Psycho-educational Horseback Riding to Facilitate Communication Ability of Children with Pervasive Developmental Disorders

Drop-out rates in animal-assisted psychotherapy - Results of a quantitative meta-analysis

INTRODUCTION

Animal-assisted psychotherapy is an emerging field with great potential and growing popularity. However, empirical research on its effectiveness is insufficient, and consistent evidence about patients' commitment is missing. The present meta-analysis addresses this gap by systematically comparing drop-out rates in animal-assisted psychotherapy and by relating the resulting across study drop-out rate to across study drop-out rates reported in meta-analyses on conventional psychotherapy.

METHOD

Fifty-seven studies published until August 2022 were identified as eligible for meta-analytic comparison, that is, they conducted animal-assisted psychotherapy on at least one group of psychiatric patients and reported drop-out rates. Potential moderating influences of the type of animal and patients' disorder were considered, as well as multiple other demographic and study design variables.

RESULTS

The across study drop-out rate in animal-assisted psychotherapy was 11.2%. This was significantly lower than the across meta-analyses drop-out rate of conventional psychotherapy (d = -.45, p = .0005). Although effects of moderator variables could not be evaluated statistically due to too small and heterogeneous data sets, descriptive results suggest influences of the type of animal and patient disorder. However, study quality ratings identified serious shortcomings regarding proper research design, most critically concerning the report of effect size measures, the use of standardized intervention plans and Open Science practices.

CONCLUSION

Drop-out constitutes a major problem of psychotherapeutic research and practice. By proposing that the inclusion of an animal in the psychotherapeutic setting can enhance patients' commitment and by outlining challenges and opportunity of animal-assisted psychotherapy, this meta-analysis offers a starting point for future research in this evolving field.

Physical Activity for Anxiety for Autistic People: A Systematic Review

Clinical anxiety is a common comorbidity in autistic people. Due to the prevalence of anxiety in the autism population and the adverse effects it causes, there is a critical need to develop effective interventions which address anxiety symptoms for autistic people. Therefore, the purpose of this systematic review was to examine the effectiveness of the use of physical activity as an intervention to reduce anxiety in autistic people. Three databases PubMed, PsychInfo, and Cochrane RCTs, were searched utilizing key terms. PRISMA systematic search procedures identified 44 studies meeting predetermined inclusion criteria. Participant characteristics, the type of physical activity performed, the nature of the physical activity program/delivery, anxiety-related outcomes, and research methodology was evaluated for each study. Each paper included was appraised and scored for risk of bias using Cochrane Handbook for Systematic Reviews of Interventions risk of bias tool. Titles and abstracts of 44 articles were reviewed and 8 articles met inclusion criteria which evaluated interventions. Evidence from 8 studies suggests that yoga, a community-based football program, an app-assisted walking program, group exercise programs, and horseback riding interventions reduced anxiety for autistic people. The studies included in this systematic review provide strong-to-moderate evidence that physical activity can reduce anxiety for autistic children and adults. However, additional research is needed to identify which mode of physical activity is most beneficial for anxiety reduction. Further, future research should evaluate frequency, duration, and intensity and their effects on anxiety for autistic people.

The feasibility and acceptability of integrating dogs into inpatient rehabilitation therapy with children with acquired brain injury

INTRODUCTION

Children with acquired brain injury (ABI) are at risk for poor therapeutic engagement due to cognitive impairment, affect lability, pain, and fatigue. Animal-assisted therapy (AAT) has the potential to improve patient engagement in rehabilitation therapies; however, the feasibility of integrating AAT into the rigorous therapy schedule of inpatient clinical care or its reception by patients, families, and staff is unknown.

OBJECTIVE

To examine the feasibility and acceptability of incorporating dogs into physical therapy and occupational therapy sessions with pediatric patients being treated on an inpatient rehabilitation unit for acquired brain injury.

DESIGN

A feasibility study of AAT within the context of a within-subjects crossover study.

SETTING

Pediatric inpatient rehabilitation unit.

PARTICIPANTS

Sixteen patients, aged 7-28 years (mean = 13.6 years, standard deviation [SD] = 5.2 years; 50% male), being treated on the inpatient rehabilitation unit following ABI.

INTERVENTION

AAT - the integration of dogs into inpatient physical therapy and occupational therapy sessions.

MAIN OUTCOME MEASURES

Feasibility measures: enrollment rate, the proportion of AAT sessions a dog attended, adverse events, instances where therapist or handler ended session early, patient animal closeness, and utilization of dog in session. Satisfaction measures: parent satisfaction questionnaires and therapist feedback.

RESULTS

Feasibility was supported by high enrollment rate (88.9%) and dog attendance rate of 93%-95%; 84.3% of sessions used the dog in multiple ways and patients reported a high level of closeness with the dog in session, indicating that the dogs were integrated in meaningful ways. No adverse events were noted, therapists reported that intervention was convenient, and clinical care was not negatively impacted. A high level of satisfaction was reported by families and therapists.

CONCLUSIONS

Findings suggest that AAT is feasible and acceptable, and it may be a valuable tool for therapists working with patients with ABI on an inpatient rehabilitation unit.

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.

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.

Evaluating Animal-Assisted Interventions: An Empirical Illustration of Differences between Outcome Measures

Simple Summary

This study compares and contrasts several outcome measures to assess the effect of an equine-assisted intervention for a child with Autism Spectrum Disorder. Before and after the equine-assisted sessions, we conducted a semi-structured interview with the participant’s parents, asked parents to fill out a general screening instrument separately, and observed the participant’s social and communication skills during five equine-assisted sessions. We found differences between the interview and questionnaire with regard to parents’ perceptions of aggression regulation and interacting with peers. Differences with regard to parental reports and observations were found for play development and anxiety. The observations provided a detailed view of the child’s development during the intervention, which yielded an interesting hypothesis in terms of the current dose–response discussion in AAI for children with Autism Spectrum Disorder.

Abstract

Multiple authors have called for strong empirical evaluations to strengthen the foundation of Animal-Assisted Interventions. Carefully choosing the outcome measures of these studies is important, as choosing the wrong outcomes may lead to a failure to detect effects. The current study therefore compares and contrasts the use of several outcome measures, to assess the effect of an equine-assisted intervention for a child with Autism Spectrum Disorder: (1) a semi-structured interview with both parents, specifically designed for children with cognitive disabilities, (2) a general screening instrument filled out by both parents separately, which can be used to assess children’s psycho-social problems, and (3) systematic observations of social and communication skills during the equine-assisted sessions. All instruments indicated an improvement in the participant’s social and communication skills. We found differences between the interview and questionnaires with regard to parents’ perception of aggression regulation and interacting with peers. Differences with regard to parental reports and observations were found for play development and anxiety. The observations provided a detailed view of the child’s development during the intervention, which yielded an interesting hypothesis in terms of the current dose–response discussion in AAI for children with Autism Spectrum Disorder.

Effects of Equine-Assisted Activities and Therapies on the Affective Network of Adolescents with Internet Gaming Disorder

OBJECTIVES

Internet gaming disorder (IGD) has been suggested to be a mental health disorder. Attachment and emotional status in IGD patients are important for understanding the etiology and progression of IGD because both parameters are considered to be associated with the affective network. Equine-assisted activities and therapies (EAAT) have been reported to improve emotional status and attachment in subjects. We hypothesized that EAAT would improve attachment in IGD adolescents with insecure attachment issues and increase functional connectivity (FC) within the affective network.

DESIGN

Subjects completed a demographic questionnaire, the Korean Experiences in Close Relationships Scale Revised version (K-ECRS), the Child Depression Inventory, Young's Internet Addiction Scale, the Korean Attention-Deficit Hyperactivity Disorder Rating Scale, and resting-state functional magnetic resonance imaging at baseline at the end of EAAT.

SUBJECTS

Fifteen IGD adolescents with insecure attachment issues and 15 healthy comparison adolescents with secure attachment agreed to participate in this study.

RESULTS

After 7 days of EAAT, K-ECRS avoidance and anxiety scores improved in all adolescents. K-ECRS avoidance scores of the IGD group showed marked improvement compared with those of the healthy group. In all participants, FC from the left amygdala to the left parahippocampal gyrus, left medial frontal gyrus, and left inferior frontal gyrus, as well as from the right amygdala to the left caudate, right claustrum, and left inferior frontal gyrus increased. In IGD adolescents, FC from the left amygdala to the left frontal orbital gyrus, as well as from the right amygdala to the right corpus callosum also increased.

CONCLUSION

These findings suggested that EAAT improves attachment, which could lead to a decrease in the severity of IGD symptoms in IGD patients with insecure attachment issues. In addition, EAAT increases FC within the affective network, which was associated with attachment not only in healthy adolescents but also in adolescents with IGD.

The Impact of a Horse Riding Intervention on the Social Functioning of Children with Autism Spectrum Disorder

This paper reports a case-control study of a horse riding intervention for children with autism spectrum disorder (ASD). A sample of 26 children, aged 6 to 9 years, were assigned to either the intervention (n = 12) or control group conditions (n = 14). Pre- and post-tests were carried out using the Childhood Autism Rating Scale, Second Edition (CARS2) and the Aberrant Behaviour Checklist-Community Edition (ABC-C). An observational measure of compliance and behaviour during the horse riding sessions was completed for the intervention group. There was a significant reduction in the severity of ASD symptoms and hyperactivity from pre- to post-test for the intervention group only. These results indicate that the intervention improves some aspects of social functioning for children with ASD.

Assessing Preferences for Animals in Children with Autism: A New Use for Video-Based Preference Assessment

The inclusion of animals into interventions for children with autism spectrum disorder (ASD) is a growing practice known as animal-assisted intervention (AAI). The choice of the animal to include in an intervention is often solely up to the interventionist and depends on their experience, subjective judgment, and ease of access to different animals. For individuals with ASD who are non-verbal and unable to indicate preferred stimuli or activities, incorporating preference into interventions has been linked to increases in positive behaviors and enhanced quality of life. We propose that animal choice based on a participant's preference may enhance the experience of AAI and maximize its outcomes. A common technique used to reliably determine preferred interactions and activities in interventions for children with ASD is a stimulus preference assessment. The video-based multiple-stimulus without replacement (MSWO) procedure, in particular, allows for discrimination of complex stimuli that could not feasibly be presented all at once, which is the case when choosing an animal. Based on the well-documented reliability of this technique in the field of applied behavior analysis, we propose that a future direction in AAI is utilizing video-based MSWO to guide animal selection.

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

In this study the effectiveness of an equine-assisted therapy (EAT) in improving adaptive and executive functioning in children with autism spectrum disorder (ASD) was examined (children attending EAT, n = 15, control group n = 13; inclusion criteria: IQ > 70). Therapeutic sessions consisted in structured activities involving horses and included both work on the ground and riding. Results indicate an improvement in social functioning in the group attending EAT (compared to the control group) and a milder effect on motor abilities. Improved executive functioning was also observed (i.e. reduced planning time in a problem-solving task) at the end of the EAT program. Our findings provide further support for the use of animal-assisted intervention programs as complementary intervention strategies for children with ASD.

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

OBJECTIVE

This study expands previous equine-assisted intervention research by evaluating the effectiveness of therapeutic horseback riding (THR) on self-regulation, socialization, communication, adaptive, and motor behaviors in children with autism spectrum disorder (ASD).

METHOD

Participants with ASD (aged 6-16 years; N = 127) were stratified by nonverbal IQ standard scores (≤85 or >85) and randomized to 1 of 2 groups for 10 weeks: THR intervention or a barn activity (BA) control group without horses that used similar methods. The fidelity of the THR intervention was monitored. Participants were evaluated within 1 month pre- and postintervention by raters blinded to intervention conditions and unblinded caregiver questionnaires. During the intervention, caregivers rated participants' behaviors weekly.

RESULTS

Intent-to-treat analysis conducted on the 116 participants who completed a baseline assessment (THR n = 58; BA control n = 58) revealed significant improvements in the THR group compared to the control on measures of irritability (primary outcome) (p = .02; effect size [ES] = 0.50) and hyperactivity (p = .01; ES = 0.53), beginning by week 5 of the intervention. Significant improvements in the THR group were also observed on a measure of social cognition (p = .05; ES = 0.41) and social communication (p = .003; ES = 0.63), along with the total number of words (p = .01; ES = 0.54) and new words (p = .01; ES = 0.54) spoken during a standardized language sample. Sensitivity analyses adjusting for age, IQ, and per protocol analyses produced consistent results.

CONCLUSION

This is the first large-scale, randomized, controlled trial demonstrating efficacy of THR for the ASD population, and findings are consistent with previous equine-assisted intervention studies.

CLINICAL TRIAL REGISTRATION INFORMATION

Trial of Therapeutic Horseback Riding in Children and Adolescents With Autism Spectrum Disorder; http://clinicaltrials.gov; NCT02301195.

Brief report: the smiles of a child with autism spectrum disorder during an animal-assisted activity may facilitate social positive behaviors--quantitative analysis with smile-detecting interface

We quantitatively measured the smiles of a child with autism spectrum disorder (ASD-C) using a wearable interface device during animal-assisted activities (AAA) for 7 months, and compared the results with a control of the same age. The participant was a 10-year-old boy with ASD, and a normal healthy boy of the same age was the control. They voluntarily participated in this study. Neither child had difficulty putting on the wearable device. They kept putting on the device comfortably through the entire experiment (duration of a session was about 30-40 min). This study was approved by the Ethical Committee based on the rules established by the Institute for Developmental Research, Aichi Human Service Center. The behavior of the participants during AAA was video-recorded and coded by the medical examiner (ME). In both groups, the smiles recognized by the ME corresponded with the computer-detected smiles. In both groups, positive social behaviors increased when the smiles increased. Also, negative social behaviors decreased when the smiles increased in the (ASD-C). It is suggested that by leading the (ASD-C) into a social environment that may cause smiling, the child's social positive behaviors may be facilitated and his social negative behaviors may be decreased.

Animal-assisted intervention for autism spectrum disorder: a systematic literature review

The inclusion of animals in therapeutic activities, known as animal-assisted intervention (AAI), has been suggested as a treatment practice for autism spectrum disorder (ASD). This paper presents a systematic review of the empirical research on AAI for ASD. Fourteen studies published in peer-reviewed journals qualified for inclusion. The presentation of AAI was highly variable across the studies. Reported outcomes included improvements for multiple areas of functioning known to be impaired in ASD, namely increased social interaction and communication as well as decreased problem behaviors, autistic severity, and stress. Yet despite unanimously positive outcomes, most studies were limited by many methodological weaknesses. This review demonstrates that there is preliminary "proof of concept" of AAI for ASD and highlights the need for further, more rigorous research.

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.

Psycho-educational Horseback Riding to Facilitate Communication Ability of Children with Pervasive Developmental Disorders

In this study, we applied a novel psycho-educational horseback riding (PEHR) program to the treatment of four Japanese children with pervasive developmental disorders (PDD) in order to facilitate the acquisition of verbal and nonverbal communication skills. The behavioral changes in each child were evaluated using a psychological and behavioral scale. The scale for evaluating the effect of Human-Equips-Interaction on Mental activity (HEIM scale) was designed to assess the behavioral improvement of children based on the following 10 items: Human relationships, Imitation, Emotional expression, Sudden physical movement, Fixative behavior, Adaptation to change, Visual response, Fear or nervousness, and Verbal and nonverbal communication. After taking part in the PEHR program for several months, all subjects showed remarkably improved HEIM scores and marked improvements were observed in eye contact with others (instructors, side walkers, and leaders) in the riding area. A statistical difference was found in items 1, 2, 3, 6, 7, 8, and 9. However, no statistical difference was found in items 4, 5, and 10. As the program progressed, the children showed enhanced verbal and nonverbal communication skills, and became more expressive in their emotional and empathetic interaction with their parents. These observations suggest that the normal functioning of pleasurable emotions and empathy may facilitate further improvements in joint attention, imitation and empathy, and may result in successful verbal expression by PDD children. Therefore, horseback riding can play a very important role in the psycho-educational support required for the communication ability of PDD children.