May 31, 2024
Therapy Animals
By: Christine Charpie, MSW Intern & Janelle Schenk, LMSW
Introduction
For many, homes wouldn’t be complete without the presence of animals, and many individuals consider them as cherished family members. People rely on animals for companionship, security, and, more recently, emotional support. This blog post will delve into the various categories of therapy animals, their connection to emotional support animals, and offer guidance for providers. Additionally, it will explore the advantages of therapy animals for young individuals with autism spectrum disorder and attention deficit hyperactivity disorder (ADHD).
Service, Working, Therapy, and Emotional Support Animals
Service dogs..
..are individually trained to perform specific tasks and to work with people with disabilities. Furthermore, the work of the service dog must be directly related to the handler’s disability. These may be guide dogs who are seen regularly aiding people who are blind, hearing or signal dogs, psychiatric dogs who are trained to detect psychiatric episodes, autism assistance, and dogs trained to recognize seizures (Reisen, 2024).
Working dogs..
..are typically specially trained dogs that assist humans in a purposeful fashion. For instance, police, search and rescue, and military animals (typically dogs) are utilized and trained specifically for detection relying on their sense of smell. Working dogs shouldn’t be approached or pet, and typically they require a high level of focus without distractions. Along with service animals, working animals are some of the most highly trained (Reisen, 2024).
Therapy dogs..
..aren’t trained to live with a specific handler. Rather, they have human “teammates” in which they provide affection, comfort, and love to people, especially in clinical settings such as hospitals, mental health institutions, hospice centers, schools, and nursing homes. These animals typically have a very calm demeanor and are unfazed by unfamiliar noises and movements. There are no uniform state or national rules that regulate and certify therapy dogs, but they are considered service dogs under the American Disabilities Act (U.S. Department of Justice Civil Rights Division, 2020; Reisen, 2024).
Emotional support animals..
..(ESA) are not considered a service dog under the ADA. They are not trained for specific tasks or duties to aid a person with a disability; rather they are companion animals that may help ease anxiety, depression, some phobias, and loneliness. A mental health professional, however, must be the person to prescribe the ESA for a patient diagnosed with a psychological or emotional disorder (Reisen, 2024).
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What is the Fair Housing Act?
The Fair Housing Act (FHA) allows for service animals and emotional service animals to reside on properties that generally have a no-pet policy. The FHA is a federal law that was established in 1968 with a goal to eliminate discrimination during the sale, rental, or financing of a home. It was established to protect minorities from not being able to rent or purchase housing due to race or skin color (Latino, 2024).
The Fair Housing Act protects service animals because they are not considered to be pets. Denying ownership or rental because of a service animal is prohibited under the FHA. However, it must be noted that any damages that occur to the house due to the service animal may not be covered by the owner (Latino, 2024).
Emotional support animals, however, are considered pets. The FHA protects emotional service animals and people can not be denied housing for this reason. One must have documentation for emotional support animals that are written by a mental health professional. Landlords have the right to ask for this documentation. The documentation must outline exactly what the emotional support animal is necessary for, breed, and size. Furthermore, a service animal is almost always a dog, but emotional support animals do not have to be. People have been taking emotional support animals everywhere such as dogs, ducks, and insects claiming the animal as a vital aspect of their mental health. This has led some states to be particular about the labeling of animals as “emotional support” (Latino, 2024).
Frequently, attempting to get a letter from a mental health professional can be quick with online services, which has increased the number of online services for quick letters. Fraudulent ESA letters from online service providers have become increasingly prevalent. Healthcare professionals must be properly and actively licensed, and if a website mentions “registering” or “certifying” an ESA, this is likely a fraudulent scheme. Registrations and certifications are not valid forms for proving your animal is an ESA. Other red flags, such as instant turnarounds for letters and/or cheap rates to acquire an ESA letter online, are likely not approved ESA letters (Dexter, G., 2021).
Misconceptions about Emotional Support Animals
Myth 1:
One of the biggest myths to date is that emotional support animals need special training. This is not true. In fact, since so many animals can fall under the category of “emotional support” it is challenging to train certain animals. Many public spaces, however, are required by law to allow service animals inside, but emotional support animals are not included in this. The rights for emotional support animals apply to housing solely (ESA Doctors, n.d.).
Myth 2:
You may bring emotional support animals with you anywhere, anytime – you can not. In fact, a legitimate letter for an emotional support animal in the home does not apply to other places such as stores, hotels, restaurants, or planes due to health codes. The primary residence is protected under the Fair Housing Act, but that is all it applies to (ESA Doctors, n.d.).
Myth 3:
This is a myth that is frequently abused within the system and it’s that ANYONE can get an ESA. The true value of an ESA is helping others with mental health problems utilizing companionship, support, and relaxation. People think that simply stating that their animal is an emotional support animal would be allowed. Yet, not everyone with depression, anxiety, or another mental illness qualifies for an ESA, and some people obtain emotional support animals purely to glaze over the “no-pet” policy (ESA Doctors, n.d.).
Advice for Mental Health Professionals Signing ESA Letters
A study by Ferrell and Crowley (2023) looked at statistics between individuals and dogs in emotional support partnerships, instances of service-animal misrepresentation, health professional involvement, and animal welfare, behavior, and bond quality. They found that only half of the documenters met the dog prior to signing a letter, and fewer were involved in the actual animal selection process. They concluded that these differences may have to do with a lack of clear understanding of an ESAs role and what they are doing for their clients. The study hypothesized that better animal welfare (proper care and treatment of pets) would be associated with a more positive bond between owners and their emotional support dogs, as well as fewer behavioral problems in the dogs. However, around 1 in 7 emotional support dogs may not be receiving consistent, quality care. Lastly, of the participants, nearly a quarter of them received an ESA letter from a free online website. Over half were not being cared for by the professional that wrote the ESA letter for them.
Given this information, mental health providers have a dilemma navigating the ESA letter request process. The American Association for Physician Leadership (Baker et al., 2020) suggests that when a patient approaches a clinician requesting ESA approval, they have three options:
- Refer to a specialist for comprehensive evaluation
- Authorize the request
- Decline the request
The AAPL (2020) notes that it may be feasible to follow a comprehensive system in determining whether or not a patient should receive an ESA. Read more about their decision-making algorithm here:
Current Research on Therapy Animals Integrated in Autism Therapeutic Techniques
A study by Becker and colleagues (2017) looking at the impact of animal-assisted social skills training wanted to see how animals could aid in exhibiting prosocial behaviors in social skills groups. By comparing social skills groups with therapy dogs to traditional social skills groups without an animal present, after twelve weeks, students in the social skills group with a therapy dog (treatment) were shown to be significantly less symptomatic than those in the traditional social skills group.
Furthermore, the students in the treatment group indicated greater reduction in problems with peers, feelings of ineffectiveness, and social isolation. Specific symptoms of depression were also noted to decrease in the interpersonal ratings of those in the animal-assisted social group. Teacher ratings showed that compared with the control group, participants who received animal-assisted social skill intervention exhibited fewer social skill deficits overall, fewer restricted and repetitive behaviors, and more developmentally appropriate social communication. They suggest that this may help us understand how therapy dogs specifically can be implemented into ASD interventions (for some but not all social groups) considering the significant positive effects on participants’ affective or emotional states. Children were found to be asking about the therapy dog and showed the potential for human-animal interactions as motivation to attend and be present in social group activities (Becker, 2017).
Therapy animals likely have to be very temperamental as to not overwhelm or overstimulate individuals in the social groups. Other types of animals have been found to provide other benefits. For example, equine assisted intervention may be more prevalent for sensory motor interventions. Similarly, therapy dogs were used to practice prosocial behavior such as using the command “watch me” to practice eye contact and engage in interaction such as asking for the dog’s paw (Becker, 2017).
Current Research on Therapy Animals Integrated in ADHD Therapeutic Techniques
One study of canine-assisted therapy for children with ADHD sought to provide findings on how therapy dogs can be implemented in clinical interventions (Schuck, 2015). In this study, children were randomly assigned to therapeutic interventions with a canine-assistant and without. Other studies have shown that motivation deficits are fairly common for individuals with an ADHD diagnosis (Schuck, 2015), so this study’s goal was to see if having a human-animal interaction as part of the intervention may “prime” children for therapy by heightening arousal, emotion, attention, and engagement in the therapeutic environment. The canine-assisted intervention group included three certified therapy dogs during each session. The control group did not utilize real dogs, but rather toy dogs or realistic puppets (Schuck, 2015).
After 12 weeks, both control and treatment groups showed improvements in children’s social skills, prosocial behaviors, and problematic behaviors. ADHD symptoms also declined, but the canine-assisted group exhibited greater reductions in ADHD symptom severity, inhibitory control, and attention overall. The authors suggest canine-assisted therapy may help with inhibition, attention redirection, and warrants further research examining physiological stress responses in individuals with ADHD (Schuck, 2015).
Conclusion
Further research into the effects of animal-assisted therapy and its advantages for interventions involving youth with autism spectrum disorder and attention deficit hyperactivity disorder could prove beneficial in enhancing social skills, motor abilities, and regulating impulsivity and attentiveness. Furthermore, clinicians should engage in thoughtful conversations to determine the most appropriate course of action for patients seeking emotional support animals, as well as brainstorming other options for individuals who would like to have pets in the home.
References
Becker, Joanna L. ; Rogers, Erica C. ; Burrows, Bethany. (2017). Animal-assisted Social Skills Training for Children with Autism Spectrum Disorders. Anthrozoös. Routledge.
Dexter, G. (2021). Avoids being scammed by fake ESA letters: 7 red flags. Retrieved from https://esadoctors.com/dont-be-scammed-fake-esa-letters/
ESA Doctors. (n.d.). Common misconceptions about emotional support animals. https://esadoctors.com/common-misconceptions-about-emotional-support-animals/
Ferrell, J., &, Crowley, S., L. (2023) Emotional support animal partnerships: Behavior, welfare, and clinical involvement. Anthrozoös, 36(3), 471-487. DOI: 10.1080/08927936.2023.2166711
Herzog, Hal. (2023, February 13). The use and misuse of emotional support animals. Psychology today. https://www.psychologytoday.com/us/blog/animals-and-us/202302/the-use-and-misuse-of-emotional-support-animals
Baker, J., Adams, P., & Paulson, J. (2020, June 8). Managing emotional support animal requests in the primary care clinic. American association for physician leadership.
Latino, D.J. (2024, March 5). Emotional support animals and the fair housing act. U.S. service animals. https://usserviceanimals.org/blog/emotional-support-animals-the-fair-housing-act/
Reisen, Jan. (2024, January 11). Service, working, therapy, and emotional support dogs: What’s the difference? American Kennel Club. https://www.akc.org/expert-advice/training/service-working-therapy-emotional-support-dogs/
Schuck, S. E., Emmerson, N. A., Fine, A. H., & Lakes, K. D. (2015). Canine-assisted therapy for children with ADHD: preliminary findings from the positive assertive cooperative kids study. Journal of attention disorders, 19(2), 125–137. https://doi.org/10.1177/1087054713502080
U.S. Department of Justice Civil Rights Division. (2020, February 28). ADA requirements: service animals. ADA.gov. https://www.ada.gov/resources/service-animals-2010-requirements/