Animal-Assisted Therapy With Maltreated Youth: A Systematic Review and Meta-Analysis
In the U.S., nearly 700,000 children per year are victims of maltreatment warranting intervention by child protective services. Children who experience maltreatment commonly present in clinical settings with problematic emotional, behavioral, and social functioning. Animal-Assisted Therapy (AAT) has been shown to produce beneficial outcomes for adults with maltreatment histories, and several primary studies have investigated the use of AAT with maltreated children. However, no systematic review has examined the overall effect of AAT with maltreated children. This review seeks to account for existing research on AAT with maltreated children in order to examine the overall effect and potential moderators of AAT with this population.
Systematic review and meta-analysis were utilized to examine the existing research on effects of AAT for children younger than 18 years with a history of maltreatment. To be included, peer-reviewed articles or dissertations must have reported quantitative data on outcomes of AAT intervention with maltreated children and been published in English. Fifty-five studies were identified through a systematic keyword search of 18 databases. The abstracts of 19 studies were examined; four studies ultimately met inclusion criteria.
The four studies meeting inclusion criteria were submitted to systematic review and meta-analysis. Measured outcomes included anxiety, depression, anger, post-traumatic symptoms, dissociation, sexual concerns, functioning, empathy, well-being, coping, and social role functioning. Overall, AAT produced moderate, meaningful, and statistically significant results, Hedge’s g = 0.57 (C.I. = 0.42 - 0.72), z = 7.42, p < .001. However, the overall effect size was unstable as evidenced by high heterogeneity, Qw (3) = 82.86, p < .001, I2 = 68.62. Some moderators were identified, such as how the clinician integrated the animal into treatment. Notably, one study compared whether simply presenting a dog during therapy was as beneficial as presenting a dog plus delivering a structured story-telling approach to purposefully tie the dog to treatment objectives; the more purposeful approach was significantly more helpful, g = 0.67 (C.I. .52-.81), z = 8.78, p<.001.
Conclusions and Implications
From the available studies, AAT appears to provide an overall positive contribution to the treatment of abused/neglected children. While having an animal present during therapy provided some benefit, the advantage of a purposeful approach to integrating the animals into therapeutic discourse was linked to dramatic improvements. This review indicates that the method by which animals are incorporated into clinical services has important implications. Further research might explore the conditions under which introducing an animal can be most helpful to maltreated children. Some caution is warranted in interpreting the results of this review as few studies met inclusion criteria and the included studies often suffered from low rigor. Ultimately, research examining AAT with maltreated children is in a developmental stage. Additional empirical knowledge could guide a more nuanced examination of AAT with maltreated youth, and could prove helpful to the many children facing struggles associated with maltreatment.