Dog Therapy for Dental Care Among Autistic Children: A Randomized Trial.

Abstract

We aimed to assess whether the presence of a therapy dog during 2 dental care sessions could facilitate subsequent dog-free dental care for anxious autistic children who had difficulty cooperating. We conducted a parallel-arm randomized trial: control group using usual behavioral strategies only and experimental group using animal-assisted therapy (AAT) strategies combined with usual behavioral strategies. All patients had 3 dental care sessions. In the experimental group, the therapy dog was present during the first 2 dental sessions, and the third dental session was dog-free. The primary outcome was the mean overall anxiety during the dog-free third treatment session. Generalized estimating equations (GEEs) were also used to account for the correlation of repeated measures. A total of 49 patients were enrolled. The most frequently usual behavioral strategies were positive reinforcement (n = 31; 64%), hypnosis (n = 28; 58%), demystification (n = 26; 52%), and in vivo modeling (n = 25; 51%). AAT-specific strategies included imitating dog (n = 18; 69%), positive supportive reinforcement with dog incentives (n = 14; 54%), and distraction or therapeutic touch (n = 11; 42%). Mean anxiety scores were significantly lower in the experimental group during the third session (mean difference, -1.4; 95% CI, -2.43 to -0.37). GEE analysis showed a significant reduction in anxiety over time in the experimental group compared with controls (P = .0001; β = -1.03). Dog served mainly as an in vivo model and positive reinforcer. Our findings suggest that AAT could play a key role in helping children acclimate to dental procedures, and, consequently, ease the transition back to conventional, animal-free dental treatments.