Thai Elephant-Assisted Therapy Research Outcomes in Autistic Individuals

Thai Elephant-Assisted Therapy Research Outcomes in Autistic Individuals

Mental health, including emotional, psychological, and social wellbeing, is extremely important, and can impact every part of our existence. According to some estimates, up to 25% of people will personally experience mental health problems at some point in their lives, meaning that both mental health awareness and the availability of appropriate care and treatment options are vital to local communities and society in general. Certain groups of people, such as those who live with Autism Spectrum Disorder (ASD), are at much higher risk of developing mental health issues. Autism itself is a developmental condition and not a mental health issue, but the likelihood of an autistic person experiencing a mental health problem in their life can be as high as 80%.

Many forms of treatment for ASD have been attempted since the 1960s, when it was first recognised as a distinct disorder. Contemporary treatment methods attempting to address the often significant social, communication, physical coordination, and sensory difficulties faced by people with autism include communication training, environmental restructuring, and using positive reinforcement to encourage behavioural changes. Over approximately the same amount of time as autism-specific treatment has been evolving, animal-assisted therapy (AAT) has been developed as a viable form of treatment for a wide range of physical and mental health problems. AAT has also been shown to be significantly effective (in combination with other forms of therapy) in promoting beneficial outcomes in those with ASD. In the case of young people specifically, many autistic children report feeling a deep bond with animals, and often feel they can relate to them better than other humans. In controlled studies, autistic children who underwent therapy involving animals displayed significantly greater social interaction and use of language than those who attended therapy sessions without animals present.

The use of many different therapy animals in has been attempted throughout decades of research, with mixed success. By far the most common animals used in AAT are dogs, likely due to their ubiquity, intelligence, and empathetic traits, in addition to the ease of training a highly domesticated animal. In the past two decades, however, an unlikely animal has emerged as a potential alternative candidate for AAT in the case of autism and other disorders, at least in Thailand – the Asian elephant. At the time of writing, at least 6 research studies had been completed by scholars in Thailand exploring the viability of elephants in animal-assisted therapy, focusing specifically on ASD and, to a lesser extent, Down Syndrome. Projects stemming from this research, which exist under the banner of ‘Thai Elephant-Assisted Therapy Program (TETP),’ are ongoing, and the use of elephants makes this field unique, as there are no other elephant-assisted therapy programs in the world.

TETP research conducted in recent years has been led by occupational therapists from Chiang Mai University and has, among other areas of study, investigated the effects of elephant-assisted therapy on sensory processing capability, adaptability, social skills and levels of maladaptive behaviour, and balance control in children with autism spectrum disorder. According to the researchers, elephants were selected primarily for their high intelligence, naturally caring and empathetic disposition, and large size. It was theorised that the elephants’ size might be novel enough to attract and hold the attention of autistic children, and thus encourage them to engage with both the animals and their environment. In addition, the fact that elephants consume a large amount of food each day offered participants in the studies ample opportunity to participate in feeding and feeding-related activities. The ability to engage in activities involving tactile stimulation and frequent touching of the animals, such as bathing, were also theorised to potentially impart benefits for the children.

Many people with autism enjoy watching things which are constantly in motion, as such stimuli engage function in a part of the brainstem known as the reticular formation. This is responsible for sensory and spatial awareness, concentration, posture, balance, and discrimination between important from unimportant stimuli. Without sufficient stimuli to result in activation of the reticular formation, the process of accurately responding to the external environment through touch, sight, and sound may be significantly impaired. The fact that elephants are almost constantly in motion, moving their ears, trunks, tails, and legs, combined with their large size, mean that they are able to provide sufficient stimulation to gain and hold the attention of a child with ASD.

A typical elephant-assisted therapy program, as used in one study, utilised a program of intensive treatment for 7 hours per day, 4 days per week, for 3 weeks. Occupational therapists devised a series of activities for children with ASD to perform, structured around an elephant care routine. In addition to non-elephant-related therapeutic activities such as relaxation and arts and crafts, the children participated in activities including locating and accompanying the elephants to certain areas, “buying” elephant food at a makeshift shop and then feeding the elephants, bathing the elephants, and playing games which included elephant participation. In this particular study, post-program testing revealed that in all cases, participants’ sensory processing, balance, and adaptive behaviour capability were significantly improved. Other projects involving TETP for children with ASD have shown equally promising results, including a demonstrable reduction in maladaptive behaviour post-treatment. Autistic children have also seen improvements in balance, motor control, and motor planning after interacting with elephants as part of treatment.

While this form of animal-assisted therapy has demonstrated positive results for children and adolescents living with both ASD and Down Syndrome, it has obvious limitations. Therapists and patients in most places on Earth don’t have easy access to Asian elephants, and thus this form of therapy is infeasible. The large size and care requirements of elephants also produces limitations of the location and potential mobility of therapy sessions. TETP researchers also noted that the existing studies were conducted with Thai autistic children who had previous familiarity with elephants, and that elephant-assisted therapy may not be as effective with children who are not familiar with the animals. Although the cost of this form of treatment is relatively high, researchers believe the significant short-term behavioural improvements in the participants warrant, at a minimum, further investigation in the field. Long-term studies involving children from different backgrounds will be needed to establish a solid research framework, but the use of the elephant as a therapy animal may have wide-reaching applications in future, not only with children, but with people of all ages, and with disorders not previously researched.


References:

National Institute of Mental Health. (n.d.). Autism Spectrum Disorder.
https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd

Pedugsorn, M., Phiraban, C., Pongsaksri, M., Sasat, D., Satiansukpong, N., Sung-U, S., Tipprasert, P., & Vittayakorn, S. (2008). Thai Elephant-assisted Therapy Program: The Feasibility in Assisting an Individual with Autism. World Federation of Occupational Therapists Bulletin, 58(1): 17–26.
http://dx.doi.org/10.1179/otb.2008.58.1.004

Pongsakri, M., Sasat, D., & Satiansukpong, N. (2016). Thai Elephant-Assisted Therapy Programme in Children with Down Syndrome. Occupational Therapy International, 23: 121-131.
 https://doi.org/10.1002/oti.1417

Pongsakri, M., Sasat, D., & Satiansukpong, N. (2017). Thai Elephant-Assisted Therapy Program. MOJ Yoga & Physical Therapy, 2(2): 45-48.
https://doi.org/10.15406/mojypt.2017.02.00016

Sasat, D., & Satiansukpong, N. (2019). Effect of Motorized Elephant-assisted Therapy Program on Balance Control of Children with Autism Spectrum Disorder. Occupational Therapy International, Vol. 2019: 10 pages.
https://doi.org/10.1155/2019/5914807

Thai Elephant Therapy Project. (n.d.). What to Expect: Thai Elephant-Assisted Therapy Project.
http://www.tetp.org/index.php?lay=show&ac=article&Id=2147504408

UCLA Health. (n.d.). Animal-Assisted Therapy Research.
https://www.uclahealth.org/pac/animal-assisted-therapy

Zaky, E. A. (2017). Autism Spectrum Disorder (ASD); The Past, Present, and The Future. Journal of Child and Adolescent Behavior, 5: e116.
https://doi.org/10.4172/2375-4494.1000e116

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