Tasks to mitigate certain disabling illnesses classified as mental impairments under The Americans with Disabilities Act.
SERVICE DOG TASKS FOR PANIC DISORDER, PTSD and DEPRESSION
According to the Americans with Disabilities Act (ADA), a service animal must be individually trained to do work or perform tasks of benefit to a disabled individual in order to be legally elevated from pet status to service animal status. It is the specially trained tasks or work performed on command or cue that legally exempts a service dog [service animal] and his disabled handler from the “No Pets Allowed” policies of stores, restaurants and other places of public accommodation under the ADA.
The following list identifies a number of tasks a service dog could be trained to do that would serve to mitigate the effects of a disabling condition classified as a psychiatric disability. In particular, the tasks were developed for those who become disabled by Panic Disorder, Post Traumatic Stress Disorder (PTSD), or Depression, conditions attributed to a brain chemistry malfunction. In addition to task training, it should also be recognized that housebreaking, basic obedience training and mastering the behaviors of no nuisance barking, no aggressive behavior, and no inappropriate sniffing or intrusion into another person or dog’s space are an essential part of educating any dog for a career as a service dog.
CLARIFICATION: While a dog’s companionship may offer emotional support, comfort or a sense of security, this in and of itself does NOT qualify as a “trained task” or “work” under the ADA, thus it does not give a disabled person the legal right to take that dog out in public as a legitimate service dog. Setting up a realistic training plan to transform a dog with a suitable temperament into an obedient, task trained service dog is the only way to legally take the dog into restaurants, grocery stores, hospitals, medical offices and other places of public accommodation. Please refer to the IAADP Minimum Training Standards for further guidance at www.iaadp.org.
GENDER: While I refer to a dog as “him” in this article rather than using the word “it,” both genders can be equally good at a service dog career if the dog has the temperament to calmly tolerate loud noises, other animals, strangers reaching out to pet the dog without permission and the other challenges of working with a service dog out in public.
ASSISTANCE IN A MEDICAL CRISIS
A service dog can learn a number of helpful tasks to assist his partner to cope during a sudden flare up of symptoms, medication side effects, or in a situation requiring outside help.
Bring Medication to Alleviate Symptoms
Dog assists partner to cope with nausea, cramps, dizziness, other medication side effects or the fear paralysis of PTSD or the sudden waves of terror, chest pains and respiratory distress of a severe panic attack by fetching antidote medication to alleviate the severity of the symptoms.
- Dog is trained to retrieve a small canvas bag with medication from a specific location that he is schooled to go to on command, such as a closet floor, bathroom vanity or shelf.
- Dog can be trained to go tug open a cupboard door and retrieve a basket or satchel with medication if access to the first location is blocked by the door to the room being shut.
- Dog can be trained to locate a purse with medication in home, office or on a hotel room dresser, desk or chair by following directional commands, then drag-deliver it to partner.
Bring a Beverage So Human Partner Can Swallow Medication
This complex task involves a sequence of skills, takes four to six months to master.
- Dog can be trained to fetch a beverage to enable the human partner to swallow the medication.
Must master the skills of: 1) going to the kitchen from another room to pull open a refrigerator door or cupboard door with a strap, 2) picking up the beverage from refrigerator shelf before the door swings shut, 3) carrying cold beverage to the partner in another room, 4) going back, if need be, to shut the refrigerator door or instead: 5) fetch a basket or some other container from a kitchen cupboard with a beverage and other items; may also contain antidote type medication in a vial with a childproof cap.
Bring The Emergency Phone During a Crisis
Enables the human partner to contact a doctor, therapist or others in a support system when experiencing alarming medication side effects, terror or respiratory distress from a panic attack, or a flashback. An individual suffering from depression, possibly with suicidal ideation, also needs to be able to reach a supporting person or agency. Retrieval of the portable phone can be very useful in other situations too. (Training Note: this should be made a “place command,” as asking a dog to visually search the house is unreliable, especially if the phone is left on a counter or piece of furniture above the dog’s line of sight. It is best to locate the charger unit on the floor in a room with two entrances. If possible, the emergency phone should never be used except during practice sessions. This will ensure its availability during a crisis.)
- Dog is trained to bring the handler a portable phone. If the room where the emergency phone is permanently located has two entrances, the dog should also be specifically taught to find the second entrance in case the first is blocked. The end goal is to train a service dog to bring the phone to any room in the house when needed on command.
Answer the Doorbell
When situations occur in which the handler urgently needs help but cannot get to the front door to let someone into the home due to physical incapacity from drug interactions, injuries that occurred due to lightheadedness, fainting, other side effects, or illness, the service dog could assist by opening the front door and escorting emergency personnel or a member of the support system to the handler’s location.
- Dog is trained to tug strap on a lever handle to open the front door to let in emergency personnel or members of support system on command or in response to the doorbell itself.
- Dog is trained to escort the person to the handler’s location.
Bring Help Indoors and Provide Speech Impairment Assistance
Symptoms of extreme terror, shortness of breath or the wrong dosage of a major tranquilizer like thorazine are a few of the reasons why the patient may need to summon help and may not be able to give a verbal command. Suggested tasks can be taught with hand signals so as to enable the team to communicate in such a crisis. These tasks may be useful at other times too.
- Dog is trained to go nudge a certain household member on command in a crisis.
- Dog taught to carry a note to a spouse or another household member on command.
- Dog should learn to open interior doors with a lever handle and strap or knob-to-lever conversion device so he could exit bedroom or office to carry out a “get help” task.
Summon Help from a Secretary, Co-worker or Supervisor
Dog can learn to carry a message to designated support person or relief person in an office or retail setting.
- There are a variety of ways a dog could summon help in the workplace. It will depend on the situation and/or particular tasks he has been schooled to perform.
Provide Balance Assistance on Stairs
Goal is to prevent a serious injury from a fall. Very useful if the person experiences dizziness due to medication side effects of psychotropic drugs. Task also can assist individuals who experience dizziness or weakness due to not eating because of major depression. Rest one hand on the withers of a large sturdy dog to steady oneself on each step, harness optional.
- Large dog is trained to assist his partner to climb or descend stairs with greater safety, by halting on each step, then bracing himself on command to steady the person when the person takes their next step. Dog must learn to only take one step, not 2 or 3 at a time. This task is also considered a mobility task, and therefore the dog must be at least 18 months old with physically sound hips and elbow joints.
Assist Person to Rise & Steady that Person
When the partner must cope with weakness or medication side effects like dizziness, a service dog schooled in balance support work can prevent a fall or assist the partner to get up after a fall occurs. This task is also considered a mobility task, and therefore the dog must be at least 18 months old with physically sound hips and elbow joints. Ethically, the service dog must be an appropriate size for this work – e.g. 55 lbs. or more.
- Dog assists someone to get up from the floor or a chair by holding a Stand Stay position and stiffening his muscles on command, bracing himself to offer counter resistance for balance support when the partner places one hand on the dog’s withers and gets up.
- Dog is further trained to Brace on command, stiffening body, acts as the Rock of Gibraltar, for at least ten seconds, to steady someone as soon as they rise to their feet instead of darting away or sitting, so as to prevent an accidental loss of balance.
Balance Support to Ambulatory Partner
Balance support skills in a dog of suitable size can be a valuable asset when medication side effects or symptoms suddenly put the individual at risk of falling. These tasks can be performed off leash, without a harness, indoors. Frequent practice needed to keep these skills viable. This task is also considered a mobility task, and therefore the dog must be at least 18 months old with physically sound hips and elbow joints.
- A large dog can be schooled to prevent a fall by stiffening his body to provide counter balance help if a person suddenly stumbles or feels dizzy. Ethically, you must give a warning with a command like “Brace” before putting weight on the dog’s withers, so he can stiffen his muscles first.
- Large dogs can be trained to assist a person to ambulate to the nearest seat, step by step, bracing after each step to allow the person to steady oneself when taking next step.
Respond to Smoke Alarm if Partner Unresponsive
Someone who has dissociative episodes with PTSD might be an excellent candidate for the same kind of training given to a dog who must alert a heavily sedated partner (as described in next section ) whenever a smoke alarm goes off. If he or she has disassociated and there’s a fire, the dog can learn to respond to the sound by nudging the partner persistently until the handler is aware enough to reward the dog and dial 911.
TREATMENT RELATED ASSISTANCE
Tasks in this section suggest additional ways in which a service dog might assist a patient to cope with aspects of living with a psychiatric disability. This may include tasks to help a partner mitigate chronic or intermittent medication side effects or to take his or her medication on schedule or to assist with symptoms experienced in spite of the treatment being received.
Alert Sedated Partner to the Cry of Someone in Distress
Some psychotropic medication cause deep sedation, during which it is almost impossible to regain consciousness. Other medications for pain, seizures or anxiety also can cause sedative side effects. If a parent or care-giver who takes such medication has a service dog trained to perform this outstanding “get help” task, the child or a spouse or an elderly parent who calls out in the middle of the night for the dog’s partner won’t be calling out in vain
- Similar to a hearing dog responding to an alarm clock; dog jumps on bed, persistently licks face or nudges partner till the partner wakes up, gives the dog a reward.
- The dog leads the groggy adult to whoever is calling for the dog’s human partner.
Wake Sedated Partner, Alerting to Doorbell
Waiting for a plumber, other repairmen, a delivery truck which may or may not show up can be problematic. One cannot skip a dose or forego medication if panic attack symptoms begin. Schooling a dog to wake up his partner in response to doorbell chimes can solve the dilemma.
- Similar to hearing dog alert. Dog trained to awaken sleeping partner who takes medication with sedative side effects and lead that person to the source of the sound.
Alert Sedated Partner to Smoke Alarm & Assist to Exit
The dog can be trained to persist in arousing a person if sedative side effect prevents person from responding appropriately to the smoke alarm in an emergency. The dog can show the way to nearest exit, tug the door strap on a lever handle to open the door, not because a dog understands “danger” but due to many practice sessions that condition the service dog to perform this habitual sequence of tasks whenever the dog hears a smoke alarm going off.
- Dog is trained to alert the human partner and to persist with the method taught such as face licking or nuzzling till the person sits up, rewards dog, indicating awake state.
- Dog is trained to lead his partner to the front door (or some other pre-selected exit)
- Dog opens exit door with a pull strap in case the partner is too sedated to think clearly.
COPING WITH EMOTIONAL OVERLOAD
This section details specific work or tasks a service dog can be trained to perform to assist the handler with emotionally disabling symptoms other than a fear of a violent crime reoccurring. It suggests strategies to use at home or in the workplace or in public to cope with and recover from an emotional overload. It also looks at ways to prevent feelings of panic from escalating. Quite frankly, most dogs do not rush sympathetically to the side of a human to comfort the person when he or she becomes tearful or trembles with fear or experiences a panic attack. The calm detachment of many dogs enables them to learn and carry out tasks to earn a reward. Dogs who initially show avoidance behavior can often be desensitized to emotional reactions if highly food motivated and then learn a task. Such tasks if practiced on a regular basis will empower the disabled individual to do something constructive about very unwelcome or inappropriate emotional reactions rather than feeling helpless and overwhelmed when they occur.
Provide Tactile Stimulation to Disrupt the Overload
Tasks that can provide a tactile distraction from a disorder’s symptoms have proven to be quite useful in emotional overload situations. One or more of the tasks listed below may put a stop to unwelcome reactions in the workplace, classroom or out in public. In addition, for those experiencing nightmares, night terrors, hypnagogic hallucinations or flashbacks, tactile stimulation can provide a vitally important reality affirmation when the partner summons the dog. While some dogs may naturally perform a behavior, it takes schooling to transform it into a task the dog will do immediately on command, reliable even in the presence of distractions, at any location where needed.
- Dog is trained to vigorously lick someone’s face on command to bring his partner to full awareness, just as seizure response dogs can be trained to do when their partner is extremely groggy after a grand mal, which shortens the recovery time. This unpleasant tactile stimulation also can divert the partner’s attention from something that triggers tears or other inappropriate emotional reactions in school or a workplace.
- Dogs can be trained to get up from under a desk or behind chair on command or a cue like patting one’s knee to use nose to nudge the partner which disrupts sudden overload. To assist the person to regain composure, the dog must learn to be obnoxiously persistent with the nudging till the partner recovers enough to respond with the desired reward. A caregiver can adapt this nudging task into a “Go See (David)” command so the service dog will go over and perform this nudging to interrupt inappropriate repetitive behavior that a child on the autism spectrum may engage in. If a dog is large and persistent, unfazed by emotional outbursts, this nudging could also disrupt a child’s tantrum or assist someone crying or having a flashback to recover faster.
Wake up Human Partner for Work or School
Panic Disorder, PTSD, Major Depression can disrupt normal thought processes. The person may not want to get up for work or school, as it means he or she will be returning to a place that he or she blames as being responsible for the panic attack or flashback. Depression can cause apathy or a desire to withdraw rather than face the world. Success has been noted in fighting back against avoidance behavior, apathy or withdrawal by having the service dog respond like a hearing dog to the alarm clock in the morning. It may also be possible to train the dog to go by his internal alarm clock to eagerly awaken the person at a certain hour of the day, through use of a feeding schedule or if not motivated by food, by the promise of a walk. After sitting up to reward the dog for performing this task, the sight of the dog’s happy face, the extra tactile stimulation as he eagerly anticipates a walk or play session or a bowl of dog food can motivate a dog lover to fight back against avoidance behavior or apathy and get out of bed, which is why having a dog perform this task is arguably superior to just using an easily silenced alarm clock.
- Dog responds to alarm clock like a hearing dog. Wakes up his partner by getting up on the bed, then nuzzling the partner with a cold nose or by licking the partner’s face.
Assist to Leave the Area by Finding Exit
Just as a guide dog can be taught to “Find the Exit” in a store or hotel lobby or a classroom, a number of persons with PTSD or panic disorder report it is helpful to have their service dogs schooled to lead them to the nearest Exit on command or cue, whenever they fear imminent loss of self control due to anger or experience symptoms that are precursors to a full blown panic attack or dissociative episode. The dog should learn ahead of time where a specific exit can be found, be encouraged to find it, rewarded for finding it with several practice sessions minimum in a new place before he can be expected to find it on command without a lot of help from the handler and/or a trainer. It can take months of schooling for this to become a reliable strategy for leaving an area when symptoms flare up, especially if the dog is expected to respond to symptoms as a cue rather than a verbal command. Input from trainers clarified the dog does not drag the person; the partner must be willing and able to immediately respond to the dog’s effort to lead them away from a stressful situation as soon as the person feels a slight tug on the leash.
- Dog is schooled to find a specific exit to a classroom, an office, a store, a hotel lobby etc. on command or cue to assist someone to leave a high stress situation.
Provide Deep Pressure for Calming Effect
Those who suffer from panic attacks have reported that the pressure of the weight of a medium size dog or a large dog against their abdomen and chest has a significant calming effect. It can shorten the duration of the attack; often prevent the symptoms from escalating. This same task performed by service dogs for its calming benefit for children and adults who are autistic and prone to panic attacks has become known as “deep pressure therapy” in the assistance dog field. One way it is performed is to have a medium size dog lie atop someone who is lying on their back on a floor, bed or sofa, forepaws over the shoulders of the partner. A large dog could be too heavy in that position; also some dogs dislike it. A second way is have the partner sit up in a recliner chair, with the large dog approaching from the side so when he does a “Lap Up” on command, standing on his hind legs, he will be draping most of his body weight across the partner’s abdomen, lying partly on his side, leaning his shoulder into the partner’s torso, his forelegs on the other side of the partner across the lap. Once trained to quietly hold that position for up to five minutes, this same task can be adapted to just about any chair, couch or bench seat his partner sits on. A dog should be given a rest break for at least a minute, back on all four paws, before repeating this task on his hind legs. Similarly, the weight and warmth of a medium to large size dog lying across the partner’s lap, applying pressure to that person’s stomach and chest, may be utilized in a vehicle’s front seat, on the ground or in another location that supports the dog’s entire body in the Down position, for as long as needed during a panic attack.
- Dog is trained to provide deep pressure therapy during a panic attack. Precise behavior at such a time may be dictated by dog’s size, preference and partner’s location. Dog must be trained to promptly get Off the person on command.
Crowd Control, Panic Prevention In Public
A number of individuals disabled by PTSD and other psychiatric conditions report one of their difficulties in maintaining employment is the claustrophobic reaction they suffer when a colleague, boss, or customer comes too close to them. The revulsion they experience is not limited to the workplace of course. Avoiding situations where closeness may take place will lead to someone becoming increasingly homebound. Through teamwork with a service dog, some of these individuals have regained the ability to do their own shopping and to ride on public transportation
- Dog is first trained on how to brace himself on a Stand Stay so that he cannot be jostled out of position. This task can prevent or reduce panic by creating enough distance for a situation to become tolerable. A large sturdy dog is schooled to move into Position (front, behind, left or right side) and to brace for possible impact with an innocuous command, such as “Stay Close.” Dog holds his ground, preventing people from making body contact with his partner while in line or on a bus, elevator or in the same room etc. •Dog is trained to repeatedly circle the partner to keep people at a comfortable distance. This is a short term strategy for backing people off.
- Dog of any size can be schooled to move fast into requested Position, usually in front of or behind the partner and perform a quick Down Stay. Must learn to drop with his back to the person approaching or persons in line. Should lie flat on his side or at least on one hip, to maximize the distance between the partner and nearest person. If worried a small dog might be stepped, have him do a Stand-Stay instead, with the tail end nearest to the person to be kept at bay so as to maximize the distance this achieves.
Arouse From Fear Paralysis or Disassociation Spell
In Parkinson’s, where the person freezes and is unable to move, the dog is schooled to assist the individual by making physical contact, such as lightly tapping the person’s shoe with his paw. This apparently is sufficient to break the spell, allowing the individual to resume movement. Reportedly, similar behavior – physical stimulation through pawing or nose nudging – can rouse someone from a dissociative state, at least sufficiently to make the person aware of his/her plight, thus providing a chance to focus and fight the symptoms. This may also be effective in fear paralysis, another symptom of PTSD. Transforming it from an accidental spontaneous behavior into a reliable skill will require months of diligent schooling and practice.
- Dog is trained to nudge the handler during freezing behavior to rouse the handler from a dissociative state or fear paralysis.
- Dog is trained to respond with nudging and/or pawing whenever he hears the beeping from a wristwatch with an alarm clock function, which his partner can set to go off as frequently as desired, so the dog can arouse the seated or ambulating partner from a dissociative episode at home or in public. If fully alert, the partner can just reset the alarm before the alarm is due to go off, unless he chooses to give the dog a practice session. Could be useful for someone with appointments or classes to get to or other responsibilities, if he or she is responsive to a service dog nudging or pawing when dissociating.
SECURITY ENHANCEMENT TASKS
Not every person who becomes the victim of assault develops a psychiatric disorder with symptoms severe enough to qualify them as disabled under the Americans with Disabilities Act. But those who do become disabled by Post Traumatic Stress Disorder (PTSD) experience the world as an extremely dangerous place. This psychological injury can be just as disabling as an injury which causes a loss of vision or hearing. It amputates the sense of safety or security that most people take for granted. The tasks in this section offer the human partner some innovative coping strategies. Teamwork with a service dog can empower the victim to win back a measure of independence and to resist incorrect and unrealistic responses. For the traumatized handler, a service dog who masters these tasks will be an invaluable ally.
Coping with Fear of Hidden Intruders in the Home
Assault victims who develop post-traumatic stress disorder (PTSD) may find it extremely difficult to live alone or to spend time in the house when other household members are not at home for fear of being attacked again. Others are afraid to leave the house for fear of returning to discover there is a hidden intruder. A state of mind known as hyper vigilance, in which all senses are straining to detect where the next attack is coming from, is common to victims of assault who develop PTSD. It can impair the ability to function in a home or public setting. In addition, some of the tasks suggested here may help patients with sleep disturbances such as night terrors to cope better with the fear they experience.
Lighting up Dark Rooms
A service dog can be trained to precede the handler into rooms, hallways or the basement, turning on lamps or overhead lights to reduce the partner’s fear of a lurking intruder, when a strange noise or some other stimulus necessitates inspection of the home before the partner can resume daily life activities or go back to sleep. A floor pedal device, a touch lamp device for lamps with a metal base or inexpensive wireless lights to illuminate dark areas if a dog nudges them are some of the clever options available if worried about wall scratches from the dog pawing conventional light switches. A touch pad made for the severely disabled could control up to six lights at once throughout the house and be operated by a service dog.
When the team arrives home after dark, the service dog’s ability to operate a touch lamp or other devices can be put to good use to mitigate the partner’s fear of returning home to a hidden intruder. The dog can be trained to enter a dark residence by himself to switch on one or more lamps. Not only is the light itself beneficial, the dog’s behavior during the performance of the task will provide reality based feedback to aid the handler in the decision of whether or not to risk entering the house. If somebody did happen to be inside, chances are very high the dog will skip the task or rush off to investigate the new scent as soon as he performs the task. This teamwork approach is an option for a victim of assault that is arguably superior to relying on a timer to turn on the lights when the sun goes down.
- Dog must learn to operate light switches and/or other devices like a floor pedal device or touch lamps. Then the dog is schooled to precede handler into each room turning on lights one by one to reduce partner’s fear of a lurking intruder.
- Dog is trained to enter a dark home or apartment by himself to switch on lamp(s) to reduce the partner’s fear of entering the premises.
Author: Joan Froling; Copyright on original Task List February 1, 1998 All rights reserved.
updated by Board of Directors April 1, 2022
Contact IAADP for reprint permission. May not be published or reproduced in part