Framework for behavioural consultation

Our guide to consultations, incorporating history, clinical exams, behavioural first aid and more.

Introduction

A recently published paper from the ongoing longitudinal study Generation Pup, found that 31% and 35% of owners reported their dog (at ages six and nine months respectively) to be showing a behaviour or behaviours that they found a problem.

Problem behaviours are any behaviours that the owner perceives as being problematic. Owners most often sought help for these behaviours from dog trainers, online sources, the veterinary community (a vet, a vet who is also a behaviourist, a vet nurse, or another member of the veterinary team) and behaviourists.

This research highlights how important it is for the veterinary team to be confident in performing behaviour consultations in general practice.

The aim of this resource is to provide the veterinary team with an easy-to-follow, step-by-step guide to behavioural consultations. It covers the gathering of the behavioural history, the clinical exam, further investigations and considerations, behavioural first aid and behavioural referral.

The behavioural history

The aim of the behavioural history is to gather a comprehensive understanding of the current problem behaviour. And to identify whether there are other potential concurrent medical conditions or medications that could be causing or contributing to it.

This will help to focus the clinical examination and further investigations as well as allow vets to ascertain whether this is a problem behaviour that can be managed within their first opinion veterinary clinic, or whether referral to a clinical animal behaviourist is required.

To get to a history of the current problem behaviour, clinicians should:

obtain a detailed picture of what the problem behaviour looks like. Asking owners to video the behaviour can be useful to help with this
identify what precedes the behaviours. What's the trigger?
identify the context(s) that the behaviour occurs in
map how the problem has developed over time. Including when the behaviour first appeared, how the owner initially responded to the behaviour, how the owner is currently managing the behaviour and what the owner will do if the behaviour cannot be improved.

Questions relating to the problem behaviour
The problem behaviour	The development of the problem behaviour	The context of the problem behaviour
What is the current problem behaviour?	When did it first start?	When does the problem occur?
What does the problem behaviour look like? What is the dog doing? Could the owner video this?	Was there a notable event that occurred when the problem behaviour first started?	Who does the problem behaviour occur with?
Does the problem behaviour always look the same?	Has the behaviour got worse, stayed the same, improved?	Is the context consistent? Does it always occur in the same situation, or in multiple situations? Is it predictable? How long does it take the dog to recover from the trigger? Can the behaviour be interrupted?
Is there a known trigger? Are there multiple triggers? If owner is unsure what the trigger is, then ask what the owner doing during the time the behaviour occurred?	How has the owner responded to the problem behaviour? What does the owner do when the dog does the behaviour and/or what steps has the owner put in place to help manage the behaviour? Has the owner already sought help for the behaviour? If so, from where? What advice?	Can the owner easily avoid the context/ trigger in day-to-day life?

General health and wellbeing

Identifying underlying medical conditions or medications that could be causing or contributing to the problem behaviour is an important part of the behavioural consultation.

Pain

A recent study reviewed 100 cases that were presented to referral veterinary behaviourists and found that pain was identified as a cause for or influence on the behaviour problem in 28% to 82% of cases.

The same study concluded that it is better for veterinarians to treat suspected pain first rather than consider its significance, only when the animal does not respond to behaviour therapy.

There are many ways that pain can be expressed by dogs. However, the following table adapted from Hellyler et al. (2007) provides vets with a useful summary, which can form the basis for questions during the behavioural history.

**Signs of pain**
General signs	Specific signs
Loss of normal behaviour	Decreased ambulation or activity, lethargic attitude, decreased appetite
Expression of abnormal behaviours	Inappropriate elimination, vocalisation, aggression or decreased interaction with other pets or family members, altered facial expression, altered posture, restlessness
Reaction to touch	Increased body tension or flinching in response to gentle palpation. Hiding or protecting a part of their body
Physiologic parameters	Elevations in heart rate, respiratory rate, body temperature and blood pressure

There are also observational-based chronic pain questionnaires that owners can fill out either before or after the consultation, which can help identify whether pain could be the cause or contributing factor to the problem behaviour.

These include the Helskini Chronic Pain Index (HCPI) and Canine Brief Pain Inventory (CBPI).

Medical conditions that alter a dog’s ability to behave ‘normally’

Changes in a dog’s motivation caused by a medical condition can cause or contribute to behaviour problems. For example, a dog that has hyperadrenocorticism (Cushing’s disease) will have an increased motivation to drink and eat.
This could lead to problem behaviours such as resource-guarding food and water stations
Canine osteoarthritis may cause a dog to feel more vulnerable as they're not able to get up and move away from a situation. This could lead to a dog showing more overt signs of fear when previously they would just have walked away
Canine cognitive dysfunction may lead to an alteration in their normal behaviour. For example, barking during the night due to an altered sleep-wake cycle
Direct impairment of brain function. For example, a space-occupying lesion may alter a dog’s behaviour

Further information regarding this is provided within the Health, Pain, and Behaviour article.

Ways in which medication can alter behaviour

A side effect of the medication. For example, steroids causing polyuria, polydipsia and polyphagia could cause resource-guarding around the food and water stations
Unmasking of underlying conditions, which could lead to behaviour problems. For example, treatment with trilostane for hyperadrenocorticism unmasking arthritis, leading to a change in behaviour due to pain
Direct effect due to overdose. For example, excessive treatment of hypothyroidism with levothyroxine, causing hyperthyroidism and the associated clinical signs, such as excitability and nervousness

Questions relating to underlying health and wellbeing
Eating and Drinking	Daily routine	Other health concerns or behaviour changes	Current medication
Changes in appetite or thirst?	Altered sleeping pattern?	Any other health concerns?	Is the dog on any medication?
Changes in attitude towards food? Stealing food?	Altered social interactions with people or animals?	Any other behaviour changes?	Has the dose changed recently?
Changes in urination or defecation habits?	Altered daily physical activity?	Any other changes within the household?	Have there been changes in dose administration?
Changes in weight, musculature or appearance?	Altered play?		Has the therapeutic level been checked recently e.g. thyroxine or phenobarbitone levels?

The clinical examination

Behaviour may be the first change reported with a medical condition, so the clinical examination is key to identifying any potential underlying medical causes for the problem behaviour.

This will also enable the vet to create a comprehensive problem list based on the history and clinical exam, which will help to guide further investigations.

The clinical examination should encompass all body systems and ideally a neurological examination. But the vet should be mindful of the current problem behaviour and respond to how the dog is feeling accordingly.

Information regarding how to carry out a low-stress clinical examination is found within the handling of dogs during consultations resource

Routine health screens

It is recommended that routine health screens are considered in behaviour cases.

A health screen can help to identify whether there are underlying health conditions that could be causing or contributing to the problem behaviour. And they also provide a baseline profile, which is useful for when long term behaviour medications are being considered.

This should include:

Haematology
Biochemistry
Urinalysis

Further diagnostic investigations

Further diagnostic investigations will be guided by the preceding history, clinical examination and the results from initial health screens. However, the following could be considered:

Additional blood work If the history, clinical signs and routine health screen are consistent with a medical condition then additional blood work might be required. For example, an adrenocorticotrophic hormone stimulation test (ACTH stimulation test) for hyperadrenocorticism

X-rays If the dog is displaying signs of musculoskeletal discomfort during the clinical examination, then x-rays might be performed to help understand the underlying cause of the pain and whether surgical intervention might be beneficial

Analgesia trial If the history and/or clinical examination and/or further diagnostic investigations indicate that pain could be causing or contributing to the problem behaviour, then an analgesia trial should be considered.

This includes:

Using an appropriate analgesic agent(s)
Considering using multimodal analgesia if the pain is complex or chronic
Continuing the analgesia for at least four to six weeks, and ideally eight weeks to rule out pain as an underlying factor.
During this period of time, having regular communication/ consultations with the owner to ascertain whether there are any side effects to the medication.

Or whether there appears to be an improvement in the behaviour. For example, a dog that was previously showing signs of aggression when a younger dog wanted to play but now (after the analgesia) is wanting to interact and play and is not displaying the behaviour towards that dog to the same degree.
The analgesia trial should be accompanied with behavioural modification +/- behavioural medication to:
- address the emotional component of pain
- reduce the development of anticipation of pain
- reduce the likelihood of learned associations with the painful stimulus.

Considering referral to an accredited clinical animal behaviourist or veterinary behaviourist is discussed in more detail in behavioural referrals.

Further information regarding behavioural modification can be found within desensitisation and counter conditioning.

Behavioural first aid

It is important that whilst you are waiting for the results of any in-house diagnostic investigation(s) or whilst arranging a behavioural referral, you have provided the owner with information regarding how to make the situation safe and ways to prevent the problematic behaviour from escalating.

Information regarding these points is discussed within the behavioural first aid for owners.

Behavioural referral

The Royal College of Veterinary Surgeons (RCVS) states that referral should be considered ‘when a case or treatment option is outside their area of competence’.

For a behaviour case, this could be when:

there is no obvious medical cause (for example, pain from arthritis) for the presenting behaviour problem and/or
there is a concern that the presenting behaviour problem could result in injury to the owner or to the public (for example, escalation of the problem resulting in biting) and/or
the presenting behaviour problem is complex and/or
the presenting problem will require long-term training or behavioural management.

‘The veterinary surgeon should also make a referral appropriate to the case’ and this will involve considering all of the relevant factors.

Such as, ‘the ability and experience of the referred veterinary surgeon, the location of the service, the urgency of treatment and the circumstances of the owner, including the availability and any limitations of insurance.

Insurance cover

Owners should be informed that some insurance policies may cover behaviour consultations by, for example, ABTC/CCAB registered clinical animal behaviourists, RCVS advanced practitioners, and RCVS specialists in behavioural medicine.

Clients should therefore be encouraged to check their insurance policy, the specific terms and conditions of the policy, and any limitations on the policy, prior to referral if the cost would be prohibitive should their policy not cover it.

Where to find a Clinical Animal Behaviourist (CAB/CCAB) or Veterinary Behaviourist

Anybody may call themselves a behaviourist, even without qualifications or experience, so it’s worth checking what your behaviourist’s qualifications mean, as well as the types of methods they use.

Inappropriate or outdated advice might make matters worse.

The Animal Behaviour and Training Council (ABTC) is a regulatory body that represents and maintains registers of animal trainers, clinical animal behaviourists and veterinary behaviourists (veterinary surgeons with an interest in behaviour) that fulfil their accreditation criteria.

In addition, the Association for the Study of Animal Behaviour (ASAB) is an independent organisation that also runs a certification scheme. Certified Clinical Animal Behaviourist is a standard identical to the certification mentioned above.

Registered behaviourists

Behaviourists registered with these organisations at the level of Clinical Animal Behaviourist (CAB) or Certified Clinical Animal Behaviourist (CCAB) will hold an approved qualification at a degree level or higher and have undertaken an extensive period of supervised training in order to build up a portfolio of casework.

Veterinary surgeons can also go through the ABTC and ASAB accreditation and may also do post-graduate qualifications such as RCVS Advanced Practitioner in Companion Animal Behaviour, or residencies with the European College of Animal Welfare and Behaviour Medicine.

Both CAB, CCAB and veterinary behaviourists will only see behaviour cases that have been referred to them by a veterinary surgeon, ensuring that any underlying illness, injury, or pain is being treated in conjunction with their behavioural support.

After the referral

Once the referral has been set up and taken place, you, the referring veterinary surgeon, will be informed of the outcome of the consultation and any advice that was given.

Note that only veterinary surgeons can prescribe medications, so if the CAB/CCAB feels behaviour medication might be beneficial, this might be discussed with you. A veterinary behaviourist is able to prescribe medications as they are a qualified veterinary surgeon.

They may do this directly or suggest medication is prescribed by you the referring veterinary surgeon.

Further information regarding behaviour referrals can be found within the behaviour referrals resource. The veterinary team may also like to direct owners to the accessing training and behaviour support owner-facing resource.

If the owner can no longer care for their dog

If the owner is unable to meet their dog’s specific needs, then rehoming them could be a kind and sensible option.

Below are two websites that you can direct owners to:

Our rehoming centres where owners can speak to a member of our expert rehoming team
The Association of Dog and Cat Homes where owners can find their nearest registered rehoming organisation and ask for advice.

Behavioural euthanasia should be considered if:

the owner is no longer able to care for their dog due to the significant safety risk and/or
the dog’s welfare is unlikely to be improved by behavioural management in a reasonable time frame and/or
the dog’s welfare would be further compromised if sent to a rehoming centre.

Concluding the behavioural consultation

By the end of the consultation, there should be an appropriate plan of action put together that is tailored to the individual case. The client should have been informed about behaviour first aid if applicable and should understand the next step for the case.

Be it a further in-house diagnostic investigation, in-house behaviour case management with a member of the veterinary team (vet or nurse with experience in animal behaviour), or external referral to a clinical animal behaviourist or veterinary behaviourist.

References

Lord, M.S., Casey, R.A., Kinsman R.H., Tasker, S., Knowles, T. G., Da Costa, R.E.P., Woodward, J.L., Murray, J.K. 2020. Owner perceptions of problem behaviours in dogs aged 6 and 9-months. Applied Animal Behaviour Science; https://doi.org/10.1016/j.applanim.2020.105147
Mills, D et al. 2020. Pain and problem behaviour in cats and dogs Animals 10:318 https://www.mdpi.com/2076-2615/10/2/318
Hellyer P, Rodan I, Brunt J et al. (2007) AAHA/AAFP Pain Management Guidelines for Dogs & Cats. Journal of the American Animal Hospital Association 43, 235–248 https://journals.sagepub.com/doi/10.1016/j.jfms.2007.09.001
Helsinki Chronic Pain Index (HCPI). Available at https://www.fourleg.com/media/Helsinki%20Chronic%20Pain%20Index.pdf [Accessed Jan 2022]
Canine Brief Pain Index (CBPI). Available at https://www.vet.upenn.edu/docs/default-source/VCIC/canine-bpi.pdf?sfvrsn=6fd20eba_0 [Accessed Jan 2022]
Fatjo, J., Bowen, J. 2010. Medical and metabolic influences on behavioural disorders. British Small Animal Veterinary Association (BSAVA) Manual of Canine and Feline Behavioural Medicine. Second edition, p 6
Fellowship of Animal Behaviour Clinicians (FABC) website. Available at: https://fabclinicians.org/help-i-think-its-a-behaviour-case/ [Accessed Jan 2022]
Royal College of Veterinary Surgeons website. Available at: https://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/referrals-and-second-opinions/ [Accessed February 2022]