Effectiveness of a Standardized Equine-Assisted Therapy Program for Children with Autism Spectrum Disorder

Exploring the Human-Animal Interaction (HAI) for Children with ASD Across Countries: A Systematic Review

Human-Animal Interaction (HAI) has been widely adopted as an approach to enhance the well-being of children with ASD, who often experience significant social impairments, emotional dysregulation, and other daily challenges. Given the potential variation of HAI across countries, there is a particular need to explore this phenomenon within different cultural contexts and to illuminate directions for facilitating positive HAI among children with ASD. The purpose of this review is to systematically synthesize the current knowledge of HAI as applied to children with ASD and to discuss possible variations across different cultural contexts. A systematic database search was conducted to synthesize HAI characteristics from existing studies that met the selection criteria. The results highlighted that most of the selected studies (N = 97) were conducted in Europe or the United States. The most common format of HAI identified was animal-assisted intervention, followed by pet ownership. Dogs and horses were the primary animals involved in HAI for children with ASD, while the majority of HAI occurred in home settings and at horse riding or training centres. To conclude, this review provides a more comprehensive lens for understanding the phenomenon of HAI for children with ASD across different countries and discusses cultural variations in terms of the companion animals involved, the formats, and the settings of HAI. It also offers therapeutic insights into the multicultural aspects of HAI, which may shed light on future interventions for children with ASD through HAI in more diverse settings.

Physical activity and executive functions in children and adolescents with neurodevelopmental disorders: A systematic review and meta-analysis

OBJECTIVE

The current study aimed to examine the effects of physical activity interventions on executive functions in children and adolescents with neurodevelopmental disorders and to identify possible moderators and the interactions among moderators.

METHODS

Six databases (Web of Science, PsycINFO, SPORTDiscus, MEDLINE, CINAHL, and ERIC) were searched from inception to January 2024. Randomized controlled trials/quasi-experimental designs applying physical activity interventions and reporting at least one executive function outcome in children and adolescents with neurodevelopmental disorders were included. Random multilevel meta-analyses and moderator analyses were conducted in 2024.

RESULTS

Thirty-nine studies were included, 35 of which were used for meta-analysis. The findings indicated that physical activity interventions elicited significant benefits for overall executive functions (Hedges' g = 0.60) and its subdomains: cognitive flexibility (Hedges' g = 0.60), inhibitory control (Hedges' g = 0.55), working memory (Hedges' g = 0.40), and higher-level functions (Hedges' g = 0.83). Session duration, number of intervention weeks, total session, and total duration were identified as moderators. The interactions among session duration, physical activity type, total duration, frequency, and executive function subdomains were also observed.

CONCLUSIONS

Physical activity interventions could serve as an alternative or adjunctive method to promote multiple aspects of executive functions in children and adolescents with different types of neurodevelopmental disorders. However, physical activity, especially the type, session duration and frequency, should be carefully designed to produce significant effects when targeting different domains of executive functions in this population.

Comparative effectiveness of physical activity interventions on cognitive functions in children and adolescents with Neurodevelopmental Disorders: a systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

Physical activity (PA) interventions have been shown to yield positive effects on cognitive functions. However, it is unclear which type of PA intervention is the most effective in children and adolescents with Neurodevelopmental Disorders (NDDs). This study aimed to compare the effectiveness of different types of PA interventions on cognitive functions in children and adolescents with NDDs, with additional analyses examining intervention effects across specific NDD types including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

METHODS

In this systematic review and network meta-analysis, seven databases (Web of Science, PubMed, Medline, APA PsycINFO, Embase, CINAHL, and SPORTDiscus) for randomized controlled trials from database inception to September 2023 were searched. Randomized controlled trials comparing the effectiveness of PA intervention with any non-pharmacological treatment or control group on cognitive functions in children and adolescents diagnosed with NDDs aged 5-17 years were included. Frequentist network meta-analyses were performed based on standardized mean differences (SMD) using random effects models to examine post-intervention differences in cognitive functions, including attention, memory, and executive functions. Intervention dropout was assessed as a measure of treatment acceptability.

RESULTS

Thirty-one randomized controlled trials (n = 1,403, mean age 10.0 ± 1.9 years) with 66 arms were included in the network. Mind-body exercise (MBE; SMD = 1.91 for attention; 0.92 for executive functions), exergaming (SMD = 1.58 for attention; 0.97 for memory; 0.94 for executive functions), and multi-component physical activity (MPA; SMD = 0.79 for executive functions) were associated with moderate to substantial cognitive improvements compared with usual care, whereas the effectiveness of aerobic exercise (AE) was non-significant. Exergaming (SMD = 0.78, 95%CI 0.12 to 1.45) and MPA (SMD = 0.64, 95%CI 0.11 to 1.18) were more effective than AE for executive functions. When analyzing specific NDD types, exergaming lost its superiority over usual care for attention and memory in ADHD, nor for executive functions in ASD. Instead, MPA demonstrated significant benefits across these domains and populations. The certainty of evidence for these comparisons was very low to low. No significant differences in acceptability were observed among MBE, exergaming, and MPA.

CONCLUSIONS

The findings in this study suggest that MBE, exergaming, and MPA were effective interventions for improving domain-specific cognitive functions in children and adolescents with NDDs. AE demonstrated non-significant effectiveness for all outcomes. MBE emerges as particularly advantageous for attention. MPA yielded consistent improvements in memory and executive functions across NDD types. Further high-quality randomized controlled trials of direct comparisons are needed to confirm and expand on the findings from this NMA.

TRIAL REGISTRATION

PROSPERO CRD42023409606.

Heart rate and salivary cortisol as indicators of arousal and synchrony in clients, therapy horses and therapist in equine-assisted therapy

BACKGROUND

This exploratory study aimed to analyse physiological interaction processes in equine-assisted-therapy (EAT) between client, therapy horse and therapist.

METHODS

We measured heart rate (HR), heart rate variability (HRV) and cortisol levels before, during and after a standardized therapy session and a control condition in one therapist, four therapy horses and ten female clients in emerging adulthood (Mn = 21.8 years, SD = 3.39). The clients were diagnosed with mild (N = 5) to moderate (N = 5) intellectual disability (ID).

RESULTS

There was no significant change in the client's HR, HRV and cortisol levels during an EAT session. No difference was observed between therapy sessions with or without a therapy horse, except during the challenge phase of the EAT protocol, where clients had a significantly lower HR when interacting with the therapy horse. HR between therapist and client correlated significantly, as well as between therapist and horse. This effect was greater when therapists interacted with a familiar horse. Clients' and horses' HRs also correlated, but only when the horse was the clients' familiar and preferred horse.

CONCLUSIONS

These results indicate that relationship intensity is an important factor for the synchronization process. Moreover, the inclusion of horses in a therapeutic setting can lead to a decreased HR in young adults with intellectual disability while mastering a challenge. Future research should investigate this potential benefit of EAT, considering the reciprocal influences and the relationship between client, therapist and horse.

Effectiveness of Equine-Assisted Activities and Therapies for Children with Autism Spectrum Disorder: An Update

BACKGROUND/OBJECTIVES

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition requiring personalised therapeutic approaches. This study evaluated the effectiveness of Equine-Assisted Activities and Therapies (EAATs) in 86 children with varying ASD severity levels (levels 1-3).

METHODS

Vineland Adaptive Behaviour Scales and the Parenting Stress Index were used. Between May 2022 and October 2023, participants completed 20 weekly sessions of 45 min each, tailored to their individual needs.

RESULTS

Children with level 3 ASD demonstrated greater challenges in communication (level 1: 67.1 ± 29.0 vs. level 3: 30.0 ± 12.6; p < 0.001), daily living skills (81.0 ± 26.8 vs. 42.6 ± 18.1; p < 0.001), and socialisation (72.2 ± 23.2 vs. 37.3 ± 14.2; p < 0.001). Parental distress was higher in cases of greater ASD severity. Nevertheless, significant improvements were observed across the entire cohort in daily living skills (58.3 ± 25.5 vs. 67.8 ± 29.0; p = 0.023), with particularly notable outcomes in children with level 1 ASD (65.7 ± 26.9 vs. 81.0 ± 26.8; p = 0.010). While increases in socialisation were noted among children with level 1 ASD, these were not statistically significant (p = 0.073).

CONCLUSIONS

EAAT fosters improvements in daily living skills, particularly in children with level 1 ASD, and has a positive impact on socialisation. For children with more severe ASD, targeted interventions are required.

Autistic sociality: challenging representations of autism and human-animal interactions

PURPOSE

The objective of this synthesis research was to explore representations of autism and human-animal interactions (HAI) in the health sciences literature and the implications for autistic children and their families.

METHODS

Guided by critical interpretive synthesis methods proposed by Dixon-Woods et al. (2006), we synthesized and examined how autism and HAI were described in the health sciences literature and explored assumptions and goals underlying HAI as an intervention.

RESULTS

Across 47 reviewed articles, animals were represented as therapeutic objects whose purpose from a biomedical perspective was to address "problematic" behaviours and "deficits" in social functioning and development. HAI was employed as a therapy to address improvements in these problematic behaviours in the majority of studies. Relational and social aspects of HAI were present but not explicitly discussed. An alternative perspective proposed by Olga Solomon positioned autistic sociality as one form of diverse human socialities that can be embraced, rather than held problematic and in need of being normalized.

CONCLUSIONS

Implications for HAI in rehabilitation include recognizing the multiple purposes of animals in a child's life, not only the therapeutic goal of normalizing functioning.

Equine-assisted services for motor outcomes of autistic children: A systematic review

LAY ABSTRACT

Equine-assisted services use various aspects of horses, like their movement, warmth, and size, to enhance individuals' overall well-being. Many studies have underscored the positive impact of equine-assisted services on autistic children, affecting areas such as social interaction, communication, engagement, stereotypical behaviors, and motor functions. Given the growing recognition of motor functions as clinical specifiers in autism, it is imperative to specifically investigate how equine-assisted services influence these outcomes. To address this, we conducted a systematic review to synthesize existing literature on the effects of equine-assisted services on motor outcomes of autistic children. Our review encompassed study characteristics, features of equine-assisted service interventions, and major motor outcomes. We also evaluated the methodological quality of the equine-assisted service studies to offer insights for future research directions. Through thorough database searches and the use of the standardized procedure of conducting a systematic review (The Preferred Reporting Items for Systematic Reviews and Meta-analyses), 12 research studies were identified and included. These studies reported the effects of various equine-assisted service types (such as therapy, horsemanship, or learning) on motor outcomes of autistic children. Significant enhancements in coordination, strength, balance, posture, and overall motor skills indicate the effectiveness of equine-assisted services in improving motor outcomes of autistic children. Building on these findings, we provide recommendations for future research endeavors aimed at enhancing the reliability and validity of using equine-assisted services to improve motor outcomes of autistic children. This work contributes to a deeper understanding of how equine-assisted services can benefit this population and guides the development of more effective equine-assisted service interventions.

Comparative effectiveness of physical exercise interventions on sociability and communication in children and adolescents with autism: a systematic review and network meta-analysis

OBJECTIVE

To investigate the efficacy of physical activity as a crucial intervention for Autism spectrum disorder (ASD) in clinical settings, we conducted a network meta-analysis to evaluate the effect of various exercise interventions on sociability and communication in individuals with ASD. Our aim was to identify the exercise modalities most conducive to enhancing these essential skills.

METHODS

We searched Web of Science, PubMed, Cochrane Library, Scopus, Embase, and searched Chinese databases from inception to April 2024. We included randomized controlled trials that assessed the effects of different exercise types on sociability and communication in individuals with ASD. Network meta-analysis (NMA) was performed using a frequentist approach, and the node-splitting method was applied to assess inconsistency.

RESULTS

We included 38 original studies published between 2009 and 2024, with a total of 1,382 participants analyzed for sociability outcomes. Results indicated that sports games [SMD = 1.12, 95%CI (0.51, 1.73)], combination therapy [SMD = 1.11, 95%CI (0.13, 2.09)], group ball sports [SMD = 1.06, 95%CI (0.37, 1.75)], and outdoor exercise [SMD = 1.02, 95%CI (0.50, 1.55)] were more effective than passive controls. A total of 25 original literatures were included in the analysis of communication ability, involving 904 subjects, and the results showed that combination therapy [SMD = 1.57, 95% CI (0.74, 2.40)], sports games [SMD = 1.01, 95% CI (0.45, 1.56)], group ball games [SMD = 0.85, 95% CI (0.45, 1.26)], outdoor exercise [SMD = 0.79, 95% CI (0.48, 1.11)], and mind-body exercise [SMD = 0.79, 95% CI (0.29, 1.30)], all of which were more effective than passive controls.

CONCLUSION

Physical exercise plays a significant role in alleviating symptoms and enhancing sociability and communication in individuals with ASD. Our findings highlight that sports games, combination therapy, team ball sports, and outdoor exercise are particularly effective in improving sociability. In terms of communication skills, combination therapy, sports games, team ball sports, outdoor exercise, and mind-body exercise demonstrated the most substantial benefits. These results provide a robust foundation for future interventions aimed at improving the quality of life for individuals with ASD.

Mechanisms Linking Physical Activity With Mental Health in Children and Adolescents With Neurodevelopmental Disorders: A Systematic Review

INTRODUCTION

Physical activity (PA) is a promising way to improve mental health in children and adolescents with neurodevelopmental disorders (NDDs). However, the underlying mechanisms remain unclear. The current review aimed to explore the potential neurobiological, psychosocial, and behavioral mechanisms between PA interventions and mental health in children and adolescents with NDDs.

METHODS

Web of Science, PsycINFO, SPORTDiscus, MEDLINE, CINAHL, and ERIC were searched from inception to June 2023. Randomized controlled trials/quasi-experimental designs applying PA interventions and reporting at least one mental health outcome and at least one potential mechanism in children and adolescents with NDDs were included. The best evidence synthesis rating system was adopted to determine the strength and consistency of potential mechanisms and was performed in 2024.

RESULTS

In total, 45 studies were included, 29 of which were randomized controlled trials and 16 were quasi-experimental, with a total of 1,751 participants. According to the best evidence synthesis rating system, neurobiological (theta activity and P3 amplitude), psychosocial (social skills and social participation), and behavioral (motor skills and sleep) mechanisms were the frequently examined and consistent mechanisms through which PA affected mental health in children and adolescents with NDDs. However, evidence regarding P3 latency, beta activity, and physical self-concept was insufficient.

DISCUSSION

Future PA interventions could consider neurobiological (theta activity and P3 amplitude), psychosocial (social skills and social participation), and behavioral (motor skills and sleep) mechanisms. Alternatively, PA can be developed as an adjunctive approach with interventions that specifically focus on these mechanisms to enhance mental health in children and adolescents with NDDs.

Unveiling directional physiological coupling in human-horse interactions

This research investigates the human-horse bond, aiming to unveil the physiological mechanisms regulating interspecies interactions. We hypothesized observing a physiological synchronization in human-horse dynamics, akin to human interactions. Through time-frequency Granger causality analysis of heart rate variability (HRV) and behavioral data, this study reveals the establishment of bidirectional synchronization in HRV between humans and horses. The coupling directionality is influenced by behavior and familiarity. In exploration scenarios led by horses, bidirectional interactions occur, particularly with familiar individuals. Conversely, during human-led activities such as grooming, physiological connectivity direction varies based on the familiarity level. In addition, the methodology allows in-depth analysis of sympathetic and parasympathetic nervous system contributions, highlighting their intricate role in the human-horse relationship. Such a physiological coupling estimate, correlated with behavioral data, provides a quantitative tool applicable across contexts and species This holds significant promise for assessing animal-assisted therapies and for applications in sports and various animal-related domains.

Effects of different exercise interventions on executive function in children with autism spectrum disorder: a network meta-analysis

Background

A large body of research has identified the positive effects of physical activity on children with autism spectrum disorders (ASD). However, the specific benefits of different types of sports on executive functioning in children with ASD remain unclear. The aim of this study was to further analyze the effects of different sports on executive functioning in children with ASD using reticulated meta-analysis and to establish their effectiveness ranking.

Methods

This study conducted a comprehensive online search in Web of Science, PubMed, Cochrane, Embase, and CNKI databases. It included randomized controlled trials and quasi-experimental studies, and synthesized the data using a Bayesian framework.

Results

Several relevant studies were included. The results showed that physical activity significantly improved all three dimensions of executive functioning (inhibitory control, cognitive flexibility, and working memory) in children with ASD. The improvement in cognitive flexibility and inhibitory control both reached a medium effect size. However, the improvement in inhibitory control was better than that in cognitive flexibility, while the improvement in working memory did not reach the level of a medium effect. Mini Basketball was effective in improving inhibitory control and cognitive flexibility, but not working memory. Ping Pong was more effective in cognitive flexibility and working memory, but weaker in inhibitory control. Fixed Bicycle was less effective in all three dimensions. Among other interventions, Learning Bicycles, Animal-assisted therapy, and Exergaming performed better in cognitive flexibility. SPARK, Neiyang Gong, and Martial Arts were also effective in improving inhibitory control. However, SPARK and Fixed Bicycle were not significant in improving working memory.

Conclusion

Physical activity as an intervention can significantly improve the executive function of children with ASD. The intervention effects of different sports on different dimensions of executive function vary. Mini Basketball was outstanding in improving inhibitory control and cognitive flexibility. Ping Pong was effective in improving cognitive flexibility and working memory. Fixed Bicycle was not effective in any dimension.

The impact of exercise intervention on social interaction in children with autism: a network meta-analysis

Background

Extensive research has documented the positive impacts of physical activity on children and adolescents with Autism Spectrum Disorders (ASD). However, the specific benefits of various sports on the social functioning of children with ASD remain ambiguous. This study aims to employ a network meta-analysis to investigate the effects of different sports on the social functioning of children and adolescents with ASD and to establish a ranking of their effectiveness.

Methods

This study conducted a comprehensive online search across Web of Science, PubMed, Cochrane, and Embase databases for randomized controlled trials and quasi-experimental studies focusing on social functioning outcomes. Data were synthesized using a Bayesian framework.

Results

Sixteen relevant studies encompassing 560 participants were included. According to Cohen's classification, mini-basketball (SMD = 0.84, 95% CI: 0.46, 1.20), SPARK (SMD = 0.88, 95% CI: 0.06, 1.70), and Karate (SMD = 1.10, 95% CI: 0.27, 2.00) demonstrated high effect sizes, with Karate identified as the most effective intervention. Conversely, Combined Exercise and Nei Yang Gong interventions exhibited the least significant effects, falling below small effect sizes.

Conclusion

Physical activity interventions have been shown to enhance social functioning in children and adolescents with ASD to varying extents, with Karate emerging as the most efficacious.

Bibliometric Analysis on Equine-Assisted Interventions

Equine Assisted Interventions (EAIs) integrate the active participation of horses in therapeutic or educational interventions. A bibliometric analysis was carried out on this topic, using traditional bibliometric laws and recommendations. For this purpose, a search on the Web of Science (WoS) Core Collection database was carried out, obtaining 333 documents. Annual publications followed an exponentially increasing trend (R2 = 86%), pointing out that this topic is a growing interest among researchers, publishers, and journals. The USA was the most productive country worldwide and Jeong-yi Kwon and Ji Lee were the prolific co-authors. The WoS category with the highest number of papers was Rehabilitation (84 papers). The Journal of Alternative and Complementary Medicine, and Pediatric Physical Therapy were the journals with the highest number of publications. The most cited paper was "State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy". The most used author keywords were rehabilitation, balance, and those related to specific populations such as Cerebral Palsy and Autism Spectrum Disorder. These results suggest that EAIs is a topic of increasing interest for researchers, editors, and professionals.

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.

Interaction during equine-facilitated rehabilitation from the rehabilitees' perspective - A phenomenological study

INTRODUCTION

Interaction has a multidimensional role in equine-facilitated rehabilitation.

PURPOSE

The aim of this study was to understand rehabilitees' experiences of interaction during equine-facilitated rehabilitation.

METHODS

Six children and four adults with individual diagnoses or reasons to participate in equine-facilitated rehabilitation were included in this qualitative study. Data were collected by interviewing individually the rehabilitees. A phenomenological Spiegelberg's seven-phase meaning analysis was performed to reveal the meanings.

RESULTS

Seven meanings were identified: 1) Trust; 2) Friendly horse; 3) Mirror of feelings; 4) Inspiring riding; 5) Feeling competent; 6) Rehabilitee-oriented approach; and 7) Uniting experience. In addition, the essential meanings of the phenomenon form three different circles: circle of recognition, circle of supporting active agency and circle of empowerment.

CONCLUSION

Interaction during equine-facilitated rehabilitation is essential to rehabilitees in many ways that have important roles in the entire rehabilitation process that aims for empowerment in the rehabilitees' daily lives.

Movement as a Gateway to Participation for Individuals With Neuromotor Conditions: A Scoping Review

PURPOSE

The purpose of this scoping review was to examine and analyze the developmental and rehabilitation literature related to movement and participation at key points of transition for individuals with neuromotor conditions.

METHODS

Arksey and O'Malley's scoping review protocol was applied, and 37 articles were included. Extracted data included population, developmental transition points, movement opportunity, type of participation, and outcome measures.

RESULTS

Most studies covered developmental transition points; none examined transitions as a variable for participation outcomes. Physical activity/exercise was the most common movement opportunity. Most publications used formal outcome measures of participation; others used observation or interviews.

CONCLUSION

No publications adequately addressed the effect of movement opportunities on participation during developmental transition points.

The relationship between executive function and the association of motor coordination difficulties and social communication deficits in autistic children

Background

Motor coordination difficulties could contribute to social communication deficits in autistic children. However, the exploration of the mechanism implicated in these claims has been limited by the lack of potential confounders such as executive function (EF).

Methods

We investigated the role that EF plays in the relationship between motor coordination and social communication in a school-aged autistic population via a structural model in a statistically robust manner. The results of questionnaires, including the Developmental Coordination Disorder questionnaire, the Behavior Rating Inventory of Executive Function, and the Social Responsiveness Scale, were collected to measure motor coordination, social communication deficits, and EF.

Results

A total of 182 autistic children (7.61±1.31 years, 87.9% boys) were included in the final analysis. In the model with EF as a mediator, the total effect (β=-0.599, P<0.001) and the direct effect (β=-0.331, P =0.003) of motor coordination function on social communication were both significant among autistic children without intellectual disability (ID), as were indirect effects through EF (β=-0.268, P<0.001).

Conclusion

EF partially mediates the motor coordination and social communication correlation among autistic children. We suggest that motor coordination should be included in the routine evaluation of autistic surveillance and rehabilitation procedures.

Physical Activity and Mental Health in Children and Adolescents With Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis

Importance

Children and adolescents with neurodevelopmental disorders experience mental health issues and are encouraged to be brought together in real-life treatment. However, physical activity, which is a promising method for boosting mental health, has only been examined in children and adolescents with certain types of neurodevelopmental disorders.

Objective

To examine the association of physical activity interventions with mental health (ie, cognitive function, psychological well-being, internalizing, and externalizing problems) in children and adolescents with neurodevelopmental disorders and to identify possible moderators.

Data Sources

Studies were searched from inception to May 2023 through Web of Science, PsycINFO, SPORTDiscus, MEDLINE, CINAHL, and ERIC.

Study Selection

Randomized clinical trials or nonrandomized designs applying physical activity interventions and reporting at least 1 mental health outcome in children and adolescents aged 5 to 17 years with neurodevelopmental disorders were included. Two independent reviewers selected and assessed the studies.

Data Extraction and Synthesis

Random multilevel meta-analysis using Hedges g was performed. Data extraction and risk-of-bias assessment were conducted by multiple reviewers. Heterogeneity, publication bias, sensitivity analysis, and moderator analysis were examined to substantiate the results.

Main Outcomes and Measures

The main outcomes were mental health related to cognitive function, psychological well-being, internalizing, or externalizing problems measured by neurocognitive tasks or subjective questionnaires.

Results

A total of 76 studies involving 3007 participants were included in systematic review, 59 of which were used for meta-analysis. The findings indicated that physical activity interventions were associated with significant benefits for overall mental health (g, 0.67; 95% CI, 0.50-0.85), cognitive function (g, 0.74; 95% CI, 0.53-0.95), psychological well-being (g, 0.56; 95% CI, 0.16-0.96), internalizing (g, 0.72; 95% CI, 0.34-1.10), and externalizing problems (g, 0.58; 95% CI, 0.28-0.89). Moderators were also identified: frequency, total sessions, and total duration for overall mental health; total sessions, and total duration for cognitive function; session duration and frequency for psychological well-being; physical activity type for internalizing problems; and session duration for externalizing problems. Moderator analyses showed that type of neurodevelopmental disorder did not modify the associations between physical activity and overall mental health or its subgroups.

Conclusions and Relevance

The findings in this study suggest that children and adolescents with different types of neurodevelopmental disorders may be grouped together when performing physical activity interventions, which were confirmed to be beneficial to overall mental health and its subgroups in this new diagnostic population, but that physical activity interventions should be tailored when targeting different mental health domains.

[Motor intervention strategies on postural control in children and youth with autism spectrum disorder: A systematic review]

Autism spectrum disorder (ASD) has varied characteristics with an impact at the social, communicative and sensorimotor (SM) level. An SM feature is postural control (PC) problems. There are various motor intervention strategies (MIS), but the benefit over LC is something that has been analyzed less extensively. The objective was to describe the MIS and its results on the PC of children and adolescents with ASD. A search of PubMed, Scopus, Web of Science and Cochrane was performed. A total of eight articles met the eligibility criteria. All MIS showed beneficial results on the improvement of PC. The MIS were of a varied nature (dance practice, personalized physical activity, video games, Tai Chi Chuan, Taekwondo and virtual reality). It is necessary to improve the designs and consider the risks of bias, since they limit the scope of the results.

Nature-Based Interventions for Autistic Children: A Systematic Review and Meta-Analysis

Importance

There is a gap in the evidence regarding nature-based interventions (NBIs) for children with autism spectrum disorder (ASD).

Objective

To systematically review and meta-analyze available evidence on the health-related outcomes in NBIs for children with ASD.

Data Sources

The Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, Emcare, Education Resources Information Center, Global Health, MEDLINE, PsycInfo, SPORTDiscus, and Web of Science were searched from inception until May 2023. Google Scholar and references from included studies were searched for additional studies.

Study Selection

Included studies were randomized clinical trials (RCTs), controlled studies, and single-group before-and-after studies that reported health-related outcomes.

Data Extraction and Synthesis

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guidelines. Random-effects meta-analyses were used to synthesize the data. The findings of studies that were ineligible for meta-analysis were summarized according to the Synthesis Without Meta-analysis (SWIM) reporting guidelines.

Main Outcomes and Measures

The outcomes of interest were health-related outcomes (ie, social functioning, behavioral functioning, emotional functioning, sensory functioning) and the self-reported well-being of children with ASD.

Results

A total of 24 studies with 717 participants (mean age range, 5.3 to 17.8 years; 141 [21.9%] female) were included. A meta-analysis from 13 studies indicated a significant negative moderate association between NBIs and social communication (standardized mean difference [SMD], -0.59; 95% CI, -0.85 to -0.34). For behavioral functioning outcomes, NBIs showed a significant moderate association with reduced hyperactivity (SMD, -0.56; 95% CI, -0.86 to -0.26) and a small to moderate association with reduced irritability (SMD, -0.49; 95% CI, -0.79 to -0.19). For sensory functioning, NBIs were significantly associated with improved inattention and distractibility (SMD, 1.13; 95% CI, 0.67 to 1.60). Significant moderate associations were observed in sensory seeking (SMD, 0.77; 95% CI, 0.33 to 1.22; P < .001; I2 = 0%) and sensory sensitivity (SMD, 0.56; 95% CI, 0.12 to 1.00; P = .01; I2 = 0%). Heterogeneity of the intervention effects was not high, and I2 ranged from 0% to 67%.

Conclusions and Relevance

The findings of this systematic review and meta-analysis suggested an association of NBIs in group-based recreational therapy with experiential learning with positive short-term outcomes on sensory, social, and behavioral functioning for children with ASD. Future evidence using robust study design to aid the health and functional trajectories of children with ASD is recommended.

Use of complementary and alternative medicine in children affected by oncologic, neurologic and liver diseases: a narrative review

Complementary and alternative medicine (CAM) consist of a broad group of restorative resources often linked to existing local cultures and established health care systems and are also increasingly used in children with some serious illnesses. In this narrative review, we examine the epidemiology of the use, efficacy, and safety of complementary and alternative medicine in pediatric oncology, neurology, and hepatology. We searched for relevant articles published in Pubmed evaluating CAM use and its efficacy in safety in children affected by oncologic, neurologic and liver diseases. CAM is used to improve the success of conventional therapies, but also to alleviate the pain, discomfort, and suffering resulting from the diseases and their treatment, which are often associated with a significant burden of adverse effects. CAM use must be evaluated in children with neurological, oncological and liver diseases.

Animal-assisted therapies for autism

Animal-assisted therapies have been increasingly used as part of treatment for a range of emotional-behavioral conditions and have more recently been incorporated into treatment for children with symptoms associated with autism spectrum disorder. Autism spectrum disorder affects one in 36 children and early interventions can be very effective. The aims of this paper are to: 1) provide background into animal-assisted therapies including a breakdown on the subtypes of therapies, 2) report broad summaries of research outcomes across various domains: social-emotional, physical, quality of life, behavioral skills, and adaptive skills, and 3) summarize key takeaways for pediatric practitioners when supporting families of youth with autism spectrum disorder who are interested in participating in animal-assisted therapy. This paper is not a systematic review or meta-analysis as several rigorous review studies have been published already. This paper is an overview of the background and research for pediatric practitioners when advising families on treatment options. Implications for future research are covered.

Positive effects of physical activity in autism spectrum disorder: how influences behavior, metabolic disorder and gut microbiota

Autism spectrum disorder is a neurodevelopmental disorder characterized by social interactions and communication skills impairments that include intellectual disabilities, communication delays and self-injurious behaviors; often are present systemic comorbidities such as gastrointestinal disorders, obesity and cardiovascular disease. Moreover, in recent years has emerged a link between alterations in the intestinal microbiota and neurobehavioral symptoms in children with autism spectrum disorder. Recently, physical activity and exercise interventions are known to be beneficial for improving communication and social interaction and the composition of microbiota. In our review we intend to highlight how different types of sports can help to improve communication and social behaviors in children with autism and also show positive effects on gut microbiota composition.

Equids in Equine Assisted Services: A Scoping Review

Equid welfare in equine assisted services (EAS) is an area that has received attention, but less attention than the documentation of human outcomes in response to EAS. To safeguard the well-being of equids and minimize human risk of injury, continued research on the effects of EAS programming and participants on equids needs to occur. The aims of this systematic scoping review were to identify the approaches taken for describing and understanding equids in EAS and the methods employed in evaluating equids' responses to EAS programming, participants, or both. Literature searches were performed in relevant databases to identify titles and abstracts for screening. Fifty-three articles were identified for full-text review. Fifty-one articles met the inclusion criteria and were retained for information and data extraction. The qualitative grouping of articles by study aim resulted in four categories: (1) characterization and description of equids in EAS; (2) the acute responses of equids to EAS programming, participants, or both; (3) the effects of management practices; and (4) the chronic responses of equids to EAS programming and participants. The latter three areas are in need of more research, especially as it relates to differentiating acute and chronic effects of EAS on the equids involved. Detailed reporting of information on study design, programming and participant characteristics, equid demographics, and workload are needed to facilitate comparison among studies and permit eventual meta-analysis of studies. Multi-faceted approaches including an array of measurements as well as relevant and informative control groups or conditions are required to identify the complex effects of EAS work on equids, their welfare, well-being, and affective states.

Potential Mechanisms of Action and Outcomes of Equine-Assisted Services for Veterans with a History of Trauma: A Narrative Review of the Literature

Equine-assisted services (EASs) are being increasingly used as complementary interventions for military veterans who have experienced trauma. However, there is limited evidence of benefit for this population and almost no literature describing the desired potential outcomes and possible mechanisms of action. The aim of this article is to address these gaps by reviewing the extant literature of animal-assisted interventions in general, and equine-assisted services in particular, with the goal of providing guidance for future investigations in the field. Currently, the field is in the early stage of scientific development, but published results are promising. Interventions that enhance treatment compliance and/or outcomes could benefit this population. Preliminary results, reviewed herein, indicate that EAS interventions might benefit the military veteran population by enhancing treatment engagement and therapeutic alliance, as well as by contributing to symptom reduction and resulting in various transdiagnostic benefits. It is recommended that future studies include exploration of potential beneficial outcomes discussed herein, as well as investigate suggested mechanisms of action.

Can Interacting with Animals Improve Executive Functions? A Systematic Review

There has been growing interest in the potential benefits of using human-animal interactions to improve executive functions: cognitive processes that allow individuals to plan, solve problems, and self-regulate behaviour. To date, no comprehensive review has been conducted. The purpose of this study was to evaluate existing literature, adopting broad inclusion criteria. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 16 papers were identified from peer-reviewed literature. Additional papers were identified from grey literature, including 6 dissertations and 1 thesis. A review of these 23 studies found that human-animal interactions and executive functions are investigated in three main ways: (1) exploring the potential benefits of the human-pet relationship, (2) exploring the impact of an animal's presence during administration of executive function tests, and (3) evaluating the efficacy of animal-assisted services (e.g., animal-assisted therapy) on executive functions. Five of the included studies reported a significant improvement across all measured domains of executive functions, but effect sizes were underreported. Comparatively, 9 studies reported mixed findings, d = 0.32-0.55, while 8 studies reported no significant results. The overall rigour of the research was limited, with great heterogeneity between the study methodologies and outcome measures used. It is recommended that future studies utilise high-quality research methodologies through the use of randomisation, pre- and postmeasures, and appropriate control conditions, where possible.

Effectiveness of exercise intervention on improving fundamental motor skills in children with autism spectrum disorder: a systematic review and meta-analysis

Background

Autism spectrum disorder (ASD) is a severe public health concern, and most of the children with ASD experience a substantial delay in FMS. This study aimed to investigate the effectiveness of exercise interventions in improving FMS in children with ASD, and provide evidence to support the scientific use of exercise interventions in practice.

Methods

We searched seven online databases (PubMed, Scopus, Web of Science, Embase, EBSCO, Clinical Trials, and The Cochrane Library) from inception to May 20, 2022. We included randomized control trials of exercise interventions for FMS in children with ASD. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database Scale. Stata 14.0 software was used for meta-analysis, forest plotting, subgroup analysis, heterogeneity analysis, and meta-regression.

Results

Thirteen studies underwent systematic review (541 participants), of which 10 underwent meta-analysis (297 participants). Overall, exercise interventions significantly improved overall FMS in children with ASD. Regarding the three categories of FMS, exercise interventions significantly improved LMS (SMD = 1.07; 95% CI 0.73 to 1.41, p < 0.001), OCS (SMD = 0.79; 95% CI 0.32 to 1.26, p = 0.001), and SS (SMD = 0.72; 95% CI 0.45 to 0.98, p < 0.0001).

Conclusion

exercise interventions can effectively improve the FMS of children with ASD. The effects on LMS are considered as large effect sizes, while the effects on OCS and SS are considered as moderate effect sizes. These findings can inform clinical practice.

Systematic review registration

https://inplasy.com/inplasy-2022-12-0013/.

Human-Animal Interaction in Animal-Assisted Interventions (AAI)s: Zoonosis Risks, Benefits, and Future Directions-A One Health Approach

Animal-assisted interventions (AAI)s represent the expression of integrated medicine, according to the One Health approach. Actually, animal-assisted therapies and animal-assisted activities are implemented in hospitals, rehabilitation centers, etc. The efficacy of AAIs is based on interspecific interactions and would be impacted by different factors, such as the characters of both the animal and the handler, a suitable selection of animal species, an appropriate animal educational protocol, the relationship between the handler and the animal, and mutual relationship among the animal, the patients, and members of the working team. AAIs produce many advantages for the patients but could expose them to zoonotic-pathogens transmission. Therefore, positive animal welfare, as preventative medicine to avoid incidents or transmission of zoonosis, is a relevant aspect with implications for human and animal health and wellbeing. This review aims to summarize the current published knowledge regarding the occurrence of pathogens in AAIs and to discuss their relevance in light of health and safety in AAIs participants. In addition, this review will contribute to defining the state of the art of AAIs through a careful benefits/challenges analysis and offers discussion points on the possible future developments according to the One Health approach.

A pilot observational study of horsemanship skills training for veterans with posttraumatic stress disorder

OBJECTIVES

Pilot assessment of an equine-assisted services intervention for Veterans with posttraumatic stress disorder.

DESIGN

Prospective cohort.

SETTING

A large Veterans Administration healthcare system.

INTERVENTION

Two sessions of instruction in horsemanship skills and two sessions of trail rides.

MAIN OUTCOME MEASURES

Safety and feasibility of recruitment, retention, providing the intervention, and measuring outcomes, as well as acceptability of the intervention to the population studied were the main outcome measures.

RESULTS

There were no injuries among the 18 participants, 6 staff, or 11 equines over the 3 months of the study. Eleven of 12 (92 %) planned intervention sessions were provided, with one being canceled due to weather. Out of approximately 1800 potential subjects, 21 were enrolled within three months and three dropped out before the first session. The mean number of sessions attended was 3 % and 52 % of participants completed all sessions. The mean PACES score for all sessions together was 109 (SD = 12), with a range of 50-126. Pre- to one-month post-intervention exploratory results indicated increased psychological flexibility (p = 0.008) and positive affect (p = 0.008) as measured by the Acceptance and Action Questionnaire II and the Positive and Negative Affect Scale, respectively as well as decreased PTSD (p = 0.001) and depressive symptoms (p = 0.017) as measured by the PTSD Checklist for DSM 5 and the Beck Depression Inventory, respectively.

CONCLUSIONS

Results suggest the intervention can be conducted with minimal risk. Further, it was feasible to recruit participants as well as provide the intervention and measure exploratory outcomes. Session attendance and PACES scores indicate acceptability to the Veteran population. The exploratory results will provide sample size estimates for future randomized controlled studies of this intervention Future studies should plan for missed sessions due to weather and consider compensating subjects to enhance retention. Finally, this work provides preliminary evidence that this intervention, without a mental health treatment component, might benefit the mental health of Veterans with PTSD.

The effectiveness of animal-assisted therapy for children and adolescents with autism spectrum disorder: A systematic review

BACKGROUND

and purpose Individuals with autism spectrum disorder (ASD) experience difficulty with communication, learning, behaviour, and social interactions. Animal-assisted therapy (AAT) is a growing alternative and complementary therapy for ASD. This review aims to investigate the effectiveness of AAT for children and adolescents with ASD in the domains of cognitive, social, emotional, behavioural, and physical.

METHODS

A systematic search of databases (Medline, Emcare, Embase, Cochrane Library, PsycINFO, PsycARTICLES, Scopus, ERIC and OTseeker) was conducted in March 2022. Grey literature was also explored which included searching Trove database and the first 10 pages of Google, as well as pearling reference lists of included studies. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The methodological quality of the included studies was assessed using a modified Joanna Briggs Institute Review Form for Randomised Controlled Trials. A descriptive synthesis was undertaken due to heterogeneity within the evidence base.

RESULTS

Seven randomised controlled/clinical controlled trials with moderate methodological quality were included in this review. Overall, participation in AAT identified positive trends in the cognitive, social, emotional, behavioural, and physical domains. Despite the positive outcomes, implementation of AAT should be taken with caution as there are currently no standardised frameworks due to heterogeneity within the intervention protocols and outcome measures.

CONCLUSION

AAT may have positive effects across a multitude of outcomes in the management of ASD for children and adolescents. However, the current literature has considerable methodological concerns which should be addressed by future research.

Effects of Equine-Assisted Activities and Therapies for Individuals with Autism Spectrum Disorder: Systematic Review and Meta-Analysis

Autism spectrum disorder (ASD) has become a critical public health issue that affects more than 78 million people. In many recent studies, the authors have demonstrated that equine-assisted activities and therapies (EAATs) can substantially improve the social and behavioral skills of children with ASD. However, the qualities of the studies differ, and some authors reached opposite conclusions. In this review, we systematically and objectively examined the effectiveness of EAATs for people with ASD, combining both qualitative and quantitative methods. We searched five databases (PubMed, Scopus, ERIC, ProQuest, and MEDLINE) and added relevant references, and we identified 25 articles for data extraction and analysis. According to our results, EAAT programs can substantially improve the social and behavioral functioning and language abilities of children with ASD. However, among the subdomains, the results were inconsistent. According to the meta-analyses, there were considerable improvements in the social cognition, communication, irritability, and hyperactivity domains, but not in the domains of social awareness, mannerisms, motivation, lethargy, stereotypy, or inappropriate speech. Moreover, there was a lack of sufficient comparative data to conclude that EAAT programs lead to substantial improvements in motor and sensory functioning. In addition, among the included studies, we noted the indicator of whether EAAT programs decreased parental stress and improved family functioning, and although there were four articles in which the researchers considered this aspect, we were unable to draw any conclusions because of the insufficient data and conflicting descriptive evidence. However, we need to consider the improvement in parental mental health as a factor in the effectiveness of this complementary intervention. We hope that in future studies, researchers will focus on family functioning and conduct more randomized controlled trials (RCTs) with blinded assessments using different scales and measures.

Dancing out for a voice; a narrative review of the literature exploring autism, physical activity, and dance

Autism Spectrum Disorder is characterised by profound challenges with social communication and social interaction. Currently, there are few therapeutic interventions that successfully target some of the functionally impairing traits associated with autism. Furthermore, many of these interventions comprise a variety of limitations; including, limited accessibility, extensive durations, or the requirement of a trained professional to deliver the intervention. New research suggests that instead of targeting all traits associated with Autism Spectrum Disorder with a single solution, scientific research should focus on providing therapeutic tools that alleviate functionally impairing facets specific to the individual. Owing to the nature of physical activity, sports, and dance (coordinated movement) these activities could provide opportunities to enhance communication skills and social development in autistic children. Therefore, this paper gives a narrative overview of the literature surrounding communication and coordinated movement; outlining what is meant by communication challenges, exploring the benefits of coordinated movement for traits associated with Autism Spectrum Disorder, and delineating how coordinated movement elicits positive outcomes for autistic children.

Meta-analysis and systematic review of physical activity on neurodevelopment disorders, depression, and obesity among children and adolescents

Background

No consensus on whether physical activity (PA) is related to physical and mental health among pediatric population remains has been reached to date. To further explore their association, our study assessed the effect of PA on physical and mental health of children and adolescents through a systematic review and meta-analysis of randomized controlled studies (RCTs).

Methods

Several databases(Web of science, PubMed, Embase, Cochrane Central register of controlled trials, CINAHL) were searched from inception to 1st, December 2020 without language restrictions.

Results

38,236 records were identified primitively and 31 included studies with 1,255 participants eventually met our inclusion criteria, all of which exhibited a relatively low-moderate risk of bias of overall quality. In regard to mental health, the administration of PA, compared with the control group, led to moderate improvements in Autism Spectrum Disorder(ASD)[Standard mean difference (SMD) = -0.50, Confidence interval(CI): -0.87, -0.14)] and depression(SMD = -0.68, CI: -0.98, -0.38) among children and adolescents. Similarly, significant result was observed in obesity (SMD = -0.58, CI: -0.80, -0.36). No significant differences were observed in Attention deficit hyperactivity disorder (ADHD) (SMD = -0.29, CI: -0.59, 0.01).

Conclusion

Altogether, PA may have a beneficial effect on children and adolescents with ASD, depression and obesity; nevertheless, there is insufficient evidence to confirm its efficacy in ADHD. More large-scale population based randomized controlled trials are needed to explore more reliable evidence between them.

Physical Activity, Gut Microbiota, and Genetic Background for Children and Adolescents with Autism Spectrum Disorder

It is estimated that one in 100 children worldwide has been diagnosed with autism spectrum disorder (ASD). Children with ASD frequently suffer from gut dysbiosis and gastrointestinal issues, findings which possibly play a role in the pathogenesis and/or severity of their condition. Physical activity may have a positive effect on the composition of the intestinal microbiota of healthy adults. However, the effect of exercise both on the gastrointestinal problems and intestinal microbiota (and thus possibly on ASD) itself in affected children is unknown. In terms of understanding the physiopathology and manifestations of ASD, analysis of the gut-brain axis holds some promise. Here, we discuss the physiopathology of ASD in terms of genetics and microbiota composition, and how physical activity may be a promising non-pharmaceutical approach to improve ASD-related symptoms.

Effects of Therapeutic Horseback-Riding Program on Social and Communication Skills in Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

Animal-assisted therapy has become a fast-growing and effective approach for remediating core impairments of children with ASD; however, recent systematic review studies on the effects of AAT in children with ASD have some limitations, including referral to a variety of animal-assisted interventions rather than to horseback-riding therapy alone and the absence of any meta-analysis in systematic reviews. A complete systematic review of the studies that describe the use of THR as an intervention is needed to specifically target the core impairments of children with ASD. The purpose of this study was to employ the systematic review method to synthesize research findings regarding the effects of THR programs on the social interaction and communication skills of children with ASD. We conducted a structured search in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for potentially relevant studies in five databases (Web of Science, PubMed, CINAHL, Scopus, and SPORTDiscus) from inception until February 2022. In addition, we manually searched the bibliographies of the included studies to find articles that might otherwise have been missed. We considered articles eligible or ineligible if they satisfied specific inclusion or exclusion criteria. Our results showed that the THR program is an effective direct and alternative therapeutic program that can considerably improve the social behaviors and communication skills of children with ASD and can effectively impact autistic impairments in areas such as social awareness, social cognition, social motivation, and social communication. These findings are in line with those of previous studies; however, we did not find statistical evidence of any effect of THR on the autistic behaviors of irritability, stereotypy, and inappropriate speech. In conclusion, the findings produced by this meta-analysis study provide evidence that THR programs can considerably improve the social behaviors and communication skills of children with ASD.

Using sport-based interventions for people with severe mental disorders: results from the European EASMH study

People with severe mental disorders report significantly poorer physical health and a higher mortality rate compared with the general population. Several interventions have been proposed in order to challenge this mortality gap, the promotion of physical activities represents one of the most important strategies. In fact, in people with severe mental disorders, physical activity can improve body composition, quality of life, personal functioning, self-esteem, cognition, and cardiorespiratory fitness, as well as reducing affective, psychotic and anxiety symptoms, cardiometabolic burden and increase the global recovery. While sport-based programs are consistently being proposed as an integral part of effective personalized treatment approaches for people with severe mental disorders, their routine implementation is hampered by poor working task integration among different professionals and the lack of training programmes for sport professionals focused on people with severe mental disorders. In this paper, we will: (a) review the efficacy of exercise/sport-based interventions for people with severe mental disorders; (b) describe the main difficulties in engaging patients with severe mental disorders in these interventions; and (c) report the results of the first study on the best practices available in Europe in the field of sport and mental health carried out in the context of the European Alliance for Sport and Mental Health (EASMH) project. According to the EASMH survey, sport-based psychosocial interventions are not frequently available in mental health services, with significant differences at the European level. In the near future, it would be advisable to promote the integration and collaboration between mental health professionals and sport professionals, in order to improve the dissemination and availability of sport-based interventions in routine clinical practice. The EASMH project aims to fill this gap by creating a network of collaborators, researchers and stakeholders with different backgrounds in order to improve the dissemination of sport-based rehabilitation interventions and by developing an innovative training programme for sport coaches in order to improve their skills in interacting and building an effective relationship with people with severe mental disorders.

Effects of equine-assisted interventions on older adults' health: A systematic review

Objective

Equine-assisted interventions (EAI) can improve a variety of health problems in older adults and thus promote their well-being. This systematic review aimed to synthesize studies on EAI to understand better their effects on the health of older adults.

Method

A systematic search guided by the PRISMA 2020 approach was performed on specific databases: Medline (PubMed), EMBASE, PsycINFO, and Cochrane Library. Peer-reviewed articles published in the English language from inception to June 2022 were retrieved. Methodological quality was established using the modified version of the Downs and Black checklist.

Results

A total of 244 studies were retrieved, and 13 eligible studies were finally included. Three health domains were investigated: physical (balance, gait, and muscular strength), psychological (quality of life and cognitive assessment), and physiological (hormonal measures, cerebral and muscular activity). Among the eight studies investigating the physical dimension, four studies highlighted a positive effect of EAI on balance, four for gait, and three for strength. Regarding the three studies investigating the psychological dimension, two studies showed a positive effect of EAI on quality of life. Lastly, the four studies investigating the physiological dimensions all demonstrated a positive effect of EAI on hormonal measures and cerebral and muscular activity.

Conclusion

Nevertheless, this systematic review provides promising findings regarding the positive effects of EAI on physical, psychological, and physiological health in older adults. Research on EAI should therefore be pursued rigorously to promote this non-pharmacological intervention in an older adult population.

Animal-assisted Interventions as an Adjunct to ABA Services: Clinician Practices and Perceptions

Although the popularity of animal-assisted interventions (AAI) continues to increase, an examination of these practices among clinician populations that may incorporate AAI in their clinical services are largely absent from the literature. This study examined the practices and desirability of incorporating animals into ABA services. A total of 544 ABA clinicians completed a web-based survey. Data revealed respondents not only considered incorporating animals into ABA services (n = 307), but almost 20% (n = 107) also reported engaging in this practice. Dogs were reported as the most frequently incorporated animals and an examination of animal sources and prior training revealed substantial variability. Animal incorporation practices were viewed as desirable, feasible, and a majority of respondents reported being interested in AAI implementation. Implications of these results beget a discussion about potential adverse consequences to clients and clinicians that participate in these practices. This discussion includes physical safety risks, financial threats, and potential Behavior Analysis Certification Board (BACB) code violations. Animal welfare concerns, which are often omitted from discussions about AAI, are also discussed to inform clinicians of the added responsibilities that need to be considered. In total, survey results and the accompanying discussion should urge ABA clinicians to pause when considering the incorporation of animals into their clinical practices. No published articles could be found that examine the use of animal incorporation practices within the area of clinical ABA services. Personal and professional risks and animal welfare concerns associated with the utilization of these practices, as identified in this study, should inform programmatic decision-making by clinical practitioners and supervisors interested in engaging in these practices. Results of this survey highlight the potential need for modifications to professional standards and ethical codes of the BACB and state licensing authorities. As this is a novel area of investigation, this article illustrates the need for further empirical evaluation of animal-assisted interventions as an adjunct to ABA services.

A pilot observational study of a psychotherapy incorporating equines resiliency intervention for staff at a large medical center

BACKGROUND

and purpose: Stress and burnout among healthcare workers are significant public health concerns. The primary aim of this pilot study was to conduct preliminary assessments of safety, feasibility, and participant satisfaction with a psychotherapy incorporating equines (PIE)-based resiliency intervention for healthcare workers. The overarching goal was to lay the groundwork for future, more rigorous investigations. Lastly, a very preliminary assessment of using the Acceptance and Action Questionnaire II (AAQII) to assess for changes in psychological flexibility (PF) associated with PIE was conducted.

MATERIALS AND METHODS

Thirty-seven staff members from a medical center participated in a 4-h PIE-based resiliency retreat. Pre- and post-intervention instruments were utilized to assess participants' self-perception of physical and psychological health (PROMIS Global Short Form) and enjoyment of (Physical Activity Enjoyment Scale) and satisfaction with (Client Satisfaction Questionnaire) the intervention, as well as changes in PF (AAQII).

RESULTS

There were no adverse effects on participants, staff, or equines. Preliminary results suggested that the intervention was perceived as enjoyable by participants. However, the intervention was not fully utilized. Finally, there was a significant (p = 0.02) pre-to post-intervention change in AAQII scores.

CONCLUSION

This study provides a foundation for future rigorous studies of PIE-based resiliency interventions for medical staff. Given the limitations of this pilot work, firm conclusions cannot be drawn regarding safety and feasibility. However, the preliminary results suggest that future studies of this intervention are warranted and that the AAQII may be a useful instrument to assess for possible changes in PF.

Calm with horses? A systematic review of animal-assisted interventions for improving social functioning in children with autism

LAY ABSTRACT

Children with autism typically experience difficulties interacting socially with others when compared to their non-autistic peers. Establishing how effective interventions are for improving social functioning is important to help inform what should be offered to children with autism. This study reviewed how effective interventions that involved interaction with a live animal, known as animal-assisted interventions, are in improving social functioning in children with autism. A systematic search of the evidence on this topic found nine studies, which were explored for the effectiveness of animal-assisted interventions and the quality of methods used. Overall, these studies showed improvements in social functioning following equine-assisted or therapeutic horse-riding interventions, with initial evidence showing improvements are sustained in the short and medium term. However, several issues were identified, which limit the strength of any conclusions that can be drawn from this evidence. For example, in many studies people assessing the children were aware that they received the intervention or were in a control group. There was also not enough evidence available to draw conclusions on the effectiveness of other animal-assisted interventions. Future research should address the limitations that were common in the designs of these studies and investigate the potential benefit of other animal populations, such as dogs and cats.

Presentation of the "Step-by-step in communication” equine-assisted therapy intervention program for children with autism

ABSTRACT The objective of this paper is to present the “Step-by-step in communication” equine-assisted speech-language-hearing rehabilitation program to treat language impairment in children. The program was developed in three stages: literature analysis, pilot application, and clinical analysis. The literature was analyzed by searching, reading, and discussing articles and books on the topic, published up to 2018. After this stage, the first version of the program was developed. This version addressed: participants’ language assessment, application of 10 sessions, monitoring and record of activities in each session, participants’ reassessment, and adjustment of techniques and activities. The clinical analysis took place after the pilot application with the following procedures: analysis by three judges, revision of the approach by the authors, and development of the final version of the “Step-by-step in communication” program, comprising eight theme modules with 24 sessions, and based on four main pillars, which are applied in equine-assisted therapy activities. Each pillar has specific objectives and strategies. The activities aim at formal (semantic and morphosyntactic) and pragmatic aspects of language. Their theoretical/practical framework is grounded on functional grammar, and the strategies are based on equine-assisted therapy experiences that open the way for communication.

Apresentação do Programa de intervenção em equoterapia “Passo a passo na comunicação” para crianças com autismo

RESUMO O objetivo desse trabalho é apresentar o Programa de reabilitação fonoaudiológica em equoterapia “Passo a passo na comunicação” para tratamento de prejuízos de linguagem em crianças. O Programa foi elaborado em três etapas: análise de literatura, aplicação piloto e análise clínica. A análise da literatura foi realizada por meio da busca, leitura e discussão de artigos e livros sobre o tema publicados até 2018. No final desta fase foi elaborada a primeira versão do Programa. Essa versão foi aplicada de forma a contemplar: avaliação de linguagem dos participantes; aplicação de dez sessões; monitoramento e registro de atividades de cada sessão; reavaliação dos participantes; ajustes de técnicas e atividades. A etapa de análise clínica ocorreu após a aplicação piloto, por meio dos procedimentos: análise por três juízes, revisão da proposta pelos autores, elaboração da versão final do Programa “Passo a passo na comunicação”. O Programa contém oito módulos temáticos com 24 sessões e possui quatro pilares principais que são aplicados durante as atividades em equoterapia. Cada um dos pilares possui objetivos e estratégias específicas. Possui atividades voltadas para os aspectos formais (semânticos e morfossintáticos) e pragmáticos da linguagem, seu arcabouço teórico-prático está ancorado na gramática funcional e as estratégias são baseadas em vivências de equoterapia que possam fornecer momentos de abertura para comunicação.

Terapias y actividades asistidas con animales para niños con TEA: un estudio de revisión

Este trabajo incluye una revisión de la literatura publicada entre 2010 y 2019 que aborda la efectividad de las Terapias y Actividades Asistidas con Animales como intervención con niños y adolescentes con Trastorno del Espectro Autista (TEA). Se realizó una búsqueda bibliográfica en PsycINFO, PsycARTICLES, ProQuest, ERIC y Google Scholar, empleando los términos [(animal assisted therapy OR animal assisted intervention OR dog-assisted therapy OR equine-assisted therapy OR dolphin-assisted therapy) AND (autism OR ASD)]. Se identificaron 245 estudios, de los cuales se seleccionaron 40 con base en diferentes criterios de inclusión, tales como que las intervenciones descritas tengan un enfoque psicoeducativo y sean evaluadas mediante instrumentos rigurosos. En cada uno de ellos se revisaron las variables analizadas, los instrumentos de evaluación utilizados, las características de cada intervención y los resultados obtenidos. Los resultados sugieren que los animales más utilizados son el caballo y el perro, y que este tipo de intervención tiene efectos positivos para niños con TEA en áreas como la interacción y la comunicación social, el comportamiento y el desarrollo motor, entre otros. Se concluye que es una intervención beneficiosa para niños y adolescentes con autismo, aunque siempre como complemento de otro tipo de tratamientos.

Ultrasonographic examination of equine fetal growth parameters throughout gestation in pony for Equine-Assisted Therapy

Equine-Assisted Therapy (EAT) is gaining popularity. Ultrasound examination is used to decrease the abortion rate in horses. In this study, to monitor fetal well-being throughout the gestation for EAT, we measured fetal heart rate (FHR), fetal eye orbit (FEO), fetal gonad length (FGL), fetal kidney length (FKL), and the combined thickness of the uterus and placenta (CTUP) by ultrasonography in pony mares. Additionally, we measured the plasma progesterone (P₄) and estradiol (E₂) concentrations in pregnant horses using enzyme immunoassay. The FGL peaked at week 32 and then decreased to term, and a strong correlation (r=0.72, P<0.001) between the FGL and E₂ concentration was observed. A strong correlation with gestational age was detected among the FEO (r=0.96, P<0.001), FKL (r=0.85, P<0.001), and CTUP (r=0.96, P<0.001). The P₄ concentration peaked at week 10, decreased to low levels (below 5 ng/ml), and peaked before parturition. In conclusion, this study provides information on fetal growth throughout gestation in pony mares for EAT. In addition, it revealed the relationship between ultrasonographic profile and plasma hormone concentrations during gestation.

Interest in Humans: Comparisons between Riding School Lesson Equids and Assisted-Intervention Equids

Simple Summary

Very little is known about the impact of equine-assisted interventions on equids’ perception of humans. Different factors can influence human–horse relationships: animal characteristics, daily interactions with the caretakers, and working and living conditions. In this study, 172 equids working in equine-assisted interventions, ‘classical’ riding school lessons, or both were submitted to a standardised human–horse relationship test in order to test if EAI had an impact on the equid reactions to humans. The possible influence of intrinsic (age, sex, type) or other extrinsic factors (housing and feeding conditions) was also considered. The results showed that the number (more than the type) of experimenter-directed behaviours varied significantly between individuals and that the activity was the most important factor of influence: Equids working in riding school lessons performed more interactive behaviours than those working in equine-assisted interventions or having mixed activity. Other factors such as daily hay quantity, the horses’ age, and sex also influenced secondarily the horse’s motivation to interact, although no interaction was found between factors. These results suggest that equine-assisted interventions do influence horses’ perception of humans outside work. Further studies are needed in order to understand the processes involved.

Abstract

Little is known about the impact of equine-assisted interventions (EAI) on equids’ perception of humans. In this study 172 equids, living in 12 riding centres, were submitted to a standardised human–horse relationship test: the motionless person test. Age, sex, type (horse/pony), housing, and feeding conditions of subjects were recorded. Overall, 17 equids worked in EAI, 95 in riding school lessons (RS), and 60 in both (EAI-RS). There were high inter-individual variations in the number of interactive behaviours directed towards the experimenter: negative binomial general linear models showed that activity was the most important factor: RS equids performed more interactive behaviours than EAI (p = 0.039) and EAI-RS (p < 0.001) equids. Daily quantity of hay appeared as the second most important factor (equids with more than 3 kg interacted more than equids with less than 3 kg, p = 0.013). Individual characteristics were also important as horses interacted more than ponies (p = 0.009), geldings more than mares (p = 0.032), and 3–15-year-old equids more than equids over 15 years (p = 0.032). However, there was no interaction between factors. The lower number of interactive behaviours of EAI equids leads to different hypotheses—namely, selection on temperament, specific training, or compromised welfare (apathy). In any case, our results raised new lines of questions on EAI.

Equine-Assisted Interventions (EAIs) for Children with Autism Spectrum Disorders (ASD): Behavioural and Physiological Indices of Stress in Domestic Horses (Equus caballus) during Riding Sessions

Equine-assisted interventions (EAIs) are well-known complementary practices combining physical activity with emotional/cognitive stimulation. They are especially suited for children with autism spectrum disorders (ASD) who need a high degree of physical and psychological enrichment. Even though EAIs have become a common practice, stress responses in horses interacting with individuals that can manifest inappropriate behaviours, such as ASD children, have not been thoroughly investigated. Our multicentre study aimed to investigate behavioural and physiological indices of stress in horses involved in EAI standardised sessions with children with ASD compared to typically developing (TD) children. A controlled within-subject design with repeated measurements involving 19 horses and 38 children was adopted. Stress-related behaviours, heart rate, heart rate variability, and eye temperature were recorded during the riding sessions. Moreover, blood samples were collected from horses before and after each session to monitor changes in blood adrenocorticotropic hormone (ACTH), cortisol, and catecholamines. Results indicate that, in general, stress responses in horses involved in EAIs did not differ as a function of the horse being ridden by children with ASD or TD. A lower sympathetic tone in horses involved in ASD sessions was found, while in the mounting and dismounting phases, horses displayed behavioural signs of stress, independently from children's behaviour. We conclude that professionals working in EAI should increase their awareness of animal welfare and refine riding practices, taking into account horse's needs.

Effectiveness of Equine-Assisted Activities and Therapies for Improving Adaptive Behavior and Motor Function in Autism Spectrum Disorder

Equine-assisted activities and therapies (EAAT) have been suggested to improve adaptive behavior, and possibly motor function, in autism spectrum disorder (ASD). This study investigated the effects of EAAT on adaptive behavior and motor function in 15 children with ASD (13 males) aged 7–15 years as well as the impact of EAAT on the magnitude of stress in the parent–child system and the evolution in the child interaction with both the trained therapist and the therapeutic animal through the 20 weekly sessions of EAAT. EAAT were associated with greater adaptive behavior and coordination (all p ≤ 0.01) as well as a progressive improvement in the child’s abilities to respond to the increasing complexity of such form of positive behavioral support (all p < 0.001). However, EAAT did not prove to be effective in reducing parental distress. Collectively, preliminary evidence presented here may have important public health implications and gives reason to hope that EAAT could possibly be an effective option in ASD, warranting further investigation of its potential benefits in clinical trials among larger samples.

The Effect of Physical Activity Interventions on Executive Function Among People with Neurodevelopmental Disorders: A Meta-Analysis

The current meta-analysis comprehensively examined the effects of physical activity interventions on executive function among people with neurodevelopmental disorders. The meta-analysis included 34 studies with 1058 participants aged 5-33 years. Results indicated an overall significant medium effect of physical activity interventions on improving executive function in people with neurodevelopmental disorders under the random-effect model (Hedges' g = 0.56, p < .001). Significant moderators of the effects of physical activity intervention on executive function included age, intervention length and session time, executive function subdomains, and intervention dose (total minutes in the intervention). This meta-analysis provides support for the effectiveness of physical activity interventions on executive function among people with neurodevelopmental disorders. Future studies and limitations are discussed.

Equine-Assisted Services for Children with Attention-Deficit/Hyperactivity Disorder: A Systematic Review

Objective: This systematic review evaluated equine-assisted activities and therapies (EAATs), formerly referred to as equine-assisted services (EAS), in children and youth (ages 6-18 years) with attention-deficit/hyperactivity disorder (ADHD), according to the International Classification of Functioning, Disability, and Health. Methods: Electronic database searches were conducted of studies from inception through December 2020. Results: A total of 12 articles were included: 8 noncontrolled prospective studies and 4 randomized-controlled trials (RCTs). Furthermore, seven of moderate methodological quality studies and five of moderate high methodological quality studies were included. Evidence was found for the effectiveness of various forms of EAS, including equine-assisted physical therapy (EAPT) and therapeutic riding (TR). Improvements in body functions and structures (n = 10) were found in the domains of mental and neuromusculoskeletal functions, as well as functions of the cardiovascular system using EAPT (n = 6). Limited evidence was found regarding the positive effect on activity and participation (n = 4) following TR interventions. Quality of life (QoL) was improved in both TR and EAPT (n = 4). Conclusion: There seems to be preliminary evidence that EAS may be beneficial in promoting the physiological functions of body systems for children with ADHD. The influence on participation and QoL still requires further evidence. More generally, further controlled studies, including bigger sample sizes, are needed to understand the specific effects of different EAS on the core symptoms and consequence of ADHD.