ร่วมวิจัย "สัตว์เลี้ยงบำบัด" กับมหาวิทยาลัยมหิดล
The study of appropriated types and activities of animal-assisted therapy for various types of children with developmental disorders การศึกษาชนิดและกิจกรรมของการใช้สัตว์บำบัดที่เหมาะสมสำหรับเด็กที่มีความบกพร่องทางพัฒนาการประเภทต่างๆ Warangkhana Phanwanich1,2, Pisamai Sukgerd3, Chalermpol Plahon3, Yodchanan Wongsawat1* วรางคณา พันธุ์วาณิช1,2, พิศมัย สุขเกิด3, เฉลิมพล พลาหน3, ยศชนัน วงศ์สวัสดิ์1* 1Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Thailand 2Animal Supplement & Pharmaceutical Co., Ltd., Vet Products Group, Thailand 3The Lighthouse Special Learning Center, Thailand 2012 Abstract
Developmental disorders are the abnormal brain function usually developed in childhood. Searching for the permanent therapy for these disorders is a very challenging problem. One of the currently emerging therapies is via the Animal-Assisted Therapy (AAT) since animals can clearly give the potent attraction to the patient and hence can improve the brain function. In this study, dogs, rabbits and hamsters are selected as the animals of interest. In order to efficiently evaluate the therapy, three activities are proposed to make the children 1) paying attention to some tasks, 2) interacting with the animals, and 3) participating in the activities. The evaluated scores are given into 3 levels, i.e., 1) no participation (score=1), 2) participating with the incorrect procedure (score=2), and 3) participating with the correct procedure (score=3). Forty-four children with various types of developmental disorders, i.e., 14 children with Mental Retardation (MR), 24 children with Autism and 6 children with Down syndrome, are participated in this experiment. Each of them is required to participate four times of the activities with all three kinds of animals,
once a week for one month. After one month of experiment, we have notified the improvement of motor, speech, and communication skills. In MR children, the efficiencies of using rabbits (13.49%) and hamsters (14.29%) are clearly better than using dogs (5.16%). In Autistic children, the efficiency of using hamsters (28.47%) is the better than using rabbits (16.90%) and dogs (15.05%). In Down syndrome children, the efficiencies of using rabbits (15.74%) and hamsters (14.81%) are better than dogs (11.73%). By comparing among all 3 types of animals and the corresponding activities, our proposed AAT give the best results with the Autistic children. To further extend our results, more activities and animals need to be investigated. Key words: Animal-Assisted Therapy (AAT), Developmental disorders, Mental Retardation (MR), Down syndrome, Autism. บทคัดย่อ
ความบกพร่องทางพัฒนาการคือความผิดปกติในการทำงานของสมองซึ่งมักเกิดขึ้นในวัยเด็ก การหาวิธีรักษาที่ได้ผลสำหรับความผิดปกติเหล่านี้นับว่าเป็นโจทย์ที่ท้าทาย หนึ่งในวิธีการรักษาในปัจจุบันที่ให้ผลเร็วคือการใช้สัตว์บำบัด ด้วยเหตุที่สัตว์มีความสามารถสร้างแรงจูงใจที่มีพลังให้กับผู้ป่วย ซึ่งส่งผลต่อการพัฒนาของสมอง ในการศึกษานี้เราได้เลือกสุนัข กระต่าย และหนูแฮมสเตอร์ในการบำบัด เพื่อการประเมินผลการรักษาที่มีประสิทธิภาพ เราได้ใช้กิจกรรม 3 ชนิดเพื่อจูงใจให้เด็ก 1) เกิดความสนใจ 2) มีปฏิสัมพันธ์กับสัตว์ และ 3) มีส่วนร่วมในกิจกรรม การให้คะแนนแบ่งออกเป็น 3 ระดับ ได้แก่ 1) ไม่ให้ความร่วมมือในการฝึกปฏิบัติตามขั้นตอน (คะแนน=1) 2) ปฏิบัติแต่ไม่ถูกต้องตามขั้นตอน (คะแนน=2) 3) ปฏิบัติได้เองตามขั้นตอน (คะแนน=3) โดยมีเด็กที่มีความบกพร่องทางพัฒนาการประเภทต่างๆ 44 คน ได้แก่ เด็กที่มีความบกพร่องทางสติปัญญา 14 คน เด็กออทิสติก 24 คน เด็กดาวน์ ซินโดรม 6 คนเข้าร่วมการทดลองทั้งนี้เด็กแต่ละคนต้องเข้าร่วมกิจกรรมกับสัตว์ทั้ง 3 ชนิด สัปดาห์ละครั้งเป็นเวลา 1 เดือน หลังจากทดลองไปเป็นเวลา 1 เดือนพบว่ามีการพัฒนาขึ้นของทักษะการเคลื่อนไหว การพูด และการสื่อสาร ในเด็กที่มีความบกพร่องทางสติปัญญานั้น ประสิทธิภาพการบำบัดโดยใช้กระต่าย (13.49%) และ
หนูแฮมสเตอร์ (14.29%) ให้ผลดีกว่าการใช้สุนัข (5.16%) อย่างชัดเจน ในเด็กออทิสติก ประสิทธิภาพการบำบัดโดยใช้หนูแฮมสเตอร์ (28.47%) ให้ผลดีกว่าการใช้กระต่าย(16.90%) และสุนัข (15.05%) ในเด็กดาวน์ ซินโดรมประสิทธิภาพการบำบัดโดยใช้กระต่าย (15.74%) และหนูแฮมสเตอร์ (14.81%) ให้ผลดีกว่าการใช้สุนัข (11.73%) เมื่อเปรียบเทียบระหว่างสัตว์ทั้ง 3 ชนิดและกิจกรรมที่สัมพันธ์กันพบว่า สัตว์บำบัดให้ผลที่ดีที่สุดแก่กลุ่มเด็กออทิสติก เพื่อขยายผลการรักษาในอนาคต กิจกรรมและการใช้สัตว์ที่หลากหลายจำเป็นต้องมีการศึกษาต่อไป คำสำคัญ: สัตว์บำบัด ความบกพร่องทางพัฒนาการ ความบกพร่องทางสติปัญญา ดาวน์ ซินโดรม ออทิสติก
Introduction
From all over the world, the number of children and adolescence suffered from the mental disorders is approximately 15-20% (Brandenburg et al., 1990; Waddell and Shepherd, 2002). It is extensively recognized that the developmental disorders, e.g., Attention Deficit Hyperactivity Disorder (ADHD), Mental Retardation (MR), and Autism, is one major categorize of the mental disorders in the Diagnosis and Statistical Manual of Mental Disorders (DSM)-IV manual. The developmental disorders causes the abnormal Central Nervous System (CNS) function that usually common evident in young people, especially in childhood (Association, 1994). The prevalence of psychotic symptoms is higher in childhood (9–12 years old) than adolescents (13–18 years old) (Kelleher et al., 2012). These patients have a various symptoms depend on the types of disorders, i.e., inattention, hyperactivity, impulsivity, sub-average intelligence, deficit in adaptive function, impaired social interaction, stereotyped behavior, language deficits, including somebody also have the abnormal physical (Bonder, 1991). Although the pharmacological treatment is commonly used for some cases of the developmental disorders, however it sometimes causes some side effects. Furthermore, since the main problem of these patients is that they do not know how to interact with the other people in the correct way, i.e. they feel difference and start social isolation, the behavior treatment is also needed. Using only medicine seems not to be the final solution for the long term therapy since it cannot directly improve the behavior of patients.
The widely used behavior treatment concept is to train the patient in many areas, e.g., self-help and adaptive skills, language and communication skills, leisure and community skills, along with replace of maladaptive behavior (Alloy et al., 1999). Accordingly, searching for the permanent therapy for these disorders is a very challenging problem, especially how to “attract” the disorders with the naturalistic resources. Since animals can obviously give the potent attraction to the patient and hence can improve the brain function, the Animal-Assisted Therapy
(AAT) becomes one of the currently emerging therapies for enhancing the behavior training procedure.
Currently, many researchers employ the AAT in the areas of psychological and psychiatric disorders to activate the physiological and psychological mechanisms, as well as to improve the metabolic health. These approaches are also well applied to other kinds of patients, e.g., hypertension, cardiovascular diseases, cancer and AIDS for improving their quality of life (Cevizci et al., 2009). By using the AAT (dog) in the pervasive development disorders (PDD), the patients become more playful in mood, more focused, as well as more aware of their social environments (Martin and Farnum, 2002). Technically, AAT seems to be an appropriate method of therapy because it is a “push” of an interaction by enthusiastic power differently with a “pull” from routine training from the physician (Palley et al., 2010). Therefore, in this work, we aim to find the appropriated types of animals and activities of AAT for children with MR, Autism, and Down syndrome. Three types of animals (dogs, rabbits and hamsters) are pre-selected since they are suitable for the routine therapies in school or at home, and they are also easy to be taking care of. With our designed activities, after one month of experiment, we can clearly see that, our proposed AAT give the promising results with the children with autism, especially to make them participating in the activities. Materials and Method
There are various ways to implement the AAT for palliating the patients, e.g. AAT using companion animals, farm animals, or wildlife (Mallon et al., 2010). In this study, dogs, rabbits and hamsters are selected. Forty-four children with various types of developmental disorders, i.e., 14 children with Mental Retardation (MR), 24 children with Autism and 6 children with Down syndrome, are participated in this experiment. Each of them is required to participate four times of the activities with all three kinds of animals, once a week for one month, 90 minutes per class (30 minutes per animal). In order to efficiently evaluate the therapy, we propose three activities (Table 1, Figure 1 (a-i)), i.e.
Table1. Summary of three activities in each AAT (dog, rabbit and hamster) to make the children 1) paying attention to some tasks, 2) interacting with the animals, and 3) participating in the activities
Types of AAT
Approach
Activity
Dog
1. Paying attention to some tasks
Stare at the dog
2. Interacting with the animals
Touch, pat, call, carry the dog
3. Participating in the activities
Walk while leashing the dog
Rabbit
1. Paying attention to some tasks
Stare at the rabbit
2. Interacting with the animals
Touch, pat, call, carry the rabbit
3. Participating in the activities
Feed the rabbit
Hamster
1. Paying attention to some tasks
Stare at the hamster or pay attention on hamster cage or maze
2. Interacting with the animals
Touch, pat, call, carry the hamster
3. Participating in the activities
Press the button when hamster makes the LED on
1) Paying attention to some tasks: In this activity, we encourage the children to stare at the animal or pay attention to the device. Especially, for hamster, the home-made hamster cage with the light are designed. The hamster cage is installed with 4 lights and 1 speaker so that when the hamster is running in the wheel, the cage will create the light and sound to draw the attention. 2) Interacting with the animals: The children will be encouraged to touch, pat, call, or carry all three kinds of animals. 3) Participating in the activities: The children will be asked to walk and leash the dog, feed the rabbit directly to the rabbit’s mouth and pressed the device button of our home-made hamster maze (when the hamsters run through the sensor, the light in the maze will be on, then the children need to push the button within 4 seconds, otherwise the light will be off).

มหาวิทยาลัยมหิดลกับศูนย์การเรียนรู้พิเศษประภาคาร ร่วมงานวิจัยสัตว์เลี้ยงบำบัดสำหรับเด็กที่มีความต้องการพิเศษ

Figure 1. Animal-Assisted Therapy (AAT) using (a-c) dogs, (d-f) rabbits, and (g-i) hamsters, with various types of children with developmental disorders. (a) Stare at the dog, (b) Touch, pat, call, carry the dog. (c) Walk while leashing the dog. (d) Stare at the rabbit. (e) Touch, pat, call, carry the rabbit. (f) Feed the rabbit. (g) Stare at the hamster or pay attention on hamster cage or maze. (h) Touch, pat, call, carry the hamster. (i) Press the button when hamster makes the LED on. The evaluated scores are given into 3 levels, i.e., 1) no participation (score=1), 2) participating with the incorrect procedure (score=2), and 3) participating with the correct procedure (score=3). The disorders are scored after finishing the AAT class once a week for one month. The improvement is described and calculated by the variation between the maximum score (best performance) and the initial score (primary performance).
Results According to the observation from the parents and teachers, our AAT approaches can efficiently draw the attention of the children, decrease the impulsivity, induce the pronunciation, improve the sense of consciousness, improve the social skill, and develop the physical. Furthermore, it can also be the tools that lead the children to express the conceal skills. To quantitatively evaluate the results, the average score improvements among the three mentioned activities in MR children with the dogs are 2.38%, 5.95% and 7.14%, with the rabbits are 4.76%, 13.10% and 22.62%, and with the hamsters are 9.522%, 11.90% and 21.43%, respectively. Hence, for MR children, the average improvements using dog, rabbit and hamster are 5.16%, 13.49% and 14.29%, respectively (Table 2). Table2. The average score improvements of MR children with three mentioned activities in dogs, rabbits and hamsters.* is the best three activities that improve the MR children.
Improvement of MR children (%)
Activity
Dog
Rabbit
Hamster
1. paying attention to some tasks
2.38%
4.76%
9.52%
2. interacting with the animals
5.95%
13.10%*
11.90%
3. participating in the activities
7.14%
22.62%*
21.43%*
Average
5.16%
13.49%
14.29%
Table3. The average score improvements of Autistic children with three mentioned activities in dogs, rabbits and hamsters. .* is the best three activities that improve the Autistic children.
Improvement of Autistic children (%)
Activity
Dog
Rabbit
Hamster
1. paying attention to some tasks
20.83%
14.58%
23.61%*
2. interacting with the animals
9.72%
13.19%
29.86%*
3. participating in the activities
14.58%
22.92%
31.94%*
Average
15.05%
16.90%
28.47%
In addition, the average score improvements among the three mentioned activities in Autistic children with the dogs are 20.83%, 9.72% and 14.58%, with the rabbits are 14.58%, 13.19% and 22.92%, and with the hamsters are 23.61%, 29.86% and 31.94%, respectively. Therefore, the average improvements using dog, rabbit and hamster are 15.05%, 16.90% and 28.47%, respectively (Table 3). Furthermore, the average score improvements among the three mentioned activities in Down syndrome children with the dogs are 16.67%, 5.56% and 12.96%, with the rabbits are 8.33%, 13.89% and 25.00%, and with the hamsters are 11.11%, 19.44% and 13.89%, respectively. The average improvements using dog, rabbit and hamster are 11.73%, 15.74% and 14.81%, respectively (Table 4). Table4. The average score improvements of Down syndrome children with three mentioned activities in dogs, rabbits and hamsters. * is the best 3 activities that improve the Down syndrome children.
Improvement of Down syndrome children (%)
Activity
Dog
Rabbit
Hamster
1. paying attention to some tasks
16.67%*
8.33%
11.11%
2. interacting with the animals
5.56%
13.89%
19.44%*
3. participating in the activities
12.96%
25.00%*
13.89%
Average
11.73%
15.74%
14.81%
Conclusion In MR children, the efficiencies of using rabbits (13.49%) and hamsters (14.29%) are clearly better than using dogs (5.16%). The best 3 activities are 1) feeding the rabbits, 2) pressing the button when hamsters makes the LED on, and 3) touching, patting, calling, carrying the rabbits.
In Autistic children, the efficiency of using hamsters (28.47%) is the better than using rabbits (16.90%) and dogs (15.05%). The best 3 activities are 1) pressing the button when hamsters makes the LED on, 2) touching, patting, calling, carrying the hamsters, and 3) staring at the hamsters or paying attention on hamster cage or maze. In Down syndrome children, the efficiencies of using rabbits (15.74%) and hamsters (14.81%) are better than dogs (11.73%). The best 3 activities are 1) feeding the rabbits, 2) touching, patting, calling, carrying the hamsters, and 3) staring at the dog. By comparing among all 3 types of animals and the corresponding activities, our proposed AAT give the best results with the Autistic children. Discussions and Suggestion Although the use of dog does not give the high improvement, in some cases of MR children that require the muscle development or balance improvement, dog activities can give a promising result, especially for the use of medium-sized dog. To further improve our results, other types of practical activities still need more investigation as well as the efficient ways to train the AAT animals. Further understanding of the mental mechanism of human with respect to the AAT animals also needs more investigation. Acknowledgements This project is partially supported by the National Research University (NRU) Funding of Mahidol University and the Vet Product Group. The authors would also like to convey the thanks to Mrs. Kanchana Pattrapornnan, Director of the Lighthouse Special Learning Center, and all members of the Lighthouse Special Learning Center for all cooperation including the helpful comments.
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