Empirical Research

Introduction

Research evaluating the use of animal-assisted therapy (AAT), including therapeutic horseback riding, as a therapeutic option for various disabilities is relatively new. Animal-assisted therapy describes the use of animals in goal directed treatments. AAT has demonstrated effectiveness across multiple domains including cognitive, psychological, and social functioning (Bass, et al., 2009).

Therapeutic Horseback Riding (THR) is a form of AAT that utilizes horseback riding as a therapeutic treatment for physical and mental disabilities. “THR emphasizes control, attention and focus, sensory management, and communication (verbal and/or nonverbal). It also stimulates physiological, psychological, and social responses in children and adolescents through direct contact with the horse (Ward et al., 2013). THR has been proven to improve various aspects of motor, cognitive, and social functioning (Bass, et al., 2009). THR has been used to treat physical impairments, psychiatric illnesses, including schizophrenia, and social disorders in children, including autism spectrum disorders (ASD) and attention deficit hyperactive disorder (ADHD); however, empirical research for these treatments is lacking. Most research has been conducted with regard to the significant effects of THR on children with autism.

Autism spectrum disorders are characterized by severe deficits in social interaction, restricted, repetitive activities and interests, and in severe cases, communication deficits. Individuals with ASD exhibit difficulty in recognizing and implementing social cues and non-verbal behaviors. They also perform repetitive movements and express a preoccupation with routine. Individuals with severe cases of ASD exhibit the same difficulties in social interaction and repetitive behaviors, however, they also demonstrate difficulties in communication including restrictions or a complete absence of spoken language as well as the use of unusual languages they have themselves created (Choukas-Bradley, 2014). There are several causes of ASD ranging in origin from psychogenic to neurobiological. For instance, the cerebellum has been implicated in both motor and social functioning, and “cerebellar abnormalities may be a significant factor in explaining the externalizing symptomology of autism (Bass, et al., 2009).”

The following is an example of a study conducted to evaluate the effects of therapeutic horseback riding on individuals with autism spectrum disorders.

“The Effect of Therapeutic Horseback Riding on Social Functioning in Children with Autism”

Purpose

The purpose of this study was to determine the effects of therapeutic horseback riding on social functioning in children with Autism.

Methods

Participants

Thirty-Four children, all of which met criteria for diagnosis of ASD as defined by the DSM-IV-TR, participated in the study. None of these participants had any past experience with horse-related interventions. Upon receiving permission from their doctors to participate in this study, the participants were randomly assigned to either the experimental THR intervention condition or to the waitlist control condition.

Measures

The Social Responsiveness Scale (SRS) and the Sensory Profile (SP) were used to assess social functioning before and after the THR intervention. Pre-test measures were distributed to parents of all participants before initiation of the THR intervention. Post-test evaluations were completed at the end of the 12 week intervention.

Social Responsiveness Scale

The Social Responsiveness Scale (SRS) is a type of questionnaire that measures the detrimental impact of ASD in terms of social functioning. In particular, it evaluates multiple dimensions of social functioning. In this particular study, the SRS was used to assess social functioning in children with ASD over the following dimensions: social awareness, social cognition, and social motivation. “According to the SRS manual, social awareness is operationally defined as the ‘ability to pick up on social cues;’ social motivation is defined as ‘the extent to which a respondent is generally motivated to engage in social interpersonal behavior;’ and social cognition is defined as ‘expressive social communication (Bass, et al., 2009).’” The reliability and validity of the SRS has been established.

Sensory Profile

The Sensory Profile (SP) is another type of questionnaire that measures overall social functioning as well as impairments in sensory processing, modulation, and behavioral and emotional responses. The SP also measures various domains of social functioning. In this particular study, the SP was used to measure social functioning in children with ASD over the following domains: fine motor/perception, sensory seeking, attention and distractibility, sensory sensitivity, and sedentary. The reliability and validity of the SP has also been established.

Procedure

Each child in the experimental THR intervention group participated in a 1-hour long therapeutic riding session per week for the duration of 12 weeks.The THR sessions consisted of mounting and dismounting, exercises, riding skills, mounted games, and horsemanship activities. Upon completion of the THR intervention, the parents of all participants completed both post-test assessments.

Mounting/Dismounting

The first 5 minutes of the session focused on mounting and dismounting. The instructor provided verbal step-by-step instructions. Through this activity, researchers aimed to stimulate verbal communication.

Exercises

After mounting the horse, subjects performed multiple warm-up exercises for approximately 10 minutes, including arm circles, trunk twists, and toe touches in order to stretch and prepare their bodies for the physical demands of horseback riding. The trained side walkers provided verbal and/or physical assistance as necessary.

Riding Skills

The subjects participated in 15 minutes of riding skills, which were aimed at stimulating sensory seeking as well as gross and fine motor domains, including balance and coordination. Such riding skills included directed and open guided reining as well as upward and downward transitions. Once the participants learned how to perform these riding skills, they were then instructed to verbalize these commands, or to use sign language for those who were nonverbal. The participants also completed several exercises aimed at improving planning and spatial reasoning. During these exercises, participants were instructed to guide their horse about obstacles and simultaneously maintain position on the horse.

Mounted Games

After learning the necessary riding skills, subjects participated in riding games, including “Simon says” and “red light/green light.” These activities encouraged social communication among the participants, the volunteers, and the instructor.

Horsemanship Activities

At the end of the intervention, the participants were instructed on how to properly care for a horse, including what tools are used when grooming and bathing a horse.

Results

Results indicated a significant effect of THR on overall SP and SRS scores when the pre- and post-tests of those in the experimental condition were compared. Results indicated a significant effect of THR on the following domains targeted by the SP: sensory seeking, attention and distractibility, sensory sensitivity, and sedentary. There existed no significant effect of THR on the fine motor/perceptual domain of social functioning. Results also indicated a significant effect of THR on the social motivation dimension of the SRS. No significant effects of THR on the social cognition or social awareness dimensions of the SRS were identified. There existed no difference in the pre- and post-tests of those in the control group for either questionnaire. Together, these findings suggest that observed improvements were the result of the THR intervention.

Discussion

The results of this study suggest that THR may be an effective form of treatment for children with autism spectrum disorders. In particular, participants exhibited improvements in social motivation and sensory sensitivity. Decreased sedentary behaviors as well as decreased inattention and distractibility were also observed.
Children that participated in the THR intervention may have perceived the experience of riding a horse as quite enjoyable and this perception, in turn, may account for the increased levels of social engagement and motivation observed in the study.

Furthermore, “because interaction with a horse demands a high level of active and physical engagement (Bass, et al., 2009),” this experience may have been very stimulating to the participants. In particular, the stimulating presence of and interaction with the horse may have compelled participants to engage in more physically engaging activities over that of their usual sedentary activities, and in turn, may account for the significant effects of treatment on the measure of sedentary behaviors observed in the study.

It is possible that THR, which emphasizes motor control and social engagement, lead to the stimulation of the cerebellum of the participants. This cerebellar stimulation in turn may account for the significant effects of treatment on measures of social motivation, sedentary behaviors, and sensory seeking obtained in the study.

The structure of the intervention may also have contributed to the participants’ improved attention and maintenance of focus demonstrated in the study. During the THR sessions, participants were instructed to listen and to observe, to verbalize commands, and to demonstrate knowledge of shapes and horse anatomy. This may have encouraged consistent active participation, and thus, a sustained level of directed attention and focus.

The results revealed a lack of significant treatment effects on fine motor/perceptual skills, social cognition, and social awareness. It may require longer sessions, more sessions per week, and/or extended intervention (i.e. more than 12 weeks) to observe significant effects of THR intervention on such domains of social functioning.

There were several limitations to this study. One limitation to this study includes the lack of information concerning medication regimens. In particular, the researchers did not make note of how many children were on medication during the intervention nor was it noted what type and dosage of medication they were prescribed. The medication could have resulted in the improvements in social functioning rather than the THR intervention. In general, a lack of control over confounding and/or extraneous variables presents challenges in determining the true effects of THR on the children. Particularly, a lack of information addressing these variables makes it difficult to determine if the observed results are indeed a consequence of the THR intervention.

An increase in length and number of sessions should be implemented in future studies. Certain significant treatment effects may require more time to develop and thus, may arise in the event that sessions are extended. Furthermore, further research can test the effects of extensions in length and number of sessions on the degree of improvements in social functioning, specifically, if longer and more frequent sessions demonstrate even greater improvement in social functioning than that which has already been established in sessions of shorter duration.

Bass, M. M., Duchowny, C. A., & Llabre, M. M. (2009). The effect of therapeutic horseback riding on social functioning in children with autism, Journal of Autism and Developmental Disorders, 39, 1261-1267.

Conclusion

Other studies have also verified the beneficial effects of THR on individuals with impairments in functioning. For instance, parents and teachers have noted improvement in behaviors of children with ASD following THR (Ward et al., 2013). In addition, studies have also revealed that THR improves relationships, increases confidence and self-esteem, and provides significant enjoyment to individuals suffering from schizophrenia or schizoaffective disorder (Corring, et al., 2013).

Many studies employ qualitative reports of measurements and lack standardized quantitative measures evaluating the effects of THR however. Future research should construct valid and reliable quantitative measures to measure the effects of THR and in turn, compare such observations to those obtained through qualitative measures. Many studies also lack a control condition. Future research studies should include a control group to which they can compare the effects of THR intervention on the experimental group.

Furthermore, there exists little understanding of the human-animal function characteristic of THR. Dr. Temple Grandin asserts that animals, including horses exhibit common learning styles demonstrated by individuals with impaired social functioning. Grandin’s observations suggest that there may be something unique about animal interactions, particularly in AAT (Gabriels, et al., 2012). Further scientific exploration is warranted.

References

Bass, M. M., Duchowny, C. A., & Llabre, M. M. (2009). The effect of therapeutic horseback riding on social functioning in children with autism, Journal of Autism and Developmental Disorders, 39, 1261-1267.

Choukas-Bradley, S. (2014). Psychology 245: Abnormal Psychology. Chapel Hill: University of North Carolina

Corring, D., Lundberg, E., & Rudnick, A. (2013). Therapeutic horseback riding for ACT patients with schizophrenia. Community Mental Health Journal, 49(1), 121-6. doi:http://dx.doi.org/10.1007/s10597-011-9457-y

Gabriels, R. L., Agnew, J. A., Holt, K. D., Shoffner, A., Zhaozing, P., Ruzzano, S., et al. (2012). Pilot study measuring the effects of therapeutic horseback riding onschool-age children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 6, 578-588.

Ward, S. C., Whalon, K., Rusnak, K., Wendell, K., & Paschall, N. (2013). The Association Between Therapeutic Horsback Riding and the Social Communication and Sensory Reactions of Children with Autism. Journal of Autism and Developmental Disorders. September 2013, Volume 43, Issue 9, pp 2190-2198.

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