Prognosis of Behavior Problems
Debra F. Horwitz DVM, Diplomate ACVB
A discussion of prognosis is an important component when treating behavioral disorders in dogs and cats. The outcome of treatment may influence the owner attitude and willingness to treat the problem and the pet. A discussion of prognosis can put the problem in a framework of time, discuss emotions and allow the owner to address the problem one step at a time. Part of assessing prognosis is providing realistic expectations for improvement that may influence owner desire to treat the pet at all. When discussing the prognosis of aggression, safety issues and the risk of present and future injury need to be evaluated. Finally, financial considerations can also be addressed both at the present time and in the future.
There are various ways to assess the prognosis of behavior problems. Prognosis can be assessed by diagnosis, which usually is possible in cases with medical components such as FLUTD, which may be short term, and resolvable versus Cognitive Dysfunction which is chronic and progressive. In other situations, prognosis may be assessed using personal experience, anecdotal reports (Animal Behavior Case of the Month, published case reports) or financial limitations. While accumulated data in behavior is sparse, data based studies are very useful to assess prognosis if statistically meaningful data is available.
Follow-up is imperative in assessing prognosis. Not only does it add information to the overall behavior database it allows the practitioner to fine tune the behavioral treatment plan. It also allows for attention to ongoing problems as well as addressing new areas of concern or recent emergent risk factors. Various follow-up protocols are available. For example weekly telephone follow-up, monthly rechecks, and six-month phone or mail contacts.
Reasons for treatment failure
Behavior problems may not always have good resolution. Reasons for treatment failure include ongoing risk of injury to humans or other animals that the owner is not willing to assume or cannot control. The expense of chronic medication may result in some owners electing to discontinue treatment. Continued destruction and property damage may cause owners to re-evaluate their commitment to ongoing treatment. Many owners have expectations of "quick-fix" cures with drug therapy and are impatient and unwilling to take the time needed to make behavioral treatment plans work. In other cases the difference between improvement vs. resolution may discourage some owners from continuing. In many behavior problems, reoccurrence is common, straining owner resolve to keep their pet. Finally, chronic problems that respond slowly or minimally may stretch the limits of owner patience and desire to keep their pet.
In some situations risk of further injury is high and owners are unwilling or unable to take the necessary precautions to safely keep the pet while working to change behavior. While certainly not a hoped for outcome, in some cases it may be prudent to discuss whether euthanasia is an option. In cases where animals present clear and certain dangers to either family members or others this must be discussed and evaluated with the owners at the time of the initial consultation and throughout treatment.
When discussing prognosis it is valuable to take into consideration what the owner considers a good or bad outcome. Prognosis could refer to the behavior itself yet it also can be whether or not the owner is willing to live with the behavior. In some cases, the improvement and outcome are not what the practitioner expected, yet the owner is willing to continue to live with the pet based on whatever improvement or information they have obtained.
Prognosis of selected behavioral disorders of dogs and cats
When discussing prognosis in canine aggression both owner factors and pet factors must be considered. Generally speaking if the animal has bitten people, the prognosis is guarded to poor; it is likely that given the same or similar circumstance that the pet may bite again. The risk of further injury must be evaluated based on victim, family composition (ages, abilities of individuals), other animals, liability and willingness to commit to behavior modification and safety measures. The dog factors to consider include the size of the pet, predictability of the aggression, intensity of the aggression relative to the stimulus, genetic predisposition, fear and learning components. Over the long term aggressive disorders tend to be controlled but not cured.
Most compulsive disorders require long term owner commitment to behavior modification. In addition, some cases may require medical care for self inflicted injury. Drug therapy is often a useful adjunct and can be expensive and long term.
Learned elimination disorders
For most canine and feline learned elimination disorders the outcome is generally good. Using behavior modification techniques, environmental manipulation and retraining many animals will respond to treatment. Urine marking will often have a good prognosis as well if the arousing stimuli can be controlled and/or removed. For some feline cases drug therapy can be a useful adjunct. In cases of urine marking in intact animals, sterilization can improve prognosis.
Separation anxiety in dogs
Generally most cases have a good outcome. The best results are obtained with a combination of behavior modification and concurrent medication when needed. When social circumstances such as job changes, vacations, or visitors occur, retraining may be necessary.
Noise and environmental phobias
The outcome in these cases is variable and may be guarded. Owners must anticipate and institute appropriate behavioral and/or medical intervention at the first signs of the behavior. Often these are seasonal or unpredictable and desensitization may be difficult.
Long standing problems (aggression, elimination, anxiety or phobias)
Prognosis for long standing behavior problems is more guarded. Learning and reinforcement can influence any behavior. Ongoing exposure to stimuli will often maintain the behavior, which may be displayed at very high levels. These factors may strain owner resolve or ability to work with or tolerate the behavior.
Where does prognosis fit into the behavior consultation?
Ideally, a discussion of prognosis should be part of the initial consultation. This allows both the practitioner and the pet owner to have a realistic assessment of where they are and what they hope to accomplish. It is perfectly acceptable for small steps to be tried, follow-up obtained and then re-evaluate prognosis based on that information. Often it is beneficial to establish treatment plans focusing on one month, 3 month, 6 month and one year targeted behavioral changes. This might allow owners to delay difficult decisions as they learn to cope with what needs to be done and assess their ability to comply and the pets ability to change its behavior. What is important in many situations is for the owner to understand that treatment of behavioral disorders often entails long-term management. This is similar to medical disorders such as diabetes mellitus, where control is possible while cure is not.
By addressing prognosis we allow pet owners to become better educated about the behavioral disorder of their pet. We can educate them to be vigilant of behavioral changes and how they affect outcome. By allowing for realistic expectations of the outcome of treatment we can have more satisfied clients.