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Social-emotional adjustment and pet ownership among adolescents with autism spectrum disorder
Journal of Communication Disorders 65 (2017) 35–42
Contents lists available at ScienceDirect
Journal of Communication Disorders
Social-emotional adjustment and pet ownership among adolescents with autism spectrum disorder Amanda Warda,* , Nicole Arolab , Amy Bohnertc , Rebecca Liebd a
Massachusetts General Hospital/Harvard Medical School, 151 Merrimac, Boston, MA 02114, United States University of Minnesota, 2450 Riverside Avenue South, Minneapolis, MN 55454, United States c Loyola University Chicago, 1032 W. Sheridan Rd., Chicago, IL 60660, United States d Akron Children’s Hospital,215 W. Bowery St., Akron, OH 44308, United States b
A R T I C L E I N F O
Article history: Received 5 June 2015 Received in revised form 19 January 2017 Accepted 19 January 2017 Available online 25 January 2017 Keywords: Pet ownership Social impairment Social-emotional adjustment Autism
A B S T R A C T
Adolescents with Autism Spectrum Disorder (ASD) often experience poor social-emotional adjustment and interactions with peers, but taking care of a family pet may serve as a buffer. This study utilized 81 parent-adolescent dyads to examine how dimensions of pet ownership (responsibility, comfort, companionship) may be associated with socialemotional adjustment (depression, loneliness, friendship quality) among adolescents with ASD, as well as how social impairments may influence these relations. Results revealed that adolescents who took more responsibility for their pet exhibited fewer depressive symptoms. Additionally, parents of more socially impaired adolescents reported better friendship quality than less socially impaired adolescents. Findings suggest taking care of a pet may facilitate better social-emotional adjustment among adolescents with ASD. Published by Elsevier Inc.
1. Introduction One of the hallmarks of Autism Spectrum Disorder (ASD) is a deficit in social interactions, which often results in fewer friends and poorer friendship quality (Orsmond, Krauss, & Seltzer, 2004). Adolescents with high-functioning ASD (HFASD), characterized by no to mild cognitive impairment, often have greater awareness of their social challenges, which can lead to frustrations, isolation, and higher rates of depressive symptoms and loneliness compared to typically developing populations (e.g., Klin, McPartland, & Volkmar, 2005; Locke, Ishijima, Kasari, & London, 2010; Lopata et al., 2010; Strang et al., 2012). Given that youth with HFASD may be at increased risk for these negative outcomes, research has prioritized exploring potential buffers to enhance social-emotional adjustment, including human-animal interactions. The literature in this area suggests that human-animal interaction may improve health and wellness, as well as facilitate positive social-emotional adjustment, among typically developing individuals (Lem, Coe, Haley, Stone, & O’Grady, 2016; Levine et al., 2013; McConnell, Brown, Shoda, Stayton, & Martin, 2012; Stanley, Conwell, Bowen, & Van Orden, 2014). As such, high functioning youth with ASD, in particular, may also benefit from intervention efforts in this area in light of their greater capacity to care for pets independently and ability to more fully engage in the interactions.
* Corresponding author. E-mail address: [email protected] (A. Ward). http://dx.doi.org/10.1016/j.jcomdis.2017.01.002 0021-9924/Published by Elsevier Inc.
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1.1. Benefits of human-animal interaction Initially, research focused on examining the benefits of working with service animals in treatment settings. Recent metaanalytic reviews of animal-assisted interventions in mental health highlighted several themes that have emerged regarding the mechanisms through which human-animal interactions are beneficial to treatment. Researchers have found that animals may provide safe and calm companions that facilitate social expression by not only reducing anxiety and arousal in patients, but also promoting interactions between providers and patients (Berry, Borgi, Francia, Alleva, & Cirulli, 2013; Kruger & Serprell, 2006). More recently, however, researchers have turned to examining the benefits of human-animal interactions specifically within ASD populations, and have found that animals increase the ability to seek social relationships with others through increased use of prosocial behaviors (i.e., eye contact and talking), as well as decrease negative behaviors such as whining and crying (Carlisle, 2014; O’Haire, 2013; O’Haire, McKenzie, Beck, & Slaughter, 2013). Further support for the role of animals in promoting social functioning among youth with ASD can be found in neurobiological research. In one recent study, the presence of animals was shown to reduce stress in children with ASD as measured by physiological biomarkers (i.e., skin conductance) across a variety of social conditions (O’Haire, McKenzie, Beck, & Slaughter, 2015). That is, children with ASD demonstrated heightened arousal as compared to typically developing youth in all social contexts (e.g., reading silently, reading aloud in class, free play with peers), with the exception of when animals were present. Additionally, MRI studies have confirmed that youth with HFASD exhibited greater activation in affective and face-processing brain regions when shown animal versus human faces, as compared to their age-matched, typically developing counterparts (Whyte, Behrmann, Minshew, Garcia, & Scherf, 2016). More specifically, while typically developing adolescents demonstrated similar activation patterns to human and animal faces, youth with HFASD demonstrated stronger responses to the animal faces. Collectively, these results highlight the potential for animal use in interventions moving forward. Although a number of studies have explored the benefits of the presence of animals to increase social functioning among ASD populations, only a few have examined the role of family pets in the context of the everyday lives of youth with HFASD and their families. Grandgeorge, Tordjman, Lazartigues, Deleau, and Hausberger (2012) found that children with ASD ages five and older demonstrated improvements in prosocial behaviors (i.e., offering to share and offering comfort) after acquiring a pet. Additionally, Carlisle (2014) conducted a qualitative study examining qualities of dog ownership in families of children with ASD. Of the dog owners, 47% of parents reported that their child talked to his/her dog and used it for companionship. To build on qualitative data, Wright et al. (2015a) conducted a randomized, controlled trial examining the influence of pet dogs on caregiver stress levels among families with a child with ASD. Results revealed significantly lower stress levels among parents in the intervention group (i.e., acquiring a pet) as compared to the parents in the control group (i.e., not acquiring a pet), with stress levels within normal limits for intervention parents. These results suggest that pet ownership may be associated with improved social-emotional and family functioning. A follow-up study utilizing the same sample also revealed a decrease in symptoms of anxiety among the children with ASD from pre-intervention to follow-up for the dogowning group (Wright et al., 2015b). Taken together, these studies suggest a link between pet ownership among youth with ASD and social-emotional adjustment. They also highlight the importance of examining qualities of the human-animal interaction, including comfort, companionship, and responsibility, that may be related positive outcomes. The current study builds upon the emerging literature examining human-animal interactions (e.g., service animals) in therapeutic settings to further explore the socialemotional benefits of family pets in daily life. This provides an initial attempt to better understand the mechanisms that link human-animal interactions to improved functioning, which can provide valuable information in the development of future intervention efforts. Specifically, this study explored the associations between certain qualities of pet ownership (e.g., responsibility for pets, turning to the pets for comfort/companionship) and social-emotional adjustment (e.g., depressive symptoms, loneliness, friendship quality) among adolescents with HFASD. Further, given that higher functioning youth may have greater capacity to take care of and engage with their pets, this study investigated whether these links differed depending on the adolescents’ level of social impairment. 2. Method 2.1. Participants and procedure All participants for this study were recruited from a larger study assessing dimensions of executive functions, social impairment, and friendship quality in HFASD youth. The majority of families for the larger study were recruited nationally from the Interactive Autism Network (IAN) Research Database at the Kennedy Krieger Institute and Johns Hopkins Medicine – Baltimore, sponsored by the Autism Speaks Foundation. Additional families were recruited via postings in online support groups, advocacy group websites, and clinics as part of the larger study of HFASD youth. Participants from the larger study were then contacted via email about a follow-up survey assessing pet ownership, and either completed measures online through Opinio or via mailed paper survey within that same year. Of note, high functioning is not defined clearly in the literature and can refer to many aspects of development and functioning (e.g., social skills, language, cognitive abilities, etc.), but for the purposes of this study referred to youth with no to mild cognitive impairment. Consistent with this characterization, inclusion criteria for the current study required that adolescents (1) had a current ASD diagnosis (per DSM-
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IV-TR criteria), (2) were 12–17 years old, (3) had a 6th grade reading level, (4) had a family pet, and (5) could verbally communicate regularly with family and peers. Participants in this cross-sectional study included 73 high functioning adolescents with ASD (M age = 13.91, SD = 1.75 years; 87.5% male) and their parents who were recruited from the larger study (N = 152) described above. Examination of T-scores from the Social Responsiveness Scale (used in this study to assess social impairment) indicated that all current participants had total T-scores 60, which indicates mild to moderate impairment or worse consistent with an ASD diagnosis. Research has demonstrated that, for parents whose reports on the SRS yield a T-score of 60, the likelihood of a diagnosis of ASD is 84% (Constantino et al., 2007). Seventy-nine percent of the qualifying participants had T-scores 76, which is considered in the severe range of social impairment and is strongly associated with a clinical diagnosis of ASD (Constantino & Gruber, 2005). However, given our characterization of HFASD as youth who exhibit no to mild cognitive impairment as evidenced by their ability to read and complete study surveys, we utilized these social impairment indices as variables of interest rather than inclusion/exclusion criteria. Further validation of the inclusion criteria capturing youth with only no to mild cognitive impairment was found in the mean Full Scale IQ (by parent report; M = 106, SD = 20.24), and all participants whose parents reported IQ scores fell within the low average range or higher. Of note, participants in the current study did not differ from the larger study population in terms of any diagnostic or demographic variables (see Table 1). Most families (74%) completed measures online. Informed consent was obtained from all individual participants included in the study. 2.2. Measures 2.2.1. Pet ownership qualities Parents completed a demographic and pet ownership questionnaire assessing number of pets owned, types of pets, whether their child considers a pet as a best friend, and how long pet(s) have been owned to gather qualitative information about the family pet. Additionally, three dimensions of pet ownership (i.e., responsibility, comfort, companionship) were assessed and utilized as independent variables in this study. Pet ownership dimension questions were developed by the investigators for this study and correspond with the perceived benefits of dog ownership among families of children with ASD as outlined in recent literature (Carlisle, 2014). Parents responded to one item for each dimension of pet ownership. Items included, “On a scale of 0–4 how much responsibility does your child have in the care of the pets?” (0 = no responsibility to 4 = complete responsibility). “On a scale of 0–4, how much does your child turn to the pet for comfort?” and “On a likert scale of 0–4, how much does your child turn to the pet for companionship?” For these items, scores of 0 indicate “never” whereas scores of 4 indicate “all the time.” 2.2.2. Social-emotional adjustment Adolescents’ perceptions of social-emotional adjustment were assessed via the Youth Self Report-Depression Scale (YSRD; Achenbach, 1991) with the suicide questions removed, the Loneliness Scale (LS; Asher, Hymel, & Renshaw, 1984; a = 0.90), and the Friendship Quality Questionnaire-Abbreviated edition (FQQ-A; Parker & Asher, 1993; a = 0.91). Parents completed the Child Behavior Checklist-Depression Scale (CBCL-D; Achenbach, 1991) with the suicide questions removed, the Loneliness Scale-Parent (LS-P; Asher et al., 1984; a = 0.90), and the Friendship Quality Questionnaire-Abbreviated Parent Table 1 Means (SD) of All Study Variables for the current and larger study. Pets Study (n = 73) Mean (SD)
Larger Study (N = 79) Mean (SD)
t (p-value)
Participant Variables Age (years) FSIQ (n = 50) Social Impairment (Parent Report; T-score)
13.91 (1.75) 106.40 (20.24) 96.28 (16.19)
13.97 (1.54) 107.55 (21.36) 96.62 (15.82)
0.07 (0.94) 0.26 (0.80) 0.13 (0.90)
Pet Ownership Variables Number of Pets Responsibility (scale: 0–4) Comfort (scale: 0–4) Companionship (scale: 0–4)
4.75 (7.99) 1.85 (1.11) 2.48 (1.24) 2.55 (1.18)
– – – –
– – – –
Social-Emotional Variables Depression (Adolescent Report) Loneliness (Adolescent Report) Friendship Quality (Adolescent Report) Depression (Parent Report) Loneliness (Parent Report) Friendship Quality (Parent Report)
0.73 (0.39) 25.58 (12.99) 71.05 (13.54) 0.72 (0.38) 32.74 (9.58) 63.39 (15.68)
0.69 (0.40) 23.21 (11.73) 72.96 (15.85) 0.68 (0.39) 31.65 (8.40) 65.56 (16.02)
0.51 (0.61) 1.04 (0.30) 0.78 (0.44) 0.61 (.54) 0.73 (0.46) 0.80 (0.42)
Note. FSIQ was only available for a subset of the sample.
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edition (FQQ-AP; Parker & Asher, 1993; a = 0.91). Both the parent and adolescent version of the FQQ assess the quality of an adolescent’s best friendship. Examples of items include “my child’s best friend says he’s/she’s good at things” and “my child’s best friend makes him/her feel good about his/her ideas.” In the current study, all measures demonstrated acceptable reliabilities, including a = 0.79 for the CBCL-D, a = 0.78 for the YSR-D, a = 0.89 for the FQQ-A, and a = 0.91 for the FQQ-AP. Additionally, the reliability for the measures of loneliness were a = 0.84 and a = 0.91 for the LS-P and LS respectively. 2.2.3. Social impairment Parents completed the Social Responsiveness Scale (SRS; Constantino & Gruber, 2005) to assess their child’s social impairment. T-scores were calculated based on all items of the SRS. The scale’s internal consistency was considered reliable (a = 0.80). 2.3. Analytic plan Descriptive analyses, including t-tests between the full and study sample, as well as correlational analyses were run. Multiple regression analyses were then run to examine associations between pet ownership qualities and social-emotional adjustment. Separate regression analyses were conducted for each of the measures of adjustment described above (3 completed by the adolescent; 3 completed by the parent). Each regression included the following independent variables: responsibility for pets, turning to the pets for comfort, and turning to the pets for companionship. For all analyses, the social impairment variable was entered in Step 1 to control for the variable, followed by the pet ownership qualities variables in Step 2 (IVs). Finally, the pet ownership qualities x social impairment interaction terms were entered simultaneously in step 3. Post-hoc tests of simple slopes probed significant interactions through regression analyses. Of note, post-hoc power analysis using the G*Power program (Faul, Erdfelder, Lang, & Buchner, 2007) determined that the sample size was adequately powered to detect large effects, but was underpowered to detect both small and medium effect sizes through regression analyses. 3. Results 3.1. Descriptive statistics In addition to the information shown in Table 1, 51.4% of parents reported that a pet was their child’s best friend. Participants also provided information regarding the types of pets in their homes, including that 68% had cats, 64% had dogs, 21% had rodents, 21% had fish, reptiles, or amphibians, 9% had rabbits, and 9% had birds. Average length of pet ownership was 3.91 years. Additionally, the majority of parents (56.7%) reported that their child turned to a pet for comfort often or all the time, while 66.2% noted that their child took moderate to complete responsibility in caring for the pet. As shown in Table 1, there were no significant differences between the current study sample versus the larger sample on any participant or socialemotional variables. Correlational analyses (see Table 2) revealed significant positive associations between adolescents’ responsibility for pets and how much the adolescent turned to pets for companionship and comfort. In terms of participant variables, IQ was significant positively associated with adolescents’ responsibility for pets, as well as how much adolescents turned to pets for companionship, while age was significantly positively associated with adolescents’ responsibility for pets. Based on these analyses, IQ and age were utilized as covariates in any regression analyses in which a significant relation emerged between the pet ownership variables (i.e., responsibility and companionship) and social-emotional outcomes. As such, IQ and age were included as a covariate in the model exploring responsibility and depressive symptoms, and results are described in a footnote below Table 3.
Table 2 Bivariate Correlations between Study Variables.
1. Depressive Sxs- Parent 2. Depressive Sxs- Adolescent 3. Loneliness- Parent 4. Loneliness- Adolescent 5. Friendship Quality- Parent 6. Friendship Quality- Adolescent 7. Social Impairment 8. Responsibility 9. Comfort 10. Companionship 11. FSIQ 12. Age
1
2
3
– 0.61*** 0.49*** 0.45*** 0.10 0.01 0.40*** 0.25* 0.26*** 0.18 0.17 0.07
– 0.42*** 0.61*** 0.21 0.05 0.32*** 0.18 0.22*** 0.28*** 0.24 0.06
– 0.48*** 0.37*** 0.03 0.50*** 0.09 0.08*** 0.05*** 0.36** 0.05
4
5
6
7
8
9
10
11
12
– 0.31** 0.29* 0.32* 0.36**
– 0.82*** 0.27 0.15
– 0.32* 0.12
– 0.08
–
– 0.26** 0.44*** 0.23** 0.10 0.13*** 0.16*** 0.30* 0.09
– 0.45*** 0.34*** 0.06*** 0.13 0.06 0.01 0.12
– 0.09 0.10 0.25* 0.18 0.27 0.20
– 0.08 0.17 0.13 0.12 0.08
Note: * Significant at the 0.05 level, ** Significant at the 0.01 level, *** Significant at the 0.001 level (2-tailed).
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Table 3 Linear Regression Analyses for Pet Ownership Dimensions and Depressive Symptoms. Depressive Symptoms Adolescent Report Step 1 Step 2
Step 3
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B 0.01 0.09 0.01 0.11 0.01 0.01 0.01
b 0.32** 0.25* 0.01 0.32 0.04 0.07 0.24
t 2.79 2.13 0.06 1.77 0.38 0.37 1.21
Total R2 Parent Report Step 1 Step 2
Step 3
D R2 0.10 0.11
0.03
0.25
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B 0.01 0.11 0.10 0.01 0.01 0.01 0.01
b 0.42*** 0.32** 0.33 0.04 0.14 0.24 0.20
t 3.90 2.90 1.82 0.20 1.23 1.30 1.06
Total R2
D R2 0.18 0.13
0.03
0.34
Note: * Significant at the 0.05 level, ** Significant at the 0.01 level, *** Significant at the 0.001 level (2-tailed).1 SI: Social Impairment as measured by the Social Responsiveness Scale.
Table 4 Linear Regression Analyses for Pet Ownership Dimensions and Loneliness. Loneliness Adolescent Report Step 1 Step 2
Step 3
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B 0.27 1.35 0.35 2.01 0.06 0.03 0.08
b 0.33** 0.11 0.03 0.17 0.08 0.04 0.12
t 2.89 0.95 0.16 0.91 0.66 0.21 0.59
Total R2 Parent Report Step 1 Step 2
Step 3
D R2 0.11 0.03
0.03
0.16
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B 0.33 0.38 0.17 0.24 0.06 0.09 0.02
b 0.57*** 0.05 0.02 0.03 0.11 0.19 0.05
Total R2
t 5.89 0.43 0.13 0.17 1.02 1.06 0.29
D R2 0.33 0.01
0.03
0.37
Note: * Significant at the 0.05 level, ** Significant at the 0.01 level, *** Significant at the 0.001 level (2-tailed). SI: Social Impairment as measured by the Social Responsiveness Scale.
3.2. Pet ownership and social emotional adjustment Linear multiple regressions were conducted examining relations between dimensions of pet ownership (i.e., responsibility, comfort, companionship) and adolescents’ social-emotional adjustment, and whether these relations varied by level of social impairment. Social impairment was entered on the first step of the regression, followed by dimensions of pet ownership, and the interaction terms. Regressions were run separately for parent and adolescent report because parent and adolescent reports of adolescent psychopathology are often discrepant, especially with HFASD (McMahon & Solomon, 2015). As shown in Table 3, after controlling for levels of social impairment, adolescents who took more responsibility for their pet exhibited fewer depressive symptoms according to both adolescent (p < 0.05) and parent report (p < 0.01). No
1 Given that IQ and age correlate with the responsibility domain of pet ownership, additional analyses were run controlling for these variables when exploring the relation between responsibility and depressive symptoms. These follow up analyses revealed that the relation between responsibility and depressive symptoms held after accounting for IQ and age in the model.
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Table 5 Linear Regression Analyses for Pet Ownership Dimensions and Friendship Quality. Friendship Quality Adolescent Report Step 1 Step 2
Step 3
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B
b
t
D R2
0.09 0.09 3.83 0.82 1.32 0.07 0.15
0.10 0.01 0.33 0.07 0.17 0.11 0.21
0.86 0.05 1.68 0.34 1.36 0.52 1.01
0.01 0.08
Total R2 Parent Report Step 1 Step 2
Step 3
0.04
0.13
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B
b
t
D R2
0.37 0.57 4.09 1.94 0.06 0.15 0.35
0.37** 0.04 0.30 0.13 0.07 0.19 0.44*
3.23 0.32 1.57 0.71 0.56 0.94 2.23
0.14 0.04
Total R2
0.09
0.27
Note: * Significant at the 0.05 level, ** Significant at the 0.01 level, *** Significant at the 0.001 level (2-tailed). SI: Social Impairment as measured by the Social Responsiveness Scale.
140 120 100
FQQ-AP
80 60 40
Low SI
20
High SI
0 -20 -40
Low Companionship
High Companionship
Fig. 1. Simple slopes analyses of companionship social impairment interaction on parent-reported friendship quality. FQQ-AP: Friendship Quality Questionnaire – Parent; SI: Social Impairment.
significant relations emerged between pet ownership dimensions and loneliness or friendship quality (see Tables 4 and 5). However, a significant social impairment X companionship interaction emerged for friendship quality, such that for adolescents with greater social impairment, turning to pets for companionship was associated with higher parent-reported friendship quality, but for those with less social impairment, turning to pets for companionship was associated with lower friendship quality (p < 0.05; see Fig. 1). 4. Discussion This study expands upon prior work examining human-animal interactions and prosocial outcomes, and specifically explores associations between pet ownership and social-emotional adjustment among adolescents with HFASD. Humananimal interaction theory suggests that many humans seek out contact with animals as calming and non-judgmental sources of support and facilitators of social interaction (Kruger & Serprell, 2006). Particularly for socially isolated individuals such as those with HFASD, animals may offer unique outlets for social engagement, especially given that animal interaction requires a limited need for well-developed social skills to have a successful positive social experience. Previous metaanalyses have examined human-animal interactions through the use of animal-assisted mental health interventions, with results suggesting positive benefits such as increased verbal and nonverbal behaviors in youth with ASD in the context of interactions with therapy animals (Berry et al., 2013). However, the current study builds upon this work by examining how human-animal interactions are associated with social-emotional functioning in adolescents with HFASD. In line with recent research demonstrating a link between acquiring a pet and decreased symptoms of anxiety among youth with ASD (Wright et al., 2015b), results of this study suggest that specific dimensions of pet ownership may be
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associated with social-emotional adjustment among adolescents with HFASD. Responsibility emerged as an important dimension of pet ownership that may be linked to depressive symptoms. Adolescents who took greater responsibility for pets experience fewer depressive symptoms based on parent and adolescent report regardless of level of social impairment and IQ. Building on previous studies documenting associations between human-animal interaction and positive socialemotional adjustment among normative populations, these results suggest that not only interaction, but also taking responsibility for pets is associated with fewer depressive symptoms for adolescents with ASD. However, the cross-sectional nature of the data does not allow for determination of the directionality of the effects. That is, taking responsibility for their pets may alleviate symptoms of depression among individuals with HFASD; alternatively, more depressed youth may take less responsibility for their pets. However, previous results provide stronger support for the former given that findings from a recent study focusing on pet ownership demonstrated that taking responsibility for a pet was associated with social skills improvements among ASD youth (Grandgeorge et al., 2012). Responsibility may also be linked to an increased sense of purpose and may be an area to explore when developing intervention programs for adolescents with HFASD. In addition to responsibility, turning to pets for comfort may be a protective factor for a subset of youth with HFASD. In this study, adolescents with greater social impairments who turned to pets for comfort reportedly experienced benefits in terms of their friendships (e.g., positive associations with friendship quality) according to parent report. Interestingly, adolescents with better social skills who turned to pets for comfort reportedly experienced negative associations with friendship quality per parents. This may in part be due to the fact that adolescents with more social impairment might be less cognizant of their social deficits, and thus benefit more from social engagement and social skill building offered through interacting with pets. Adolescents with less impairment likely have a better understanding of their deficits, and research has suggested that individuals who turn to animals for companionship may do so to compensate for a lack of support in human relationships (Kurdek, 2009). Still, given that the presence of animals has been associated with decreased arousal (i.e., stress) in social situations for youth with ASD (O’Haire et al., 2013), as well as increased neural activity in affective brain regions (Whyte et al., 2016), the physical and emotional comfort provided by pets may serve as a platform for youth with HFASD to better utilize the social skills they have developed. Additionally, a recent qualitative study with parents of ASD youth identified both social interaction and companionship as key benefits of pet ownership (Carlisle, 2014), highlighting the importance of studying these dimensions of pet ownership in future research. 4.1. Limitations Although this study is among the first to explore benefits of pet ownership outside of a controlled treatment/intervention setting, data was collected cross-sectionally as part of a larger study of youth reported to have an HFASD. Future research should substantiate ASD diagnoses with in-person assessments, as well as utilize a longitudinal design to assess how pet ownership might influence social-emotional adjustment over time beyond cross-sectional associations. Given the correlational nature of the results, future studies should actively recruit a non-pet owner control group to enhance the ability to make direct comparisons, as well as speak to the influence of pet ownership on outcomes and control for potential confounds. Further, the benefits of pet ownership may extend beyond adolescents with ASD to a typically developing population of adolescents or those with other developmental disabilities. Future work should also examine whether there are differential effects among these populations. Additionally, the small sample size limits not only the power to detect effects, but also the generalizability of the results. In terms of reliability of findings, several measures in the study were not specifically designed for youth with ASD. Future research could develop measures specifically designed for ASD youth, while also taking into consideration that self-report measures among this population may need to be interpreted with caution. Still, the findings in this study highlight the need to further explore the implications of pet ownership among youth with HFASD. While a considerable amount of research has focused on therapeutic animal interventions and the development of prosocial skills, a growing body of literature is focusing on the normative experience of animals in the home. Although this study represents the next step in understanding the benefits associated with pet ownership among a community sample of adolescents with HFASD, results suggest that aspects of pet ownership (e.g., taking responsibility for pets, turning to pets for companionship) may be relevant to social-emotional functioning in this population. References Achenbach, T. (1991). Manual for the youth self-report and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry. Asher, S. R., Hymel, S., & Renshaw, P. D. (1984). Loneliness in children. Child Development, 55, 1456–1464. Berry, A., Borgi, M., Francia, N., Alleva, E., & Cirulli, F. (2013). Use of assistance and therapy dogs for children with autism spectrum disorders: A critical review of the current evidence. The Journal of Alternative and Complementary Medicine, 19, 73–80. http://dx.doi.org/10.1089/acm.2011.0835. Carlisle, G. K. (2014). Pet dog ownership decisions for parents of children with autism spectrum disorder. Journal of Pediatric Nursing, 29, 114–123. http://dx. doi.org/10.1016/j.pedn.2013.09.005. Constantino, J. N., & Gruber, C. P. (2005). Social responsiveness scale (SRS). Los Angeles, CA: Western Psychological Services. Constantino, J. N., Lavesser, P. D., Zhang, Y., Abbacchi, A. M., Gray, T., & Todd, R. D. (2007). Rapid quantitative assessment of autistic social impairment by classroom teachers. Journal of the Academy of Child & Adolescent Psychiatry, 46, 1668–1676. http://dx.doi.org/10.1097/chi.0b013e318157cb23. Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. http://dx.doi.org/10.3758/BRM.41.4.1149. Grandgeorge, M., Tordjman, S., Lazartigues, A., Deleau, M., & Hausberger, M. (2012). Does pet arrival trigger prosocial behaviors in individuals with autism? PloS One, 7, e41739. http://dx.doi.org/10.1371/journal.pone.0041739.
42
A. Ward et al. / Journal of Communication Disorders 65 (2017) 35–42
Klin, A., McPartland, J., & Volkmar, F. R. (2005). Asperger syndrome, In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (pp. 88–125).3rd ed.) Hoboken, NJ: John Wiley & Sons, Inc.. Kruger, K. A., & Serprell, J. A. (2006). Animal-assisted interventions in mental health: Definitions and theoretical foundations, In A. H. Fine (Ed.), Handbook on animal-assisted therapy: Theoretical foundations and guidelines for practice, 2nd ed.) Burlington, MA: Academic Press. Kurdek, L. A. (2009). Pet dogs as attachment figures for adult owners. Journal of Family Psychology, 23, 439–446. http://dx.doi.org/10.1037/a0014979. Lem, M., Coe, J. B., Haley, D. B., Stone, E., & O'Grady, W. (2016). The protective association between pet ownership and depression among street-involved youth: A cross-sectional study. Anthrozoo¨s, 29, 123–136. http://dx.doi.org/10.1080/08927936.2015.1082772. Levine, G. N., Allen, K., Braun, L. T., Christian, H. E., Friedmann, E., Taubert, K. A., . . . Lange, R. A. (2013). Pet ownership and cardiovascular risk: A scientific statement from the American Heart Association. Circulation, 127, 2353–2363. http://dx.doi.org/10.1161/CIR.0b013e31829201e1. Locke, J., Ishijima, E. H., Kasari, C., & London, N. (2010). Loneliness, friendship quality and the social networks of adolescents with high-functioning autism in an inclusive school setting. Journal of Research in Special Educational Needs, 10, 74–81. http://dx.doi.org/10.1111/j.1471-3802.2010.01148.x. Lopata, C., Toomey, J. A., Fox, J. D., Volker, M. A., Chow, S. Y., Thomeer, M. L., . . . Smerbeck, A. M. (2010). Anxiety and depression in children with HFASDs: Symptom levels and source differences. Journal of Abnormal Child Psychology, 38, 765–776. http://dx.doi.org/10.1007/s10802-010-9406-1. McConnell, A., Brown, C., Shoda, T., Stayton, L., & Martin, C. (2012). Friends with benefits: On the positive consequences of pet ownership. Journal of Personality and Social Psychology, 101, 1239–1252. http://dx.doi.org/10.1037/a0024506. McMahon, C., & Solomon, M. (2015). Brief report: Parent-adolescent informant discrepancies of social skill importance and social skill engagement for higher-functioning adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(10), 3396–3403. http://dx.doi.org/ 10.1007/s10803-015-2494-6. O’Haire, M., McKenzie, S., Beck, A., & Slaughter, V. (2013). Social behaviors increase in children with autism in the presence of animals compared to toys. PloS One, 8, e57010. http://dx.doi.org/10.1371/journal.pone.0057010. O'Haire, M. E., McKenzie, S. J., Beck, A. M., & Slaughter, V. (2015). Animals may act as social buffers: Skin conductance arousal in children with autism spectrum disorder in a social context. Developmental Psychobiology, 57, 584–595. http://dx.doi.org/10.1002/dev.21310. O’Haire, M. E. (2013). Animal-assisted intervention for autism spectrum disorder: A systematic literature review. Journal of Autism and Developmental Disorders, 43, 1606–1622. http://dx.doi.org/10.1007/s10803-012-1707-5. Orsmond, G. I., Krauss, M. W., & Seltzer, M. M. (2004). Peer relationships and social and recreational activities among adolescents and adults with autism. Journal of Autism and Developmental Disorders, 34, 245–256. http://dx.doi.org/10.1023/B:JADD.0000029547.96610.df. Parker, J. G., & Asher, S. R. (1993). Friendship and friendship quality in middle childhood: Links with peer group acceptance and feelings of loneliness and social dissatisfaction. Developmental Psychology, 29, 611–621. http://dx.doi.org/10.1037//0012-1649.29.4.611. Stanley, I. H., Conwell, Y., Bowen, C., & Van Orden, K. A. (2014). Pet ownership may attenuate loneliness among older adult primary care patients who live alone. Aging & Mental Health, 18, 394–399. http://dx.doi.org/10.1080/13607863.2013.837147. Strang, J. F., Kenworthy, L., Daniolos, P., Case, L., Wills, M. C., Martin, A., & Wallace, G. L. (2012). Depression and anxiety symptoms in children and adolescents with autism spectrum disorders without intellectual disability. Research in Autism Spectrum Disorders, 6, 406–412. http://dx.doi.org/10.1016/j. rasd.2011.06.015. Whyte, E. M., Behrmann, M., Minshew, N. J., Garcia, N. V., & Scherf, K. S. (2016). Animal, but not human, faces engage the distributed face network in adolescents with autism. Developmental Science, 19, 306–317. http://dx.doi.org/10.1111/desc.12305. Wright, H. F., Hall, S., Hames, A., Hardiman, J., Mills, R., Mills, D. S., & PAWS Team (2015a). Acquiring a pet dog significantly reduces stress of primary carers for children with autism spectrum disorder: A prospective case control study. Journal of Autism and Developmental Disorders, 45, 2531–2540. http://dx.doi. org/10.1007/s10803-015-2418-5. Wright, H., Hall, S., Hames, A., Hardiman, J., Mills, R., PAWS Project Team, & Mills, D. (2015b). Pet dogs improve family functioning and reduce anxiety in children with autism spectrum disorder. Anthrozoo¨s, 28, 611–624. http://dx.doi.org/10.1080/08927936.2015.1070003.
Contents lists available at ScienceDirect
Journal of Communication Disorders
Social-emotional adjustment and pet ownership among adolescents with autism spectrum disorder Amanda Warda,* , Nicole Arolab , Amy Bohnertc , Rebecca Liebd a
Massachusetts General Hospital/Harvard Medical School, 151 Merrimac, Boston, MA 02114, United States University of Minnesota, 2450 Riverside Avenue South, Minneapolis, MN 55454, United States c Loyola University Chicago, 1032 W. Sheridan Rd., Chicago, IL 60660, United States d Akron Children’s Hospital,215 W. Bowery St., Akron, OH 44308, United States b
A R T I C L E I N F O
Article history: Received 5 June 2015 Received in revised form 19 January 2017 Accepted 19 January 2017 Available online 25 January 2017 Keywords: Pet ownership Social impairment Social-emotional adjustment Autism
A B S T R A C T
Adolescents with Autism Spectrum Disorder (ASD) often experience poor social-emotional adjustment and interactions with peers, but taking care of a family pet may serve as a buffer. This study utilized 81 parent-adolescent dyads to examine how dimensions of pet ownership (responsibility, comfort, companionship) may be associated with socialemotional adjustment (depression, loneliness, friendship quality) among adolescents with ASD, as well as how social impairments may influence these relations. Results revealed that adolescents who took more responsibility for their pet exhibited fewer depressive symptoms. Additionally, parents of more socially impaired adolescents reported better friendship quality than less socially impaired adolescents. Findings suggest taking care of a pet may facilitate better social-emotional adjustment among adolescents with ASD. Published by Elsevier Inc.
1. Introduction One of the hallmarks of Autism Spectrum Disorder (ASD) is a deficit in social interactions, which often results in fewer friends and poorer friendship quality (Orsmond, Krauss, & Seltzer, 2004). Adolescents with high-functioning ASD (HFASD), characterized by no to mild cognitive impairment, often have greater awareness of their social challenges, which can lead to frustrations, isolation, and higher rates of depressive symptoms and loneliness compared to typically developing populations (e.g., Klin, McPartland, & Volkmar, 2005; Locke, Ishijima, Kasari, & London, 2010; Lopata et al., 2010; Strang et al., 2012). Given that youth with HFASD may be at increased risk for these negative outcomes, research has prioritized exploring potential buffers to enhance social-emotional adjustment, including human-animal interactions. The literature in this area suggests that human-animal interaction may improve health and wellness, as well as facilitate positive social-emotional adjustment, among typically developing individuals (Lem, Coe, Haley, Stone, & O’Grady, 2016; Levine et al., 2013; McConnell, Brown, Shoda, Stayton, & Martin, 2012; Stanley, Conwell, Bowen, & Van Orden, 2014). As such, high functioning youth with ASD, in particular, may also benefit from intervention efforts in this area in light of their greater capacity to care for pets independently and ability to more fully engage in the interactions.
* Corresponding author. E-mail address: [email protected] (A. Ward). http://dx.doi.org/10.1016/j.jcomdis.2017.01.002 0021-9924/Published by Elsevier Inc.
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1.1. Benefits of human-animal interaction Initially, research focused on examining the benefits of working with service animals in treatment settings. Recent metaanalytic reviews of animal-assisted interventions in mental health highlighted several themes that have emerged regarding the mechanisms through which human-animal interactions are beneficial to treatment. Researchers have found that animals may provide safe and calm companions that facilitate social expression by not only reducing anxiety and arousal in patients, but also promoting interactions between providers and patients (Berry, Borgi, Francia, Alleva, & Cirulli, 2013; Kruger & Serprell, 2006). More recently, however, researchers have turned to examining the benefits of human-animal interactions specifically within ASD populations, and have found that animals increase the ability to seek social relationships with others through increased use of prosocial behaviors (i.e., eye contact and talking), as well as decrease negative behaviors such as whining and crying (Carlisle, 2014; O’Haire, 2013; O’Haire, McKenzie, Beck, & Slaughter, 2013). Further support for the role of animals in promoting social functioning among youth with ASD can be found in neurobiological research. In one recent study, the presence of animals was shown to reduce stress in children with ASD as measured by physiological biomarkers (i.e., skin conductance) across a variety of social conditions (O’Haire, McKenzie, Beck, & Slaughter, 2015). That is, children with ASD demonstrated heightened arousal as compared to typically developing youth in all social contexts (e.g., reading silently, reading aloud in class, free play with peers), with the exception of when animals were present. Additionally, MRI studies have confirmed that youth with HFASD exhibited greater activation in affective and face-processing brain regions when shown animal versus human faces, as compared to their age-matched, typically developing counterparts (Whyte, Behrmann, Minshew, Garcia, & Scherf, 2016). More specifically, while typically developing adolescents demonstrated similar activation patterns to human and animal faces, youth with HFASD demonstrated stronger responses to the animal faces. Collectively, these results highlight the potential for animal use in interventions moving forward. Although a number of studies have explored the benefits of the presence of animals to increase social functioning among ASD populations, only a few have examined the role of family pets in the context of the everyday lives of youth with HFASD and their families. Grandgeorge, Tordjman, Lazartigues, Deleau, and Hausberger (2012) found that children with ASD ages five and older demonstrated improvements in prosocial behaviors (i.e., offering to share and offering comfort) after acquiring a pet. Additionally, Carlisle (2014) conducted a qualitative study examining qualities of dog ownership in families of children with ASD. Of the dog owners, 47% of parents reported that their child talked to his/her dog and used it for companionship. To build on qualitative data, Wright et al. (2015a) conducted a randomized, controlled trial examining the influence of pet dogs on caregiver stress levels among families with a child with ASD. Results revealed significantly lower stress levels among parents in the intervention group (i.e., acquiring a pet) as compared to the parents in the control group (i.e., not acquiring a pet), with stress levels within normal limits for intervention parents. These results suggest that pet ownership may be associated with improved social-emotional and family functioning. A follow-up study utilizing the same sample also revealed a decrease in symptoms of anxiety among the children with ASD from pre-intervention to follow-up for the dogowning group (Wright et al., 2015b). Taken together, these studies suggest a link between pet ownership among youth with ASD and social-emotional adjustment. They also highlight the importance of examining qualities of the human-animal interaction, including comfort, companionship, and responsibility, that may be related positive outcomes. The current study builds upon the emerging literature examining human-animal interactions (e.g., service animals) in therapeutic settings to further explore the socialemotional benefits of family pets in daily life. This provides an initial attempt to better understand the mechanisms that link human-animal interactions to improved functioning, which can provide valuable information in the development of future intervention efforts. Specifically, this study explored the associations between certain qualities of pet ownership (e.g., responsibility for pets, turning to the pets for comfort/companionship) and social-emotional adjustment (e.g., depressive symptoms, loneliness, friendship quality) among adolescents with HFASD. Further, given that higher functioning youth may have greater capacity to take care of and engage with their pets, this study investigated whether these links differed depending on the adolescents’ level of social impairment. 2. Method 2.1. Participants and procedure All participants for this study were recruited from a larger study assessing dimensions of executive functions, social impairment, and friendship quality in HFASD youth. The majority of families for the larger study were recruited nationally from the Interactive Autism Network (IAN) Research Database at the Kennedy Krieger Institute and Johns Hopkins Medicine – Baltimore, sponsored by the Autism Speaks Foundation. Additional families were recruited via postings in online support groups, advocacy group websites, and clinics as part of the larger study of HFASD youth. Participants from the larger study were then contacted via email about a follow-up survey assessing pet ownership, and either completed measures online through Opinio or via mailed paper survey within that same year. Of note, high functioning is not defined clearly in the literature and can refer to many aspects of development and functioning (e.g., social skills, language, cognitive abilities, etc.), but for the purposes of this study referred to youth with no to mild cognitive impairment. Consistent with this characterization, inclusion criteria for the current study required that adolescents (1) had a current ASD diagnosis (per DSM-
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IV-TR criteria), (2) were 12–17 years old, (3) had a 6th grade reading level, (4) had a family pet, and (5) could verbally communicate regularly with family and peers. Participants in this cross-sectional study included 73 high functioning adolescents with ASD (M age = 13.91, SD = 1.75 years; 87.5% male) and their parents who were recruited from the larger study (N = 152) described above. Examination of T-scores from the Social Responsiveness Scale (used in this study to assess social impairment) indicated that all current participants had total T-scores 60, which indicates mild to moderate impairment or worse consistent with an ASD diagnosis. Research has demonstrated that, for parents whose reports on the SRS yield a T-score of 60, the likelihood of a diagnosis of ASD is 84% (Constantino et al., 2007). Seventy-nine percent of the qualifying participants had T-scores 76, which is considered in the severe range of social impairment and is strongly associated with a clinical diagnosis of ASD (Constantino & Gruber, 2005). However, given our characterization of HFASD as youth who exhibit no to mild cognitive impairment as evidenced by their ability to read and complete study surveys, we utilized these social impairment indices as variables of interest rather than inclusion/exclusion criteria. Further validation of the inclusion criteria capturing youth with only no to mild cognitive impairment was found in the mean Full Scale IQ (by parent report; M = 106, SD = 20.24), and all participants whose parents reported IQ scores fell within the low average range or higher. Of note, participants in the current study did not differ from the larger study population in terms of any diagnostic or demographic variables (see Table 1). Most families (74%) completed measures online. Informed consent was obtained from all individual participants included in the study. 2.2. Measures 2.2.1. Pet ownership qualities Parents completed a demographic and pet ownership questionnaire assessing number of pets owned, types of pets, whether their child considers a pet as a best friend, and how long pet(s) have been owned to gather qualitative information about the family pet. Additionally, three dimensions of pet ownership (i.e., responsibility, comfort, companionship) were assessed and utilized as independent variables in this study. Pet ownership dimension questions were developed by the investigators for this study and correspond with the perceived benefits of dog ownership among families of children with ASD as outlined in recent literature (Carlisle, 2014). Parents responded to one item for each dimension of pet ownership. Items included, “On a scale of 0–4 how much responsibility does your child have in the care of the pets?” (0 = no responsibility to 4 = complete responsibility). “On a scale of 0–4, how much does your child turn to the pet for comfort?” and “On a likert scale of 0–4, how much does your child turn to the pet for companionship?” For these items, scores of 0 indicate “never” whereas scores of 4 indicate “all the time.” 2.2.2. Social-emotional adjustment Adolescents’ perceptions of social-emotional adjustment were assessed via the Youth Self Report-Depression Scale (YSRD; Achenbach, 1991) with the suicide questions removed, the Loneliness Scale (LS; Asher, Hymel, & Renshaw, 1984; a = 0.90), and the Friendship Quality Questionnaire-Abbreviated edition (FQQ-A; Parker & Asher, 1993; a = 0.91). Parents completed the Child Behavior Checklist-Depression Scale (CBCL-D; Achenbach, 1991) with the suicide questions removed, the Loneliness Scale-Parent (LS-P; Asher et al., 1984; a = 0.90), and the Friendship Quality Questionnaire-Abbreviated Parent Table 1 Means (SD) of All Study Variables for the current and larger study. Pets Study (n = 73) Mean (SD)
Larger Study (N = 79) Mean (SD)
t (p-value)
Participant Variables Age (years) FSIQ (n = 50) Social Impairment (Parent Report; T-score)
13.91 (1.75) 106.40 (20.24) 96.28 (16.19)
13.97 (1.54) 107.55 (21.36) 96.62 (15.82)
0.07 (0.94) 0.26 (0.80) 0.13 (0.90)
Pet Ownership Variables Number of Pets Responsibility (scale: 0–4) Comfort (scale: 0–4) Companionship (scale: 0–4)
4.75 (7.99) 1.85 (1.11) 2.48 (1.24) 2.55 (1.18)
– – – –
– – – –
Social-Emotional Variables Depression (Adolescent Report) Loneliness (Adolescent Report) Friendship Quality (Adolescent Report) Depression (Parent Report) Loneliness (Parent Report) Friendship Quality (Parent Report)
0.73 (0.39) 25.58 (12.99) 71.05 (13.54) 0.72 (0.38) 32.74 (9.58) 63.39 (15.68)
0.69 (0.40) 23.21 (11.73) 72.96 (15.85) 0.68 (0.39) 31.65 (8.40) 65.56 (16.02)
0.51 (0.61) 1.04 (0.30) 0.78 (0.44) 0.61 (.54) 0.73 (0.46) 0.80 (0.42)
Note. FSIQ was only available for a subset of the sample.
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edition (FQQ-AP; Parker & Asher, 1993; a = 0.91). Both the parent and adolescent version of the FQQ assess the quality of an adolescent’s best friendship. Examples of items include “my child’s best friend says he’s/she’s good at things” and “my child’s best friend makes him/her feel good about his/her ideas.” In the current study, all measures demonstrated acceptable reliabilities, including a = 0.79 for the CBCL-D, a = 0.78 for the YSR-D, a = 0.89 for the FQQ-A, and a = 0.91 for the FQQ-AP. Additionally, the reliability for the measures of loneliness were a = 0.84 and a = 0.91 for the LS-P and LS respectively. 2.2.3. Social impairment Parents completed the Social Responsiveness Scale (SRS; Constantino & Gruber, 2005) to assess their child’s social impairment. T-scores were calculated based on all items of the SRS. The scale’s internal consistency was considered reliable (a = 0.80). 2.3. Analytic plan Descriptive analyses, including t-tests between the full and study sample, as well as correlational analyses were run. Multiple regression analyses were then run to examine associations between pet ownership qualities and social-emotional adjustment. Separate regression analyses were conducted for each of the measures of adjustment described above (3 completed by the adolescent; 3 completed by the parent). Each regression included the following independent variables: responsibility for pets, turning to the pets for comfort, and turning to the pets for companionship. For all analyses, the social impairment variable was entered in Step 1 to control for the variable, followed by the pet ownership qualities variables in Step 2 (IVs). Finally, the pet ownership qualities x social impairment interaction terms were entered simultaneously in step 3. Post-hoc tests of simple slopes probed significant interactions through regression analyses. Of note, post-hoc power analysis using the G*Power program (Faul, Erdfelder, Lang, & Buchner, 2007) determined that the sample size was adequately powered to detect large effects, but was underpowered to detect both small and medium effect sizes through regression analyses. 3. Results 3.1. Descriptive statistics In addition to the information shown in Table 1, 51.4% of parents reported that a pet was their child’s best friend. Participants also provided information regarding the types of pets in their homes, including that 68% had cats, 64% had dogs, 21% had rodents, 21% had fish, reptiles, or amphibians, 9% had rabbits, and 9% had birds. Average length of pet ownership was 3.91 years. Additionally, the majority of parents (56.7%) reported that their child turned to a pet for comfort often or all the time, while 66.2% noted that their child took moderate to complete responsibility in caring for the pet. As shown in Table 1, there were no significant differences between the current study sample versus the larger sample on any participant or socialemotional variables. Correlational analyses (see Table 2) revealed significant positive associations between adolescents’ responsibility for pets and how much the adolescent turned to pets for companionship and comfort. In terms of participant variables, IQ was significant positively associated with adolescents’ responsibility for pets, as well as how much adolescents turned to pets for companionship, while age was significantly positively associated with adolescents’ responsibility for pets. Based on these analyses, IQ and age were utilized as covariates in any regression analyses in which a significant relation emerged between the pet ownership variables (i.e., responsibility and companionship) and social-emotional outcomes. As such, IQ and age were included as a covariate in the model exploring responsibility and depressive symptoms, and results are described in a footnote below Table 3.
Table 2 Bivariate Correlations between Study Variables.
1. Depressive Sxs- Parent 2. Depressive Sxs- Adolescent 3. Loneliness- Parent 4. Loneliness- Adolescent 5. Friendship Quality- Parent 6. Friendship Quality- Adolescent 7. Social Impairment 8. Responsibility 9. Comfort 10. Companionship 11. FSIQ 12. Age
1
2
3
– 0.61*** 0.49*** 0.45*** 0.10 0.01 0.40*** 0.25* 0.26*** 0.18 0.17 0.07
– 0.42*** 0.61*** 0.21 0.05 0.32*** 0.18 0.22*** 0.28*** 0.24 0.06
– 0.48*** 0.37*** 0.03 0.50*** 0.09 0.08*** 0.05*** 0.36** 0.05
4
5
6
7
8
9
10
11
12
– 0.31** 0.29* 0.32* 0.36**
– 0.82*** 0.27 0.15
– 0.32* 0.12
– 0.08
–
– 0.26** 0.44*** 0.23** 0.10 0.13*** 0.16*** 0.30* 0.09
– 0.45*** 0.34*** 0.06*** 0.13 0.06 0.01 0.12
– 0.09 0.10 0.25* 0.18 0.27 0.20
– 0.08 0.17 0.13 0.12 0.08
Note: * Significant at the 0.05 level, ** Significant at the 0.01 level, *** Significant at the 0.001 level (2-tailed).
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Table 3 Linear Regression Analyses for Pet Ownership Dimensions and Depressive Symptoms. Depressive Symptoms Adolescent Report Step 1 Step 2
Step 3
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B 0.01 0.09 0.01 0.11 0.01 0.01 0.01
b 0.32** 0.25* 0.01 0.32 0.04 0.07 0.24
t 2.79 2.13 0.06 1.77 0.38 0.37 1.21
Total R2 Parent Report Step 1 Step 2
Step 3
D R2 0.10 0.11
0.03
0.25
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B 0.01 0.11 0.10 0.01 0.01 0.01 0.01
b 0.42*** 0.32** 0.33 0.04 0.14 0.24 0.20
t 3.90 2.90 1.82 0.20 1.23 1.30 1.06
Total R2
D R2 0.18 0.13
0.03
0.34
Note: * Significant at the 0.05 level, ** Significant at the 0.01 level, *** Significant at the 0.001 level (2-tailed).1 SI: Social Impairment as measured by the Social Responsiveness Scale.
Table 4 Linear Regression Analyses for Pet Ownership Dimensions and Loneliness. Loneliness Adolescent Report Step 1 Step 2
Step 3
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B 0.27 1.35 0.35 2.01 0.06 0.03 0.08
b 0.33** 0.11 0.03 0.17 0.08 0.04 0.12
t 2.89 0.95 0.16 0.91 0.66 0.21 0.59
Total R2 Parent Report Step 1 Step 2
Step 3
D R2 0.11 0.03
0.03
0.16
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B 0.33 0.38 0.17 0.24 0.06 0.09 0.02
b 0.57*** 0.05 0.02 0.03 0.11 0.19 0.05
Total R2
t 5.89 0.43 0.13 0.17 1.02 1.06 0.29
D R2 0.33 0.01
0.03
0.37
Note: * Significant at the 0.05 level, ** Significant at the 0.01 level, *** Significant at the 0.001 level (2-tailed). SI: Social Impairment as measured by the Social Responsiveness Scale.
3.2. Pet ownership and social emotional adjustment Linear multiple regressions were conducted examining relations between dimensions of pet ownership (i.e., responsibility, comfort, companionship) and adolescents’ social-emotional adjustment, and whether these relations varied by level of social impairment. Social impairment was entered on the first step of the regression, followed by dimensions of pet ownership, and the interaction terms. Regressions were run separately for parent and adolescent report because parent and adolescent reports of adolescent psychopathology are often discrepant, especially with HFASD (McMahon & Solomon, 2015). As shown in Table 3, after controlling for levels of social impairment, adolescents who took more responsibility for their pet exhibited fewer depressive symptoms according to both adolescent (p < 0.05) and parent report (p < 0.01). No
1 Given that IQ and age correlate with the responsibility domain of pet ownership, additional analyses were run controlling for these variables when exploring the relation between responsibility and depressive symptoms. These follow up analyses revealed that the relation between responsibility and depressive symptoms held after accounting for IQ and age in the model.
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Table 5 Linear Regression Analyses for Pet Ownership Dimensions and Friendship Quality. Friendship Quality Adolescent Report Step 1 Step 2
Step 3
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B
b
t
D R2
0.09 0.09 3.83 0.82 1.32 0.07 0.15
0.10 0.01 0.33 0.07 0.17 0.11 0.21
0.86 0.05 1.68 0.34 1.36 0.52 1.01
0.01 0.08
Total R2 Parent Report Step 1 Step 2
Step 3
0.04
0.13
Social Impairment Responsibility Comfort Companionship SI X Responsibility SI X Comfort SI X Companionship
B
b
t
D R2
0.37 0.57 4.09 1.94 0.06 0.15 0.35
0.37** 0.04 0.30 0.13 0.07 0.19 0.44*
3.23 0.32 1.57 0.71 0.56 0.94 2.23
0.14 0.04
Total R2
0.09
0.27
Note: * Significant at the 0.05 level, ** Significant at the 0.01 level, *** Significant at the 0.001 level (2-tailed). SI: Social Impairment as measured by the Social Responsiveness Scale.
140 120 100
FQQ-AP
80 60 40
Low SI
20
High SI
0 -20 -40
Low Companionship
High Companionship
Fig. 1. Simple slopes analyses of companionship social impairment interaction on parent-reported friendship quality. FQQ-AP: Friendship Quality Questionnaire – Parent; SI: Social Impairment.
significant relations emerged between pet ownership dimensions and loneliness or friendship quality (see Tables 4 and 5). However, a significant social impairment X companionship interaction emerged for friendship quality, such that for adolescents with greater social impairment, turning to pets for companionship was associated with higher parent-reported friendship quality, but for those with less social impairment, turning to pets for companionship was associated with lower friendship quality (p < 0.05; see Fig. 1). 4. Discussion This study expands upon prior work examining human-animal interactions and prosocial outcomes, and specifically explores associations between pet ownership and social-emotional adjustment among adolescents with HFASD. Humananimal interaction theory suggests that many humans seek out contact with animals as calming and non-judgmental sources of support and facilitators of social interaction (Kruger & Serprell, 2006). Particularly for socially isolated individuals such as those with HFASD, animals may offer unique outlets for social engagement, especially given that animal interaction requires a limited need for well-developed social skills to have a successful positive social experience. Previous metaanalyses have examined human-animal interactions through the use of animal-assisted mental health interventions, with results suggesting positive benefits such as increased verbal and nonverbal behaviors in youth with ASD in the context of interactions with therapy animals (Berry et al., 2013). However, the current study builds upon this work by examining how human-animal interactions are associated with social-emotional functioning in adolescents with HFASD. In line with recent research demonstrating a link between acquiring a pet and decreased symptoms of anxiety among youth with ASD (Wright et al., 2015b), results of this study suggest that specific dimensions of pet ownership may be
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associated with social-emotional adjustment among adolescents with HFASD. Responsibility emerged as an important dimension of pet ownership that may be linked to depressive symptoms. Adolescents who took greater responsibility for pets experience fewer depressive symptoms based on parent and adolescent report regardless of level of social impairment and IQ. Building on previous studies documenting associations between human-animal interaction and positive socialemotional adjustment among normative populations, these results suggest that not only interaction, but also taking responsibility for pets is associated with fewer depressive symptoms for adolescents with ASD. However, the cross-sectional nature of the data does not allow for determination of the directionality of the effects. That is, taking responsibility for their pets may alleviate symptoms of depression among individuals with HFASD; alternatively, more depressed youth may take less responsibility for their pets. However, previous results provide stronger support for the former given that findings from a recent study focusing on pet ownership demonstrated that taking responsibility for a pet was associated with social skills improvements among ASD youth (Grandgeorge et al., 2012). Responsibility may also be linked to an increased sense of purpose and may be an area to explore when developing intervention programs for adolescents with HFASD. In addition to responsibility, turning to pets for comfort may be a protective factor for a subset of youth with HFASD. In this study, adolescents with greater social impairments who turned to pets for comfort reportedly experienced benefits in terms of their friendships (e.g., positive associations with friendship quality) according to parent report. Interestingly, adolescents with better social skills who turned to pets for comfort reportedly experienced negative associations with friendship quality per parents. This may in part be due to the fact that adolescents with more social impairment might be less cognizant of their social deficits, and thus benefit more from social engagement and social skill building offered through interacting with pets. Adolescents with less impairment likely have a better understanding of their deficits, and research has suggested that individuals who turn to animals for companionship may do so to compensate for a lack of support in human relationships (Kurdek, 2009). Still, given that the presence of animals has been associated with decreased arousal (i.e., stress) in social situations for youth with ASD (O’Haire et al., 2013), as well as increased neural activity in affective brain regions (Whyte et al., 2016), the physical and emotional comfort provided by pets may serve as a platform for youth with HFASD to better utilize the social skills they have developed. Additionally, a recent qualitative study with parents of ASD youth identified both social interaction and companionship as key benefits of pet ownership (Carlisle, 2014), highlighting the importance of studying these dimensions of pet ownership in future research. 4.1. Limitations Although this study is among the first to explore benefits of pet ownership outside of a controlled treatment/intervention setting, data was collected cross-sectionally as part of a larger study of youth reported to have an HFASD. Future research should substantiate ASD diagnoses with in-person assessments, as well as utilize a longitudinal design to assess how pet ownership might influence social-emotional adjustment over time beyond cross-sectional associations. Given the correlational nature of the results, future studies should actively recruit a non-pet owner control group to enhance the ability to make direct comparisons, as well as speak to the influence of pet ownership on outcomes and control for potential confounds. Further, the benefits of pet ownership may extend beyond adolescents with ASD to a typically developing population of adolescents or those with other developmental disabilities. Future work should also examine whether there are differential effects among these populations. Additionally, the small sample size limits not only the power to detect effects, but also the generalizability of the results. In terms of reliability of findings, several measures in the study were not specifically designed for youth with ASD. Future research could develop measures specifically designed for ASD youth, while also taking into consideration that self-report measures among this population may need to be interpreted with caution. Still, the findings in this study highlight the need to further explore the implications of pet ownership among youth with HFASD. While a considerable amount of research has focused on therapeutic animal interventions and the development of prosocial skills, a growing body of literature is focusing on the normative experience of animals in the home. Although this study represents the next step in understanding the benefits associated with pet ownership among a community sample of adolescents with HFASD, results suggest that aspects of pet ownership (e.g., taking responsibility for pets, turning to pets for companionship) may be relevant to social-emotional functioning in this population. References Achenbach, T. (1991). Manual for the youth self-report and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry. Asher, S. R., Hymel, S., & Renshaw, P. D. (1984). Loneliness in children. Child Development, 55, 1456–1464. Berry, A., Borgi, M., Francia, N., Alleva, E., & Cirulli, F. (2013). Use of assistance and therapy dogs for children with autism spectrum disorders: A critical review of the current evidence. The Journal of Alternative and Complementary Medicine, 19, 73–80. http://dx.doi.org/10.1089/acm.2011.0835. Carlisle, G. K. (2014). Pet dog ownership decisions for parents of children with autism spectrum disorder. Journal of Pediatric Nursing, 29, 114–123. http://dx. doi.org/10.1016/j.pedn.2013.09.005. Constantino, J. N., & Gruber, C. P. (2005). Social responsiveness scale (SRS). Los Angeles, CA: Western Psychological Services. Constantino, J. N., Lavesser, P. D., Zhang, Y., Abbacchi, A. M., Gray, T., & Todd, R. D. (2007). Rapid quantitative assessment of autistic social impairment by classroom teachers. Journal of the Academy of Child & Adolescent Psychiatry, 46, 1668–1676. http://dx.doi.org/10.1097/chi.0b013e318157cb23. Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. http://dx.doi.org/10.3758/BRM.41.4.1149. Grandgeorge, M., Tordjman, S., Lazartigues, A., Deleau, M., & Hausberger, M. (2012). Does pet arrival trigger prosocial behaviors in individuals with autism? PloS One, 7, e41739. http://dx.doi.org/10.1371/journal.pone.0041739.
42
A. Ward et al. / Journal of Communication Disorders 65 (2017) 35–42
Klin, A., McPartland, J., & Volkmar, F. R. (2005). Asperger syndrome, In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (pp. 88–125).3rd ed.) Hoboken, NJ: John Wiley & Sons, Inc.. Kruger, K. A., & Serprell, J. A. (2006). Animal-assisted interventions in mental health: Definitions and theoretical foundations, In A. H. Fine (Ed.), Handbook on animal-assisted therapy: Theoretical foundations and guidelines for practice, 2nd ed.) Burlington, MA: Academic Press. Kurdek, L. A. (2009). Pet dogs as attachment figures for adult owners. Journal of Family Psychology, 23, 439–446. http://dx.doi.org/10.1037/a0014979. Lem, M., Coe, J. B., Haley, D. B., Stone, E., & O'Grady, W. (2016). The protective association between pet ownership and depression among street-involved youth: A cross-sectional study. Anthrozoo¨s, 29, 123–136. http://dx.doi.org/10.1080/08927936.2015.1082772. Levine, G. N., Allen, K., Braun, L. T., Christian, H. E., Friedmann, E., Taubert, K. A., . . . Lange, R. A. (2013). Pet ownership and cardiovascular risk: A scientific statement from the American Heart Association. Circulation, 127, 2353–2363. http://dx.doi.org/10.1161/CIR.0b013e31829201e1. Locke, J., Ishijima, E. H., Kasari, C., & London, N. (2010). Loneliness, friendship quality and the social networks of adolescents with high-functioning autism in an inclusive school setting. Journal of Research in Special Educational Needs, 10, 74–81. http://dx.doi.org/10.1111/j.1471-3802.2010.01148.x. Lopata, C., Toomey, J. A., Fox, J. D., Volker, M. A., Chow, S. Y., Thomeer, M. L., . . . Smerbeck, A. M. (2010). Anxiety and depression in children with HFASDs: Symptom levels and source differences. Journal of Abnormal Child Psychology, 38, 765–776. http://dx.doi.org/10.1007/s10802-010-9406-1. McConnell, A., Brown, C., Shoda, T., Stayton, L., & Martin, C. (2012). Friends with benefits: On the positive consequences of pet ownership. Journal of Personality and Social Psychology, 101, 1239–1252. http://dx.doi.org/10.1037/a0024506. McMahon, C., & Solomon, M. (2015). Brief report: Parent-adolescent informant discrepancies of social skill importance and social skill engagement for higher-functioning adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(10), 3396–3403. http://dx.doi.org/ 10.1007/s10803-015-2494-6. O’Haire, M., McKenzie, S., Beck, A., & Slaughter, V. (2013). Social behaviors increase in children with autism in the presence of animals compared to toys. PloS One, 8, e57010. http://dx.doi.org/10.1371/journal.pone.0057010. O'Haire, M. E., McKenzie, S. J., Beck, A. M., & Slaughter, V. (2015). Animals may act as social buffers: Skin conductance arousal in children with autism spectrum disorder in a social context. Developmental Psychobiology, 57, 584–595. http://dx.doi.org/10.1002/dev.21310. O’Haire, M. E. (2013). Animal-assisted intervention for autism spectrum disorder: A systematic literature review. Journal of Autism and Developmental Disorders, 43, 1606–1622. http://dx.doi.org/10.1007/s10803-012-1707-5. Orsmond, G. I., Krauss, M. W., & Seltzer, M. M. (2004). Peer relationships and social and recreational activities among adolescents and adults with autism. Journal of Autism and Developmental Disorders, 34, 245–256. http://dx.doi.org/10.1023/B:JADD.0000029547.96610.df. Parker, J. G., & Asher, S. R. (1993). Friendship and friendship quality in middle childhood: Links with peer group acceptance and feelings of loneliness and social dissatisfaction. Developmental Psychology, 29, 611–621. http://dx.doi.org/10.1037//0012-1649.29.4.611. Stanley, I. H., Conwell, Y., Bowen, C., & Van Orden, K. A. (2014). Pet ownership may attenuate loneliness among older adult primary care patients who live alone. Aging & Mental Health, 18, 394–399. http://dx.doi.org/10.1080/13607863.2013.837147. Strang, J. F., Kenworthy, L., Daniolos, P., Case, L., Wills, M. C., Martin, A., & Wallace, G. L. (2012). Depression and anxiety symptoms in children and adolescents with autism spectrum disorders without intellectual disability. Research in Autism Spectrum Disorders, 6, 406–412. http://dx.doi.org/10.1016/j. rasd.2011.06.015. Whyte, E. M., Behrmann, M., Minshew, N. J., Garcia, N. V., & Scherf, K. S. (2016). Animal, but not human, faces engage the distributed face network in adolescents with autism. Developmental Science, 19, 306–317. http://dx.doi.org/10.1111/desc.12305. Wright, H. F., Hall, S., Hames, A., Hardiman, J., Mills, R., Mills, D. S., & PAWS Team (2015a). Acquiring a pet dog significantly reduces stress of primary carers for children with autism spectrum disorder: A prospective case control study. Journal of Autism and Developmental Disorders, 45, 2531–2540. http://dx.doi. org/10.1007/s10803-015-2418-5. Wright, H., Hall, S., Hames, A., Hardiman, J., Mills, R., PAWS Project Team, & Mills, D. (2015b). Pet dogs improve family functioning and reduce anxiety in children with autism spectrum disorder. Anthrozoo¨s, 28, 611–624. http://dx.doi.org/10.1080/08927936.2015.1070003.