Equine-Facilitated Learning for Youths with Severe Emotional Disorders: A Quantitative and Qualitative Study

Effectiveness of animal-assisted activities and therapies for autism spectrum disorder: a systematic review and meta-analysis

Background

Given the rising interest in complementary therapeutic strategies for autism spectrum disorder (ASD), this research aims to provide a comprehensive analysis of the impact of animal-assisted activities and therapies (AAAT) on various ASD symptoms.

Methods

A meticulous search of databases, including Scopus and PubMed, was conducted to gather relevant research on AAAT for ASD. This process led to the selection of 45 studies encompassing 1,212 participants. The chosen studies were then subjected to a meta-analysis to evaluate the efficacy of AAAT in alleviating core ASD symptoms.

Results

The meta-analysis revealed significant improvements in several core ASD symptoms due to AAAT. Notably, there were improvements in social communication (MD = -4.96, 95% CI [-7.49, -2.44]), irritability (MD = -2.38, 95% CI [-4.06, -0.71]), hyperactivity (MD = -4.03, 95% CI [-6.17, -1.89]), and different word usage skills (MD = 20.48, 95% CI [7.41, 33.55]). However, social awareness (MD = -1.63, 95% CI [-4.07, 0.81]), social cognition (MD = -3.60, 95% CI [-9.36, 2.17]), social mannerisms (MD = -0.73, 95% CI [-2.55, 1.09]), social motivation (MD = -1.21, 95% CI [-2.56, 0.13]), lethargy (MD = -1.12, 95% CI [-3.92, 1.68]), and stereotypical behaviors (MD = -0.23, 95% CI [-1.27, 0.80]) did not significantly improve.

Conclusion

The study demonstrates the potential of AAAT in improving certain core symptoms of ASD, such as social communication, irritability, hyperactivity, and word usage skills. However, the effectiveness of AAAT in other ASD symptom domains remains uncertain. The research is limited by the absence of long-term follow-up data and a high risk of bias in existing studies. Therefore, while the findings indicate the promise of AAAT in specific areas, caution is advised in generalizing its efficacy across all ASD symptoms.

Does Equine Interaction Facilitate Emotional Safety and Learning for College Students within an Agricultural-Based Classroom?

Effective teaching requires an educational environment that promotes learning, and yet, developing such an environment can be challenging within today's agricultural-based classroom for educators due to the trend to a more virtual teaching format and less hands-on learning. Animal interaction, particularly equine activities, has been shown to assist educators in the development of an emotionally safe environment for promoting learning. However, research is lacking as to whether the interaction with the animal needs to be direct or indirect within the collegiate educational environment to observe benefits. Therefore, the objective of this study was to determine the impact of equine interaction, both direct and indirect, within an educational environment on the emotional safety and learning for the college student within the agricultural-based classroom. Three course types were observed within the agricultural-based educational environment that included courses with no equine interaction (Group A) and courses with equine interaction, both direct (Group B) and indirect (Group C) interaction with the horse. Indirect interaction included items such as observation of equine handling via a video or gaining knowledge from reading online materials, but not engaging in direct, hands-on activities with the horse. Development of emotional safety within the students enrolled within these courses was measured using a self-reporting emotional safety evaluation. Due to the structure of the scale, a decrease in emotional safety indicated a positive change. Learning, both development of semantic and procedural memory, was measured using a student-completed knowledge examination and an instructor-completed skill evaluation, respectively. While significant improvement in emotional safety was not observed within any of the course types, a weak negative correlation was found between emotional safety and semantic memory for students enrolled in equine courses, both direct (R = -0.55, R2 = 0.28) and indirect (R = -0.25, R2 = 0.06) interaction, finding as emotional safety scores lowered to the ideal range that knowledge improved. In addition, students within equine courses showed semantic memory development in specific areas of equine sciences (Group B: Grooming/Tacking, p = 0.03; Group C: Equine Behavior, p = 0.04) and direct equine interaction resulted in development of equine-based procedural memory in all four skill areas measured within the study (p = 0.00). As such, learning is promoted through equine interaction, whether direct or indirect interaction, within the agricultural-based classroom, suggesting that both forms of equine interaction can be a valuable educational tool for the instructor within the collegiate setting.

Nature-based interventions for vulnerable youth: a scoping review

Nature-based interventions hold promise for vulnerable youth experiencing mental, emotional, developmental, behavioral, or social difficulties. This scoping review examined wilderness therapy, animal assisted therapy, care farming, and gardening and horticultural therapy programs to raise awareness and guide future development of research and treatment options. Studies included in this review were identified through a systematic search of the literature informed by a scoping review framework. Studies were examined by design, sample, intervention, and key findings. The majority of studies were quantitative using repeated measures designs and were conducted primarily in the United States. Sample sizes were generally small. Interventions were residential and community based with varying degrees of duration. Outcomes were largely positive across a wide range of psychosocial and behavioral measures and often maintained post-treatment. We emphasize the importance of robust empirical designs, comprehensive description of the interventions and surrounding therapies, and identification of target groups.

Use of Equine-Assisted Services to Improve Outcomes Among At-Risk and Indigenous Youth: A Scoping Review

Equine-assisted services (EAS) are gaining popularity as ways to promote psychological health and social well-being. EAS may show particular promise as culturally appropriate initiatives for at-risk Indigenous youth, as they are thought to align well with Indigenous ways of knowing which place emphasis on relationships between the land and all living beings. We seek to better understand previous uses of EAS as initiatives for at-risk youth populations, including Indigenous populations, and learn about which outcomes have been addressed in the literature with an EAS initiative by conducting a scoping review. The review focused on initiatives targeting at-risk youth aged 10-18 years of age in Canada, Australia, New Zealand, and the United States. A total of 27 studies were included in the final analysis from all target countries except New Zealand. The target populations were further divided into four subgroups: at-risk youth, youth with mental health disorders and/or learning disabilities, youth survivors of trauma/abuse, and at-risk Indigenous youth. Overall findings of the review suggest EAS are promising approaches for achieving therapeutic and learning goals with the potential to be successful with both Indigenous youth and at-risk youth more broadly.

The Nguudu Barndimanmanha Project-Improving Social and Emotional Wellbeing in Aboriginal Youth Through Equine Assisted Learning

Background: Recent statistics have painted a grim picture for Australia's Aboriginal youth, with reports of higher levels of almost every health indicator, including depression, sexual and emotional abuse, unemployment, and incarceration. Traditional western based therapies have proven to have limited effectiveness in engaging this group as they can often be culturally inappropriate. International studies have provided promising results using equine assisted learning, with a sound methodological basis underpinned by Indigenous ways of being and doing. In Australia Aboriginal people have strong historical ties to horses through their work on stations and were often considered some of the country's best horsemen and women. While equine assisted learning programs exist in Australia there are currently none catering specifically to Aboriginal youth, run and staffed by Aboriginal staff and provided in a culturally secure manner.

Aims: Alternative therapy for Aboriginal youth in the areas of grief, loss, and trauma, through an equine assisted learning program that focussed on self-concept, self-regulation, self-awareness, anxiety and depression, and sense of connectedness.

Methods: Participants (N = 270) aged 6–25 years old engaged in a minimum of 6-weeks of equine assisted learning. Each session was 45–50 min duration and occurred on a weekly basis. Sessions were undertaken individually, in pairs and in groups, depending on the needs of the participant and the focus of the session goals. Qualitative examination of the participants included photography to capture the lived experiences of the participants throughout the program. In addition an cultural and age appropriate adaptation of the Strength and Difficulties Questionnaire was trialed to track changes quantitively.

Conclusion: We observed improvements in self-regulation, self-awareness, and socialization skills, evident from the photography recording and the questionnaire data. In addition parent and/or caregiver and teacher reported changes in behavior, self-regulation, and socialization skills were recorded.

Benefits of Hippotherapy and Horse Riding Simulation Exercise on Healthy Older Adults: A Systematic Review

OBJECTIVE

To provide an up-to-date research analysis on equine-assisted therapies and horse riding simulation exercise in older adults, and to suggest future directions in clinical practice and research. TYPE: Systematic review.

LITERATURE SURVEY

A comprehensive search of studies was performed in 4 electronic databases (Cochrane, PubMed, PEDro, and Web of Science) regarding the effects of equine-assisted therapies and horse riding simulation exercise in older adults. Eight articles were selected, 5 of them focused on hippotherapy, 2 on horse riding simulation, and a single article that used the 2 types of therapy.

METHODOLOGY

PRISMA guidelines were followed for the data extraction process.

SYNTHESIS

The studies were all randomized controlled trials, but not double-blind, so they were classified as level of evidence B. Duration of hippotherapy programs ranged from 8-12 weeks. Sessions lasted between 15 and 60 minutes and were performed 2-5 times per week. Interventions using a horse simulator spanned 8 weeks and were conducted for 20 minutes 5 times per week.

CONCLUSIONS

Results indicate that hippotherapy might improve balance, mobility, gait ability, and muscle strength, as well as could induce hormonal and cerebral activity changes in healthy older adults. Benefits of horse riding simulation could be limited to physical fitness and muscular activity.

LEVEL OF EVIDENCE

I.

Brief Report: The Effects of Equine-Assisted Activities on the Social Functioning in Children and Adolescents with Autism Spectrum Disorder

Equine-assisted activities and therapies are increasing in popularity for treatment of ASD symptoms. This research evaluated effects of a 5-week programme of therapeutic riding on social functioning of children/adolescents (N = 15) with ASD. The effectiveness of the programme was evaluated using the autism spectrum quotient, the Vineland Adaptive Behaviour Scale and the empathising and systemising quotient. Results established that the TR intervention increased empathising and reduced maladaptive behaviours. The findings also indicated that specific adaptive behaviours like socialization and communication were not affected by the intervention. Thus, a complex picture of the effects of this intervention emerges: while TR does not change all of the child’s behaviour, it can improve specific aspects of social functioning and also reduce maladaptive ASD traits.

Hippotherapy and neurofeedback training effect on the brain function and serum brain-derived neurotrophic factor level changes in children with attention-deficit or/and hyperactivity disorder

PURPOSE

The purpose of this study was to investigate the effect of hippotherapy and electroencephalography (EEG) neurofeedback on brain function and blood brain-derived neurotrophic factor (BDNF) level in children with attention-deficit or/and hyperactivity disorder (ADHD).

METHODS

Sixteen children with ADHD participated in this study and were randomly divided into 2 groups, a 1-time hippotherapy group (W1G, n = 8) and a 2-time hippotherapy group (W2G, n = 8). All the participants attended 8 weeks of hippotherapy program in the primary training, and then 7 children with ADHD attended 8 weeks of hippotherapy program combined with neurofeedback training in the secondary training. Blood BDNF levels were measured, and functional magnetic resonance imaging (fMRI) was performed. The EEG neurofeedback training program was used to train and measure psychological factors.

RESULTS

The combined effect of hippotherapy and neurofeedback on BDNF level showed a decreased tendency in W1G (pretraining, 1766.03 ± 362.54 pg/ml; posttraining, 1630.65 ± 276.70 pg/ml). However, the BDNF level of W2G showed an increased tendency (pretraining, 1968.28 ± 429.08 pg/ml; posttraining, 1976.28 ± 425.35 pg/ml). Moreover, combined training showed a significant group x repetition interaction in W1G (pretraining, 1436.57 ± 368.76 pg/ml; posttraining, 1525.23 ± 346.22 pg/ml; F = 3.870, p = 0.039). fMRI results showed that the left thalamus activity in both groups had a decreased tendency and a significantly lower change in W2G than in W1G (p < 0.05).

CONCLUSION

This study confirmed a significant increase in blood BDNF level after combined training, which may induce brain function improvement in children with ADHD.

Exploring the Role of Farm Animals in Providing Care at Care Farms

We explore the role of farm animals in providing care to different types of participants at care farms (e.g., youngsters with behavioural problems, people with severe mental problems and people with dementia). Care farms provide alternative and promising settings where people can interact with animals compared to a therapeutic healthcare setting. We performed a literature review, conducted focus group meetings and carried out secondary data-analysis of qualitative studies involving care farmers and different types of participants. We found that farm animals are important to many participants and have a large number of potential benefits. They can (i) provide meaningful day occupation; (ii) generate valued relationships; (iii) help people master tasks; (iv) provide opportunities for reciprocity; (v) can distract people from them problems; (vi) provide relaxation; (vii) facilitate customized care; (viii) facilitate relationships with other people; (ix) stimulate healthy behavior; (x) contribute to a welcoming environment; (xi) make it possible to experience basic elements of life; and (xii) provide opportunities for reflection and feedback. This shows the multi-facetted importance of interacting with animals on care farms. In this study the types of activities with animals and their value to different types of participants varied. Farm animals are an important element of the care farm environment that can address the care needs of different types of participants.

An open trial of equine-assisted therapy for children exposed to problematic parental substance use

Children exposed to problematic parental substance use (PPSU) often face a number of deleterious developmental outcomes, yet these children are less likely to become known to child protection and welfare services. Although there is a growing evidence base for equine-assisted therapy (EAT) as an effective treatment modality for atypically developing children and adolescents, scant research has explored the benefit of EAT for children exposed to PPSU. The current study is the first to explore the benefit of EAT for children exposed to PPSU in Victoria, Australia. Five 12-week EAT programmes were delivered from 2012 to 2015 with a total of 41 children (mean age of 10.26 years) taking part. Children's parents (n = 41) and schoolteachers (n = 31) completed the Strengths and Difficulties Questionnaire pre- and post-intervention. Parents reported that children's total difficult behaviour and emotional problems decreased following the 12-week EAT programme. In addition, parents and teachers observed a significant decrease in children's hyperactivity. The findings obtained highlight the benefit of EAT for children exposed to PPSU and thus, extends the existing evidence base for this treatment modality.

Equine-Assisted Psychotherapy for adolescents experiencing depression and/or anxiety: A therapist's perspective

Animal-Assisted Interventions (AAIs) are thought to overcome some of the limitations of traditional therapies as they do not rely exclusively on language as a medium for change. One such Animal-Assisted Therapy (AAT) approach involves horses as a therapeutic medium. Equine-Assisted Psychotherapy (EAP) comprises a collaborative effort between a licensed therapist and a horse professional working with clients to address treatment goals. The purpose of the present Australian-based qualitative study was to examine EAP facilitators' perspectives on the biospychosocial benefits and therapeutic outcomes of EAP for adolescents experiencing depression and/or anxiety. The findings suggest a range of improvements within adolescent clients, including increases in confidence, self-esteem and assertiveness, as well as a decrease in undesirable behaviours. The effectiveness of the therapy was thought to be due to the experiential nature of involving horses in therapy. The lack of understanding in the wider community about EAP was seen as a barrier to recognition and acceptance of EAP as a valid therapeutic intervention.

Triads in Equine-Assisted Social Work Enhance Therapeutic Relationships with Self-Harming Adolescents

Despite an increasing number of studies, there is still a lack of knowledge about the unique features that underlie the process in equine assisted social work (EASW). This study aimed to reveal, through qualitative methods, the dyads within the triad that become stronger during the process of EASW, as well as the effect of the participation of the horse on the relationship between the counselor and client. Data were collected through in-depth interviews with nine female self-harming clients aged 15-21 years and eight staff members. The interviews, together with video-recorded human-horse interactions with three staff members and four clients were analyzed, resulting in additional issues answered by these three staff members and four clients in a second interview. Critical dialogues between patterns and fragmentations in the narratives and video-recordings, as well as a dialogue with the participants while they were viewing videos of their own EASW sessions, led to the conclusion that adding a horse qualitatively changes therapeutic relationships in EASW. The different triads consist of different liaisons between actors in the triad, giving rise to unique combinations. The quality of the relationships depends on both the staff and the clients' attachment orientations. Further research is needed to investigate how the degree of emotional connection to the horse affects the impact that horses have on triads in EASW.

Not Just Horsing Around: The Impact of Equine-Assisted Learning on Levels of Hope and Depression in At-Risk Adolescents

Equine-assisted learning (EAL) is an experiential modality which utilizes horses to provide a unique learning experience for personal growth. Research by Damon et al. (Appl Dev Sci 7:119-128, 2003) suggests a positive relationship between hope and positive developmental trajectories. Hagen et al. (Am J Orthopsychiatr 75:211-219, 2005) showed hope to be a protective factor associated with adaptive functioning in at-risk youth. Ashby et al. (J Couns Dev 89:131-139, 2011) found a significant inverse relationship between hope and depression: as hope increases, depression decreases. The current study investigates the impact of a non-riding EAL curriculum entitled L.A.S.S.O. (Leading Adolescents to Successful School Outcomes) on levels of hope and depression in at-risk youth. The study uses an experimental design with longitudinal, repeated measures. Participants were randomly assigned to treatment and control groups. Participants in the treatment received 5 weeks of EAL, while participants in the control group received treatment as usual. Repeated measures ANOVA of participants' levels of hope and depression showed statistically significant improvements in the treatment group as compared with the control group. Even a brief (5-week) intervention of EAL had a positive impact on the lives and attitudes of at-risk adolescents, with increased levels of hope and decreased levels of depression.

Effects of horseback riding exercise therapy on background electroencephalograms of elderly people

[Purpose] This study investigated the effect of horseback riding exercise on the background electroencephalograms of elderly people who performed horseback riding for 8 weeks. [Subjects] Twenty elderly people were divided into the horseback riding exercise and control group (n = 10 each). [Methods] The exercise was performed for 15 minutes, 3 times per week for 8 weeks. Electroencephalograms were analyzed. Post-exercise evaluation was performed after 8 weeks. [Results] After the horseback riding exercise, the relative slower alpha power index was active in the T3 and P4 domains but suppressed in the Fp1, Fp2, F3, F4, T4, and P3 domains. Moreover, the relative faster alpha power index was active in all domains of the horseback riding exercise group but was suppressed in all domains of the control group. There was a significant difference between groups in the F3 domain. [Conclusion] The alpha power index increased significantly after horseback riding exercise, suggesting the exercise improved background electroencephalogram.

Effects of horseback riding exercise therapy on hormone levels in elderly persons

[Purpose] The purpose of this study was to investigate the effect of riding exercise on hormone levels in normal elderly people who were taught horseback riding for 8 weeks. [Subjects] Subjects were classified into an exercise group (n=10) and control group (n=10). [Methods] The two groups, horseback riding exercise group of 10 and control group of 10, were each tested for 15 minutes, 3 times, over 8 weeks. Post-exercise tests were implemented in both groups in the same way as pre-study tests. [Results] The horseback riding group showed a significant difference in the pre- and post-exercise serotonin and cortisol levels. Additionally, serotonin and cortisol levels showed significant differences between the two groups. [Conclusion] Serotonin and cortisol levels significantly increased in the experimental group, suggesting that horseback riding exercise is effective for improving the levels of these hormones.

Effects of hippotherapy on brain function, BDNF level, and physical fitness in children with ADHD

[Purpose]

The purpose of this study was to examine the effects of hippotherapy on brain function and levels of blood-derived neurotrophic factor (BDNF) in children with attention deficit and/or hyperactivity disorder (ADHD).

[Methods]

The hippotherapy group (HRG) included twenty children with ADHD and the control group (CG) included 19 children. All participants’ physical fitness, fMRI brain scans, and blood BDNF levels were measured at baseline and after 32 weeks of participating in hippotherapy.

[Results]

After 32 weeks of participating in hippotherapy, the body fat of the HRG was significantly decreased (-1.12 ± 4.20%) and the body fat of the CG was increased (2.38 ± 6.35%) (p=0.049). There was no significant difference of physical fitness in both groups (p>0.05). Although there was a higher decrease in the activated insular area in the HRG (-1.59 ± 0.99) than in the CG (-1.14 ± 1.41), there was no significant difference between the two groups (p>0.05) Also, there was a higher increase in the activated cerebellum area in the HRG (1.97 ± 1.45) than in the CG (1.92 ± 1.81). However, there was no significant difference between the two groups (p>0.05). BDNF levels showed an increased tendency in the HRG (166.29 ± 277.52pg) compared to the CG (21.13 ± 686.33pg); otherwise, there was not any significant difference in these blood levels between the two groups (p>0.05). It can be assumed that big individual differences in the level of ADHD in the study participants might not cause any significant results, although there might be positive changes in the brain function of children with ADHD.

[Conclusion]

Therefore, this study suggests that hippotherapy training would need to be modified and developed to increase the efficacy of hippotherapy in children with ADHD.

Equine-assisted therapy for anxiety and posttraumatic stress symptoms

We tested the efficacy of the Equine Partnering Naturally(©) approach to equine-assisted therapy for treating anxiety and posttraumatic stress disorder (PTSD) symptoms. Participants were 16 volunteers who had experienced a Criterion A traumatic event, such as a rape or serious accident, and had current PTSD symptoms above 31 on the PTSD Checklist (PCL-S; Weathers, Litz, Herman, Huska, & Keane, ). Participants engaged in tasks with horses for 6 weekly 2-hour sessions. Immediately following the final session, participants reported significantly reduced posttraumatic stress symptoms, d = 1.21, less severe emotional responses to trauma, d = 0.60, less generalized anxiety, d = 1.01, and fewer symptoms of depression, d = 0.54. As well, participants significantly increased mindfulness strategies, d = 1.28, and decreased alcohol use, d = 0.58. There was no significant effect of the treatment on physical health, proactive coping, self-efficacy, social support, or life satisfaction. Thus, we found evidence that the Equine Partnering Naturally(©) approach to equine-assisted therapy may be an effective treatment for anxiety and posttraumatic stress symptoms. Future research should include larger groups, random assignment, and longer term follow-up.

Improving adolescent social competence and behavior: a randomized trial of an 11-week equine facilitated learning prevention program

There is growing evidence that promoting social competence in youth is an effective strategy to prevent mental, emotional, and behavioral disorders in adulthood. Research suggests that programs delivered in collaboration with schools are particularly effective when they target social and emotional skill building, utilize an interactive instructional style, provide opportunities for youth participation and self-direction, and include explicit attempts to enhance youth social competence. A relatively new but popular approach that incorporates these characteristics is human animal interaction, which can be implemented in educational settings. We report the results from a randomized clinical trial examining the effects of an 11-week equine facilitated learning (EFL) program on the social competence and behavior of 5th-8th grade children. Children (N = 131) were recruited through referral by school counselors and school-based recruitment and then screened for low social competence. Researchers randomly assigned children to an experimental (n = 53) or waitlisted control group (n = 60). Children in the experimental group participated in an 11-week EFL program consisting of once-weekly, 90-min sessions of individual and team-focused activities, whereas children in the control group served as a wait-listed control and participated 16 weeks later. Parents of children in both groups rated child social competence at pretest and posttest. Three independent raters observed and reported children's positive and negative behavior using a validated checklist during each weekly session. Results indicated that program participation had a moderate treatment effect (d = .55) on social competence (p = .02) that was independent of pretest levels, age, gender, and referral status. Results showed that higher levels of program attendance predicted children's trajectories of observed positive (β = .500; p = .003) and negative behavior (β = -.062; p < .001) over the 11-week program.

Therapeutic horseback riding outcomes of parent-identified goals for children with autism spectrum disorder: an ABA' multiple case design examining dosing and generalization to the home and community

We examined whether different doses of therapeutic riding influenced parent-nominated target behaviors of children with autism spectrum disorder (ASD) (a) during the session (b) at home, and (c) in the community. We used a single subject multiple Baseline, multiple case design, with dosing of 1, 3, and 5 times/week. Three boys with ASD, 6-8 years of age participated, and counts of target behaviors were collected in each setting and phase of the study. Compared to Baseline, 70% of the target behaviors were better during Intervention and improvement was retained in 63% of the behaviors during Withdrawal. Increased doses of therapeutic riding were significant for magnitude of change, and the effect of the therapeutic riding sessions generalized to home and community.

Exploring salutogenic mechanisms of an outdoor experiential learning programme on youth care farms in the Netherlands: untapped potential?

This study explored how (learning) experiences offered through outdoor experiential programmes, particularly the youth care farm approach, may (or may not) enhance young peoples’ ability to recognise and then utilise available resources for personal growth, protection and health promotion. A total of 11 youngsters were asked to look back on their half-year stay on a care farm in the Netherlands, by using semi-structured interviews to elicit their experiences from a salutogenic perspective. Analysis revealed that several resources (and the interaction of these resources) on the youth care farm worked well for the youngsters; contributed to their personal development and to their sense of coherence: the feeling that the world is or can be meaningful, comprehensible and manageable, associated with positive outcome in endeavours linked to improving health and well-being. In general, the attitude of the farmer, working with animals, the informal atmosphere and being temporarily cut-off from the former environment were elements most positively highlighted by the youngsters. The farm environment was mentioned as calming, however, as structuring as well. The strength of the programme as an experiential learning opportunity appears to be the diversity and richness of resources (and stressors!) available to the participants. This creates various opportunities for learning: making sense, interpreting and giving meaning to resources and stressors. Further research into the impact of this kind of programmes, compared to more ‘traditional’ programmes, especially on the ability of youngsters to use resources to finish school, find employment and develop better relationships with their parents is recommended.

Eating disorders and equine therapy: a nurse's perspective on connecting through the recovery process

Patients with eating disorders may have the most complex interdisciplinary treatment plans of any mental illness. Nurses need innovative evidence-based treatment interventions to assist their patients with eating disorders on their road to recovery. Although much has been written about equine-assisted psychotherapy (EAP) and equine-facilitated psychotherapy, the literature has not described a detailed session that can help nurses understand how this experiential treatment works and the impact it can have on the patient. A review of the literature on eating disorders and on the use of equine therapy in its treatment is presented in this article. In addition, the role of the nurse during equine therapy will be highlighted, and an individual example will provide a detailed review of an EAP session.

Equine-assisted activities and the impact on perceived social support, self-esteem and self-efficacy among adolescents - an intervention study

In this project, we examined the effect of a 4-month intervention with horses on perceived social support, self-esteem and general self-efficacy among Norwegian adolescents aged 12–15 years. The intervention took place at farm-based stables and included work with the horses and riding. A waiting-list crossover design was used and the participants answered questionnaires at three time periods. Study I (N = 49) examined the effect of the intervention compared with the control group. Study II (N = 41) examined the relationship between the same psychological variables and change in mastering skills with horse. The intervention group reported a significant increase in perceived social support compared with the control group. There were no differences in self-esteem and general self-efficacy between the groups. The results from study II showed that a lower level of perceived social support prior to the intervention predicted an increase in mastering skills with the horse during the intervention.

Students With Autism, Service Dogs, and Public Schools

Children with autism spectrum disorder (ASD) increasingly receive assistance from service dogs. Nonetheless, confusion surrounding service dogs for students with ASD has precipitated litigation between parents and schools. The purpose of this review was to examine state laws pertaining to the use of service dogs among children with ASD. Statutes were evaluated to identify all disability classifications eligible to use a service dog, regulations related to the authorized training of service animals, and school access for service animals. Results suggest that current state laws do not facilitate the use of service dogs by children with ASD or provide sufficient guidance for parents and schools. Recommendations for policy follow a discussion of the results.

Equine-facilitated psychotherapy for at-risk adolescents: the influence on self-image, self-control and trust

This article describes the theoretical-conceptual frame of equine-facilitated psychotherapy (EFP) for adolescents at-risk, the unique components of this intervention, and its implementation in an evaluation study. The study was conducted at a residential treatment facility for adolescents at-risk. We examined the outcomes of EFP on self-image, self-control, trust and general life satisfaction. Fourteen resident adolescents comprised the treatment group, and were compared with a matched group of 15 residents who did not receive EFP (control). The treatment comprised a weekly individual EFP session over a period of seven months. The study found a trend of positive change in all four research parameters within the treatment group. Additional indications of the intervention's positive influence were also found and are discussed.