Evidences of Therapeutic Horseback Riding in Autism
Spectrum Disorder
Jéssica Jaíne Marques Oliveira- UFSM
Fernando Copetti- UFSM
Carlo Schmidt –
UFSM
Mylena Alcantara Medeiros- U of M
Abstract
Besides psychoeducational and psychopharmacological approaches to treating the symptoms of Autism Spectrum Disorder (ASD), there are some less traditional treatment modalities. Therapeutic Horseback Riding (THR) is a large method used around the world for several physical and psychological diseases. The goal of THR is to promote physical, emotional, cognitive and social growth of the riders. In the ASD riders, the evidences rely on the belief that being around, grooming, working with the horse, as well as riding the horse can promote these benefits. Rigorous scientific evidence of any form of treatment is necessary for verification and reliability of its benefits. This poster presents an overview of the major evidences of the THR in ASD. The purpose is to show to families, educators and public politicians that THR can be an important and reliable practice to be incorporated in the routine of the person with ASD. A systematic review was conducted in eight databases. Thirty four eligible papers were found, and nine peers reviewed selected to analysis according inclusion and exclusion criterions. The main results observed were in social communication (Ward et al. 2013),
sensory processing (Ward et al. 2013; Kern et al. 2011), ASD’s severity of symptoms
research is necessary.
Keywords: Autism, Horseback Riding Therapy, Hippotherapy
Introduction
The term Pervasive Developmental Disorders emerged in the early 1980s, in the DSM-III (APA, 1980). In the latest update, the DSM-5 defined this nosological entity as Autism Spectrum Disorders (ASD), recognizing that people may have different levels of impairment within the spectrum. The DSM-5 adopts a dimensional perspective of the disorder which overlaps the old categorical approach, based on the notion that a single condition would better reflect the different levels of severity of symptoms. The essential characteristics of Autism Spectrum Disorder consist of a markedly abnormal
or impaired development in socio-communicative areas and the presence of restricted and stereotyped repertoire of behaviors, activities and interests (APA, 2013).
Early intervention programs that focus on the development of the individual with ASD rely on different theoretical perspectives, such as the behavioral (e.g. ABA - Applied Behavior Analysis), psychoeducational (e.g. TEACCH - Treatment and Education of Autistic and Communication Handicapped Children) or developmental ones (e.g. Play Project). Studies show that these programs tend to have positive results, helping to lower the frequency and/or quality of undesirable behaviors, causing improvements in communication, as well as providing autonomy and independence to the child (Simpson, 2005).
A therapy that has been gaining ground as a treatment for people with ASD is Hippotherapy. It is characterized by the use of the horse within an interdisciplinary approach (ANDE Brasil, 2013). Although the more consolidated evidences of this practice are related to physical-motor aspects, studies on the social and behavioral variables have also substantially grown in the recent years. In particular, the studies on ASD patients receiving hippotherapy showed improvements in several areas of development such as interaction, communication, and affection, among others (Gabriels et al, 2012).
By identifying the importance of the benefits produced by hippotherapy in people with ASD, it is possible to see the need to examine in the literature the evidences already found on this topic. Thus, the aim of this study was to review the evidences of the benefits of hippotherapy for the individual with Autism Spectrum Disorder.
Method
A systematic search was conducted in the HOMEOINDEX databases, Portal Periódico Capes (CAPES Scientific Journals Gateway), COCHRANE, PEDro, LILACS, SCOPUS, WEB of SCIENCE PUBMED and SCIELO. The keywords used were: "developmental riding therapy", "equine-movement therapy", "therapeutic horseback riding", "riding for disabled", "therapeutic horse riding", "equoterapia", "equine-therapy", "horseback riding "equine-therapy", "riding "equine-therapy", "hippo"equine-therapy", "equitherapy', "animal-assisted therapy". All searches were associated with the word
than ASD. Nine articles were analyzed. A summary of the studies is presented in table 1 below.
Table 1- Study characteristics and main outcomes Study Sample Size Intervention Assessments/Measusres Main results
Study Sample Size
Intervention Assessments/Measures Main results
BASSetal.
Social Responsiveness Scale (SRS)
Improvements in:
- The overall sensory profile;
- Distraction/lack of attention;
Aberrant Behavior checklist- Community (ABC-C)
Vineland Adaptive Behavior Scale- II (VABS II)
Bruininks-Oseretskytestof motor proficiency (BOT II) Sensory Integration and Praxis test (SIPT)
Improvements in adaptative language expressive skills, motor skills, and praxis/motor verbal planning skills.
- Parent- rated measures - Clinician-rated measures - Childhood Autism rating scale (CARS)
-T imberlawnparent-child interaction scale
- Sensory profile
- General reduction in scores of CARS (Rating Scale for Childhood Autism).
- Reduction of negative
considerations and mood
improvement
- Significant improvements in
t he subject’s quality of life.
LEITÃO(200
M EMISHEVI KJand HODZHIKJ (2010)
GP 2 10 Weeks 1x Week
Autism Treatment Evaluation Checklist (ATEC)
-T wo subjects had improvements in the areas of language, socialization, cognitive/sensory and health/behavior awareness.
-T wo subjects showed no changes.
TABARES et al. (2012) GP 8 04 Weeks
1x Week
E lectro-chemo-luminescence (ELISA)
I mprovementsinsocial attitudes.
TAYLORet al. (2009) GP 3 16 Weeks
1x Week
PediatricVolitional Questionnaire (PVQ)
I mprovementsinchildren's volition.
WARD et al. (2013) GP 21 30 Weeks
1x Week
G illian Autism rating Scale 2 (GARS 2) SensoryProfileschool
C ompanion (SPSC)
- Decrease in the severity of symptoms associated with Autism; - Increased social interaction and sensory processing.
K EINO et al. (2009) GP-4 UN Humans- Equips- Interaction on mental activity (HEIM scale)
I ncreasedeyecontact, language skill
Among the studies found which use intervention and insertion of a hippotherapy program with individuals with autism spectrum disorder, all report that through the practice of hippotherapy with activities planned for the subjects with autism, there are
gains in these subjects’ behavioral and developmental areas, as well as several other aspects that are directly and indirectly modified (Gabriels et al 2012, Keino et al 2009, Memishevikj., & Hodzhikj 2010, Kern et al 2011,Tabares et al 2012, Taylor et al 2009, Ward et al 2013, Bass et al 2009, Leitão 2004.)
The studies also identify the gains of self-regulation (irritability, lethargy, stereotyped behavior and hyperactivity), adaptative language expressive ability, motor skills and praxis and motor verbal planning skills (Gabriels et al 2012), increased eye contact (Keino et al 2009), socialization, cognitive and sensory awareness (Memishevikj., & Hodzhikj , 2010), quality of life, parents /children interaction (Kern et al, 2011) and significant improvements in social attitudes (Tabares et al, 2012).
References
Associação Brasileira De Equoterapia (2013). Brasília: ANDE-Brasil; Consultado em 13 de Maio de 2013 através de: http://www.equoterapia.org.br/objetivos.php
American Psychiatry Association (1980). Diagnostic and statistical manual of mental disorders, (3rd ed.). APA, Washington.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). APA, Washington.
Bass, M.M, Duchowny, C.A, & Llabre, M.M. (2009). The Effect of Therapeutic Horseback Rinding on Social Functioning in Children with Autism. Journal Autism Dev. Disord 30:1261-1267 DOI 10.1007/s10803-009-0734-3
DSM IV Tr- (2013). Diagnostic and Statistical Manual of Mental Disorders-Text Revie Wil Psicologia. PT, Consultado em 05 de Junho de 2013 através de: http://www.psicologia.pt/instrumentos/dsm_cid/dsm.php.
Gabriels, R.L., Agnew,J.A., Holt,K.D., Shoffner, A., Zhaoxing, P., Ruzzano, S., Clayton, G. H., & Mesibov G. (2012). Pilot study measuring the effects of therapeutic horseback riding on school-age children and adolescents with autism spectrum disorders. Res Autism Spect Dis 6, 578-588
Keino, H., Funahashi, A., Keino, H., Miwa, C., Hosokawa, M., Hayashi, Y., & Kawakita, K. (2009). Psycho-educational Horseback Riding Communication Ability of Children with Pervasive Developmental Disorders. J. Equine Sci. Vol 20, Nº 4 pp 79-88, Kern, J.K., Fletcher, C.L., Garver, C.R., Mehta, J.A., Grannemann, B.D., Knox, K.R., Richardson, T.A., & Trivedi, M.H. (2011). Prospective trial of equine-assisted activities in autism spectrum disorder. Altern Ther Health Med 17, 14-20
Leitão, L.G. (2004). Relações terapêuticas: Um estudo exploratório sobre Equitação Psico-Educacional (EPE) e autismo. Análise Psicológica 2 (XXII):335-354
Leitão, L. G. (2008). Sobre a equitação terapêutica: Uma abordagem crítica. Análise Psicológica, - 1 (XXVI): 81-100
Memishevikj,h.; & Hodzhikj, The effects of equine-assisted therapy in improving the psychosocial functioning of children with autism. (2010) Center for education and
rehabilitation “Mjedenica”.
Simpson, R. L. (2005). Evidence-based practices and students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 20(3), 140-149. Tabares, C., Vicente, F., Sánchez, S Aparicio, A., Alejo, S., & Cubero, J. (2012. Quantification of Hormonal Changes by Effects of Hippotherapy in the Autistic Population. Neurochemical Journal, Vol.6, No. 4, pp. 311–316. © Pleiades Publishing, Ltd., 2012.
Taylor,R.R., Kielhofner, G., Smith, C., Butler, S., Cahill, S.M., Ciukaj, M. D., & Gehman, M. (2009). Volitional Change in Children with Autism: A single-Case Design Study of the Impact of Hippotherapy on Motivation. Occupational Therapy in Mental Health, 25:193-200
