Putting Cats on the Spectrum: A Scoping Review of the Role of Cats in Therapy and Companionship for Autistic Adults and Children

Figures & data

Table 1. Inclusion and exclusion criteria.

Inclusion criteria	Exclusion criteria
Peer-reviewed primary research published in the English language without any parameters on the date or type of publication retrieved from the electronic and subsequent hand search	Articles where the population were not identified as autistic or on the autism spectrum
Research where the focus was, in full or in part, on cats (including robots that appear cat-like) and autism	Articles where the focus was not on cats

Table 2. PubMed search strategy.

(Human-Animal Bond [mh] OR Animal Assisted Therapy [mh] OR Therapy Animals [mh] OR Cats [mh] OR Pets [mh] OR companion animal [tiab]) AND (Asperger Syndrome [mh] OR Autistic Disorder [mh] OR Autism Spectrum Disorder [mh] OR ASD [tiab]) AND (english[Filter]))

Figure 1. PRISMA (Tricco et al., 2018).

Table 3. Summary of included studies.

Author, year, country	Aims & objectives	Study type	Participants	Data collection	Data analysis	Key findings
Atherton et al. (2022) UK	To inform our understanding of the human-animal bond in autistic populations as compared to neurotypical individuals.	Mixed methods.	Survey: 735 people (326 with autism, age 18–63 years, mean 28.64 (SD = 9.57), M 176, F 150; and 409 neurotypical, age 18–79 years, mean 33.91 (SD = 13.05), M 123, F 286). Interviews: 16 autistic pet owners (recruited from study 1). M 7, F 7, Non-Binary/other 2, mean age 34.75 years (18-63).	Online survey: Liebowitz Social Anxiety Scale, Satisfaction with Life Scale, UCLA Loneliness Scale, Multidimensional Scale of Perceived Social Support, Autism Quotient, Lexington Attachment to Pets Scale, and Critical Pet Rating. Semi-structured interviews.	Pearson’s Chi-square, MANOVA, Kolmogorov-Smirnov tests, Spearman’s correlations, Mann-Whitney U tests, Mediation analyses. Interpretative phenomenological analysis.	Pets owners reported greater life satisfaction than non-pet owners. Autistic adults were equally attached to their pets as neurotypicals, but less likely to own. Autistic individuals more likely to use pets as a substitute for human companionship. Themes: pets with benefits, pets as a social alternative, pets as a social lubricant and barriers and breakthroughs to pet ownership.
Byström and Lundqvist Perssontt (2015) Sweden	To understand parents’ perspectives on how children and adolescents with autism spectrum disorders benefit from a relationship with companion animals.	Qualitative, focus group discussions.	3 focus groups involving 13 parents of children and adolescents (age 8 8–20 years. M 6, F 6) diagnosed with ASD.	Focus-group discussions.	Thematic analyses.	Themes: the quality of the relationship with the companion animal; increased interaction with people; and optimisation of the child’s function and development. Companion animals can contribute to social and behavioural development support and improve mental health/ quality of life. Interests and activities with companion animals were more social than non-social. Pets as providers of comfort, regulators of feelings and stress, facilitators of motor development and cope with difficult life events, and stimuli to evoke caring behaviours.
Carlisle et al. (2021a) USA	To explore the stress and welfare of cats in families of children with autism spectrum disorder.	RCT, involved repeated measures design.	10 cats adopted by parents and their child with ASD aged 6–14 years old.	Fecal cortisol measures, cat body weight, Cat Stress Score. Data collection at BL (baseline), T1 (2 to 3 days following adoption), T2 (6 weeks following adoption), T3 (12 weeks following adoption) and T4 (18 weeks following adoption).	Descriptive statistics, ANOVA.	Adopted companion cats’ stress levels did not increase post adoption.
Carlisle et al. (2021b) USA	To investigate the effect of the introduction of a temperament screened shelter cat into the family of a child with ASD on child social skills and anxiety.	Two-group randomised, repeated measures design with a delayed treatment control group.	11 families; 4 in the initial treatment group and 7 in the delayed treatment control group. Families assigned to the treatment group adopted a cat and were followed for 18 weeks. Families assigned to the control group were followed for 18 weeks without intervention, then converted to treatment, by adopting a cat and were followed another 18 weeks. Parent’s age: 23–61 years.	Child outcome measures included social skills (Social Skills Improvement System Rating Scale) and anxiety (Child Anxiety Related Emotional Disorders), and parent/child cat bonding (Lexington Attachment to Pets Scale and Companion Animal Bonding Scale).	Repeated measures ANOVA.	Cats may have a positive impact on children with ASD and their parents. Cat adoption was associated with greater empathy and less separation anxiety, fewer problem behaviours including externalising, bullying and hyperactivity/inattention. Parents and children reported strong bonds to the cats.
Carlisle et al. (2020) USA	To explore companion animal ownership in families of children with autism spectrum disorder.	Cross-sectional survey.	764 (689 F) parents. 81.9% had a companion animal, among whom 32.6% owned a dog, 23.7% owned both a dog and cat, 21.9% owned a cat only, and 3.8% owned other species.	Online survey Lexington Attachment to Pets Scale (LAPS), Companion Animal Bonding Scale (CABS), Animal Ownership for Families of Autistic Children Scale (AOFACS), Parental Stress Scale (PSS).	Descriptive statistics, correlational analyses, ANOVA, path analysis.	Parents with lower incomes perceived more benefits of companion animals (CA) and their children were more strongly bonded with their CAs. Parents owning both a dog and cat perceived more benefits than those with only a dog or cat. Parents who perceived their CAs as providing more benefits had less stress.
Carlisle et al. (2018) USA	To identify characteristics of the relationship between children with ASD and family dogs, and to assess caregiver perceptions of the human-dog interactions in families with ASD.	Cross-sectional survey, findings from qualitative open-ended questions are reported in this paper.	338 (306 F) caregivers Mean age: 43 years.	Online survey.	Phenomenology.	7 major themes: bonding and benefits, learning opportunities, barriers, grief, fit (match of family characteristics with those of the companion animal), safety, and alternative animals.
Grandgeorge et al. (2020) France	To investigate the visual attention patterns directed to the partner in dog-child and cat-child interactions in their home environment.	Observation using video recordings.	42 children (23 with ASD and 19 with typical development), aged 6–12 years. 26 children (14 ASD and 12 typical development) had pet dogs and 16 (8 ASD and 8 typical development) had pet cats.	Video recordings – 1-hour observation sessions on the observation of child’s behaviour including interactions with the pet or with family members. Occurrences and duration of glances, gazes, and mutual gazes were calculated and analysed.	Non-parametric tests, Mann–Whitney U tests, Wilcoxon signed-rank tests, Spearman’s correlation.	Attention patterns differed, dogs displayed more gazes and cats more glances towards human interlocutor, while children showed gazes towards both species. ASD children displayed more visual attention with their pet cat than with their pet dog, while typical development children displayed the same amount of visual attention towards their pet, irrespective of type. Children with ASD may be more comfortable with the less “invasive” short glances of cats.
Hart et al. (2018) USA	To explore the nature of cat-child interactions in families who have a cat and a child with ASD and to compare cats’ interactions with children with confirmed diagnoses of severe ASD or less severe ASD as well as a sample of families with typically developing children.	Cross-sectional survey and interviews.	Phase 1: 64 families with a child with ASD and an adult cat. Identified child with ASD was a boy in 72% of families with median age range of 6–9 years. Phase 2: 44 parents with cats, whose children had diagnoses of severe ASD (n = 16), less severe ASD (n = 11), or typical development (n = 17).	Phase 1: web survey of parents; cat’s interactions with the child, and the child’s level of interest and responses to the cat. Phase 2: telephone interviews with parents: cat-children interactions according to degrees of affectionate, aggressive, and fearful interactions, playfulness with the children, and the extent to which children liked holding and interacting with the cats.	Descriptive statistics, chi-square or Fisher exact, one-way ANOVA, Wilk Shapiro tests, regression tree analysis.	Phase 1: affectionate interactions of the cats with children were common: the specified cats were more likely to be attached, affectionate, and non-aggressive to the ASD child and often preferred the specified ASD child than others in the household. Parents made positive comments about the cat (calming the child, soothing protector, guardian). Phase 2: parents identified cats as moderately affectionate towards the child. Cats exhibited less affection to children with severe ASD compared to those living with typically developing children or children with less severe ASD. Cats adopted as kittens were more affectionate and less aggressive to all children. ASD children’s behaviours showed that they valued the relationship with the cat, similar to typically developing children.
Keville et al. (2022) UK	To explore the experiences of cat ownership for young people with autism spectrum disorder from the perspective of their mothers during a time of transition generated by COVID-19.	Qualitative exploratory study.	6 mothers with an autistic child and have owned a cat for at least 1 year. Mothers aged 31–41 years. Children aged 5–12 years, length of time cat owned 3–16 years.	Semi-structured interviews via an online platform.	Thematic analysis.	Themes: sensory benefits with heightened emotions; special bond between cat and child; and learning through the relationship. Cat ownership encouraged empathy and responsibility skills in autistic children. The cat provided sensory stimulation, a calming influence, and companionship for the autistic child.
Kwon et al. (2015) South Korea	To study the effectiveness of treating children with autism spectrum disorder using a cat robot developed to enhance their social interactions.	Cross-sectional, interventional.	5 (1 F) autistic children aged 4–10 years.	Participant observation, field notes and video recordings of 40–50-minute treatment sessions with the cat robots and designated language therapists and play therapists once a week over 5 weeks.	Analysis of observation journal and video recordings.	Most participating children showed increased meaningful interactions with the cat robot. Play and language therapies for ASD children using a robot indicate that the level and span of concentration was higher and longer than existing treatments. Children showed greater reaction to texture and sound.
Lamontagne et al. (2020) USA	To determine what items of the Feline Temperament Profile (FTP) best predict temperament in shelter cats and to identify the similarities and differences in temperament between cats who qualified or did not qualify for placement.	Cross-sectional, observation of cats’ FTP behaviour.	70 domestic cats from two animal shelters. 10 months to 4 years of age.	FTP behaviour test (73 items) scores by an assessor and an observer before the adoption by families of children with ASD.	Descriptive statistics, ANOVA, Cronbach alpha coefficients, logistic regression, principal component analysis.	44 shelter cats were rejected and 26 were qualified for placement in a home with a child with ASD. Acceptable behaviour score of cats decreased the likelihood of being rejected, while questionable behaviour scores increased the likelihood of being rejected. Vocalizations’ and ‘watches with no approach’ were most predictive of acceptable temperament. The FTP was a useful tool and could be shortened with no loss of reliability facilitating shelter efforts to rehome cats successfully.
Lee et al. (2017) South Korea	To deal with language therapy and play therapy using a cat robot for children with ASD and assess the effect of such therapy.	Cross-sectional, observation of autistic children’s interaction with robot cat.	SERO I (cat robot): 6 children diagnosed with autism spectrum disorder. SERO II: 5 children diagnosed with autism spectrum disorder under the age of 10.	Field observation tests and video recordings of autistic children’s interaction with the robot cat.	Observation	There were positive connections and interactions of autistic children with the cat robot. SERO cat robot can be used effectively in the treatment of children with ASD.
Ward et al. (2017) USA	To explore the associations between certain qualities of pet ownership and social-emotional adjustment among adolescents with high-functioning autism spectrum disorder.	Cross-sectional survey.	73 high functioning adolescents with ASD (M age = 13.91, SD = 1.75 years; 87.5% male) and their parents.	Online or mailed paper survey. Pet ownership, Youth Self Report-Depression Scale, Loneliness Scale, Friendship Quality Questionnaire-Abbreviated edition, Child Behaviour Checklist-Depression Scale, Social Responsiveness Scale.	Descriptive analyses, t-tests, correlational analyses, multiple regression analyses.	68% had cats. Parents (56.7%) reported their child turned to a pet for comfort often or all the time. 66.2% noted their child took moderate to complete responsibility in caring for the pet, adolescents who took more responsibility exhibited fewer depressive symptoms. Parents of more socially impaired adolescents reported better friendship quality than less socially impaired adolescents. Taking care of a pet may facilitate social-emotional adjustment.

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