THESISFINAL COPY

Running head: A LOOK AT ALTERNATIVE INTERVENTIONS FOR CHILDREN

ON THE AUTISM SPECTRUM

Expanding the Horizons of Child and Youth Care Work:

A Look at Alternative Interventions for

Children on the Autism Spectrum

Shamim Pourfarshomi

Ryerson University

CYC48A/B Independent Study

Instructed by Dr. Kiaras Gharabaghi

A LOOK AT ALTERNATIVE INTERVENTIONS FOR CHILDREN ON THE AUTISM SPECTRUM

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Abstract

The purpose of this literature review is to explore the use of alternative interventions and

their benefits for children on the Autism Spectrum (AS). Through a Child and Youth

Care (CYC) approach, this review focuses on the foundational attitudes of CYC, and how

this practice shapes the ways in which practitioners work with children on the spectrum,

across a variety of contexts. An understanding of medical and social models to AS will be

discussed, as well as exploring the various intervention plans that exist. Alternative

interventions have been frequently overlooked, thus, this paper will work to understand

the context in which Musical Interaction Therapy (MIT), Art Therapy (AT), Animal

Assisted Intervention (AAI), and Aquatics are carried out. The terms “autism”, “ASD”

and “AS” will be used interchangeably. The words “intervention” and “therapy” will also

be used interchangeably for the context of this paper.

Understanding Autism Spectrum Disorders Through a Child and Youth Care Lens

Over the years, there has been a noticeable rise in Autism Spectrum Disorders

(ASD) especially in North America (Autism Ontario, 2013; Reinberg, 2014). In fact it is

seen as one of the most common developmental diagnosis today (Autism Ontario, 2013).

Although much of the causes and symptoms associated with ASD remains somewhat of a

mystery, researchers suggest that part of the rise of autism spectrum disorders more

recently may be due to a combination of genetic and environmental factors as well as

recent changes in the Diagnostic Statistical Manual of Mental Disorders (DSM-5) (see,

for example, Anagnostou, Zwaigenbaum, Szatmari et al., 2014; Reinberg, 2014).


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An ASD diagnosis can begin to be understood through a range of types (i.e.

Autism, Asperges etc.) and different levels of severity (i.e. verbal, limited verbal & non-

verbal) that affect areas in communication, social interactions/skills, behaviors and

interests (Autism Ontario, 2013; Autism Society, 2015; Bass, Duchowny & Llabre, 2009;

Burrows, Adams & Spiers, 2008; Elkis-Abuhoff, 2008; Emery, 2004; Finnigan & Starr,

2010; O’Neil, 2008; Scheizer, Knorth & Spreen, 2014; Wolfberg, DeWitt, Young,

Nguyen, 2014). Although there are a number of varying descriptions presented in the

literature, Autism Spectrum (AS) is most commonly explained as a complex and

pervasive neurological disorder that is heterogeneous, meaning that it is expressed

differently for each individual (Autism Ontario, 2013). Children on the spectrum often

have heightened senses (taste, touch, smell, visual, auditory) and poor self-regulation

abilities, which affects the capacity to interpret and process information in the same ways

a neurotypical child would (Elkis-Abuhoff, 2004). Even though it is a life-long trajectory,

it does not mean that improvements cannot be made to enhance the overall well being for

children, youth and families. Research indicates there are a number of alternative

interventions, with positive outcomes, that have helped improve various areas of

functioning. These recent advancements will be explored further in this paper.

While there is an overall agreement on the prevalent characteristics described,

universally approaching and defining autism is an ongoing debate for many in the

medical and social fields. The medical approach views these characteristics as

impairments or “deficits” (Molloy & Vasil, 2002; O’Neil, 2008). It is evident in the

Diagnostic and Statistical Manual of Mental Disorders (DSM-5) descriptions of autism

provided by the American Psychiatric Association (APA), which states:


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People with ASD tend to have communication deficits, such as responding

inappropriately in conversations, misreading nonverbal interactions, or having

difficulty building friendships appropriate to their age. In addition, people with

ASD may be overly dependent on routines, highly sensitive to changes in their

environment, or intensely focused on inappropriate items” (As cited in Malaysia,

2013, para. 4).

Some researchers suggest that those with AS generally have “a lack of empathy,

inappropriate one-sided interactions, clumsy and ill-coordinated movements and odd

posture” (Molloy & Vasil, 2002). Further characteristics are outlined as the inability to

play and interact with others, a low capacity for “social responsiveness” and a restricted

imagination (Molloy & Vasil, 2002; Finnigan & Starr, 2010). The goals associated with

the medical model work to “normalize the child” (O’Neil, 2008).

The social approach to AS, in contrast to medical, views common characteristics of AS as

“differences” that are not necessarily a negative “deficit (Molloy & Vasil, 2002;

Anagnostou et al., 2014). Instead, it is important to understand that autism is

characterized by developmental differences in areas that are a part of one’s everyday

functioning; it is a way of life and being for the children, youth and families experiencing

it (O’Neil, 2008; Anagnostou et al., 2014). In fact, many individuals diagnosed do not

consider autism as a disability or something that should be “fixed” (O’Neil, 2008).

Molloy and Vasil (2002) propose that the general impression of autism as a disability is

the product of societal structures. The problem, as the writers explain, is that the

predominant medical model defines characteristics of AS as “abnormal” by standards of a


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neurotypcial society (Molloy & Vasil, 2002, p. 663). What the model fails to

acknowledge are the many unique strengths and talents these individuals also have, that

are not often explored or developed due to notions of what is considered “normal” and

therefore “correct” to the general public. In contrast to a rehabilitative or medical model,

social models work to highlight and advocate for the strengths of the child and

recognizing their potential for growth (Molloy & Vasil, 2002).

A Child and Youth Care (CYC) approach values the unique individual for who

they are and advocates for empowering children, youth, families, and their rights

(Mattingly & Stuart, 2001). The works of Garfat & Fulcher (2011) describe CYC as a

unified “approach” for practitioners from all sectors and levels of education in the field.

This approach embodies the social model as proposed by Molloy & Vasil (2002). Rather

than attempting to “normalize” the child, CYC practitioners work to integrate and

celebrate adversity, recognizing that development is unique for all human beings. As a

result, meeting the needs and goals of individuals and families are explored through

different avenues (such as alternative interventions which will be discussed further) since

all individuals have different needs, goals, strengths and capabilities. In addition to

adopting a strengths and needs based approach to interventions, practitioners facilitate

opportunities for the child to grow using his/her own strengths and unlocking their full

potential (Garfat & Fulcher, 2011). Similarity, Mattingly & Stuart (2001) agree that the

attitude in a foundational child and youth care approach promotes the wellbeing of all

citizens across a variety of contexts (Mattingly & Stuart, 2001, p. 23).

Much of the literature suggests that the best practices for professionals working with AS

populations are through an ecological, interdisciplinary and multidisciplinary approach to


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interventions (Molloy & Vasil, 2002; Anagnostou et al., 2014; Autism Society, 2015).

Significantly related to a CYC’s professional development, practitioners often work with

other professionals in the service sectors to develop a plan for success across multiple

contexts of daily life that contribute to the optimal well being of the child (Mattingly &

Stuart, 2001; VanderVen, 2005; Gharabaghi, 2008; Austin, 2009; Garfat & Fulcher,

2011). The International Child and Youth Care Consortium (2010) describes:

Professional Child and Youth Care Practice focuses on infants, children, and

adolescents, including those with special needs, within the context of the family,

the community, and the life span. The developmental-ecological perspective

emphasizes the interaction between persons and their physical and social

environments, including cultural and political settings” (as cited in Curry, Eckles,

Stuart & Qaqish, 2010, p. 59).

Alternative Interventions in Child and Youth Care

Autism is progressing in diagnosis and recognition in family systems, schools,

hospitals, residential homes, and within the community (Gasalberti, 2006; Reinberg,

2014). This implies that professionals are likely to encounter individuals on the spectrum

due to the vast service sectors CYC’s are involved in. Derksen (2010) presents 5

competencies that are necessary for all CYC’s to adopt within their different practices.

These domains include professionalism, cultural & human diversity, applied human

development, relationship & communication, and developmental practice methods

(Derksen, 2010, p. 326). These strategies are also presented by Mattingly & Stuart

(2001), in their compiled document dedicated for those who work with children, youth

and families (see, for example, Mattingly & Stuart, 2001, p. 8). Hoffman (2013), also


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supports this, and further explains that across the contexts of child and youth work,

practitioners sometimes find themselves in risky situations where injury, acting out and

violence take place. Knowing how to respond appropriately not only benefits the

practitioner, but it additionally benefits the child and the workplace (Hoffman, 2013).

Therefore, practitioners should walk into their practice with a constructive understanding

of the competency’s that support and enhance professional practice, relationships,

communication, documentation, behavior guidance, and developmental practice domains

in order to enhance the quality of the work (see, for example, Hoffman, 2013, p. 14-19).

Children on the spectrum typically display difficulties in social interactions,

adapting to change, and emotional/self-regulation. Regulation is an extremely important

function, because it determines how individuals are able to relate, interact, and

experience this world (Elkis-Abuhoff, 2004). Emery (2004) explains that in a child’s

attempt to organize his/her outer environment, behaviors that may seem aggressive, odd

or socially unacceptable, are often displayed. This translated behavior is in part due to an

underdeveloped schema, as well as the lack of effective coping skills when stimulated by

the outer environment. As a result, getting into social situations tend to be avoided-

individuals experience high levels of anxiety in social interactions, low levels of self-

esteem and insist on rigid routines due to its function of familiarity (p. 144).

There are well-known intervention frameworks available for such populations,

such as and biomedical interventions, Cognitive Behavioral Therapy (CBT), Applied

Behavioral Analysis (ABA) (see, for example, Anagnostou, 2014, p. 515). These

frameworks suggest that while interventions have effective methods and successful

outcomes for some (such as the use of PECS), they are medical in nature and focus more


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on the behavior as a deficit, which leaves little room for creativity and self-expression. In

contrast, alternative interventions presented throughout the literature demonstrate the

potential for growth, happiness, expression and inclusion (see, for example, Bass,

Duchowny & Llabre, 2009; Redefer & Goodman, 1989; Elkis-Abuhoff, 2008; Emery,

2004; Finnigan & Starr, 2010; Geretsegger, Elefant, Mossler & Gold, 2014; Hillier,

Greher, Poto & Doughtery, 2011; Lasa et al., 2015; Pan, 2011; Silverman, 2008). CYC

practitioners are qualified to facilitate interventions that not only target the specific needs

of the child, but also improve the overall functioning and quality of life for individuals on

the spectrum as well as their families. Garfat & Fulcher (2011), describe CYC

interventions as tailored and flexible for the individual family. This approach recognizes

that since no two individuals are alike, no two families are alike, and there no two

interventions should be alike. Just as individuals are diverse, interventions can be

integrated or adjusted (p. 14).

Gasalberti (2006) found that using alternative approaches to interventions are

important for practitioners to consider in their practice, because they work to recognize

and accommodate the uniqueness of the child, their strengths and interests (p. 133).

Contrary to popular belief, Austin (2009), writes that alternative interventions are not just

reserved for those with musical backgrounds or art degrees, but instead should be utilized

within the context of the helping professions. Thus, this paper will review unique

interventions for the unique AS population that is encountered in the every day contexts

of professional child and youth care work.


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The most common peer-reviewed alternative therapies available in the literature today

include musical interaction therapy, art therapy, animal assisted interventions, and

aquatics.

Musical Interaction Therapy (MIT)

There are several studies that outline the positive affects of music in a child’s life

(see, for example, Gasalberti, 2006; Austin, 2009). As mentioned above, many children

on the autism spectrum experience high levels of anxiety and do not welcome change or

hold much esteem toward themselves (Hillier et al., 2011; Finnigan & Starr, 2010;

Geretsegger et al., 2014). This affects their ability to form relationships and connections

in social settings. It is suggested that these skills must be taught, because without the

proper edification, children on the spectrum can develop even further avoidant tendencies

to social situations (Finnigan & Starr, 2010).

In a pilot study done by Hillier et al. (2011), an MIT program was created for

verbal adolescents diagnosed with autism, to assess whether interacting with music would

lead to a decreased level of anxiety, higher self esteem and encourage friendships. Where

more traditional forms of MIT use vocal activities such as singing, this study focused on

using non-verbal interactions. The authors describe that non-verbal interactions promote

more “doing”, rather than “telling” as it does with some verbal approaches. “Doing”,

meant that participants were actively engaged in different varieties of music making

avenues. Each activity worked to satisfy a different goal, such as learning to give and

receive respect, acceptance, working collaboratively with others, understanding the

diversity of music and musical tastes, self-expressing through music, and much more.

Activities were different each week, which included things like making music with


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computer programs (such as garageband), with instruments and making movie

soundtracks. These activities presented many opportunities for participants to exercise

creativity and expression. Despite it’s flexibility within the program, the structure of each

session stayed consistent. It included things like going over the agenda for the day at the

beginning of each session, and ensuring that sessions were held at the same time and

place each week- this helped give participants some insight on what to expect, which

benefitted them greatly, as individuals on the spectrum sometimes have difficulty with

changes in routines. The findings of this study demonstrated that participants not only

appreciated the program, but also showed a substantial increase in self-esteem and

attitudes towards peer interactions. In addition, overall anxiety levels were seen to

decrease. At the end of the program, results from self-report questionnaires done by

participants described that slowly introducing different types of activities each week built

a tolerance to change; something that is commonly lacked with children on the spectrum.

Participants walked out with accomplishments beyond what they had expected prior to

starting the therapy, especially individuals with no musical background. They developed

a new skill set and throughout the process, established friendships that maintained even

after the program came to a close (Hillier et al., 2011, p. 204-209).

Studies such as this demonstrate that music is a motivating factor for children and

youth on the spectrum. Although the study conducted by Hillier et al. (2001) was limited

to verbal participants, other studies have found that MIT’s reduce anxiety and enhance

expression and social interaction for limited verbal and non-verbal individuals as well

(see, for example, Silverman, 2008; Geretsegger et al., 2014). Similarly, Finnigan & Starr

(2010) found that the act of listening to preferred music lowers levels of anxiety for both


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verbal and non-verbal children and adolescents (p. 326). The unique approach to MIT

contributes significantly to enhancing an individual’s self-esteem, because in music, there

is no “right” or “wrong” product; therefore “failure” would not be deemed possible

(Hillier et al., 2011).

Art Therapy (AT)

For the average individual, relating to people and different contexts in the

environment is a natural and everyday function of life. However, for children with AS,

this function does not develop so naturally (Elkis-Abuhoff, 2008). For example,

neurotypical individuals develop a schema as they grow, which enables them to

understand what “is” and “is not” supposed to happen in social settings, in contrast to

individuals where the presence of autism greatly affects their schemas (Emery, 2004). In

addition to this disconnect, the 5 human senses for those on the spectrum are increasingly

heightened, therefore the capacity for interacting and internalizing other people or

contexts of the environment is a very different process. As a result, areas in

communication, building relationships and social skills are affected (Emery, 2004;

Schweizer, Knorth & Spreen, 2014), and a “manifestation of immature behaviors” (Elkis-

Abuhoff, 2008) is observed. Although these difficulties exist, the literature demonstrates

that AT is an effective approach to helping individuals with AS interpret and make sense

of their internal world, external world, and the connection between them (Emery, 2004;

Elkis-Abuhoff, 2008; Scheizer et al., 2014).

Emery (2004), presents her AT experiences with a 6 year old male client

diagnosed with ASD. Like many on the spectrum, the child could not maintain eye

contact and had poor communication as well as motor skills. He had not developed a


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sense of schemas, which likely contributed to his un-interest in drawing. This was

initially evident, as he wrote the word “house” upon being asked to draw a house. In

summary, the beginning of the AT sessions started off with playing with play-dough.

Together the child and professional would roll the dough into a ball, flatten it out on a

sheet of paper and trace a circle around the circumference of the dough with a marker.

The functions of this activity served a sensory satisfaction (playing with play-dough) and

contributed to developments in motor skills, which he lacked. Initially, the child had poor

control over his hand movements when being asked to trace around the play-dough circle,

however after several months of practice he was able to trace the shape. Over time,

different activities and objects were introduced such as drawing human puppets, which

helped symbolize human body parts, which he would later learn to connect. Eventually,

the child would voluntarily request for a marker and paper, and organize his world

through drawings. Emery (2004) describes, “during one session after drawing several

figures, he said to me, ‘These are called people.’ I also observed that his joy in the

process of drawing was remarkable” (p. 145, para. 4). Ultimately, he was able to draw out

a representation of himself in his mother’s car, without looking at or tracing anything.

The remarkable improvements of the child demonstrate that developments can certainly

be made to enhance the ways in which a child is able to have mental representations, or

schemas, of different aspects of daily life. In addition to an increased self-awareness,

improvements in communication and eye contact were also documented. Emery (2004),

suggests that this may due to the client-professional relationship that was established

during therapy. In conclusion, Emery (2004) noted that the more the relationship


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developed in trust and engagement, the less his “autistic symptoms” were seen (Emery,

2004, p. 145)

The outcomes of this study suggest that positive sensory input and visuals are

effective guides for helping children understand the social world in which they are

observed. Similarly, in Elkis-Abuhoff ‘s (2008) work in AT with an 18 year old female

diagnosed with ASD, she demonstrates how AT’s can “create a full sensory immersion

and interaction of verbal, visual and tactile modalities” (p. 269). While both studies

concluded similar outcomes of AT, each one used a different method that was best suited

for the specific needs of the individual (see, for example, Elkis-Abuhoff, 2008; Emery,

2004).

The creative nature of AT’s allow individuals to practice self-expression

regardless of age, capabilities or developmental level. Similar to a function of musical

interaction therapies as described above, there is no “right” or “wrong” in art creation. It

is a subjective experience that many professionals agree can contribute special insights to

the internal world of the child (Elkis-Abuhoff, 2008; Schweizer et al., 2008). This is

especially significant for non-verbal individuals, who cannot use language and speech as

a form of communication. In a systematic and comprehensive review of the literature

pertaining to the effectiveness of AT’s, Schweizer et al. (2008) indicate that art is a

shared language that allows people to support expression and to share experiences. It is a

form of alternative communication. Thus, new forms of communication skills are learned

in the way that works best for the individuals. In addition, the review confirms that AT’s

satisfy sensory stimulations because of the extensive materials and techniques that art has

to offer. These include (but are certainly not limited to) paints, clay, markers, wood, etc.


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In essence, art provides opportunities for children and practitioners to learn from each

other and grow; there really is no limit to one’s creative capacity, and art as a whole helps

unlock these hidden potentials.

Animal Assisted Interventions (AAI)

Animal assisted intervention is made up of a collection of different techniques

each with it’s own terminology; Animal-assisted activities (AAA), animal-assisted

therapy (AAT) and service animal programs (SAP). The differences in these

terminologies are situated in the purpose and goals of the intervention (see, for example,

Lasa et al., 2015). Lasa et al. (2015), published a very recent systemic review of the

literature pertaining to the effectiveness of AAI’s for children and adults. These findings,

although limited, conclude that interactions with horses and dogs are the most common

avenues of AAI. SAP is directed more towards individuals with physical disabilities.

These trained animals help individuals with the everyday navigation of life (e.g. guide

dogs). AAT is a formal goal oriented therapy that involves professionals from various

disciplines creating and documenting the process (Austin, 2009). These animal therapies

have specific goals that target particular diagnosis and areas of improvement (Autsin,

2009; Lasa et al., 2015). AAA’s in contrast, have a less formal dynamic with the goal of

promoting and establishing interactions and relationships to enhance the overall quality

of life. Activities are flexible and to some degree spontaneous, which is in turn inspires

and motivates children to learn, and facilitate social relationships (Lasa et al., 2015;

Austin, 2009). Essentially, the animal chosen for the intervention works along side the

therapist as a “co-therapist” (Lasa et al., 2015).


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Due to difficulties in communication and self/emotional regulation for children

with AS, behaviors might often arise in interacting with others that may not always

translate authentically in a social setting (Elkis-Abuhoff, 2004; Martin & Farnum, 2002).

Martin & Farnum (2002), suggest that animals are “transitional objects, allowing children

to first establish bonds with them and then extend these bonds to humans” (Martin &

Farnum, 2002, p. 657). In addition, further studies present the idea that animals help

connect children to their social environment because they inspire a different sense of

awareness to the child’s surroundings, and eventually work to lessen problematic

behaviors and enhance communication skills (Burrows et al., 2008; Lasa et al., 2015). As

mentioned above, children on the spectrum often have heightened sensitivities to taste,

touch, smell, hearing and sight. These sensory needs can indeed be met through natural

human-animal interactions. For instance, it is no secret that most animals have a special

smell. Due to their nature, they offer different tactile stimulations. They have distinct and

clear noises, and provide a “vivid visual impression” (Redefer & Goodman, 1989).

Similarly, research indicates that children in the AS population “tend to be more

receptive to information that is experienced visually” (Elkis-Abuhoff, 2004).

Pet Therapy in Schools

Incorporating pets in the systems closest to the child and family is seen to have

tremendous positive outcomes. These include a decrease in anxiety, enhancing positive

behavior changes related to lower aggression, as well as increases in socialization skills

and connection with one’s surroundings (see, for example, Austin, 2009; Bass et al.,

2009; Gasalberti, 2006; Grandgeorge, Tordjman, Lazartigues, Lemonnier & Deleu, 2012;

Lasa et al., 2015; Redefer & Goodman, 1989). Most peer-reviewed studies evaluating the


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effectiveness of “pet therapy” usually focus on dogs as the type of pet. There have

however been some documented instances where dolphins, aquarium fish, cats and

rabbits have been used in intervention (Austin, 2009; Lasa et al., 2015). Although there

are a number of different pet species that can be incorporated into interventions, this

section of the paper will limit the term “pets” to domestic and service dogs. Service dogs

for children with autism are different from traditional guide dogs that support individuals

with physical disabilities (Burrows et al., 2008). These dogs are trained to bond with the

child with ASD, however following commands from the caregivers (Burrows et al.,

2008). In contrast, traditional guide dogs are trained to take commands from the

individual they are servicing.

Classroom pets have been found to be great enhancers for self-esteem, social

support and establishing deeper connections with peers and the environment.

Furthermore, these studies reveal a significant improvement in areas such as anxiety, peer

rejection, impulse control, loneliness and other elements that may affect the success rates

of children in schools (Austin, 2009; Baumgarter & Cho, 2014; Friesen, 2009; Jalongo,

2005). Perhaps in part due to the non-verbal nature of animals, or the unconditional

acceptance and affection they show, children are not subject to any judgments they might

experience when interacting with humans. Jalongo (2005) writes, “It might be less

stressful for a child to read aloud to a dog than to a teacher or peer. After all, a dog won’t

judge or correct you” (p. 152).

Professionals all over the world are beginning to recognize the therapeutic value

of working with animals, and are working to implement these strategies in the workplace

(Austin, 2009). In fact, Patcham High School, a secondary school in the United Kingdom,


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released its first dog policy in June 2014. In the release, it states that having a dog in

school addresses issues around bullying, attendance, behavior, reading and social

development, while providing an additional support and reward due to the general loving

and fun nature of interacting with gentle dogs (Patcham High School, 2014).

It is suggested that the term “Animal Assisted Learning” be used in school

settings, because it captures the full essence of the role of animals within that context

(Friesen, 2009). Baumgarter & Cho (2014) write, “The key role for animals in education

is teaching socially important behaviors” (p. 282).

Pet Therapy Within the Home

While the presence of a pet in the classroom enhances many areas around

motivation, friendships and connection, the presence of a pet within home settings also

enhances other areas such as behavior and family dynamics. A 6-month qualitative study

carried out by Burrows Adams and Spiers (2008), in Ontario Canada, observed patterns

of behavior with the presence of a registered service dog in the everyday lives of 10

families, where autism was present in at least one of the children (aged 4-14 years old).

Families reported that the service dog provided them with companionship, additional

support, respite and a sense of safety/security both in the home and in the community.

Within the home, several parents of the 10 families chose to train the dog to sleep in the

child’s room at night. Due to a dog’s natural tendency to follow and protect it’s

companion (Redefer & Goodman, 1989), it provided an additional safety net for parents,

knowing the dog would bark and alert the family if there was any trouble especially

during bedtimes. As a result, rates of the quality of sleep for each member of the family


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increased. Sensory needs, high anxiety and behavioral challenges such as tantrums were

common factors seen in the autistic children recruited for this study. The service dogs

provided calming mechanisms that alleviated many of these symptoms, thus helping

routines such as bedtime, car rides, dinners, doctor’s offices, social gatherings and other

activities run smoother for families. The dog’s presence certainly enhanced more areas

than it had initially been trained for.

Children on the spectrum present a number of behavioral challenges that are more

often than not seen as negative by association; as a result, Burrows et al. (2008) writes

that families working through ASD are constantly at a risk for social isolation. However,

with the presence of their new family service pet, families found a better sense of

acceptance and recognition in the public community. Burrows et al. (2008) suggest that

this may be because citizens could identify the service dog with the family, and perhaps

react with more understanding towards situations and behaviors that might have not been

well understood (Burrows et al., 2008).

The first documented instance of AAI was in 1792, at the York Retreat

psychiatric hospital in England (Austin, 2009). Since then, there has been a substantial

increase in the implementation and recognition of this special approach (see Gasalberti,

2006; Grandgeorge et al., 2012; Lasa et al., 2015; Redefer & Goodman, 1989).

Throughout the years, researchers have measured the outcomes of AAI in many different

contexts, and the results have nevertheless been mostly consistent, which implies that

AAI is a timeless approach with many beneficial outcomes for those wanting to explore it

in their practice or everyday life.


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In exercising AAI’s there is naturally much concern around safety for both the

child and the animal itself. The literature suggests that in order to prevent negative

experiences, developmentally appropriate preparations must be explored prior to actually

interacting with the animal (Friesen, 2009; Jalongo, 2005). For example, assessments can

be made on the eligibility and personality match between child and animals. A child with

high hyperactivity might benefit more from an animal that is calmer in temperament,

where a child with low motivation might benefit more from an energetic type (Jalongo,

2005). Lessons can be facilitated regarding how to appropriately approach, play and

interact with a dog, and what to do if the child (or dog) gets scared (Friesen, 2009). Other

lessons for practitioners, teachers, and parents/families can include instructions on

grooming, sanitary and liability concerns associated with the therapeutic animal (Friesen,

2009; Jalongo, 2005). CYC practitioners can set up workshops or connect individuals,

families and themselves to further trainings that will be needed prior to starting

interventions.

Practitioners must also ensure the cultural safety of all individuals especially

when working with animals. Cultural safety, as defined by Fulcher (n.d.), is the “state of

being in which a child or young person experiences that his or her personal well-being, as

well as social and cultural frames of reference, is acknowledged, even if not fully

understood by the worker(s) claiming to be there and help him/her” (n.d.).

While in North American culture it is common to view dogs as a companion, in

other cultures dogs may be viewed as a source of food, or as an unclean animal (Friesen,

2009; Jalongo, 2005).


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The positive outcomes of AAI’s are currently being debated among practitioners

from many different disciplines (Lasa et al., 2015). There is however a substantial

amount of evidence generated through various studies that speak to the numerous benefits

of integrating animals into interventions, not just for children on the autism spectrum, but

also for individuals with learning disabilities, hyperactivity, cerebral palsy, spine injuries,

and mental & cognitive disorders just to name a few (Austin, 2009; Lasa et al., 2015;

Baumgarter & Cho, 2014).

Aquatic Therapies

Aquatic therapies are mainly utilized by professionals in the physical,

occupational and therapeutic realms of practice (Austin, 2009). Unlike other therapies,

aquatics offer something that is beyond our physicality; zero gravity. Aquatic

interventions are unique and most often successful due to the nature of H2o (water) in

which children interact. The density of the water reduces gravitational pulls, allowing the

child to float and move around without the natural constraints that may be present “on

land” (Pan, 2011; Pan, 2010; McManus & Kotelchuck, 2007). These factors present a

number of different benefits not just for children on the spectrum, but for all individuals,

families and communities. When looking at autism, much of the available literature

agrees on the difficulties faced in communication, socialization, level of arousal/interest

and motor skills Researchers also agree that aquatic therapies target these areas in several

ways (see, for example, Pan, 2011; Yilmaz, Yanardag, Birkan & Bumin; 2004).

Although there has never been any recorded instances of a child who was once

experiencing issues in motor skills, to then altogether “grow out of their motor


20

difficulties” (Pan, 2011), there has however, been many recorded instances where

immense improvements in motor skills were made in addition to acquiring new skills

(Austin, 2009; Pan, 2011). For such individuals, aquatic therapies can be quite an

uplifting and joyous experience because they are, in essence, fun! The context of

splashing around and feelings of weightlessness, even just being around bodies of water

has been shown to contribute to many improvements in movement abilities, muscle tone,

strength and happiness (see, for example, Pan, 2011; Yilmaz et al., 2004). Additionally,

improvements in areas such as self-confidence, relationships and even physical

appearance have been evident (see, for example, Pan 2011; Huettig & Darden-Melton,

2004).

Exercising and improving motor skills is especially important to the child’s well

being because it presents different avenues and opportunity for movement, physical

activity and participation in activities with other peers (Pan, 2011; Yilmaz et al., 2004). It

is important that these skills be developed for children with ASD especially since such

areas are problematic for those on the spectrum. Notably, Studies show that individuals

on the spectrum are likely to be less active than other children developing typically for

their age (Pan, 2011; Pan, 2010). Studies show that water activities actually provide a

workout for the entire body simultaneously (Pan, 2010). Thus, aquatic therapies are a fun

way to get children active and moving.

Chien-Yu Pan (2011), in her study focusing on the efficacy of aquatic programs

and physical fitness for children on the autism spectrum, noted that children might not

have the resources to practice and expand on the skills gained during interventions (p.

663). While the findings may be accurate, it is important to consider that this study was


21

done in Taiwan, a place where oceans are vast. In places like Ontario Canada, it may be

easier to find the means to continue practicing due to many facilit ies available across

cities. Public facilities are accessible to most citizens such as the YMCA.

Regardless of any disorder, deficit, difference or condition, for the majority of

human beings, staying active improves the overall quality of life. Studies carried out all

around the globe such as in Taiwan (Pan, 2010), Turkey (Yilmaz, Yanardag, Birkan &

Bumin, 2004) and across North America all demonstrate that aquatic therapies promote

health and well being (Huettig & Darden-Melton, 2004).

The current literature pertaining to the benefits of aquatic therapies for children on

the spectrum tend focus mainly on the improvement of motor skills, as there is evidently

a substantial amount of information that conveys involvement in aquatics enhances these

skills which children on the spectrum are seen to lack (Huettig & Darden-Melton, 2004).

However, it has been found that water activities benefit one’s body, physical & mental

health and overall wellbeing (Pan, 2010; Yilmaz et al., 2004). Therefore, any future

research done on such interventions should work to assess the improvements in not just

the motor abilities, but the overall health of the child as well (Pan, 2011).

Evidence on the benefits of aquatic exercise for children with ASD is limited. Pan

(2011), suggests the most effective way to learn and maintain aquatic skills and health is

if it were to be established in schools as a part of the physical education curriculum.

Since it’s mandatory in most grade schools, it would present many opportunities for

children to engage in aquatics, learn new skills, participate in social interactions, and stay

active” (p. 664).

Discussion


22

Despite their positive outcomes, MIT, AT, AAI, and Aquatics are among the

many intervention approaches that are often underutilized by professionals in the service

sectors. Firstly, there seems to be a lack of formal regulation in incorporating therapeutic

activities as an intervention, especially in the areas of aquatics and interventions with

certain non-conventional animals such as horses and dolphins (Lasa et al., 2015).

VanderVen (2005), suggests that another reason may be due to the lack of support from

various organizations who may not value alternative therapies as playing a role in the

development of the child or family, therefore making it more difficult for practitioners to

actually carry out such activities (The Theoretical Basis of Activities section, para. 5).

This is relevant because CYC is usually situated within the “context of an agency of

organizational system” (Mattingly & Stuart, 2001, p.37). In recognizing the value these

programs will bring for children, youth and their families, CYC practitioners within the

organization should then work to advocate for them across the milieus they work. These

include schools, hospitals, group homes, foster care, juvenile justice, mental health

facilities, residential centers, etc. (VanderVen, 2005; Mattingly & Stuart, 2001).

What each of these interventions have in common is that they can be implemented

across various contexts in which CYC’s work. For example, music interaction therapies

and art therapies can take place within the home, at standard therapy sessions, out in the

community, in schools etc. The implementation and benefits of animal assisted

interventions are seen within the home, across schools and within the community.

Aquatic therapies provide benefits across different contexts in the community. Thus, with

the growing prevalence of ASD, CYC’s are likely to work with AS populations and their

families.


23

The beauty of working with families is within these different settings is that CYC

practitioners are able to move beyond holding interventions in “neutral environments”

(Garfat, 2004) such as offices, and move into environments that better reflect the natural

experiences or flow of daily life and what that consists of for each member of the family,

individually and as a whole (Garfat, 2004; Garfat & Fulcher, 2011). A relational child

and youth care approach recognizes that the best sort of intervention or healing is made

within the child’s day to day life.

Furthermore, practitioners understand that each child, youth and family is unique

in their capacity needs. This implies careful planning and considerations around physical,

emotional and cultural safety for all life must be acknowledged when implementing such

interventions. It is recommended that the child and his/her family should take an active

part in the decision making and planning for that intervention (Fulcher, n.d.; Friesen,

2009). Thus, in recognizing and providing the appropriate responses to needs and goals,

healing can be facilitated. Garfat (2002) writes, “Child and Youth Care practice is based

on helping people live their life differently as they are living it” (as cited in Garfat &

Fulcher, 2011, p. 6). The International Child and Youth Care Consortium (2010) writes:

“Child and youth care practice includes assessing client and program needs,

designing and implementing programs and planned environments, integrating

developmental, preventive, and therapeutic requirements into the life space, contributing

to the development of knowledge and practice, and participating in systems interventions

through direct care, supervision, administration, teaching, research, consultation, and

advocacy” (as cited in Curry, Eckles, Stuart & Qaqish, 2010, p. 60).


24

Conclusion

Alternative interventions for many children on the spectrum can be seen as alternative

ways of learning, communicating and relating to their world. Children, youth and

families living with AS, should be recognized for their differences, not “deficits”. In a

society where verbal interactions are the predominant way of communication, and non-

verbal cues are either acceptable or unacceptable with no middle ground, children on the

autism spectrum fall short of fitting in. and this isn’t necessarily because they “lack”

anything. In fact children on the spectrum have unique talents and abilities that are often

hidden under certain behaviors (see, for example, O’Neil, 2008). It might however, be

due to the fact that children with ASD have troubles with self-regulation and expression

as opposed to “neurotpicals” (O’Neil, 2008). These troubles may sometimes translate as

behavior deficits especially in the medical fields as well as certain contexts such as

schools. CYC’s work to understand the function of the behavior and strategize different

avenues they can meet the goals and needs of individuals and families, while building on

strengths and celebrating differences. Alternative interventions across multiple contexts

have shown that children can develop coping strategies to better help regulate behaviors.

In addition, these interventions demonstrate that existing difficulties such as social and

motor skills, low self esteem and a lack of awareness can be developed upon and

improved. This by no means is an attempt in “normalizing” a child, but rather to “meet

them where they are” (Garfat & Fulcher, 2011) and help guide the process of growth.


25

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