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Ruby Goes to Preschool: Using Therapy Dogs as Treatment Assistants
by Nancy Lewis

Maclean is more inspired to use his walker as well as to communicate more clearly when the activity involves Ruby.

Train a smart dog to accomplish a worthwhile task

I entered my third decade as a speech-language pathologist at the turn of the new millennium. Although my professional skills may steadily improve as a function of experience, the ability to "get the job done" in a public school setting seems increasingly difficult. Caseloads that are too big, budgets that are too small and endless administrative demands limit our efficacy. Both the lives of many of the children that we serve and the range of speech-language impairments are growing in complexity. In spite of my professional experience, I am too often left with a feeling of inefficacy and consequently, I am always searching for ways to remedy this situation. When an out-of town colleague mentioned to me that an audiologist in her office used a "therapy-assistance dog", I recognized this as an opportunity to effect a winning outcome for all involved: increase the communication skills in my clients, improve my feelings of job satisfaction, and train a smart dog to accomplish a worthwhile task.

Fall of 2001

Maclean, Nancy and Ruby play ball.

My experience in working with a therapy-assistance dog began in the fall of 2001 when I adopted Ruby. After several unsuccessful trips to the Santa Fe Animal Shelter in Santa Fe, New Mexico, I tried once more to find the perfect dog. That morning I spotted Ruby, a three-year-old husky mix. I knew immediately she was the one I needed.

My interest was not in having a dog accompany me to work in order to bring a smile to everyone's face. This would naturally happen. I wanted Ruby to become a communication partner in treatment sessions at the Bilingual Early Childhood Center (BECC) in the Santa Fe Public Schools. I was working there as a bilingual speech-language pathologist serving young children who were either monolingual English speakers or monolingual Spanish speakers. Many of the children used signs to facilitate communication.

Prior to bringing Ruby to work with me, I began to train her to respond to commands in English, Spanish, and sign language. Additionally, I started to investigate organizations that train assistance animals. The Delta Society (www.deltasociety.org) is a reputable and active organization for training therapy dogs. Their training is thorough and extensive; however, it is only scheduled periodically in limited locations.

Samuel and Ruby enjoy a quiet moment in the therapy room.

I found a source close to home that allowed me to begin using Ruby as a communication assistant dog in my work setting. The Santa Fe Animal Shelter Pet Outreach Program is a local program operated through the shelter. The coordinator, Sandra Miller, enrolls dogs subsequent to a review of veterinary records, health exam, and an in-person interview with the dog and owner. Miller evaluates the dog's temperament, disposition, and ability to sustain eye contact and interest in people. Ruby passed the interview with flying colors.

The Pet Outreach Program, through the animal shelter, provides the liability insurance that is essential in order to take dogs into settings such as public schools. The outreach program had an existing initiative in the schools in which dogs were brought in and children with reading difficulties read aloud to them. But, locally, there were no dogs being used as speech-language therapy assistants.

Ruby at Work

Samuel, a Spanish speaker, signs "more" and asks Ruby "¿Quieres mas?"

Ruby accompanied me to the BECC one day per week working as a communication partner in treatment sessions. The children and I communicated with Ruby in English or Spanish incorporating simple signs in the communication exchanges. Therapy activities proceeded in a typical fashion. The primary difference was the increased willingness on the part of the children-who were fascinated with Ruby-to engage in activities targeted at their specific IEP goals and objectives when the activity included my new assistant. We used doggie treats to sustain Ruby's cooperation.

My immediate supervision was essential. Ruby would indicate when she had had enough by retreating to a cozy spot under my desk. The role of a therapy dog can be stressful for the animal. Dogs may exhibit stress by panting and sudden shedding. Some organizations recommend using therapy dogs for only one hour at a time. Ambitiously, I brought Ruby to work with me initially for an entire day. I cut that back to just the morning when I noticed she was spending most of the afternoon under my desk.

In November 2002, at the ASHA Convention, I presented anecdotal data I collected on five preschool children who were seen for therapy. Four of the children were Spanish speakers and one was an English speaker whose ages ranged from 2; 9 through 5; 3. Their diagnoses included pervasive developmental disorder, developmental apraxia, phonological disorder, and other speech-language impairment of indeterminate cause. I collected measures of expressive and receptive language skills, speech intelligibility, and pragmatic language skills. I tracked the progress of the five children over a six-month period, three months without animal-assisted therapy and three months with animal assistance.

Results of this small, anecdotal "study" suggest that the use of therapy assistance dogs may facilitate progress toward improved communication skills within a population of young children with speech-language impairment. Each child demonstrated increased gains in the areas of expressive language, receptive language, and pragmatic skills during the treatment period that included the therapy assistance dog as compared to the period that did not include animal assistance. A statistical analysis was not run on the data to determine the significance of the changes noted. There was not a difference noted between the two time periods regarding rate of change of phonological skills. Simply stated, the children were more communicative, more responsive, and more appropriate in their social communication skills.

Lessons Learned

Therapy-assistance dog, Ruby, and author, Nancy Lewis

In my investigation of therapy dogs, I learned some important things. First, there is a difference in definition between service dogs and therapy dogs. Service dogs are specifically trained animals that assist people who have visual, mobility, or hearing impairments. The Americans with Disabilities Act provides a legal definition for these animals and stipulates that individuals with service dogs may be accompanied by their service animal in public places.

In contrast, federal law does not legally define therapy dogs. Federal laws have no provisions for people to be accompanied by therapy dogs in places of public accommodation that have "no pets" policies. Typically, therapy dogs are used in settings such as psychiatric units, nursing homes, prisons, rehabilitation centers, hospitals, and schools in order to "lift the spirits" of the people with whom they come into contact.

I encountered very little literature that addressed using a therapy dog to facilitate communication. For example, the Delta Society Web site has an extensive bibliography with over 100 references, yet there is only one article that discusses the use of therapy dogs in speech therapy and it is a case study. Apparently, the use of dogs therapeutically in our profession is relatively limited. However, at ASHA 2002, I met SLPs who are incorporating assistance-animals in their therapy settings.

How to account for this lack of information? It could be a matter of access, ability, and attitude. Firstly, there are many institutional hurdles to cross in order to use a therapy dog in a public locale. Perhaps this could change with the establishment of training programs to prepare dogs specifically as communication assistants. Secondly, it is extremely difficult to provide direct service, for example in a public school setting, and conduct and report research. Grant money to sponsor programs using assistance dogs could assist in generating quality data on the usefulness of the animals in therapy. Finally, I suggest we consider assistance dogs as an augmentative communication strategy, similar to signing with hearing children, to facilitate a child's willingness and ability to communicate.

Nancy Lewis is a pediatric SLP in Santa Fe, New Mexico, working as an independent consultant. Her interests include the use of communication-assistance dogs in therapy, serving the bilingual population with speech-language impairments, and phonological assessment and remediation in children. She is the co-author of the Khan-Lewis Phonological Analysis-Second Edition. Contact her by e-mail at NancyLewisSLP@aol.com.

Reprinted from The ASHA Leader

Lewis, N. (2003, September 23). Ruby goes to school: Using therapy dogs as treatment assistants. The ASHA Leader, 8(17), 12–13.