Animal Assisted Therapy Use in The Pediatric Population with Mental Illness

Introduction

Animal therapy and companionship provides advantages for the pediatric client who suffers from mental illness. Animals allow pediatric clients to feel more secure while decreasing negative side effects from their illness, promoting future growth. Animal therapy presents in many forms such as regulated animal therapy (Service Animals) and non-regulated services such as Animal Assisted Therapy (AAT) and Emotional Support Animals (ESAs). This paper focuses on the non-regulated services animals can provide. According to The World Health Organization, “it is crucial to address the needs of adolescents with defined mental health conditions. Avoiding institutionalization and over-medicalization, prioritizing nonpharmacological approaches, and respecting the rights of children in line with the United Nations Convention on the Rights of the Child and other human rights instruments are key for adolescents (Harvey et al., 2020).” One such way to accomplish this need is with the safe alternative therapy of animal companionship. AAT, which in this paper will includes ESAs, is a therapeutic alternative form of medicine that will assist the pediatric population dealing with mental health issues.

Nursing Metaparadigm

In promoting a holistic view for the pediatric client, family, friends, and community need to be involved to optimize success. Animals can enhance the holistic well being in the pediatric client. Animals provide a therapy for mental health which is beyond comparable to medications. Studies have proven animal therapy can help pediatric clients calm themselves, as seen with decreased cortisol levels when the pediatric client is in the presence of an animal; random companionship from an animal can lower stress and anxiety (Frederickson, 2019). Animal therapy can allow pediatric clients to feel more welcome, safe, and comfortable whether alone or in a group setting (Trujillo et al., 2020). It is necessary to keep the environment for a pediatric client safe and welcoming, especially in the terms of mental illness, as the client themselves may be unpredictable. Animals give a calming environment if properly matched. The environment can not only be a concern for the pediatric client but for the animal as well. If the animal senses unacceptance or fear the animal will not be able to calm the client.

Diagnosing mental illness is important and most beneficial if done early in life. Mental illness can affect the healthy development of a child. Cognitive development milestones can be indicators of whether a mental illness is a possible diagnosis. Growth and development milestones are not only detrimental for physical growth, but cognitive development. A limited number of studies have determined the importance of having animals present during infancy and show a positive correlation in milestone development (Hurley & Oakes, 2018).

Nursing acceptance of AAT will allow more interaction with pediatric clients, creating rapport between provider and client to allow for positive therapeutic relationships. Pediatric clients are known for honesty and AAT may allow the client to be more open if he/she feels safe. Positive interactions with providers and the pediatric client and family can relieve stress on all ends creating a positive family centered care model (Hoagwood et al., 2017).

Advantages Versus Disadvantages

Using AAT has many benefits such as aiding in impaired comfort related to insufficient environment control (Ackley et al., 2020). Animals relieve stress of a pediatric client. Stressful environments such as a court room, for example, can not be controlled, so comfort of an animal in that environment may prove beneficial (Zebra Child & Youth Advocacy Centre, n.d.). Another is the presence of AAT in the educational setting. Studies have shown to increase social confidence proving important progress for mental illness clients. Also, studies performed prove a reduction in blood pressure and heart rate in pediatric populations when animals are used for therapy or as a companion decreasing anxiety, restlessness, and negative behavior (Frederickson, 2019). This benefits the pediatric client and members of the family and community.

Animals in a setting with mental health therapy may improve treatment, engagement, popularity, and end results. Animals help build rapport which creates a therapeutic relationship and can calm the client if a connection – whether that be with a dog, cat, bird, or rabbit – is formed, as every client and provider will have a different preference and need. Animals provide advantages when introduced into a therapeutic setting “as they have a unique ability to relate to humans when words fail (Harvey et al., 2020).” Animals recognize emotions and body language that humans don’t recognize impacting positively in sessions, increasing rapport. Animals reduce emotional and behavioral symptoms which are more prominent in the pediatric population with mental health illness. Empirical evidence exists that animal interventions have positive behavioral improvements in the pediatric population with acute mental illnesses such as schizophrenia and anxiety, most of which have been with canines, but the possibility with other animal species exists. Proof is evident in the increase of oxytocin production and decrease of cortisol levels and blood pressure in the pediatric client (Brelsford, et al., 2017).

Disadvantages to animal therapy exist as with any treatment such as the health of the animal involved. Although cortisol levels decreased in studies in the pediatric client, they increased in the dogs who were present all day (Frederickson, 2019). However, by not overworking the animal and allowing proper rest, nutrition, and recreation this situation can be rectified (Frederickson, 2019).

Besides the health of the animal involved, cultural beliefs need to be considered. Group activities with animals may prove more difficult, but individually the animal-client relationship can be customed to the individual. Some cultures, for instance, regard dogs as an unclean nuisance (Putz, 2014). Animals need to be clean and well-groomed. The animal also needs to be up to date on vaccinations and on a leash if necessitated. Another set of questions arise in terms of infection, transmission of disease, sanitary problems, and allergy issues when animals are incorporated into public settings such as medical clinics or schools, but with proper education and trained animal handlers these issues can be minimized (Frederickson, 2019).

Psychological disadvantages associated with animal interventions, both AAT or ESAs are possessiveness, attachment issues, and grief reactions (Putz, 2014). Bonding is important but can be concerning if the animal is not an ongoing therapeutic plan. These concerns provide a means to further education for the pediatric client and family.

Personal Opinion

Animals play a vital role in children’s lives, especially in the realm of mental illness. Having grown up on a farm, surrounded by large animals, such as livestock, and by pets I learnt of many unseen advantages most do not have the chance to engage in such as stress relief, learning sympathy, responsibility, and hard work. When near animals, stress dissipated. I have a preteen son who suffers form mental illness which consists mainly of anxiety, OCD, and anger management control. My son’s emotions are controlled by medication, escitalopram, but without the presence of his cats even medication would not be as successful. The bond he has with his cats can not be felt by persons who have not experienced ‘the bond.’. In a couple years we hope to end the medication but know his need for his animals will be a lifelong affair. My son calms himself when with his cat. Sometimes AAT is that simple, having an animal present, whether in your lap, sitting beside you, or in the same room. I believe AAT, or in my son’s case an ESA, should be used if a child and family so prefer, in all settings. I also strongly believe ESAs be legalized in Alberta. Mental illness, especially in preteen boys, is at a all time high, and having animals or pets around will help many of these pediatric clients (Rice et al., 2018). I believe any animal, large or small from fish to cat to cow, could act for AAT or as an ESA. Dogs and horses are animals primarily used, but all animals bring a different sense of security to any child with each having their own personal preference and connection.

Education

Teaching pediatrics and the family about the option of AAT is of utmost importance. In the case of ESAs careful consideration of personal expenses are necessary due to costs of daily, routine, and emergency expenses. Grief of loosing an animal can also be of concern. For AAT there is not a direct cost to the client or family, but grief can still exist. Bereavement groups for pet/animal loss are available. As well, care must be taken for safety of both the pediatric client and animal. The animal should have some training or if using an ESA matched appropriately to the client and family. Education to prevent illness from disease or scratches is necessary. Preventions include vaccinations for client, family, and animal. Respect and education for the client and family need to be of utmost importance in how to treat and deal with the animal involved. One goal of using animal therapy is to prevent the use of medications. In terms of depression, antidepressants cause a significant risk of increased suicide in the pediatric population (US Food and Drug Administration, 2018). Alternative methods of therapy, rather than medications, should be considered. Animals may be a successful alternative method as they can provide comfort, a sense of safety, and an increase in self esteem which are all important variables in the health of a pediatric client with mental illness.

Community Resources

Community resources are lacking in Canada for AAT. Canada lacks the animal support of other developed countries, but some provinces are beginning to embrace animal services. With a legal letter from a therapist or doctor, one can claim their pet as an ESA. For example, with a legal letter for an ESA in the USA, a landlord can not discriminate against a tenant having with an ESA, so no home is off limits (Therapeutic, 2022).

Options in Alberta include having a pet to act as an unregistered ESA or seeking community services which have AAT available. Alberta does benefit by having the free option of Open Farm Days in August where families can meet farmland animals (Alberta Open Farm Days, n.d.). Connecting with farm animals can bring a sense of freedom and power. Edmonton also has a Cat Cafe, but it does have a cost associated with, which allows interaction to destress with cats (Cat Café on Whyte, n.d.). There are also non-profit organizations consisting of volunteers that exist in Alberta. These societies not only have Service Dogs but other dogs and animals that can help with groups or individuals that require a visit or service. In Northern Alberta individuals can request a visit through Pet Therapy Society (Pet Therapy Society, n.d.). Also, in Edmonton CAAWLS is an animal assisted intervention with a goal to combat stress. This group mainly presents in post-secondary institutions so includes the older ages of the pediatric population (Chimo Animal Assisted Wellness and Learning Society, n.d.). In some medical facilities, such as the Stollery in the University of Alberta Hospital, they offer Pet Therapy which is the beginnings of bringing animals into use to help with the healing process if a pediatric client needs this connection (Alberta Health Services, n.d.).

Conclusion

Animal therapy is an alternative form of medicine that is becoming more mainstream. More research and studies on the use of animals for treatment of mental health and possible therapeutic gains are necessary. AAT is becoming more popular but has yet to be fully accepted and legalized in Canada. Studies have shown that animals can decrease stress levels leading to decreased aggression, depression, hyperactivity, and anxiety which may be present in mental illness. Most evidence done so far supports that animals help with mental issues over other issues such as surgery or pain (Hoagwood et al., 2017). Results using animal therapy prove promising, but more research and studies to improve merit is necessary.

References

Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier.

Alberta Health Services. (n.d.) Programs and services. https://www.albertahealthservices.ca/findhealth/Service.aspx?id=1068557&serviceAtFacilityID=1107287

Alberta Open Farm Days. (n.d). About. https://albertaopenfarmdays.ca/about/

Brelsford, V. L., Meints, K., Gee, N. R., & Pfeffer, K. (2017). Animal-assisted interventions in the classroom – a systemic review. International Journal of Environmental Research & Public Health, 14(7), 669. https://doi.org/10.3390/ijerph14070669

Chimo Animal Assisted Wellness and Learning Society [CAAWLS]. (n.d). Our story. https://www.caawls.org/about

Zebra Child & Youth Advocacy Centre. (n.d.). About us. www.zebracenter.ca/about

Cat Café on Whyte. (n.d.). Welcome to Alberta’s first cat café!. https://www.catcafeonwhyte.com/

Fredericksen, L. (2019). The advantages and disadvantages of animal–Assisted therapy in an educational setting. Culminating Projects in Special Education, 80. https://repository.stcloudstate.edu/sped_etds/80

Harvey, C., Jedlicka, H., & Martinez, S. (2020). A program evaluation: Equine-assisted psychotherapy outcomes for children and adolescents. Child & Adolescent Social Work Journal, 37(6), 665-675. https://doi.org/10.1007/s10560-020-00705-0

Hoagwood, K. E., Acri, M., Morrissey, M., & Peth-Pierce, R. (2017). Animal-assisted therapies for youth with or at risk for mental health problems: A systematic review. Applied Developmental Science, 21(1), 1-13. https://doi.org/10.1080/10888691.2015.1134267

Hurley K. & Oakes L. M. (2018). Infants’ daily experience with pets and their scanning of animal faces. Front Vet Sci 10(5), 152. https://doi.org/10.3389/fvets.2018.00152

Pet Therapy Society. (2021). About PeTS. https://pettherapysociety.com/about-us-2/

Putz, Jordan N. (2014). Animal-assisted therapy and its effects on children in schools. Sophia, the St. Catherine University repository website. https://sophia.stkate.edu/msw_papers/379

Rice, S. M., Purcell, R., & McGorry, P. D. (2018). Adolescent and young adult male mental health: Transforming System Failure into Proactive Models of Engagement, 62(3), S9-S17. https://doi.org/10.1016/j.jadohealth.2017.07.024

US Food and Drug Administration. (2018). Suicidality in children and adolescents being treated with antidepressant medication. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications

Therapeutic. (2022). Emotional support animal Canada laws. https://therapetic.org/emotional-support-cat/

Trujillo, K. C., Kuo, G. T., Hull, M. L., Ingram, A. E., & Thurstone, C. C. (2020). Engaging adolescents: Animal assisted therapy for adolescents with psychiatric and substance use disorders. Journal of Child & Family Studies, 29(2), 307-314. https://doi.org/10.1007/s10826-019-01590-7