Behavioural Diagnosis and Treatment: Is It Too Complicated for the General Practitioner?
Kevin Stafford, MVB, MSc, PhD, FRCVS, MACVSc; Vicki Erceg, BVSc
Institute of Veterinary Animal and Biomedical Sciences, Massey University
Palmerston, North, New Zealand
Introduction
The human-animal bond can be severely disrupted by the occurrence of behaviour problems in cats and dogs. Surveys of dog owners report that most dogs have one or more behaviour problems. In the USA, 87% of veterinary clients stated that their dog had a behaviour problem as did 65% of dog owners in Melbourne. Veterinarians are a major source of information for many dog owners and miss a business opportunity if they do not advise owners on their pet's behaviour problems. In recent years veterinary medicine has become more holistic with veterinarians now giving advice not only on health issues but also nutrition, genetics and behaviour. Puppy schools are common and are used to give advice on puppy rearing, training, management and behaviour. They offer a conduit towards more direct involvement with behaviour problem prevention and treatment. There is a long history of veterinarians treating behaviour problems of cats, particularly anxiety based inappropriate marking but the same cannot be said of dog behaviour problems.
In 1985 Benjamin and Lynette Hart produced their seminal book titled 'Canine and feline behavioural therapy'. This has been followed by a number of excellent texts on the subject aimed at veterinary practitioners including Overall (1997), Landsberg et al. (2003) and Bowen and Heath (2005), and many other books aimed at dog owners and trainers. Thus there is no scarcity of information available on the subject and to a great extent most of the veterinary authors are in agreement with regard to diagnosis and treatment. In addition, behavioural therapy has been a part of the curriculum in most veterinary schools for two decades and thus the majority of recent graduates have some training in the subject. Veterinary nursing programmes include papers on behaviour and nurses often establish and run puppy school and training programmes for older dogs.
In the last two decades a wide range of drugs has become available for the treatment of anxiety based behaviour problems and synthetic pheromones are also available. The development of head halters has been a major development in dog training. Most towns and cities have dog training clubs with expert trainers focussing on obedience and agility. These can be used by veterinarians to assist clients with poorly trained dogs. The majority of dogs receive no formal training and advising owners to take their puppy to obedience classes is often the best recommendation.
Behaviour problems in dogs can be classified as normal or abnormal behaviour. The majority of problems are normal but undesirable behaviour. Abnormal behaviours include compulsive behaviours such as acral lick granuloma, excessive tail chasing and flank sucking. The behaviour may be a problem for the dog, the dog's owner, their neighbours or society as a whole. Most small animal behaviour specialists categorise canine behaviour problems as aggression, elimination disorders, fear/anxieties/stereotypes, and miscellaneous (destructive, unruly, mounting, hyperactivity, barking, chasing etc).
In Beaver's (1994) review of canine behavioural cases the major problem was aggression (dominance and fear-biting) followed by house soiling, chewing, fear/phobias, hyper-excitability, separation anxiety, submissive behaviour, excess barking, abnormal eating and medical problems.
The veterinary role in preventing and treating behaviour problems can be divided into four activities:
· 
Prevention--advice to new puppy/kitten owners
· Prevention--puppy/ kitten school
· Prevention--advice at annual health and behaviour checks
· Diagnosis and treatment of behaviour problems
· Advice to New Puppy or Kitten Owners
Many common behavioural problems can be prevented by simple advice at vaccination. A basic recommendation for all puppy owners is that they buy a crate for indoor dogs or a kennel and attached run. The other advice is to take the puppy to puppy school in order to learn how to rear and train it. If the practice does not run puppy school then the advice discussed below can be given to the new owner plus simple handouts about puppy training and advice about local dog training clubs.
Having a crate makes house training easier and allows owners to control chewing, digging, running away, destructive behaviour and eating faeces. Using a crate also teaches the puppy that the owner is in control of their activity and this can reduce the problems of aggression and anxiety later in life.
For kitten owners advice on behaviours such as litter training, aggression and basic feline social behaviour can be given. Some clinics run kitten socialisation classes.
Puppy or Kitten Classes
At puppy school or individual training sessions owners are taught basic dog training. Emphasis should be on training the puppy to come when called and to sit and stay. This basic dog management allows the owner to have some control. Veterinary nurses can often do this work more cheaply and effectively than the veterinarian.
Puppy school also allows the practice to teach the client about inappropriate or inadvertent reinforcement of unwanted behaviours. Many dog owners reinforce behaviour problems such as jumping up on people and furniture, barking, food begging and submissive behaviour.
Kitten classes usually cover getting the kitten used to being handled, discussing feline social behaviour and discussing some possible behavioural issues which may be encountered and their solutions.
Annual Behaviour Checks
A behaviour check should be part of the annual health check. These are particularly important at 12 and 24 months and when the pet becomes elderly. Many pets are euthanased between 12 and 24 months of age for behaviour reasons. Identifying the problems and treating them is important. Many of these problems will be management/training problems but cats or dogs may be becoming more aggressive at this stage.
Diagnosis and Treatment
Behaviour problems are usually not emergencies. People often live with cats or dogs having unacceptable behaviour for years and it is only when children or strangers are bitten or the pet's destructive or objectionable behaviours become so great as to make life unbearable that they will present the pet for treatment.
Management and training problems can be diagnosed easily and treatment involves the owner changing how the animal is managed and some basic training. As most dogs are not formally trained it is worthwhile always recommending that dogs be taken to obedience classes for basic training or to reintroduce dogs to some basic commands. Basic commands like 'sit' can be used to treat jumping up on people if combined with ignoring the behaviour. A head halter left on at all times may be used to get the dog off furniture, or go into the crate if it refuses to do so on command. Many cats can be taught basic commands also such as 'sit' and can be taught to walk on a harness.
A kennel and run allows the owner to control where the dog is. It can then be prevented from digging the garden or pulling down the washing. Retraining then can be carried out using by a simple punishment and reinforcement. Consistent retraining may work but the garden can be protected anyway. Dogs need attention and to be brought for walks whether in kennels or crates or loose. Dogs 'running' loose in a garden do surprisingly little anyway.
The motivation for aggression must be determined. Identifying the victim (family, stranger) and the situation in which the aggression occurs is important. For example, in dogs, status ('dominance') aggression would be higher on the list of differential diagnoses if the victim is a family member whereas territorial aggression would be more likely if the victim is a stranger entering the dog's enclosure. With all forms of aggression risk is a real issue. If a dog or cat has bitten people then the veterinarian has to decide whether to treat the pet him or herself, or whether to recommend referral to a behaviour specialist. Safety is a very important issue. Any treatment plan needs to make the situation as safe as possible for everyone involved. Aids such as head collars and muzzle can be useful adjuncts to treatment. Due to the potential danger euthanasia may be warranted in certain cases.
Status aggression in dogs can be treated by ignoring the dog's demand for attention, retraining basic commands, use of head halter, no attention to dog without work, restrict dog's access to furniture/bedroom, use a crate, don't stare at the dog or use punishment, training dog to go outside/get off furniture/come when called. Some dogs are much more dangerous than others and owners may vary in their level of ability--these factors should influence what the veterinary response is.
Territorial aggression in dogs can be treated by placing the dog where it does not see the stimulus as this often reduces the dog's arousal levels. A crate, kennel and run or the garage may be used or the fence or windows may be screened. Dogs are not allowed to greet people. When the door bell rings, put the dog in the crate and allow it to meet visitors while safely restrained later on. Territorial dogs should not be able to have access to unfamiliar people or animals when they are guarding their territory. Over time the dog can be desensitised and counter conditioned to the stimuli which arouse their aggression.
Fear aggressive dogs or cats can be desensitized and counter conditioned to the inciting stimuli in many ways. If the pet is afraid of men (or uniformed people, children) then it can be initially taught to relax and then the stimuli can be reintroduced at a distance where the pet does not show fear. Progressively the person is presented closer to the pet with the pet being relaxed.
Dogs with separation anxiety are 'glue dogs' i.e., glued to the preferred person when she/he is within their vicinity. Treatment is by initial basic training (stay) and desensitization and counter conditioning to the stimuli which trigger the dog's anxiety. Anti-anxiety medications may be used as a component of treatment.
The treatment of behaviour problems can be at different levels. Some problems especially those involving serious aggression or anxiety need urgent attention, but others can be treated on a graduated basis over time using a range of tools and recommendations. Increasing owner control over the animal using tools and training may reduce the problem and is recommended in all cases. Also improving the pet's lifestyle by walks for dogs, play sessions for cats and defined periods of attention are good general recommendations.
Treatment for many problems can be developed from simple to more complex recommendations. First aid for dogs to prevent problems may involve muzzles, crates and moving the dog to a training kennel. Basic management and training has been described above. More specific behaviour modification as described under the specific problems is then appropriate.
Diagnosis can be carried out by telephone consultation, in clinic or at the client's home. Much advice can be given but a few instructions and follow up after a week or two is effective for many simple problems. Handouts are useful and these can be developed from any of the major textbooks. Sometimes it is appropriate to visit the property, especially if earlier recommendations have not been effective.
Many people are involved in retraining pets and veterinarians have to decide whether they wish themselves and/or their nurses involved in this work. At a basic level veterinary practices are well set up to become involved and most problems are easily solved. This makes development of clinical skills easy. Compliance is better if recommendations are few and simple and the availability of medications gives veterinarians an advantage over many others involved in treating behaviour problems in dogs and cats.
References
1. Beaver BV. 1994. Owner complaints about canine behaviour. Journal of the American Veterinary Medical Association 204, 1953-5.
2. Bowen J, Heath S. 2005. Behaviour problems in small animals. Elsevier Saunders, London, England.
3. Campbell WE. 1986. The prevalence of behavioural problems in American dogs. Modern Veterinary Practice 67, 28-31.
4. Hart BL, Hart LA. 1985b.Canine and Feline Behavioral Therapy. Lea & Febiger, Malvern, USA.
5. Kobelt AJ. 2004. The behaviour and welfare of pet dogs in suburban backyards. Unpublished PhD thesis. University of Melbourne, Australia.
6. Landsberg G, Hunthausen W, Ackerman L. 2003. Handbook of behaviour problems of the dog and cat. Saunders, Oxford, England.
7. Overall KL. 1997. Clinical behavioral medicine for small animals. Mosby, St. Louis, Missouri, USA.
