse community (The Guardian, 2015. Spectrum News, 2016).
This confluence of circumstances created a vacuum in which there has been a proliferation of alternative, complementary therapies without an evidence base (Thyer and Pignotti, 2010. Singer and Ravi, 2015). AAI is an area of significant interest and, as a Horse Boy Method practitioner running a small not for profit organisation providing these services, this work also resonates for me personally. In a systematic review O'Haire (2017) concluded there is emerging evidence of the benefits of AAI for people with ASC which warrants further study with more robust methodology.
The aim of the proposed project is to develop a meaningful standardised outcome measure to assess Animal Assisted Interventions (AAI) for children with Autism. Research questions will include:
- How can a meaningful standardised outcome measure contribute towards establishing an empirical evidence base?
- What factors should outcome measures consider? How should they be designed and implemented?
- At what point can an evidence base said to have been reached in the specific situation set of AAI, which does not lend itself to traditional trial designs?
- How can transferability of any improvements measured be demonstrated outside the treatment setting?