Animal-Assisted Therapy in Children Living with Autism Spectrum Disorder: A Literature Review of Randomized Controlled Trials
Authors:   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Cedeño-Bruzual Maria Fernanda , Sáez-Alarcón Carolina ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Cintra Monica ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Whipple Gonzalez Gustavo ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Hamamoto Daniele ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Blanco Mendez Franiana ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Rocha Lima Ananda Queiroz ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Saavedra Michell ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Padrão Fernandes Fernanda ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Gonçalves Alejandra ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Belo-Silva Ariadne ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Sooud Asmaa ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Borges Filho Francisco Pereira ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Fernandes Diego ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Pereira Thiago ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Al-Awam Bashayer ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Lowey Megan ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Vidal Camila ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Moros David ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA, Ficher Klaus ,   Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, USA
Published: November 2023

Introduction: Autism spectrum disorder (ASD) is a prevalent neurodevelopmental condition with significant impacts, and the benefits of animal-assisted therapy (AAT) in this population are unclear. This review aims to inform clinical decision-making and guide future research in AAT for children with ASD. Methods: We conducted a comprehensive search across PubMed, Cochrane Library, Embase, and ScienceDirect of randomized controlled trials of AAT in children with ASD, published until July 2023. Other inclusion criteria involved English-language articles and full-text availability. The selection process adhered to PRISMA 2020 guidelines, and the Cochrane Bias Assessment Tool was used for quality appraisal. Results: 45 studies were retrieved; six were included after removing duplicates and applying criteria. These studies included 300 children with ASD who received different AATs as an add-on therapy with a follow-up range of 7 to 16 weeks. Additional outcomes were measured with multiple scales. Overall, studies described that AAT has various benefits in this population, including improving cognitive, communication, and social skills, increasing adaptive behaviors, and reducing irritability and hyperactivity compared to control groups that did not receive AAT. The risk of bias measured with the Cochrane Bias Assessment Tool showed varied methodological quality among studies. Conclusion: Whether involving dogs or horses, AAT can improve overall quality of life, reduce autism-related behaviors, enhance communication and cognitive skills, promote social development, and mitigate anxiety. While encouraging, further research is imperative to strengthen the evidence base and assess the long-term effects of AAT in this population.