The Vall d'Hebron University Hospital has incorporated dog assisted therapy in the treatment of children and adolescents suffering from fetal alcohol syndrome. This syndrome is caused by the mothers' alcohol consumption during pregnancy and has various symptoms, including cognitive, psychological, behavioural and social problems. Thanks to the dog-assisted therapy, some of these symptoms can be improved in selected patients. Thus, Vall d'Hebron is the first hospital in the world to use this therapy to treat fetal alcohol syndrome.As Dr. Josep Antoni Ramos-Quiroga, head of the https://www.vallhebron.com/es/especialidades/psiquiatria Psychiatric Service of Vall d'Hebron explains, "previous work shows that dog-assisted therapy can be useful in improving some of the symptoms of autism, schizophrenia or depression. So, we decided to incorporate this therapy for fetal alcohol syndrome." In addition, according to Dr. Ramos-Quiroga, who also co-leads the http://es.vhir.org/portal1/fitxa-personal.asp?id=51737 Group of Psychiatry, Mental Health and Addictions of Vall d'Hebron Institut de Recerca (VHIR), "we will launch the first clinical trial in the world to evaluate the efficacy of this therapy in fetal alcohol syndrome." For her part, Dr. Marta Segú, executive director of the Probitas Foundation, explains that her organization has been collaborating for years in innovative projects in several hospitals in Catalonia and was aware of other experiences of assisted therapy with dogs for the treatment of children with autism or other mental health pathologies. "When we were asked to get involved in the inclusion of this innovative therapy for children affected by fetal alcohol syndrome, we saw the importance of implementing this pilot project to help these children and, through the study, to see its validity for the complementary treatment of this syndrome," she explains.Dr. Nuria Gómez, psychiatrist and head of the Vall d'Hebron Fetal Alcohol Syndrome Programme, explains that "alcohol intake during pregnancy can cause damage to brain structures or neuronal functioning. Now, thanks to the dog-assisted therapy, we have one more tool in this condition, which adds to the pharmacotherapy and psychotherapy." Children and adolescents who have this disease have many difficulties to adapt to daily life. "The damage to the brain causes them to have difficulty in emotional control or abstract thinking, naivety and inability to understand social norms or double meanings, or deficits in daily and social life skills," says Dr. Nuria Gomez. For example, they have rabies attacks, engage in risky behaviour or can leave with any stranger on the street." These are problems that also drag on into adulthood. A quick and very emotional connection between patients and dogsDr. Nuria Gómez is in charge of deciding which patients are best suited for this therapy. Along with Raquel Vidal, a clinical psychologist in the program, choose what goals to work with each child, such as social skills, self-esteem, logic, impulsivity and psychomotor skills.During sessions with the dogs, a CTAC technitian is present, who monitors the relationship between the dogs and the children. In addition, Dr. Nuria Gomez and psychologist Raquel Vidal are also present to evaluate the patient's behavior and whether the objectives of the therapy are being met. For example, work the impulsivity and anxiety are two common objectives. In this way, the dog technical specialist prepares exercises such as the child throwing a ball to the dog, which forces him to wait and count to three, or the child hugs the dog, feels his heart and inhales and breathes deeply, to reduce anxiety. You can also work on the logic, as when the child is presented with four different containers (a glass, a cup, a bowl with holes in the base and a bowl without holes) to choose the most appropriate to give water to the dog. "This is the way to work on the specific objectives, and also to improve the self-esteem and safety of the patient, who sees how he or she is able to carry out the exercises," says Raquel Vidal. "The patients are delighted-adds Dr. Nuria Gomez-. They are children and adolescents who connect very quickly with animals. The relationship with dogs is not so complicated as that kept with adults, is not mediated by language or the rules of the adults. Rules are simpler, and, in addition, the relationship presents a high emotional content, fact that that helps establishing a connection." Anyway, Dr. Nuria Gómez stresses that "it's a therapy, not just playing with a dog, and that's why you have to work with the animals in a therapeutic context and with experts," she adds. First phase: individual sessionsCurrently, sessions with the dogs (Laica, which is a golden retriever, Buba and Menta, two labradors, and Bamba, a King Charles cavalier) are individual, with only one patient in each session and two dogs. "In this way, children and dogs know each other," explains Raquel Vidal. The sessions have a duration of 30 minutes approximately. When the child or the adolescent enters the query, there are two dogs in each session, awaiting them sitting in two chairs to initiate therapy. Second phase: group sessionsIn a later phase, the group sessions will begin, where two dogs and several patients will participate. This type of therapy is very focused on "working on social skills among patients -says Dr. Nuria Gomez-. One of the most important problems in these children and adolescents is the deficit in social cognition, that is to say, they present problems to understand the habitual social norms." Specifically, in terms of social cognition, one of the most characteristic symptoms of patients with fetal alcohol syndrome is naivety. "They have a 'theory of mind' deficit, that is, they have a hard time knowing what other people think and feel. They don't understand the jokes or the double meanings -adds Dr. Nuria Gómez-. Thanks to the presence of dogs, we expect patients to be more predisposed to interaction and to learn to distinguish and understand the emotions of others."More than 300 patients with FAS in Vall d'Hebron in three yearsAs explained by Dr. Nuria Gómez, fetal alcohol syndrome "affects children, but also their families, who have to adapt to the needs of their children." The Vall d'Hebron University Hospital provides multidisciplinary follow-up of these cases, with the collaboration of the Psychiatry Service, the Genetics Department and the Neurology, Radiology and Neurophysiology services. Endocrinology and Ophthalmology services are also involved assessing possible complications. In Vall d'Hebron, more than 300 children and adolescents have already been treated for this pathology in the last three years.Dog-assisted therapy for autism and cerebral palsy On the other hand, Vall d'Hebron will also incorporate dog-assisted therapy in the treatment of autism and cerebral palsy. As Dr. Josep Antoni Ramos-Quiroga explains, "those are two pathologies in which working with animals can be very useful. Dogs are 'facilitators' of the work of psychiatrists and psychologists, since they help patients to express and understand their emotions and, in the case of cerebral palsy, motivate them to move."