Randomized Controlled Trial of Therapeutic Horseback Riding in Children and Adolescents With Autism Spectrum Disorder

Abstract

Objective This study expands previous equine-assisted intervention research by evaluating the effectiveness of therapeutic horseback riding (THR) on self-regulation, socialization, communication, adaptive, and motor behaviors in children with autism spectrum disorder (ASD). Method Participants with ASD (ages 6–16 years; N=127) were stratified by nonverbal IQ standard scores (≤ 85 or > 85) and randomized to one of two groups for 10 weeks: THR intervention or a barn activity (BA) control group without horses that employed similar methods. The fidelity of the THR intervention was monitored. Participants were evaluated within one month pre- and post-intervention by raters blind to intervention conditions and unblinded caregiver questionnaires. During the intervention, caregivers rated participants’ behaviors weekly. Results Intent-to-treat analysis conducted on the 116 participants who completed a baseline assessment (THR n = 58; BA control n = 58) revealed significant improvements in the THR group compared to the control on measures of irritability (primary outcome) (p=.002; effect size [ES]=.50) and hyperactivity (p=.001; ES=0.53), beginning by week five of the intervention. Significant improvements in the THR group were also observed on a measure of social cognition (p=.05, ES=.41) and social communication (p=.003; ES =.63), along with the total number of words (p=.01; ES=.54) and new words (p=.01; ES=.54) spoken during a standardized language sample. Sensitivity analyses adjusting for age, IQ, and per-protocol analyses produced consistent results. Conclusion This is the first large-scale randomized, controlled trial demonstrating efficacy of THR for the ASD population, and findings are consistent with previous equine-assisted intervention studies. Clinical trial registration information Trial of Therapeutic Horseback Riding in Children and Adolescents With Autism Spectrum Disorder; http://clinicaltrials.gov/; NCT02301195.

A Systematic Review of Hippotherapy (horseback riding) for Individuals with Autism is the Cognitive Level Considered?

“…After independently rating each article using the AACPDM rating scale, the two raters met to discuss discrepancies in rating regarding one study, which was resolved by discussion. Three studies were randomized controlled trials rated as Level I [32] and Level II [26,33]. Three studies were cohort studies (Level III) with research and concurrent control groups [34][35][36].…”

“…One used a repeated-measures within-subject design [38] and Seven studies were single-subject research and case studies at evidence Level V [7,39,40]. Of the six (35%) studies that used a control group, only Gabriels et al [32] used a control group without horses that mirrored THR intervention methods. Six studies reported using a waitlist control group, and one study [41] employed a design in which each child acted as his or her own control ( Table 2).…”

“…There was a male preponderance (83%) representing actual male: female ratio in populations with ASD. In two studies, diagnosis of ASD was confirmed by the researchers prior to inclusion in the intervention program [7,32], while an external criterion confirmed ASD in the remainder of the studies. Two studies [7,32] excluded children with a history of previous or current psychiatric or behavioral issues or a concurrent medical disorder.…”

“…Lanning et al [36] A repeated measures research design (III) assessment combined with weekly follow-up assessments [32,33,35,42]. Most studies combined between two and six assessment tools while only three studies used a single tool [32,43,45].…”

“…Most studies combined between two and six assessment tools while only three studies used a single tool [32,43,45]. Table 3 provides a summary of outcome measures and assessment tools.…”