Perla, a standard poodle, is used to calm and entertain children before they have X-rays at Children's National Medical Center. (John Kelly/The Washington Post )

Sometimes people don’t need to speak the same language to communicate. Sometimes they don’t even need to be people.

Just consider the 6-year-old black standard poodle who’s a valued member of the hearing and speech department at Children’s National Medical Center. She’s named Elle — pronounced “Ellie” and short for “Eleanor Rigby” — and when she isn’t working with a patient, she can be found curled up in the office of Dr. Sheela Stuart, chairman of the department.

Dr. Stuart has been a pooch-pioneer at Children’s, an inspiration to others wanting to incorporate dogs into their work. Dogs can now be found helping in the hospital’s eating disorders clinic and in the radiology lab.

The idea of using dogs in therapy is credited to Boris Levinson, who worked with severely autistic children in New York City. In 1955, a nonverbal boy and his mother came early to an appointment at Levinson’s home office. Levinson’s dog, Jingles, had not yet been banished to a private area of the house. The psychiatrist noticed that the boy was much more animated and responsive with Jingles around.

Levinson used Jingles increasingly with his patients. He shared his observations in numerous books and journal articles, going so far as to recommend that dogs be prescribed to severely withdrawn children. “A child may be in therapy only twice a week,” he wrote, “but the pet can exert his healing influence on the child 24 hours a day, every day of the week.”

A well-behaved dog can certainly soothe and distract an anxious youngster. Elle does a little bit more, helping to introduce nonverbal patients to the notion of communication — and then giving them something to talk about.

She’s actually Dr. Stuart’s second canine helper. The first was an Airedale terrier named Cozmo. Dr. Stuart was having trouble reaching a 3-year-old girl who had a lot of problems: tactile deficiencies, sensory aversions, medical issues that necessitated a feeding tube. She was unable to speak and seemingly unable to communicate. The little girl would spend entire speech and language sessions in a near-continuous scream.

Dr. Stuart asked her parents what the little girl liked. Not much, they said. Then they remembered that she saw a dog once in a park and that it held her attention for a few seconds. Dr. Stuart brought Cozmo to the next session.

“She didn’t necessarily stop screaming, but she seemed to be less frenetic,” she said.

Then Dr. Stuart decided to take things further. Speech therapists often use augmentative and alternative communication devices, picture-covered boards or simple computers that can be used to convey commands.

“We set her up with two very simple speech generating devices, both of which were associated with the dog,” Dr. Stuart said. “One said ‘Hat.’ If she hit that one, we put a hat on the dog’s head. The other said ‘Eat.’ If she hit that one we put one Cheerio in this little bowl and the dog ate the Cheerio.”

They did this for months, until the little girl associated her actions with the dog, first Cozmo, then after he died of cancer, with Elle.

This was the start of achieving “joint attention,” the ability to interact in a conversation, no matter how rudimentary that conversation might be.

One of the first hurdles of communication is understanding in the first place that something is being communicated. That’s where a dog can help.

“It’s so immediate with a dog,” Dr. Stuart said. “Come, sit, eat: The dog immediately does what you ask it to do.”

Of course, any dog working in hospital setting must have all its vaccinations. It must be capable of following basic commands: sit, stay, come, leave it, etc.

The Children’s dogs must show they are not easily distracted or startled. (To be certified, the dogs go through a test where someone crashes past them using a walker, then pushes a baby carriage, then rings a bell.)

They have a complete grooming on the day of their visit. (While no dog is completely hypoallergenic, most therapy dogs are relatively dander-free breeds such as poodles and bichon frise.)

“The human animal bond, it’s a complicated thing,” Dr. Stuart said.

 Dogs may speak a language of their own, but some of them help us learn to speak ours.

Helping children

Children’s National Medical Center helps all sort of kids in our area. This is the time of year when I hope you’ll help the hospital. I’m raising money for the hospital’s uncompensated care fund, which pays the medical bills of underinsured children.

You can make a tax-deductible donation by going to or sending a check (payable to Children’s Hospital) to Washington Post Campaign, P.O. Box 17390, Baltimore, Md. 21297-1390.

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