Monday, January 27, 2014
Dear Mr. Comas,
We read your article, “City Says No To Boy’s Therapy Chickens” (Disability Scoop Online, December 10, 2013) with great interest. Previous stories have been published about the relationship of a child with autism and myriad animals, including dogs, horses and dolphins. We appreciate that young children on the autism spectrum, like their typically developing peers, may enjoy and even benefit from having a pet or interacting with animals. What your article and others have in common is that they are heartwarming stories. We do not dispute that pets may provide wonderful play experiences, or opportunities to learn and practice basic animal-care skills or enter into social exchanges with others that may revolve around the pets. However, at a time when there are 400+ advertised treatments for autism, journalists must exercise care and caution about how they pitch their message to the public, particularly the potential to misuse the term “therapy.” To this end, we would like to share a few concerns about “therapy chickens.”
The Hart family, like many families of children diagnosed with an autism spectrum disorder (ASD), conducted research on so-called “therapies” that have been marketed as effective to treat symptoms of the diagnosis, and in this case, their search led them to animal therapy. While the use of chickens as the animal of choice is unconventional, the family reported anecdotally that their son showed improvements after developing a relationship with the chickens. Clearly, parents invest time, hope and money into treatment with an underlying assumption that it will help to ameliorate some of the symptoms of autism. What is most concerning is the “assumption” piece: the promotion of “therapies” which have little-to-no scientific evidence to support them.
“Therapy” is a powerful and overused word in the realm of autism treatment. Merriam-Webster defines therapy as: “a remedy, treatment, cure, healing, method of healing, or remedial treatment.” Using this definition, the onus is on proponents of the intervention to be able to document that the “therapy” actually targets autism in an observable and direct way, that effects of the said “therapy” are measureable and significant, and that research is conducted to demonstrate that effect. What complicates the picture is that playing with a pet, as with other so-called “therapies,” may be enjoyable to an individual with autism. When we enjoy an activity or thing we tend to focus our time on and express our happiness or interest in it, through smiles, gestures, or language. This is no different for us than it is for a child with autism. The activities associated with animal therapy are just that--pleasurable experiences. Calling it an enjoyable experience does not cheapen or belittle it; however, “therapy” must involve more than that; it must promote positive change in behavior that sustains over time.
A focus on unproven methods or “treatments” may result in financial hardship and/or caregiver exhaustion--a concern echoed by the American Academy of Pediatrics. In their guidelines focusing on the management of ASDs they state, “Unfortunately, families are often exposed to unsubstantiated, pseudoscientific theories and related clinical practices that are, at best, ineffective and, at worst, compete with validated treatments or lead to physical, emotional, or financial harm. Time, effort, and financial resources expended on ineffective therapies can create an additional burden on families” (Myers & Johnson, 2007).
In this instance, the family hired an attorney in an attempt to reverse the decision of the city council to end the one-year trial program that allowed residents to maintain backyard chicken coops. We suggest that proponents of animal therapy conduct research and seek to publish their findings, as research-based evidence often leads to greater funding, potentially through fee waivers or insurance reimbursement, which could reduce the economic burden on families who choose to use this approach.
In your article, Emily Forrest, a developmental behavioral pediatrician specializing in autism at the Florida Hospital for Children, points out that children with ASD are extremely sensitive to change. She says, “So it could be devastating to him” to lose the chickens. We agree that the loss of a pet is a sad event for any child, particularly a child with autism who enjoys playing with it, and who may have unique and challenging behavioral responses to a change in his or her environment. These behavioral responses could present the parents with a difficult situation as they try to manage their child’s behavior. It also indicates the need for families and teachers to identify a wide array of powerful reinforcers which can be incorporated into an intervention, ideally an intervention with a track record of scientific support carried out by “therapists” who have earned such a designation through education, training, and demonstrated competence. We should also mention that it is possible for the efficacy of other, evidence-based therapy to be impacted by this disruption as well.
Finally, it is important to note that Dr. Forrest’s comments implied some level of support for animal therapy. A new study recently published in the Journal of Behavioral and Developmental Pediatrics indicates that the use of complementary and alternative medicine (CAM) is common in families of young children with autism. CAM is a group of diverse treatments and as such, there are varying levels of scientific evidence and safety to users within the group. Certainly, animal “therapy” would fit into this category. Pediatricians are often one of the first points of contact for newly diagnosed families--therefore it is critical that they be familiar with all areas of autism treatment, and are able to discriminate between CAM and evidence based approaches, as this will help them to advise parents regarding the dizzying array of available autism “treatments.” We would encourage Dr. Forrest to access resources such as the Association for Science in Autism Treatment’s (ASAT) Autism Treatment Reviews for Physicians: The Take Home Message, which summarizes the evidence available in the medical literature, including the American Academy of Pediatrics (AAP) guidelines, to help medical professionals guide their patients with autism.
Thank you for sharing this story and highlighting that children with autism, like their same-aged peers, can and do enjoy the benefits of pet ownership. Although the city has since decided to allow the Hart family to keep the chickens, we understand that the potential loss of a pet can certainly have a devastating impact on any young child, especially a child with autism who may have limited interests. From a journalistic perspective, we encourage you to make use of available resources, such as our ASAT databases, when researching future stories. We believe when stories about autism treatment are shared, that parents would benefit from more thorough information not only about the cost and benefits, but about whether or not there is scientific support available for that intervention. Based on the available peer-reviewed literature, animal-assisted therapy is neither comparable nor superior to established practices, such as applied behavior analysis. Unfortunately, a reader may infer from this article that pets (even chickens, for which no scientific studies exist) are an effective intervention and may postpone or decline other interventions grounded in science. In our view, that is an even sadder outcome!
Elizabeth Callahan, BA, BCaBA and David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment
Halliday, P., Houston, Z., Kinney, E., & Myers, S.M. (2012). Autism treatment reviews for physicians: The take-home messages. Science in Autism Treatment, 9(2), p. 1-6.
Myers, S. M., Johnson C. P., & the Council on Children with Disabilities (2007). Management of children with Autism Spectrum Disorders.
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