DOLPHIN THERAPY FOR AUTISTIC CHILDREN: EDUCATIONAL EFFECTS

DOLPHIN THERAPY FOR AUTISTIC CHILDREN: EDUCATIONAL EFFECTS Mindaugas Rugevičius, Algimantas Kirkutis, Aldona Žakaitienė, Nijolė Šostakienė, Ieva Kir kuty tė Klaipeda university, Klaipeda Seamen's hospital, Klaipėda Children's Hospital, Lithuania Abstract The article deals with the impact of Dolphin Therapy (DT) on children with autistic syndrome. It introduces the initial results of the research that is being carried out in the Klaipėda Sea Museum. The research reveals that the occurrence of certain behaviours, which are characteristic of autistic children performing educational tasks, decreased after 10 DT sessions. During the tenth session the children were more attentive, did their tasks more willingly, were more interested in the session and got involved in it more easily, they had to be encouraged to continue and finish their task less often. The parents of the children noticed positive changes in their children's behaviour after two months when the DT was finished. The possibilities to apply DT for educational purposes are discussed in the result analysis. KEY WORDS: Dolphin therapy, autistic children, educational outcomes. 1. Introduction Abnormal brain functions cause development of mental disability. It is difficult to find some morphological symptoms of brain damage among various mental health disorders, especially among as autism, depression, antisocial behaviour and others. Nevertheless, it is very complicated for children affected with the above mentioned disabilities to have productive contacts, to learn and master new experiences, and to increase the socialization level. That's why it is very important to study every possible opportunity to help these people. There are several theories which allege that different animal therapies can be useful for a great number of special mental disabilities (Gudonis, 2005). One of these says that dolphins can be helpful and functional for mentally retarded children, including autistics. These animals are very inquisitive and can keep playing with a child longer than other animals which have been used in therapy. Dolphins live in communities. They have a developed feeling of socialization, are very attached to each other, and have a stereotype of "always smiling". Because dolphins in the Dolphinariums are trained, the mammals are easy-going, creative and patient. They seek for a child's attention. In addition, they spread high frequency ultrasounds. One research hypothesis is that these sounds can positively affect autistic children. Based on these characteristics, today in some countries there is a new therapy called Dolphin Therapy (DT). In the late 1980s Dr. David Nathanson started to work with brain damaged and mentally handicapped children using contact with dolphins as a reward. Various experiments showed that dolphin-assisted therapy achieves positive results in learning, relaxation, and quicker concentration (Nathanson et al., 1989; 1997; 1998). During the last fifteen years many research programs were established in the USA, Israel, the Ukraine, and Germany. Researchers noticed that DT is associated with significant increase in language, speech, and gross and fine motor functions for children with severe disabilities (Lukina, 1999). Some reports were publicized during the last year, the aim of which was to evaluate the precision of the results reported by various previous experiments on dolphin therapy (Marino & Lilienfeld, 1998; Humphries, 2003). Research and other related studies reported positive outcomes of the therapies and showed improvements in language, behaviour, cognitive processes, attention, motivation to learn, and certain medical conditions. Regardless of the positive results, the authors of these articles report some threats to the accuracy of the outcomes. The first of the major threats is related to research design. This shows that some of the investigators used one-group pre-test / posttest design and had no comparison to the other groups of children. Since the experiments had no control group, there is a possibility that the post-test improvement could be the result of the child's maturation or other uncontrolled factors. Other possible threats to the reliability and validity of the studies could be the lack of a standardized testing instrument, and subjective investigators' and parents' reports, based on their expectations. Tracy L. Humphries concludes that Dolphin therapy seems to be effective; however, to prove it better-designed and better-controlled research is needed (Humphries, 2003). Today there are three different theories, which represent the key approaches to Dolphin Therapy in the world. The first one is reinforcement theory, which was founded in USA. The interaction with the dolphin is a reward for learning new behaviour. Free interaction theory is another keystone of DT and came from Israel. The exponents of this approach claim that free interaction with the dolphins in and out of the water has a therapeutic effect on a child. The third group of scientists refers to DT as an organized activity, which develops advertency, and self-sufficiency, as well as learning skills. In 1999, German scientists from the Niirnberg Dolphinarium and the University of Wurzburg started to study this theory and began to run a project. In this project the DT included three important components: a) the interaction with the dolphin, b) some sort of vacation feeling (including leisure activities), and c) a social-pedagogic care of the complete family during the therapy. With reference to the last theory and its experience, in 2003, the Lithuanian Sea Museum, in close collaboration with Klaipėda Seamen's Hospital and Klaipėda University, started a pilot study, the aim of which was to evaluate the effectiveness of DT on autistic children's behaviour, cognitive, and social - emotional state. 100

The first results of the research are introduced in this article. The effect of DT on the symptoms of autistic behaviour is analyzed by comparing the results with the behaviour changes of children who were treated by traditional methods during the research period. 2. Methods 2.1. Participants Forty-two 5 to 10 year old children, diagnosed with autistic syndrome, participated in the research. The children were grouped at random into two groups. The first, the experimental group, consisted of 22 children (14 boys and 8 girls), who participated in the dolphin therapy programme. The control group consisted of the same number of 5 to 10 year-old children (19 boys and 3 girls), who were treated using usual therapy methods. The proportion of boys and girls in the analysed group is adequate to the autism disability distribution according to sex in the population. 2.2. DT procedure The purpose of DT is to develop the child's sensomotoric, verbal, and communicative skills. We used a learningfrom-the-model method during the research. Pursuant to this method, children who participated in the session had to observe a therapist's (social pedagogue) behaviour. After that they were 4 asked to imitate the therapist's behaviour. The children were rewarded with an encounter with dolphins for correctly accomplished tasks. Encounter and contact with the dolphin were used as means of reward promoting the child's positive behaviour. The overall duration of DT was 12 days. It consisted of 10 sessions. One session lasted for 30 minutes. There was a two days break after the 5 th session. The behaviour of the children in the control group was also recorded for 12 days with two days break. 2.3. Measures With the authors' permission, we modified and used several questionnaires that are being used in a project (Fersen, 2005) in Niirnberg Dolphinarium (Germany). We made an analysis of the indicators that allow the evaluation of the changes in behaviour while performing the tasks given in the course of DT. We evaluated each child's behaviour during DT, and parents' view about the changes in the child's behaviour that they noticed during the research. Also, a special medical test was carried out on each child, but we are not analyzing the outcomes of that test in this article. A Questionnaire on the Child's Behaviour during the DT Session was filled in after each DT session. According to the task accomplishment during each DT session, 17 behaviour characteristics were evaluated with the help of the questionnaire, e.g. completing tasks independently (without assistance); putting in order the instruments used in the session, etc. A five-point Likert type scale was used for the responses, from always (1) to never (5). When the results were analyzed, the evaluation of each characteristic and the average evaluation of all behaviour characteristics during the session were calculated. Higher evaluations show behaviour features that are more characteristic of autistic children. Only the experimental group was evaluated according to that questionnaire. We interviewed the parents with another Questionnaire twice: before DT and in two months after the DT, in both the experimental and control groups. The parents were asked about their children's behaviour in 7 fields: sensomotoric, communication, social-emotional, learning-playing, nutrition, sleep, independent behaviour. The parents' answers were put in the following codes: 0-behaviour characteristic of autistic children are absent; 1 partially manifested; 2-clearly manifested. The intensity of autism symptoms was calculated in each field separately, and an overall score of autism symptoms was also calculated. Higher evaluations reveal a higher in tensity of autism symptoms observed by the parents. 3. Results The Questionnaire on the Child's Behaviour during the DT Session was filled in after each session. We compared the evaluations of the 1 st and 10 th sessions in order to evaluate the changes in behaviour during the dolphin therapy. The results are presented in Table 1. All the evaluated behaviour characteristics during the tenth DT session were better, i.e. autism symptoms were less manifest in a child's behaviour. The differences in the results of twelve behaviour characteristics were statistically significant. During the tenth session the children were more attentive, they were more interested in the activity and got involved in it more easily, they had to be encouraged to continue and complete the tasks more rarely (p < 0.001). Also, significant differences were found in the evaluations of children's activeness, independent fulfilment of tasks, how they put in order the used instruments (p < 0.01). The children were more interested in the content of the tasks, they needed less assistance and continued their work after they encountered some difficulty (p < 0.05). As it has been stated above, while analyzing the results, we have calculated an average evaluation of all behaviour features during the session. The comparison of the first and the tenth sessions according to this index also revealed a significant decrease in the intensity of autistic symptoms (p < 0.001). The intensity of autistic symptoms during the research was also evaluated by the parents. The parents in the experimental and control groups were interviewed twice. Figure 1 shows the results of the interview before DT. 101

Table 1. Evaluations of the children's behaviour according to the questionnaire (means and standard deviations) before and after DT Behaviour features Before DT After DT z P (M ± SD) (M ± SD) Interest in activity 3.68 ± 0.94 2.81 ± 1.09-3.75 0.001 Activeness during the therapy session 3.81+0.95 3.09 ±1.06-3.17 0.01 Willingness to accomplish tasks 4.09 ± 0.75 3.36 ± 0.95-3.35 0.001 Interest in the task contents 4.13 ±0.83 3.77 ±1.1-2.3 0.05 Attentiveness 4.00 ± 0.69 3.27 ± 0.88-3.39 0.001 Impulsive movements 3.14+1.2 2.82 ± 1.05-1.88 Insignif. Independent fulfilment of tasks 3.81 + 0.85 3.45 ± 1.01-2.82 0.01 Fulfilment of tasks only after encouragement 4.41 ±0.66 3.78 ±0.68-3.5 0.001 Independence during the activity 4.04 + 0.95 3.68 ±0.89-2.5 0.05 Necessity of assistance 4.05 + 0.99 3.87 + 0.94-2.5 0.05 Coping with difficulties (obstacles) 4.13 ±0.99 3.63 ± 1.13-2.42 0.05 Independent behaviour in case of difficulties 4.40 ±0.59 4.00 ± 0.75-2.71 0.01 Asking for assistance 3.59 ± 1.46 3.45 ±1.1-0.88 Insignif. Satisfaction in the completed tasks 3.90 ±1.19 3.77 ±0.92-1.13 Insignif. Manifestation of activity results 4.27 ±1.10 4.09 ± 0.92-1.26 Insignif. Search for evaluation (encouragement) 4.13 ±1.2 3.95 ± 0.99-1.41 Insignif. Putting in order the used instruments 4.45 ± 091 3.95 ±0.99-3.05 0.01 Average evaluation 3.84 ± 0.85 3.47 ± 0.94-3.96 0.001 Experimental Control Figure 1. Results of interview with the parents before dolphin therapy. As it can be seen in the chart, the main problems mentioned by the parents in both the experimental and the control groups, concern the independent work. Nutrition and sleep problems are the least manifest. Although the scores of nutrition and sleep problems in the experimental and control group are a little bit different, the differences are not statistically significant. Thus, according to the parental interview results before DT, the experimental and the control groups did not differ according to the intensity of the autistic symptoms, as well as according to the evaluations in each of 7 behaviour and ability fields. Figures 2 and 3 reveal the comparison of the parental interview results before DT and in 2 months after DT. A decrease in autistic symptoms intensity in nutrition was found during the second interview in the control group (p< 0.05). In the experimental group the results of the first and the second interview differ more significantly. Statistically significant differences were obtained in sensomotoric, social-emotional skills and independent activity fields. 102

An overall intensity of autistic symptoms is also different (p<0.05). The parents observed reduced expressions of these behaviours in their child: reduced aggression and self-aggression, oversensitivity to touch, seizing forbidden things. In the parent's opinion, a child needed less assistance, and he/she could stay alone for a longer period of time. Before therapy In 2 months Figure 2. Changes in the parental interview results in the experimental group. Before therapy In 2 months Figure 3. Changes in the parental interview results in the control group. Thus both DT specialists and the parents noticed positive changes in the children's behaviour after DT. We tried to assess whether the effectiveness of DT is related to the intensity of the autistic symptoms observed by the parents. We calculated the correlations between parental interview results and the effectiveness of DT. We considered the criterion of DT effectiveness to be the difference in behaviour between the sessions 10 to 1. The correlations are shown in the figure 4. It were found the negative correlations between the autistic symptoms noticed by the parents and the dynamics of behaviour established by DT specialists, namely, the more manifested the autistic symptoms arc, the less effective DT is. The strongest relationship was found between the effectiveness of DT and the overall 103

intensity of autistic symptoms, as well as the intensity of autistic symptoms in the social-emotional field (respectively, r = - 0.40, and r = - 0.39; p < 0.05). Figure 4. Correlations between autistic symptoms observed by the parents and the effectiveness of DT. 4. Discussion The effectiveness of DT is still under discussion. Authors with a skeptic point of view declare that the existing proof of the effectiveness of DT is not sufficient (Marino & Lilienfeld, 1998; Humphries, 2003). In their opinion, the healing effect of DT may exist, not because of dolphins, but because of the change of environment and being in the water. Some say that interaction with other animals can have a similar effect on the children. It is often stated that even though a positive change may occur, it is not clear how long it can be effective. It has to be admitted that it is very complicated to find sound arguments against such remarks and to prove the healing effect of DT with the help of traditional clinical methods. In our opinion, a more prospective trend is to consider the application of DT for educational purposes, not for treatment. The supporters of this trend make a hypothesis that reward with the dolphins increases the sensory sensitivity (attentiveness) of autistic children to outside stimuli, and that is why, when applying training elements, DT helps in developing a child's sensomotoric, verbal and communication skills, i.e. skills that are necessary for learning (Nathanson, 1997; Fersen, 2005). The results of our research approved this hypothesis. The evaluations of the features that are necessary for learning, such as activeness, attentiveness and independent activity, improved during DT. Other learning behaviour indicators also improved: skill to follow the teacher's instructions, to complete started tasks, to put work instruments in order. The literature that deals with the effectiveness of DT often depicts the dolphin as kind of an icebreaker (Fersen, 2005). It is obvious that ten DT sessions cannot have a long-term effect. DT gives a stimulus to the forming of new skills and behaviour stereotypes, further development of which has to be continued in the usual educational environment for the children with special needs. The reliability of changes in behaviour has to be discussed separately. In our research, a child's behaviour was evaluated by social pedagogues and psychologists who participated in DT. The same is done in most of the researches. The fact that the estimators know the purpose of the research increases the threat that they can "improve" the results subconsciously, i.e. result expectancy effect can become manifest. The parents of the children who participate in DT can also "improve" the results due to unjustified expectations. This is the reason why the relation between the parents' and DT specialists' evaluations does not increase the reliability of the evaluations. In this respect, the negative correlation between the intensity of autistic symptoms and the effectiveness of DT described by the parents is much more informative. It appeared that the more autistic symptoms the parents noticed in their child's behaviour, the less improvement in the child's behaviour are noticed by the specialists during the DT sessions. This statistically significant and logically explained relation between parent and specialist evaluations confirms indirectly the validity of both the evaluations. As some authors state, DT can also be effective as a means of psychotherapy for a family with a child with special needs (Donio, 2005). The results of our research show that it is not only a means of help to a family. DT can 104

stimulate the dynamics in the behaviour of a child with autistic symptoms that are important for the learning process. 5. Conclusions 1. The occurance of autistic behaviour when accomplishing educational tasks significantly decreased in children with autistic symptoms after ten DT sessions. 2. The intensity of autistic symptoms changed statistically significantly during the dolphin therapy: the evaluations of sensomotorics, social-emotional skills, independent activity and overall score of autistic symptoms improved. 3. The results of the research showed that dolphin therapy can stimulate the changes in the behaviour of a child with autistic symptoms that are important in the learning process. References 1. Donio, S. (2005). Supporting Experience with the Aid of Dolphins. In: Dolphin - Human Interaction: the Nature Treasure of the XXI" Century (pp. 13-14). Klaipeda: Klaipeda University. 2. Gudonis, V. (2005). Zoo therapy: reality and perspectives. In: Dolphin - Human Interaction: the Nature Treasure of the XXf Century (pp. 24-25). Klaipeda: Klaipeda University. 3. Humphries, T. L. (2003). Effectiveness of Dolphin-Assisted Therapy as a Behavioral Intervention for Young Children with Disabilities. Bridges, 1 (6), 1-9. 4. Fersen, L. (2005). Evaluation of Dolphin Assisted Therapy: a Research Project at the Dolphinarium Numberg. In: Dolphin - Human Interaction: the Nature Treasure of the XXI я Century, (pp. 14-15). Klaipeda: Klaipeda University. 5. Lukina, L.N. (1999). Influence of Dolphin-Assisted Therapy Sessions on the Functional State of Children with Psychoneurological Symptoms of Diseases. Human Physiology, 25,676-679. 6. Marino, L., Lilienfeld, S.O. (1998). Dolphin-assisted therapy: Flawed date, flawed conclusions. Anthrozoos, 11,194-200. 7. Nathanson, D.E., Sherri de F. (1997). Cognitive Improvement of Children in Water with and Without Dolphins. Anthrozoos, 6,17-27. 8. Nathanson, D.E. et al. (1998). Long-Term Effectiveness of Dolphin-Assisted Therapy for Children with Severe Disabilities. Anthrozoos, 11, 22-30. 9. Nathanson, D.E. (1989). Using Atlantis Bottlenose Dolphins to Increase Cognition of Mentally Retarded Children. In: P. Lovibond & P. Wilson (Eds), Clinical and Abnormal Psychology (pp. 233-242). North Holland: Elsevier. 105