Background: Attention deficit hyperactive disorder (ADHD) is associated with difficulties in executive functions (EFs), ( assessed by questionnaires) and self-esteem. Objective: To examine the contribution of therapeutic horseback riding to the EFs’ improvement and self-esteem. Method: In total, 123 Israeli children diagnosed with ADHD participated in the study. The study group participated in 20 weeks of therapeutic horseback riding sessions in addition to receiving medication, whereas the control group received only medication. The children and their mothers filled out questionnaires before treatment, at the end of treatment, and 12 weeks after the treatment ended. To examine changes in the children’s EFs and self-esteem, a series of latent growth models (LGMs) were conducted. Results: Therapeutic horseback riding contributed to the improvement of EFs and self-esteem. Improved self-esteem predicted subsequent improvement in EFs. Conclusion: Therapeutic horseback riding is an effective therapeutic method to improve EFs and self-esteem among children with ADHD.