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

Building up bit by bit, parent's experiences of equine-assisted intervention among children and adolescents with mental illness: a grounded theory study

BACKGROUND

Mental ill health among children and adolescents has increased worldwide. Mental health difficulties from a young age are associated with school absence and educational underachievement. A holistic perspective of treatments besides medical treatment is essential Thus, there is a need for research regarding equine-assisted intervention (EAI).

PURPOSE

The present study aimed to understand the outcomes of an equine-assisted intervention for children and adolescents with mental ill health from the perspectives of parents and close relatives.

METHODS

This study used a qualitative research design informed by Charmaz's Grounded Theory, with a purposive sample including six in-depth interviews.

RESULTS

The theory "building up bit by bit" was constructed, explaining the recognition that their children/adolescents were built up bit by bit and created a stronger self-identity. The participants referred to changes in the child's or adolescent's way of being and emotional regulation, which constituted building blocks leading to the child's or adolescent's 1. increased Harmony. 2. enhanced Self-identity, and 3. improved Capability.

CONCLUSION

Parents and close relatives experienced that their child or adolescent was built up bit by bit and gained a stronger foundation to stand on. This led to increased harmony in everyday life with stronger self-worth, better performance, and reduced school absenteeism.

Health-related quality of life in patients with inborn errors of immunity: A systematic review and meta-analysis

BACKGROUND

Inborn Errors of Immunity (IEI) significantly affect patients' health-related quality of life (HRQOL), presenting greater challenges than those faced by the healthy population and other chronic disease sufferers. Current research lacks comprehensive integration of this critical issue.

OBJECTIVE

This study explores HRQOL in IEI patients, identifies impacting factors, and advocates for increased research focus on their quality of life.

METHODS

Following systematic review and meta-analysis guidelines, a search of Scopus and PubMed until November 15, 2023, yielded 1633 publications. We evaluated the literature, assessed study quality, and compared the HRQOL of IEI patients to that of healthy individuals and other chronic disease patients.

RESULTS

Of 90 articles and 10,971 IEI patients analyzed, study quality varied (nine good, 63 moderate, and 18 poor). The Short Form-36 (SF-36) and Pediatric Quality of Life Inventory generic core scales (PedsQL) were the primary generic instruments used among adults and children, respectively, with 12 studies each using the disease-specific instruments. Meta-analysis showed IEI patients have significantly lower scores in general health, physical and mental health, and social and emotional roles compared to healthy populations. We noted significant differences between self and proxy reports, indicating caregiver anxiety and perception disparities.

CONCLUSION

Despite limitations like small sample sizes and reliance on generic instruments, this research underscores the substantially lower HRQOL among IEI patients, emphasizing the need for a patient-centered, multidisciplinary approach to improve their life quality and calling for more focused attention on IEI patients and their caregivers' HRQOL.

A Scoping Review of Equine-Assisted Therapies on the Mental Health and Well-Being of Autistic Children and Adolescents: Exploring the Possibilities

Animals are increasingly being utilized to assist with therapies for people with various health conditions. Horses are often used as a mechanism of engagement and development for autistic children and adolescents. Horses offer a unique opportunity for interaction as the child or adolescent can physically ride and interact with the animal, thus creating a therapy that involves contact that is different to other animals. Benefits derived from equine-assisted therapies can be physical, social, behavioral, emotional, sensory, and cognitive. However, a current and specific research gap exists in understanding the potential mental health impacts of horse riding on autistic children and adolescents, as perceived and experienced by their parents, carers, and horse-riding service providers. This scoping review examined research on parents' and service providers' perceptions of the benefits of horse-related therapies, with a particular focus on perceptions of positive mental health impacts. A comprehensive electronic search across PubMed, Scopus and Cumulative Index to Nursing and Allied Health Literature identified 16 articles from 15 studies which met the inclusion criteria. Findings included non-mental health-related benefits (as perceived by parents and service providers), mental health-related benefits (as perceived by parents and service providers), benefits for those other than the child/adolescent, and limitations of equine-assisted therapies. With the increased use of equine therapy, and the mounting evidence of its positive impacts on mental health, it is timely to expand research on how to better harness interventions and maximize the mental health benefits for autistic children and adolescents.

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.

Effects of Physical Activity on Cognition, Behavior, and Motor Skills in Youth with Autism Spectrum Disorder: A Systematic Review of Intervention Studies

The aim of this paper was to analyze the acute and chronic effects of physical activity (PA) on cognition, behavior, and motor skill in youth with autism spectrum disorder (ASD), taking into account potential confounders. In addition, it was intended to elaborate a guide of educational applications with strategies for PA use. Studies were identified in four databases from January 2010 to June 2023. A total of 19 interventional studies met the inclusion criteria. PA programs ranged from two weeks to one year in duration, with a frequency of one to five sessions per week. More than 58% of the studies showed positive effects of PA on cognition, and 45.5% on behavior and motor skill. Moderate-vigorous PA for 15-30 min has shown acute effects on cognition, general behavior, and stereotypic/repetitive behaviors in youth with ASD. A total of 9 out of 14 studies showed chronic effects on general behavior and stereotypic behaviors, and only 6 on motor skills.

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.

A multidimensional investigation of the relationship between skin-mediated somatosensory signals, emotion regulation and behavior problems in autistic children

Introduction

Autistic children may have abnormal sensory perception, emotion dysregulation and behavior problems. The aim of this cross-sectional study was to explore the relationship between skin-mediated somatosensory signals and emotion/behavior difficulties in autistic children and adolescents, in comparison typically developing peers (TDP).

Methods

Thirty-eight autistic children and adolescents and 34 TDP completed a multidimensional assessment consisting of the measurement of somatosensory thresholds of touch, pain and temperature, a task on emotion knowledge and parent-reported questionnaires on sensory reactivity, emotion regulation and behavior.

Results

Autistic children had higher pain sensitivity, less sensory reactive behaviors and more behavior problems than their TDP. In contrast to TDP, several somatosensory thresholds of autistic children correlated with emotion regulation and behavior problems.

Discussion

Sensory dysfunction may affect the development of emotional processing and behavior in autistic children and adolescents. This knowledge can lay the foundation for future studies on co-occurring alterations in corresponding neural networks and for the implementation of early interventions, including sensory rehabilitation therapy, for promoting regulated behaviors in autistic children and adolescents.