Effectiveness of animal-assisted services for school-aged children: a systematic review

Animal-assisted services (AAS) have demonstrated potential benefits for children and adolescents, particularly in emotional development and educational outcomes. However, existing systematic reviews often focused on specific populations or types of animals, and overlook the quality of included studies. This review evaluates the effectiveness of animal-assisted services on the well-being and behavior of school-aged children, and assesses the risk of bias of the included studies. Following PRISMA Guidelines, a systematic search was conducted in MEDLINE, CINAHL, PsycARTICLES, PsycINFO via EBSCOhost, Cochrane Database of Systematic Reviews, and Web of Science, from database inception until August 15, 2023. Risk of bias was assessed using the Cochrane Risk of Bias 2 for randomized trials and ROBINS-I for non-randomized studies. Two reviewers (IM, PJH) assessed each record, and two additional reviewers (IF, FS) resolved disagreements. Data were synthesized narratively, and presented in tables and figures. From 2,380 initial articles, 30 met the inclusion criteria. Studies were primarily randomized controlled trials (n = 21), involving various populations, from children with autism spectrum disorders (n = 10) to general population (n = 8). Outcomes were grouped into abilities, attitudes, externalizing behaviors, internalizing behaviors, disorder-specific measures, and well-being. AAS showed positive impacts on socio-emotional functioning and behavior despite diverse intervention approaches. Nonetheless, all studies had study design problems, which caused high risk of bias. AAS appears to enhance cognitive, behavioral, and socio-emotional aspects, as well as learning in school-aged children. Further methodologically rigorous research and evidence, such as implementation studies and cost-effectiveness analyses comparing AAS to standard practices are needed to support decision-making.