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Alerting: Everything You Need to Know

Natural Alert or Regular Dog Behavior?

Medical alert is arguably the fastest growing category of service dog. From seizures to migraines to fainting to anaphylaxis to low blood sugar, the scope of what dogs can possibly alert to seems much broader than anyone first realized. However, it is also a tricky topic and one that raises a lot of debate in the service dog community. Blood sugar alerts are currently the only trainable alerts that have been proven with peer-reviewed research. That means everything else falls under either the natural alert only category or the possibly trainable but no proof yet category. Even more confusing still is the line between natural alerting behavior and regular dog behavior.

Blood sugar alerts are currently the only trainable alerts that have been proven with peer-reviewed research.

Owner training is legally allowed in the United States, and can be a great option for many people. However, it is estimated that only 10% of service dogs are able to perform natural alerts. Considering that it is also estimated that only 10-15% of dogs have the right qualities to make it as a service dog, the number of dogs who truly have the ability to perform natural alerts is quite small. Yet this ability is claimed far more often than these statistics would suggest is possible. This is likely because the line between natural alerts and regular dog behavior is a very fine one that often gets blurred.

When a new handler brings home a puppy as a prospect, it is with the hope and intent of that dog becoming their service dog in a couple of years. Unfortunately, sometimes this means that new owner trainers can mistakenly assume regular puppy behavior is an alert. Common puppy behaviors include whining, jumping, pawing, gentle (and sometimes not so gentle!) mouthing, crawling into a lap, nudging with their nose, becoming antsy or vocal, etc. All those behaviors are also often observed when a dog is initially performing a natural alert. It can sometimes be very difficult to tell whether a dog is performing a natural alert or just displaying normal dog behavior.

Playful Puppy in LapHaving a migraine 30 minutes after your puppy was jumping on you, mouthing, and barking does not mean it was an alert. It is *possible* that it was, but in taking the statistics of how many dogs truly have the natural ability to alert into consideration, it is far more likely that it was simply regular puppy behavior. One reason natural alerts appear to be more prevalent with owner trained dogs is that many handlers unintentionally begin shaping behaviors they have mistakenly assumed are alerts. The dog learns that instead of barking or mouthing or jumping they should just place one paw on their handlers leg. Great, that behavior has been shaped, but it didn’t necessarily reinforce an alert behavior, just redirected regular puppy playfulness.

Alerting or Responding?

Dogs are emotional animals which means they can read the tone of our voice and body language as well as connect with how we are feeling. That also means that what may appear to be an alert, is actually the dog responding to outwardly visible cues the handler is unaware of. Some handlers claim their dogs are able to alert to anxiety attacks before they happen. However, many times the dog is actually responding to visible symptoms the handler is not yet aware of.

A young dog may respond to a shaking leg or repetitive movement with pawing, whining, or nudging which can be mistaken for an alert if the handler is not aware of what they are doing. Those behaviors are then shaped into a behavior that is appropriate for a dog to perform in public, and the handler believes they have a natural alerter. What has actually happened is that the dog has responded to what they may have interpreted as playful behavior (as any puppy would), and the handler has simply redirected playful interaction into a more controlled behavior. Note that this does not take away from the validity of the task or the extent that a handler can benefit from the task, but it is not an alert. It is a response. (Read more about alerts vs response.)

Breed Tendencies

Instead of actually alerting to an oncoming attack, the dog is just responding to the emotion of their handler as almost all pet dogs do.

Other issues that can blur the line between a natural alert and regular dog behavior can come from the dog itself. Some owner trainers choose to use a breed that is known for its tendency to respond to anxiety with protective behaviors. What can appear to be a dog alerting to a panic attack by licking their handler and climbing into their lap may actually be the dog responding to crying or other symptoms that can precede a full panic attack. Instead of actually alerting to an oncoming attack, the dog is just responding to the emotion of their handler as almost all pet dogs do.

Some breeds can also begin displaying protective behaviors, such as blocking, to keep other people away which can appear to be just natural intuition, but is actually anxiety driven instinct. This is not to say that handlers cannot use licking or climbing into their lap or blocking as valid tasks, but just because a dog is displaying some of these behaviors naturally does not mean they are alerting. In fact, dogs that respond out of anxiety or protective instinct should be evaluated by a behaviorist as they are highly likely to develop inappropriate or even unsafe behaviors.

Read more about breed choice:

How to Determine if Your Dog is Alerting

Taking notesBecause natural alerts are truly very rare abilities even in service dogs, it is far better for a handler to assume their dog is NOT alerting. That doesn’t mean a handler shouldn’t be open to the possibility that their dog may be one of the gifted few that can alert. Before being able to truly claim a natural alert, a handler will need to document consistent behaviors in their dog that precede specific symptoms for the handler within a limited period of time.

A dog that is whining and pawing 40 minutes before a seizure one time, then barking and mouthing an hour before another seizure, then more pawing and nosing 10 minutes before one is not exhibiting alerting behavior. A dog that becomes antsy, starts nosing its handler in the face, and refuses to leave its handler 20 minutes before a migraine and repeats similar behaviors within a similar time frame may be performing a natural alert.

As this can be such an incredibly complex issue, all owner trainers (especially first timers) are highly encouraged to consult with a professional trainer and behaviorist. These experts will be able to help find that line between natural alerting and regular dog behavior. If the dog is found to be truly performing natural alerts, they can also help shape the natural alert into appropriate behaviors to be considered a task.

Possibly Trainable Alerts

While natural alerting ability can be a hot topic, trainable alerts are also highly debated. Currently, blood sugar alerts are the only alerts that have peer-reviewed studies indicating their trainability. However, there has recently been a rise in other alerts that appear to have the potential of being scent trained. Blood pressure, heart rate, and migraine alerts have long been considered natural alerts (similar to seizure alerts) and unable to be trained.

However, there are a few success stories of also training migraine alerts using scent samples. There have also been a few personal testimonies of blood pressure and heart rate alerts being trained by the handler simply prompting their dog to perform a specific behavior when they are experiencing the changes in blood pressure or heart rate. Anaphylaxis alerts are another possibly trainable alert. Until recently this was not even considered a task service dogs would be able to perform, but there have been pockets of success with dogs being successfully scent trained to anaphylaxis and giving 10-15 minutes warning before symptoms being.

Anxiety Alerts

Possibly the most debatable alert in terms of trainability is the anxiety alert. Just like other true alerts, there does appear to be a small cohort of dogs that are able to naturally alert to an oncoming anxiety or panic attack before external symptoms begin showing. However, the majority of dogs do not have that ability. The line between a true alert and a response is a very fine line.

Natural Cortisol LevelsSome programs and handlers have claimed they successfully scent trained dogs to alert to anxiety based on changing cortisol levels. This is debatable because the science behind the anxiety alert indicates that normal cortisol fluctuations throughout the day span the levels that are supposedly trained for the anxiety alert. With cortisol changing naturally as the day progresses, it is difficult, if not impossible, to train a dog to differentiate between the natural changes in cortisol that happen throughout the day and changing cortisol in response to a trigger. (Note: This is not addressing service dogs trained for Addison’s Disease where there is no natural cortisol and the dogs truly are trained to alert to falling levels that could result in a medical emergency.)

Despite the lack of peer-reviewed science on whether a true alert for anxiety can be trained, anxiety response tasks are almost always an option and can provide just as much benefit as an alert.

Choosing an Alert Behavior

As mentioned earlier, if the dog has a natural ability to alert, it must first be shaped into a trained behavior before it can be considered a task. Similarly, trained alerts and responses must also have an associated behavior to be a valid task. In choosing which behavior is best to train as an alert, a handler should consider a few different things:

  1. A handler should choose a behavior that will work for them and their dog. Some dogs naturally do certain behaviors in play, such as pawing. This could make it difficult for a handler to differentiate between playfulness and an alert. It may be more appropriate to choose a behavior that the dog does not do naturally to keep it distinct from regular behavior.  Also, a small dog is going to be unable to perform some behaviors in certain situations, such as face licking, where a larger dog may be too overbearing to do other behaviors, such as jumping into a lap.
  2. A handler also needs to consider how the behavior will be perceived in public. A service dog should be relatively invisible. Most handlers know there is no better compliment than to hear someone comment that they had no idea a dog was in the store or restaurant. The alert behavior should be chosen with this unspoken rule in mind. Commonly chosen behaviors include pawing or nosing. Technically any behavior can be used if it appropriately communicates an oncoming medical issue and is not overly disruptive to other people who may be in close proximity to the service dog and handler. As such, barking is typically not considered an appropriate alert for most situations as it can be disruptive in a public setting. A barking dog may appear to be out of control rather than actually performing a task and a handler may be asked to remove the dog. However, there are some situations where it may be appropriate to train a dog to perform a controlled bark to attract attention to the handler experiencing a medical emergency.
  3. If multiple alerts will be trained, the handler needs to decide if there will be a specific behavior for each alert or if there will be a single generic alert. Some people with diabetic alert dogs choose to train separate alerts for low or high sugars. These behaviors need to be different enough for the dog to know the difference as well as the handler known which alert the dog is performing. Other handlers prefer to train a single alert behavior, then it is up to them to determine what the alert was for. A dog may perform the same alert behavior regardless of whether it is a low or high sugar. After receiving the alert, the handler can then test their sugar to determine whether their sugar is low or high and treat it accordingly. A handler will need to determine what approach will work best in their own situation and for their dog.

Other Things to Consider

Beyond choosing which behavior will be the best option to use for the alert, there are a couple other pieces of alert training a handler needs to consider.

  1. The handler needs to decide how they will respond when they get an alert. It is great to have a service dog for the purpose of alerting to oncoming symptoms, but if a handler does not have a plan of action in place, the task becomes much less useful. Some alerts are more straight forward. If a dog alerts to a high sugar, the handler will likely check their sugar, then administer insulin as appropriate. Other alerts are not quite as defined. For instance, a migraine alert for one handler may mean taking preventative medications but for another handler might mean grabbing some ice packs and lying down. An anxiety alert could mean the dog leading the handler out of the situation or performing deep pressure therapy. Each handler needs to figure out what their response will be so they are prepared to act after their dog has given an alert.
  2. A dog needs to be taught when the alert behavior should stop. If a dog is performing a seizure alert, there may be up to half an hour after the alert before the actual seizure starts. Without a “stop command,” the dog may continue performing the alert behavior and get anxious or agitated as they feel you are not responding appropriately or eventually stop alerting entirely as they don’t appear to see any reason to keep communicating it to the handler if it seems like nothing is being done. The “stop command” is a way for the handler to let their dog know they have done well and reward/praise the behavior to reinforce the alert. Many handlers choose to use words like “thank you” or “well done” to communicate this to their dog.

Regardless of whether the dog has the ability to alert naturally, is scent trained, or has learned response tasks, medical alert dogs help bring back some control for what are often very unpredictable medical conditions. While alerting in general can be a complex area of service dog training, ultimately, it can also be some of the most life changing.





Kylene Boka
Kylene is a grad student living in Ohio with her husband and two dogs, Bonk and Leni. Leni is her service dog and is scent trained to alert to severe allergic reactions and hypoglycemia due to Kylene’s mast cell disease. To learn more about life with mast cell disease and a service dog, you can check out Kylene’s blog,