Assessing Canine Behavior Issues in the Clinic

Conducting a Behavior Triage

Routine wellness visits generally do not allow time for comprehensive behavior assessment and treatment plans; however, behavior issues noted during wellness visits may warrant attention and necessitate a plan for next steps. A behavior triage can be quickly conducted by collecting patient history, ruling out medical causes, providing advice for patient and pet owner safety, providing tips on reducing patient stress, and referring to a behavior specialist as needed.¹ 

Once the behavior triage is complete, next steps can be appropriately outlined. If needed, a full behavior assessment can be performed and a treatment plan created during an additional, extended in-clinic appointment or by a behavior specialist (ie, veterinary behaviorist, academically trained applied animal behaviorist).

Goals of Behavior Triage

A behavior triage should include asking open-ended questions, determining the need for immediate diagnostics, providing initial advice for safety management (eg, separating a dog from a child in the home) until a more in-depth plan can be made, prescribing immediate-acting medications to treat anxiety as needed, and considering referral options. Problematic behaviors should be categorized as abnormal and require treatment or normal and require behavioral wellness guidance or problem prevention. Categorization can help inform referral recommendations.

Abnormal and unwanted behaviors may overlap. For example, dogs with anxiety-related concerns often display house soiling and/or frenetic behaviors (eg, jumping, digging, chewing, mouthing), and dogs that bark at humans and animals outside of the owners’ property may display aggression if those triggers enter the property. An underlying anxiety disorder may be driving and/or exacerbating unwanted behaviors (eg, barking, jumping, destructive or soiling behaviors).

Unwanted Normal Behaviors

Dogs have many unwanted behaviors that are normal, including pulling on the leash, jumping up on humans, lack of manners (eg, jumping up on counters or humans, knocking over household items), house soiling, destructive digging and/or chewing, barking for attention, and barking at humans or animals outside. Dogs are highly driven to perform species-typical behaviors, and appropriate outlets for these behaviors should be provided. Owners can be referred to a positive-reinforcement–based trainer and provided with appropriate reading materials and handouts.

Abnormal Behaviors

Abnormal behaviors in dogs may include, but are not limited to, aggression toward humans and/or other animals; distress when home alone or separated from the owner or other family members; repetitive behaviors that are difficult to interrupt; ingestion of nonfood items (ie, pica); and a profound fear of noises, objects, humans, places, or other animals. Abnormal behaviors that require intervention should be addressed in an additional extended appointment. Fearful, repetitive/compulsive, and aggressive behaviors often require management in addition to training; however, training should be part of an overall behavior modification program. Anxious or fearful patients are unlikely to be managed with training unless the underlying cause of the behavior problem is identified and treated.

Referral to humane, evidence-based resources for intervention should be tailored to the presented behavior (Figure 1). For example, a handout or quick tip from veterinary staff in the examination room would be dangerous and inappropriate for a dog that broke through a plate glass window during a storm or bit a small child.¹ Moreover, referral to a behavior specialist for a dog jumping on counters may be excessive.

FIGURE 1 Overview of how to handle and refer behavior cases. Image courtesy of Traci Shreyer, MA, and Susan Barrett, DVM

Aggression & Other Disorders 

Treating patients with aggression can involve an emotional and time burden, as well as greater liability, particularly when injuries to humans have occurred and/or small children may be at risk. These patients should be referred to a veterinary behaviorist when possible.  

It is important to have a level of comfort and competency in the initial treatment of separation-related behaviors, mild to moderate fear behaviors, phobias, and generalized anxiety disorders.

Preparing for an Extended Behavior Assessment & Treatment Plan Appointment 

Providing a Behavior & Patient History Questionnaire

Prior to the appointment, owners should complete a behavior and medical history questionnaire to help narrow the focus for the behavior examination and possible diagnostics. Questionnaire forms can be found online (see Suggested Reading) or created and modified.

Questions should include information on when and where the dog was obtained, other humans and animals living in the household, indoor and outdoor living environments, household routines, eating and elimination habits, diet, supplements, medications, complete medical history, previous training attempts, and behavior concerns (eg, when the behavior started, frequency).

 A questionnaire that includes possible triggers, targets, and intensity of aggressive behaviors can be helpful when screening for canine aggression (Tables 1 and 2). Owners can be asked to record problem behaviors ahead of the appointment; however, aggressive behavior or behaviors with potential for harm should not be triggered in order to obtain a video.

TABLE 1

TABLE 2

Creating Behavior Problem & Differential Diagnosis Lists

A list of medical and behavior problems can be created based on information provided in the questionnaire to determine differential diagnoses. Behavior problems can include those identified by the clinician or by both the owner and clinician but not by the owner alone. For example, use of aversive training methods on a dog with fear aggression may not be identified by the owner but should be considered a problem. Behaviors should be considered objectively, without motivations or pre-emptive diagnoses. For example, when an owner reports their dog dislikes and barks at visitors, the problem may be listed as dog barks at unfamiliar humans entering the house.

A more definitive list of differential diagnoses, including behavior and medical causes, can be created once the oral history is collected and medical diagnostics are completed. For example, differentials for a dog barking at unfamiliar humans entering the house may include fear-related aggression, frustration-related barking, and territorial aggression.

Conducting a Behavior Examination

Entering the Clinic

The owner should be asked to wait outside the clinic, preferably in a car, with the patient until it is time for the behavior examination. Inside the clinic, the patient should be kept separate from other owners and patients. White noise can be used if a quiet space is difficult to locate. Aggressive dogs should be tethered (ideally, 6-10 feet from the clinician), and a barrier (eg, sturdy exercise pen with a sheet draped over it) can be used for visual and physical separation.

High-value treats (see Ladder of Treats) and long-lasting enrichment options (eg, frozen, food-stuffed enrichment rubber toys) can be used to keep dogs content and occupied if resource guarding is not a concern. Food sensitivities, allergies, and preferences should be determined before giving food or treats to build trust, provide enrichment, and determine reward preferences.

Asking Follow-Up Questions

In addition to the questionnaire, owners should be asked open-ended questions to clarify patient history and help finalize the differential diagnosis list. The antecedent–behavior–consequence (ABC) applied behavior analysis approach (Figure 2) to taking patient history can be used to better understand motivations behind unwanted behaviors.²

FIGURE 2

The ABC applied behavior analysis can help identify triggers and generate advice on safety and stress reduction. Antecedent (ie, trigger) occurs before the behavior, behavior (ie, problem behavior) is the reaction to the antecedent, and consequence (ie, owner reaction, reinforcement) happens immediately after the behavior and may be seen as the apparent result of the behavior. Image courtesy of Traci Shreyer, MA, and Susan Barrett, DVM

For example, although many owners are surprised by seemingly sudden aggressive behavior and report the behavior as unprovoked, most incidents of aggression have a trigger. The ABC applied behavior analysis can help identify these triggers, work through possible owner misjudgments, and create safety and management strategies to help avoid provoking aggressive behaviors. For example, for a dog that barks at unfamiliar humans entering the house, the owner should be asked to give precise details about what occurs when a visitor enters (including the location and behavior of the visitor), when the dog starts barking, and the reactions of the dog, visitor, and owner.

Ruling Out Medical Etiologies for Unwanted Behaviors

If not performed during the behavior triage, additional diagnostic testing should be performed as indicated, including a complete physical examination, CBC, serum chemistry profile, total thyroxine testing, and urinalysis.³ For example, a dog presented for compulsively staring at its pelvic end, toe touching while standing, and quickly turning to stare at the pelvic limb may be experiencing pain, which is a contributing factor to behavior problems; diagnostic imaging should be considered.

Establishing a Treatment Plan

In-person questions can provide information for a more definitive diagnosis list, from which a treatment plan can be established. Primary aspects of the plan should cover introduction of safety and management strategies, implementation of environmental modification, initiation of behavior modification and training, and creation of a plan to reduce anxiety. Although a tentative treatment plan may be considered based on the patient history questionnaire, changes should be made based on additional information and behaviors demonstrated on examination. Patients can appear better or worse on paper than in the clinic; therefore, flexibility in making changes during the behavior examination is essential.

Safety & Management Strategies

A plan to avoid triggers identified via ABC applied behavior analysis should be implemented until the response can be modified. A practical solution can be suggested for each trigger. If a trigger cannot be avoided and humans or animals in the home are at risk for injury, referral to a behavior specialist and discussion regarding relinquishment or euthanasia should be considered.

Safety and management strategies can be straightforward. For example, a dog that growls or snaps at humans while chewing a high-value treat (eg, pig ear) should not be given that specific treat, or the treat should only be given when the dog is in a secure, separate space until the treat has been consumed. More severe aggressive behavior may have other considerations. For example, a dog that attacks and injures another dog in the household when visitors enter the house may require separation via a crate or leash, or the aggressor may need to be moved to another room prior to arrival or entrance of guests.

Behavioral euthanasia conversations are difficult and should be approached with compassion and care. Mentioning behavioral euthanasia as an option often helps owners feel they are permitted to talk about or consider it in future if the management plan does not adequately reduce safety risks.

Environmental Modification

Changes to the indoor and/or outdoor environment can be implemented for safety and/or stress reduction. For dogs who bark continuously at a front window, frosted window film can be placed on the window or a gate used to keep the dog out of the room. For dogs that escape invisible or too-short fences, the dog should be leashed while outside, or taller, more secure fencing options should be suggested.

Behavior Modification & Training

Behavior modification should be tailored to each patient. Emotional modification should be the focus for some patients (eg, those with aggression issues), but others may need training in which new, desirable behaviors take the place of current, unwanted ones. Training patients with severe generalized anxiety may be difficult or impossible without adequate anxiety relief, and training may need to be delayed until the anxiety reduction plan takes effect (see Reducing Anxiety).

Counterconditioning, desensitization, and response substitution training are some of the main tenets of behavior modification.

Counterconditioning 

Counterconditioning is a form of Pavlovian (ie, classical) conditioning whereby a negative emotional response becomes a positive emotional response through repeated pairing of a trigger with a reward. With repetition, the trigger evokes a positive response, thus decreasing motivation to exhibit the initial fear-induced behavior. For example, if a dog barks at other dogs on walks and the barking is determined to be a fear-based behavior or a misperception of other dogs as threats, counterconditioning may involve giving the dog a high-value reward each time it passes another dog. Repetition teaches association of passing dogs with a reward and, over time, lessens fear and reduces reactive behavior.

Desensitization 

With desensitization, the dog is exposed to a trigger under the threshold of a full fear response. Incorporating desensitization into a counterconditioning plan can be helpful for reactive dogs that cannot be in close proximity to other dogs or for dogs unwilling to accept treats with other dogs nearby. The dog may need to be walked at a greater distance from other dogs to be willing and able to accept treats and create a positive association. Distance can be decreased over time with counterconditioning at each level.

Response Substitution 

Response substitution (ie, training desirable behaviors incompatible with the problem behavior) may be beneficial as part of a behavior modification plan. A reactive dog may be trained to look at the owner on cue in a calm setting. After desensitization and counterconditioning have reduced the intensity of reactive behavior, the cue can be given so the dog looks at the owner rather than reacting when passing other dogs.

A positive-reinforcement–based trainer can help the owner better understand and implement a safe and effective behavior modification plan. If humans or other animals are at risk during behavior modification training, referral to a behavior specialist is recommended.

Reducing Anxiety

Known anxiety, aggression, and/or reactivity triggers should be avoided when possible. Exercise can relieve stress in some patients. The owner should be encouraged to provide physical movement in a manner that does not trigger stress. If walks trigger aggression or anxiety, going on a walk may not be appropriate.

For dogs with mild to moderate behavior problems, products containing synthetic dog pheromones and/or nutraceutical products (eg, L-theanine, milk proteins, calming probiotic supplements) can be recommended. In moderately severe or severe cases, psychopharmacology is likely indicated. Fluoxetine, clomipramine, and dexmedetomidine are the only FDA-approved medications for treatment of behavior problems in dogs.

Reducing anxiety should always be included in a behavior plan, as anxiety commonly contributes to behavior problems in dogs. Medication alone is unlikely to affect significant change and should be used alongside behavior and environmental modification; however, anxious patients may struggle to learn new behaviors and have decreased response to behavior modification strategies without medication.

Follow Up & Monitoring

Behavior problems can be emotionally taxing, and an extended appointment can be inconvenient⁴; however, gaining the owner’s support of the plan, particularly regarding psychotropic medications, is critical for success. The owner may need time to consider the plan, especially when medications are involved. Ensuring they are comfortable and part of the decision-making process can increase compliance.

A staff member should follow up 5 to 7 days (2-3 days if medication is prescribed) after the appointment to encourage cooperation with management, medication, and behavior modification. Following up is critical to ensure correct dosages are given and confirm there are no adverse effects. A recheck may be scheduled in 6 to 8 weeks to allow time to gauge effectiveness of the plan and make adjustments as needed.