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

在文献中，越来越多的人认识到动物可以发挥治疗功能。研究表明，养宠物；减少抑郁（Siegel et al. 1999）；心理健康问题的辅助管理（Brooks et al. 2018, Beals and Eve, 2009）；改善青少年的社会情绪结果（Jacobson and 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150名儿童中有1名上升到2012年的68名儿童中有1名，这一异质性很强的特殊群体具有多种合并症（Politte et al. 2015），精神健康障碍的患病率也很高（Mcleod et al. 2015）。自闭症患者被边缘化，缺乏社会联系（Mcleod et al. 2015），有孤立感（Brancroft et al. 2012），全职就业率只有16% （National Autistic Society, 2016）。《柳叶刀神经病学杂志》（2017）称，自闭症护理的成本每年为320亿英镑，人们越来越意识到ASC的经济和社会成本影响。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。收集治疗方案的证据基础已成为进一步研究和研究的一个重要重点领域。虽然ASC干预研究的质量和数量都在提高，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（ABA）、发展社会语用模型（DSPM）或其变体。尽管支持实证基础ABA/DSPM被一些人认为是有争议的。针对这些疗法以及支持这些疗法的组织和政策（如“自闭症之声”和《自闭症关怀法案》（2014年）），人们提出了残疾歧视、非人化甚至虐待的指控。越来越多的自闭症患者、倡导者和神经多样性社区反对使用它们（《卫报》，2015年）。频谱新闻，2016)。这种情况的汇合造成了一个真空，在这个真空中，没有证据基础的替代、补充疗法激增（Thyer和Pignotti， 2010）。Singer and Ravi, 2015)。AAI是一个非常有趣的领域，作为一名马男孩方法的实践者，我经营着一家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。在一项系统综述中，O'Haire（2017）得出结论，有新证据表明AAI对ASC患者有益，值得用更可靠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果测量，以评估动物辅助干预（AAI）对自闭症儿童的影响。研究问题将包括：-有意义的标准化结果测量如何有助于建立经验证据基础？-结果测量应考虑哪些因素？它们应该如何设计和实施？-在AAI的特定情况集中，在什么情况下可以说已经达到了证据基础，而这并不适合传统的试验设计？-如何在治疗环境之外证明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?