The Behavioral Assessment

A behavioral evaluation is a complete medical examination that encompasses the evaluation of the whole patient. The American Veterinary Medical Association, the Association of Feline Practitioners, and the American Animal Hospital Association all include behavioral health in their guidelines and highlight behavior as an essential part of animal health and routine wellness visits.

Recognizing that behavior is a symptom rather than a diagnosis is essential. Because many behavioral changes can be initiated by changes in physical health or be a sign of an underlying medical condition, a complete physical examination and appropriate diagnostic testing (eg, CBC, serum chemistry profile, thyroid panel, urinalysis) should be performed. Laboratory data help rule out obvious physical causes for behavioral changes and establish a baseline if medication is warranted. Additional testing may be indicated depending on physical examination findings. If no physical or medical cause for the change is identified, a behavioral assessment should be conducted.

The most efficient way to gather behavior information is through a questionnaire completed by the client and returned to the practice at least 48 hours before the scheduled appointment. Posting the questionnaire on the practice’s website makes it easy for the client to access and print.

The events described in the questionnaire can be placed on a timeline to provide a clear picture of the intensity, frequency, and duration of the behavior, as well as any triggering events. Sample behavioral questionnaires for both dogs and cats are available from behavioral textbooks^1,2 and online.

These surveys typically collect the following information about the patient: 

• Principal complaint
• Personality
• Relationship with other pets and family members
• Diet
• Daily activities and routine
• Training, responses, and reinforcement techniques
• Punishment
• Handling
• House-training
• Behavior when away from home
• Reactivity
• Aggression

The veterinarian and veterinary nurse should review the questionnaire responses with the client to confirm the information provided and to elicit more detailed answers, if necessary.

Photographs and videos showing a patient’s behavior away from the veterinary practice are helpful tools for identifying the specific problem and potential cause. Clients should be encouraged to use a smartphone to document behaviors of concern before the assessment. For example, clients could record a dog that reacts aggressively to home delivery people before, during, and immediately after the triggering event. Clients must be advised not to provoke unwanted behaviors. Photographs and videos should be obtained only in a manner that is safe for both client and patient. 

Observations by trainers and groomers also can provide valuable insight about a patient’s behavior. For example, a trainer might note that the dog seems nervous around children, or the groomer may say she can work with the dog without a muzzle if she lets the dog relax for a few minutes before she begins grooming.

Observation should start from the time the patient enters the practice until he or she leaves. Note if the patient approaches, retreats from, or actively threatens veterinary team members. Consider creating a checklist of behaviors to quickly record which behaviors are present or absent. (See Checklist of Behaviors handout.)

Simple interactions such as offering the patient treats (ie, will he or she eat?), tossing a ball or tug toy (ie, will he or she play?), or gentle handling (ie, does the patient seek contact?) can be used as a rough assessment of anxiety. If a patient has a preferred treat or toy, ask the client to bring it with them to the assessment and to not feed the pet prior to the appointment. Providing the dog with favorite choices will help determine the severity of distress (ie, the dog is likely more distressed if he or she refuses the favorite food, despite not being fed, than if he or she refuses generic treats).

Combining the information from all these different observations and sources will allow you to form a comprehensive picture of the pet’s behavior. For example, although the client may complain that the dog is aggressive toward strangers, if team members have observed approach-and-retreat behavior in a variety of interactions, the motivation for that aggression is most likely fear.

If the veterinarian cannot be present to observe the patient’s behavior throughout the appointment, client service representatives, veterinary assistants, and veterinary nurses should be asked for their impressions. Simple observations (eg, The dog moved behind the client when I approached to escort them to the examination room) can provide valuable information. Team members should be familiar with the body language of dogs and cats to accurately assess a specific patient’s behavior. Resources are available to help determine how an animal is reacting to a specific situation based on its body language. (See Resources.) Being a veterinary professional does not guarantee the ability to recognize canine body language,³ but experience with dogs has been shown to increase the ability to recognize the signs of fear in dogs.⁴

Create a list of the problem behaviors identified during the assessment. Be as descriptive as possible (eg, aggression directed at unfamiliar people, unfamiliar dogs, children) and include the target or triggers and the underlying motivation.⁵ Create a list of differential diagnoses and then develop a comprehensive behavioral treatment plan that includes safety precautions; management, including avoidance of triggers; training of foundation skills using positive reinforcement; behavioral modification; and, if needed, appropriate medication.⁶

Behavioral assessments need to be comprehensive but not cumbersome or overwhelming. By collecting information from your team, and a variety of other sources, you can provide valuable behavioral support to clients and their pets.