Why and how to investigate your canine patients whose overactivity drives their owners up the walls.
For a dog that can never sit still, life is risky. Dogs that wander are hit by cars. Or, when human tolerance for a bouncing, roaming dog wears thin, it's dumped at a shelter. Extremely active dogs worsen in the confines of a shelter-a formula for misery and early death.
The word hyper dogs seem to be everywhere. “My dog is too hyper!” has become one of the most common complaints I hear. Why are dogs “hyper,” and what can be done to help them?
Increased exercise is the wrong place to start, despite a trend to address all behavioral complaints with dogs this way. The best practice of behavioral medicine starts in the same place as all other parts of a veterinary evaluation: taking an exhaustive history, listening to the clients and observing the dog carefully in person and via video.
Understanding the complaint
The adjective hyper could describe anything from a herding dog puppy locked in a crate 23 to 24 hours a day to a 3-year-old pug belonging to a 75-year-old owner who is too arthritic to bend down to the dog. Context is everything, and there are three aspects that contribute to how the dog's behavior is perceived:
1. The client's expectations and abilities.
2. The dog's age and breed.
3. The dog's stimulatory environment.
Notice that the dog has control over none of these. Understanding the relative contributions of these factors will help clients understand the range of “normal” behaviors, and it will also help veterinarians and clients recognize when behaviors deviate from normal. Often just knowing whether a behavior is either normal or extreme is enough for the client-it gives them a context in which to root the dog's behaviors. But for clients to make progress, veterinarians need to conduct full behavioral assessments.
In addition to the dog-centric components, behavioral assessments should include human-centric components. Which behaviors do the clients like, which don't they like and which ones confuse them? These questions can be answered through direct or video observation and discussion. If clients take a video of a day in the life of the dog, with an emphasis on all the circumstances in which the dog is “hyper,” the veterinary team will have the context in which to discuss both the dog's behaviors and the client's desires. Only when you can clearly define the behaviors that the dog exhibits (e.g., jumping, pawing, pacing, barking, getting into things) and the circumstances in which these occur can you decide, given the three factors above, whether the dog is behaving normally. A description by the client is an essential part of any history, but clients' interpretations are subjective and can be wrong-clients who have mouthy, playful puppies often describe them as “aggressive.” Behavioral observations-especially if they are videotaped-provide objective data, allowing the veterinarian to review what's normal, what's problematic and how best to intervene.
Managing client expectations
Regardless of whether a dog's behaviors are normal, client expectations are key to keeping a dog in the home, and clients can adjust their expectations if they have data. Veterinarians should consider themselves as sources of reliable behavioral data and understand that their main role in engendering client compliance is education.
Dogs are their own individuals and, like people, their individual makeup is more important than any beliefs about breed, sex, litter and family. Every study that has measured dog personality over time has found as much or more variation across individuals than when litters, lines or breeds are compared.
Roles for age permeate many behavioral myths. We have the impression that somewhere between 2 and 3 years of age dogs grow up and slow down. In truth, there are few to no reliable data on breed- and age-associated behaviors, and some dogs don't “slow down.”
The jobs for which breeds were selected may provide a guide, but clients should understand that folklore is no substitute for measurements. Breeds and families selected for active hunting (e.g., English setters) and carting (e.g., Viszlas) may have been selected for endurance, but they may not take more steps per day than does an excitable Yorkie. We don't know because no one has objectively measured activity across breeds, ages and lifestyles. Herding breeds are said not to kennel well, but the distress that they feel in shelters could be as much about social and cognitive stimulation than it is about a need for physical exercise. Labrador retrievers are frequently viewed as the most constant and gentle of companions, but when they are wired (and there are lines of very active and reactive Labs), this impression has nothing in common with reality.
All of these dogs can have their behaviors changed through learning, but learning doesn't give you a completely different individual. Learning produces a different skill set in the same individual. Understanding that dogs can change their skill sets can be enough to keep dogs with people who might have considered relinquishment.
Here's what we actually know.
1. Puppies are mouthier and less inhibited than adult dogs. They may seem more active, but they have frequent wake and sleep cycles, and there is a lot of variation between pups in activity levels. Very active pups get into situations humans consider problematic more than do laid-back pups.
2. Dogs undergo brain changes at social maturity (which can start as early as 10 to 12 months and end as late as 24 to 36 months) and can appear completely different than they did before undergoing maturity.
3. Social maturity appears to be a period of neuronal pruning and remodeling in multiple parts of the brain. True behavioral pathologies can become apparent after this.
4. By 2 to 3 years of age, the dog you see is pretty much the dog you get. If the 2-year-old is calm, the 7-year-old will be calm. If the 2-year-old is active, the older dog may be quite active.
5. Active, curious dogs can stay active and curious into old age, provided that someone cares enough to commit to meeting the behavioral and mental health needs of the dogs throughout their lives. In fact, working dogs that keep working live longer than working dogs that retire.
6. Breed plays a role in the types of broad behavioral patterns dogs exhibit, as does purpose. For example, working dogs of any breed tend to be quite different from pet dogs. In addition, clients should ensure that they know which types of lines their dogs are coming from if they are buying purebred dogs. A client who wants a pet beagle to cuddle is going to be disappointed in a hunting beagle. A border collie whose parents and grandparents worked stock may be more interesting looking than a pet or conformation border collie, but it may also have behaviors that are too interesting for the average household.
Choosing the correct “hyper” diagnosis
Whether a dog is normal or abnormal in its reactivity and activity, the key to engendering relative calm is to keep the dog below its threshold for reaction. This is easy for a calm dog, and any amateur can do it-most environmental stimuli are below the level that will cause them to react. But for dogs with behavioral pathologies such as overactivity, generalized anxiety disorder (GAD), hyperreactivity, hyperactivity/hyperkinesis and attention-seeking behavior, even normal, common levels of stimuli can be problematic (Table 1). All of these diagnoses involve “hyper” dogs, but teasing them apart and becoming comfortable with the patterns that separate them will help both veterinarians and clients recognize these dogs early, when treatment is easiest.
Overactive dogs. These are the easiest of this group to manage. Overactive dogs display excessive motor activity that resolves with increased aerobic activity and interaction. These dogs can lie down, can sleep through the night and can relax, but they are always ready to go. And their exercise periods may be cut short because they are painful or exhausting for the humans.
This is a management-related “diagnosis” that is contingent on the age of the dog, the age of the client, the breed of the dog and the dog's social and physical environment. These dogs may have needs in excess of what most people would consider normal, but redress is as simple as meeting those needs.
The test for overactivity is simple: Have the client determine how much sustained exercise is required for the dog to change its behavior. Endurance and aerobic scope increase with conditioning, but most overactive dogs live relatively sedentary lifestyles. If an extended walk at a pace that requires deep breathing for at least 10 to 15 minutes improves the dog's behavior, the dog is likely overactive. Fine-tuning the type and duration of exercise needed to render the dog as calm as possible or as calm as the client prefers can be a challenge, but once any change associated with exercise can be seen, clients just have to keep a chart of length of activity, type of activity, and heart and respiratory rates of the dog every five to 10 minutes, and they will understand to what lengths they must go to meet the dog's needs.
Generally, when clients collect this type of information, they become more sympathetic and empathetic to the dog. The challenge arises if the client cannot meet these needs. Dog walkers and doggie daycare facilities that include appropriate, supervised play groups can help meet these dogs' needs. Clients whose means are limited may wish to see if there are any older children and young adults who cannot have a dog but who would like to exercise their dogs on a regular basis. Finally, indoor games involving rolling and retrieving balls (physical exercise) and finding substances using their nose (cognitive exercise) can help meet these dogs' needs in a worst-case scenario. The sessions will need to be fairly long and frequent, but if the dog and human understand one another, this less-than-ideal situation can be made to work.
Generalized anxiety disorder. For dogs with this diagnosis, the issue is not exercise. In fact, afflicted dogs should have worn themselves out by activity compelled by their vigilance. Instead, they monitor the world until exhausted, and then they may have multiple bouts of nonrestorative sleep until some stimulus that others would consider benign or nonexistent again arouses them.
Dogs with GAD worry and consistently show increased autonomic hyperactivity and hyperreactivity, increased motor activity, and increased vigilance and scanning that interferes with a normal range of social interaction in the absolute absence of any specific provocative stimuli. Clients comment that these dogs show heightened monitoring and attentiveness to any environmental and social stimuli. When the inciting stimulus is present, these dogs show signs of autonomic arousal that clients can note (e.g., panting, increased heart rate and respiratory rates, mydriasis). Clients complain that these dogs are easily distracted and don't seem to be able to concentrate or pay attention. If the dogs are calm, the dogs can pay attention and can learn, but the reactivity gets in the way of learning normal behaviors. Because of the heightened reactivity, dogs with GAD often have secondary diagnoses involving aggression. If they were not so reactive and could attend more to the context, the aggression would not occur.
The danger with a diagnosis of GAD is that it is very specific but could carelessly be made in the absence of critical thought or incomplete history. Accordingly, it should be a diagnosis of last resort, not first, and all of the signs should concomitantly be present under conditions where any of these signs would have subsided in a normal or asymptomatic animal. This caution does not mean that the condition may not be common. GAD is likely very common, especially in breeds or individuals that have been selected for faster response times.
If we are interested in accurately describing behavior so that we can understand mechanism, the ability to label and understand a condition discretely is nowhere more important than it is here. GAD is first and foremost an anxiety-related condition. And the most common nonspecific sign, which is likely to be overlooked and classified as a catch-all medical diagnostic category-irritable bowel syndrome (IBS)-is diarrhea. Dogs with overactivity, true hyperactivity and hyperreactivity do not usually experience periodic and recurring diarrhea. Dogs with pathological attention-seeking behavior may experience recurrent diarrhea if their caregiver does not routinely and expeditiously give them the attention sought. We would benefit from knowing how many animals displaying IBS have other behavioral signs of anxiety.
If clients can keep a log (or video) of their dogs, they can set the lower bound for stimulation (e.g., the dog reacts faster and to a greater level when little kids are playing than when older kids are), which will be helpful as we work to teach the dogs that not reacting feels better to the dogs. These dogs are particularly anxious in novel environments (a park, the veterinarian's office) and will not lie down and rest until they are exhausted, which can take more than an hour. Clients are worn out by the dogs' pacing and arousal, and everyone becomes cranky. Veterinarians and clients should keep a record of how long it takes dogs to sit or lie down in different circumstances. Patients that do not have GAD usually at least sit or lie down within the first 10 to 15 minutes of a behavior consultation, but dogs with GAD may still be vigilant and pacing after an hour. Worse yet, exercise may slightly change the threshold for arousal but leave the vigilance and reactivity relatively unchanged.
Hyperactivity/hyperkinesis. This diagnosis involves motor activity in excess to that warranted by a dog's age and stimulation level and that does not respond to “correction,” redirection or restraint. For true textbook hyperkinesis to be diagnosed, there is an additional requirement of sympathetic signs (increased heart rate, increased respiratory rate, vasodilation), even when at rest. These signs, when present, should occur in the absence of other signs or significant laboratory data associated with thyroidal or other somatic disease.
Affected dogs are reported to never seem to sit down or settle and always have some signs of sympathetic arousal-slightly elevated baseline heart rates and temperatures and dilated pupils. Affected dogs have been said to arouse easily and appear to sleep less and less deeply, although this has not been measured. Affected dogs change their focus frequently, but this may be because they encounter a lot of stimuli that trigger sympathetic arousal. The hallmark of true hyperactivity is not attentional focus, but sympathetic arousal. The original definition of hyperkinesis in dogs focused on this sympathetic arousal, and dogs were considered hyperkinetic/hyperactive only if they responded to treatment with 0.2 to 1 mg/kg methylphenidate with a 15% decrease in heart and respiratory rates 75 to 90 minutes after treatment.1
Hyperreactivity. Hyperreactivity may best be characterized as a physical and behavioral response to some perceived external stimulus (e.g., a sound or smell), activity or social stimulus that is out of context given the stimulus, or extreme in form, frequency, intensity or duration. Affected dogs usually have a low threshold for reactivity and extremely rapid arousal. Signs may include vocalization, extreme motor activity, inattention to signals, lack of focus and sympathetic arousal in response to extreme activity. But these dogs do not meet the hyperkinetic criteria of true, aberrant, sympathetic arousal and aberrant baseline sympathetic functioning.
Before making this diagnosis it is important to ensure that the dog is not overactive (inadequately exercised or stimulated) and that it does not have GAD. Unlike dogs with GAD, dogs that are truly hyperreactive may not be distressed. Instead, they appear hypersensitive to anything that arouses them and behave with a motor energy and lack of focus that is annoying to people. The clients may complain that they cannot train their dogs without their dogs becoming aroused, so the question of lack of focus is usually raised but seldom quantified (see discussion in the section on hyperactivity). Hyperreactive dogs may not start out as anxious, but anxiety can develop as a sequela. Here, the reactivity becomes reinforced and learned at the molecular and neurochemical levels, lowering the threshold for reaction regardless of context and stimulus level.
Hyperreactive dogs may destroy parts of the house or items in the house, but not just when left alone. They destroy secondary to their extreme motor activity and apparent lack of focus-why go around the table if you can go over or through it? These dogs may injure people by jumping on them, grabbing at them and bowling them over because they do not seem to be able to stop long enough to realize that these events are occurring and may be a problem for the people. In fact, these dogs appear to become more aroused the more such interactions occur. Clients will often note that these dogs become “overexcited” very easily and then are unable to relax or focus. These dogs are often described as having a lot of “environmental sensitivity,” which can either cause them to completely shut down and respond to little (except escape) or become aroused in excess of what's appropriate given the context.
Attention-seeking behavior. Part of the social condition is to seek and return attention. When seeking of attention is out of context and unaffected over time by the attention received, it is time to start thinking of attention-seeking behavior as a potential pathology. “Bratty” dogs may have their humans well-trained, but if they fail to get attention they either move on or cope. Dogs with truly problematic attention-seeking behavior are distressed and use vocal or physical behaviors to obtain passive or active attention from people when the people are engaged in passive or active activities not directly involving the dogs. These dogs need not have separation anxiety or be “hyperattached.” They need attention more than they want it because no amount of attention redresses their distress. Common signs may include vocalizing (barking, whining, crying, howling), jumping, pawing or grabbing, chewing on or using any other behavior in a context solely designed to redirect people's attention to the dog. These dogs become more distressed the longer they are forced to seek attention, and the distress does not completely abate with the attention. Unlike for GAD, the focus of the anxiety and monitoring here is solely the dog's caretaker of the moment.
So now that we have taught clients to understand normal activity and to recognize deviations from it, how can we help these dogs?
Because so many of these dogs have taught themselves to be more reactive as part of a self-reinforcing series of behaviors, medication is always a part of treatment in full-blown cases. Generally, both norepinephrine (NE) and 5-HT receptors are involved in the behaviors associated with most anxieties. However, the relative contributions of each type and subtype of receptor may vary among patients, so any particular medication's ultimate effects may be determined by the overall distribution of those medications in the specific patient's brain. Medications to which dogs with GAD, hyperreactivity and attention-seeking behavior best respond include:
> Gabapentin, alone or in combination with tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), or both. Gabapentin is ideally suited to decrease overall arousal and nonspecific anxiety levels with few potential side effects.
> TCAs (clomipramine, amitriptyline if in combination with an SSRI) will affect both NE and 5-HT subtype receptors.
> SSRIs (fluoxetine, sertraline, fluvoxamine) primarily affect the 5-HT1A subtype receptor and thus may exert their largest effects in the hippocampus and cortex in regions involved in learning. As such they should speed the acquisition of new, more suitable coping behaviors taught through behavior modification and also modulate arousal level.
> Serotonin antagonist and reuptake inhibitors (SARIs) such as trazodone affect 5-HT2A subtype receptors, which are commonly involved in anxiety-related conditions involving repetitive movement.
> Central alpha agonists such as clonidine stimulate central NE receptors and thus modulate NE receptors in the peripheral vasculature, decreasing the agonistic sympathetic response. Depending on the level of the arousal response they may be helpful. When used with TCAs, which also potentially increase central NE or the efficiency of its receptor actions and turnover, clients should be asked to watch for side effects, including agitation, that can result from increased central NE concentrations.
> Benzodiazepines (alprazolam, clonazepam) may be helpful if there is concomitant noise reactivity or phobia or if a dog's reaction to a specific stimulus or set of stimuli is extreme. Benzodiazepines affect the reticular activating system and may help to engender a lower reactive state, in general. Benzodiazepines can be used as outlined in the protocols for noise or storm phobia and panic.
> Because the diarrhea may be a nonspecific sign of arousal, loperamide may be beneficial as needed since it will decrease a physiological component of arousal.
Management is always important in these conditions, and any humane intervention that can keep the dog in question below its threshold for reacting should be tried. The use of harnesses and head collars may help minimize the damage that these dogs can do in interacting with humans and animals. Any tool that appears to help the dog attend more to people (eye shades, ear muffs) can be used as long as it does not hurt, punish or scare the dog.
All dogs benefit from the basic behavior modification programs, but some may require medication beforehand so that they can attend to learning replacement behaviors for the obnoxious and dangerous ones they usually exhibit. These reactive dogs are already using a set of rules that fail to help them understand and manage the world. If we can provide them with new rules that allow them to control their reactivity (which is what behavior modification is), they can learn that they feel better and have better interactions when they are less reactive.
What other interventions may help?
> In desperation, some clients may have tried some fairly severe control techniques including extensive and inappropriate crating, which usually makes the dogs worse; nonjumping harnesses, which may injure active dogs; and electric shock to stop the dogs. None of these are likely to be effective but their discussion or use can be a gauge of the extent to which these dogs are disrupting the household.
> The effectiveness of interventions such as massage, pressure, using an underwater treadmill (provides constant, mild compression because of the way the water moves) and pressure wraps is not known, although some data suggest that with repeated use, wraps may decrease reactivity to certain stimuli.2
> At first, the presence of other dogs is unlikely to help because these patients are too reactive to focus on them. As the affected dogs begin to improve, they may play more and become more able to use nonreactive dogs as models for calmer behaviors and sensors for true risk.
How can we tell if treatment is working? As these dogs improve, clients may note that they begin to gain weight, despite the same diet. Clients can be instructed to watch for weight gain as a sign that the dog is no longer patrolling so much as part of its need to be hypervigilant. Clients may also note that if there are multiple dogs in the house, all dogs seem calmer and may play more as the GAD or other hyperactivity diagnosis resolves or is controlled. Finally, clients may note that they, themselves, are calmer, and if they care to measure it they will learn that there is less noise and dogs are quicker to both seek them out for input and more quickly respond to signals to calm.
When dealing with conditions in which diagnostic criteria appear to drift, we should adequately represent what we know and don't know to clients. With such diagnoses, the roles for logical thought, putative mechanisms and the use of a diagnosis as a hypothesis to be tested cannot be overstated. Clients are excellent observers and data collectors, if we tell them what to look for. Furthermore, by better watching their dogs they come to better understand and empathize with them, and the extent to which those two factors contribute to successful outcomes is nontrivial.
1. Corson SA, Corson EO, Becker RE, et al. Interaction of genetics and separation in canine hyperkinesis and in differential responses to amphetamine. Pavlov J Biol Sci 1980;15(1):5-11.
2. Cottam, N, Dodman NH, Ha JC. The effectiveness of the Anxiety Wrap in the treatment of canine thunderstorm phobia: An open-label trial. J Vet Behav 2013;8(3):154-161.
Dr. Karen Overall, researcher at the University of Pennsylvania, has given hundreds of national and international presentations on behavioral medicine. She is a diplomate of the American College of Veterinary Behavior (ACVB) and is board-certified by the Animal Behavior Society (ABS) as an applied animal behaviorist.