Working Towards an Evidence Base: Developing Meaningful Outcome Measures for Animal Assisted Interventions for Children and Young People with Autism.

在文献中，人们越来越认识到动物可以发挥的治疗作用。研究表明，养宠物;减少抑郁症（Siegel等，1999）;艾滋病管理的心理健康问题（布鲁克斯等人，2018年，比尔斯和伊芙，2009年）;改善青少年的社会情绪结果（Jacobson和Chang，2018）;减少老年人对医疗服务的使用（Raina和Parminder，1995年）。自闭症的患病率稳步上升，从2002年的1/150儿童上升到2012年的1/68，这种强烈的异质性，特异质组具有多种共病（Politte et al. 2015）和精神健康障碍的高患病率（Mcleod et al. 2015）。自闭症患者被边缘化，报告缺乏社会联系（Mcleod et al. 2015），孤独感（Brancroft et al. 2012），全职就业率仅为16%（国家自闭症协会，2016）。《柳叶刀神经病学杂志》（2017年）援引自闭症护理的成本为每年320亿英镑，人们越来越意识到ASC的财务和社会成本影响。在当前紧缩政治的社会经济气候下，提供有效、高效和安全的ASC干预措施有多方面的驱动因素。获得治疗方案的证据基础已成为进一步研究和学习的重点领域。虽然关于ASC干预措施的研究质量和数量正在提高，但目前的文献仍然缺乏广度。研究主要集中在应用行为分析（阿坝），发展社会语用模型（DSPM），或其变体。尽管有支持性的经验基础，阿坝/DSPM被一些人认为是有争议的。对这些疗法以及支持它们的组织和政策，如“自闭症代言人”和“自闭症关怀法”（2014年），提出了能力歧视，非人化，甚至虐待的指控。自闭症患者、倡导者和神经多样性社区越来越强烈地反对使用它们（《卫报》，2015年。这种情况的汇合创造了一个真空，在这个真空中，没有证据基础的替代性补充疗法激增（Thyer和Pillotti，2010年。Singer and Ravi，2015）. AAI是一个非常感兴趣的领域，作为一个马童方法的实践者，经营着一个提供这些服务的小型非营利组织，这项工作也引起了我个人的共鸣。在一项系统性综述中，O 'Haire（2017）得出结论，有新的证据表明AAI对ASC患者的益处，值得采用更强大的方法进行进一步研究。拟议项目的目的是开发一种有意义的标准化结局指标，以评估自闭症儿童的动物辅助干预（AAI）。研究问题将包括：-一个有意义的标准化结果衡量标准如何有助于建立一个经验证据基础？结果测量应该考虑哪些因素？应该如何设计和实施？在AAI的特定情况下，在什么时候可以说已经达到了证据基础，这并不适合传统的试验设计？在治疗环境之外，如何证明所测量的任何改善的可转移性？

There is increasing recognition in the literature of the therapeutic function animals can play. Studies have shown pet ownership; reduces depression (Siegel et al. 1999); aids management of mental health issues (Brooks et al. 2018, Beals and Eve, 2009); improves socioemotional outcomes in youths (Jacobson and Chang, 2018); reduces the use of medical services in the elderly (Raina and Parminder,1995).Autism has a steadily increasing prevalence from 1 in 150 children in 2002 to 1 in 68 in 2012, this strongly heterogeneous, idiosyncratic group features a great diversity of co-morbidities (Politte et al. 2015), and a high prevalence of mental health disorders (Mcleod et al. 2015). Autistic people are marginalised, reporting a lack of social connections (Mcleod et al. 2015), feelings of isolation (Brancroft et al. 2012) with only a 16% full time employment rate (National Autistic Society, 2016). The Lancet Neurology Journal (2017) quotes the cost of Autistic care to be £32 billion annually, and there is a rising awareness of the financial and social cost implications of ASC. In the current socio-economic climate of austerity politics there are manifold drivers to providing effective, efficient and safe ASC interventions. Garnering an evidence base for treatment protocols has become an area of significant focus for further research and study.Whilst the quality and quantity of research on ASC interventions is improving, there remains a lack of breadth in the current literature. Studies are predominately focused on Applied Behaviour Analysis (ABA), Developmental Social Pragmatic Models (DSPM), or their variants. Despite the supportive empirical base ABA/DSPM are considered by some to be controversial. Accusations of ableism, dehumanisation, even abuse have been made against these therapies and the organisations and policies supporting them such as 'Autism Speaks' and the Autism CARES Act (2014). There is a growing and increasingly vocal opposition to their use from Autistic individuals, advocates and the Neurodiverse community (The Guardian, 2015. Spectrum News, 2016).This confluence of circumstances created a vacuum in which there has been a proliferation of alternative, complementary therapies without an evidence base (Thyer and Pignotti, 2010. Singer and Ravi, 2015). AAI is an area of significant interest and, as a Horse Boy Method practitioner running a small not for profit organisation providing these services, this work also resonates for me personally. In a systematic review O'Haire (2017) concluded there is emerging evidence of the benefits of AAI for people with ASC which warrants further study with more robust methodology.The aim of the proposed project is to develop a meaningful standardised outcome measure to assess Animal Assisted Interventions (AAI) for children with Autism. Research questions will include:- How can a meaningful standardised outcome measure contribute towards establishing an empirical evidence base?- What factors should outcome measures consider? How should they be designed and implemented?- At what point can an evidence base said to have been reached in the specific situation set of AAI, which does not lend itself to traditional trial designs?- How can transferability of any improvements measured be demonstrated outside the treatment setting?