Parent-Reported Behavioral Changes Following Equine-Assisted Therapy in Children with Autism Spectrum Disorder: A Single-Group Longitudinal Study

The burgeoning field of complementary therapies for Autism Spectrum Disorder (ASD) has seen equine-assisted therapy (EAT) emerge as a promising intervention. A recent longitudinal study, published in Frontiers in Psychology, investigated the impact of an eight-week EAT program on the behavior of children with ASD, providing valuable insights into the persistence of parent-reported changes over time. While previous research has indicated positive outcomes in behavioral and social domains, this study specifically aimed to address the limited evidence regarding the long-term effects of such programs.

Background: The Growing Interest in Equine-Assisted Therapies for ASD

Equine-Assisted Interventions (EAI) encompass a broad spectrum of practices that integrate horses into therapeutic settings to improve human well-being. EAT, a specific modality within EAI, focuses on structured, goal-oriented interactions with horses under professional guidance to achieve behavioral and functional goals. Unlike hippotherapy, which is delivered by licensed therapists utilizing the horse’s movement as a clinical tool, EAT as studied here does not position itself as a direct clinical rehabilitation method but rather as a supportive approach.

Children with ASD often face challenges across multiple developmental domains, including motor coordination, sensory processing, communication, and social interaction. Conventional physical activity programs can be difficult for these children to engage with due to these co-occurring difficulties. EAT’s inherent multidimensional nature—simultaneously engaging motor skills, sensory systems, communication, and environmental awareness—makes it a compelling intervention for this population. Regular physical activity has been linked to reduced maladaptive behaviors and improved attention, emotional regulation, and social skills in individuals with ASD. However, sustained engagement in traditional settings remains a hurdle for many.

The current study builds upon a growing body of literature that highlights potential benefits of EAT for children with ASD. Recent meta-analyses have pointed to improvements in social communication, social functioning, irritability, and hyperactivity. Crucially, parent-reported measures are considered vital in autism intervention research as they capture behavioral changes that may generalize to everyday contexts, offering a more ecologically valid perspective than solely focusing on in-clinic observations. This study sought to bridge a gap by combining longitudinal data with parent reports to assess the temporal impact of EAT.

Theoretical Framework: Unpacking the Mechanisms of EAT

The observed effects of EAT in children with ASD are theorized to stem from a confluence of interconnected mechanisms, drawing upon sensory integration theory, human-animal interaction theory, and social motivation theory.

From a sensory integration perspective, children with ASD often experience difficulties in processing sensory information. The rhythmic and repetitive motion of a horse provides continuous multisensory input, potentially aiding in sensory modulation, postural control, and motor planning. The constant need to adapt to the horse’s movements can foster a greater sense of embodiment and responsiveness to environmental cues.

Human-animal interaction theory suggests that the non-judgmental and emotionally responsive nature of horses can foster emotional regulation and reduce anxiety. These supportive interactions may lead to decreased stress-related behaviors and enhanced engagement in therapeutic activities.

Taken together, these theoretical pathways suggest that EAT may influence children with ASD through a complex interplay of sensory regulation, emotional engagement, and social participation. It is important to note that while these mechanisms provide a theoretical basis for understanding potential outcomes, they were not directly measured in this study and remain speculative.

Study Design and Methodology: A Longitudinal Approach

This research employed a longitudinal, single-group pretest-posttest design with a two-week follow-up assessment. The study involved 36 children diagnosed with ASD (18 girls and 18 boys), with a mean age of 9.90 ± 1.44 years. The intervention consisted of an eight-week structured EAT program, with sessions held twice weekly for 30 minutes each.

Behavioral outcomes were evaluated using the Autism Behavior Checklist (ABC), a standardized instrument administered through face-to-face parent reports. The ABC assesses five subdomains: sensory-related behaviors, relationship-building, body and object use, social and self-care skills, and language-related behaviors. Scores on the ABC indicate the prevalence of autism symptoms, with higher scores signifying more pronounced symptoms. The Turkish adaptation of the ABC has demonstrated good validity and reliability.

The study’s design aimed to track changes in behavior over time, acknowledging that parent reports offer valuable insights into a child’s functioning in naturalistic settings. The pre-test was administered before the intervention, the post-test immediately after the eight-week program, and the follow-up test two weeks later to assess the short-term persistence of any observed changes.

The sample was recruited from children attending private special education and rehabilitation centers in Istanbul, Turkey. Strict inclusion criteria were applied: a confirmed ASD diagnosis according to DSM-5 criteria, partial verbal communication skills, no prior EAT experience, no regular pharmacological treatment, and no other significant chronic medical conditions. Participants exceeding a 60 kg weight limit were excluded to ensure safety for both the child and the therapy horse. This weight criterion aligns with established safety and animal welfare principles in EAT.

Statistical analysis involved repeated-measures analysis of variance (ANOVA) to examine changes across the three assessment points. Effect sizes, calculated using Cohen’s d and partial eta-squared (η²), were used to quantify the magnitude of observed changes.

Results: Significant Behavioral Shifts Observed

The findings from the study revealed significant changes in parent-reported behavioral outcomes across multiple domains of the ABC.

Sensory Dimension: A statistically significant difference was observed in parent-reported sensory-related behaviors from pre-test to post-test, with scores decreasing and showing some maintenance at follow-up (p < 0.01). The effect size for the time effect was very large (η² = 0.932).

Relationship Building: Significant improvements were noted in the relationship-building subdomain. Parent reports indicated a substantial decrease in scores from pre-test to post-test, with a notable degree of persistence at the follow-up assessment (p < 0.01). The within-group effect size was large (η² = 0.696), and the time effect was also large (η² = 0.883).

Body and Object Use: The study found significant changes in parent-reported body and object use behaviors. Scores decreased substantially from pre-test to post-test and showed partial maintenance at follow-up (p < 0.01). The within-group effect size was large (η² = 0.576), with a large time effect (η² = 0.633).

Social and Self-Care Skills: A marked reduction in parent-reported social and self-care difficulties was observed. Scores significantly decreased from pre-test to post-test and demonstrated partial retention at the two-week follow-up (p < 0.01). The effect sizes were substantial, with a large within-group effect (η² = 0.717) and a very large time effect (η² = 0.777).

Language Skills: Parent reports indicated significant improvements in language-related behaviors. Scores decreased notably from pre-test to post-test and were partially maintained at follow-up (p < 0.01). The within-group effect size was large (η² = 0.727), and the time effect was exceptionally large (η² = 0.954).

Total ABC Score: Across all subdomains, the total ABC scores showed a significant decrease from pre-test to post-test, with some of these gains being partially sustained at the follow-up assessment (p < 0.01). The effect sizes were very large, indicating substantial within-group changes (η² = 0.719 for within-group and η² = 0.964 for time effect).

The statistical analysis indicated that for all measured variables, there were significant differences between the pretest, posttest, and follow-up scores. Pairwise comparisons using the Bonferroni correction confirmed these differences across all measurement points, with scores generally decreasing from pre-test to post-test and showing a slight increase from post-test to follow-up, suggesting partial maintenance of gains.

Discussion: Interpreting the Findings and Future Directions

The study’s findings suggest that participation in an eight-week EAT program is associated with positive changes in parent-reported behavioral outcomes among children with ASD. The significant reductions in ABC scores across multiple domains from pre-test to post-test indicate a favorable shift in observed behaviors following the intervention. The partial maintenance of these changes at the two-week follow-up is particularly encouraging, suggesting that some benefits may extend beyond the immediate post-intervention period.

Sensory Adaptations: The improvements in sensory-related behaviors could be attributed to the continuous multisensory stimulation provided by the horse’s movement, potentially aiding in sensory modulation and environmental responsiveness.

Enhanced Social and Communication Skills: The observed changes in relationship-building and language skills may reflect the structured opportunities for interaction, turn-taking, and communication embedded within EAT sessions. The presence of the horse can serve as a social catalyst, encouraging engagement and reciprocal interactions.

Motor and Functional Development: Improvements in body and object use, as well as social and self-care skills, might be linked to the motor coordination and balance demands inherent in equine-assisted activities. These experiences, integrated within a meaningful context, could contribute to greater functional engagement.

Physical Literacy as a Conceptual Lens: While physical literacy was not directly measured, the study’s findings may offer a conceptual link. The engagement in movement, potential increase in confidence (though not directly measured), and participation in structured activities could align with broader aspects of physical literacy. However, the authors emphasize that these are conceptual connections and not empirical evidence of physical literacy development.

Limitations and Future Research Needs

Despite the promising results, the study acknowledges several limitations that warrant cautious interpretation. The primary limitation is the absence of a control group. This single-group design means that observed changes cannot be definitively attributed to EAT alone. Factors such as natural maturation, regression to the mean, increased parental attention, or concurrent therapies could also have contributed to the outcomes.

Furthermore, the reliance solely on parent-reported data, while ecologically valid, is susceptible to expectancy bias. Future research should incorporate multi-informant assessments, including observations by trained clinicians and educators, to provide a more objective evaluation of behavioral changes.

The follow-up period of only two weeks is insufficient to determine the long-term sustainability of the observed benefits. Future longitudinal studies should include extended follow-up periods (e.g., 3, 6, or 12 months) to assess the durability and generalization of behavioral improvements.

The study’s focus on children with partial verbal communication skills also limits the generalizability of the findings to the broader ASD population, including those with more severe communication impairments. Larger, more diverse samples encompassing a wider range of ASD severity and communication abilities are needed.

Finally, while the study provides preliminary evidence for behavioral changes, it did not directly investigate the underlying mechanisms. Future research should aim to explore potential mediators, such as changes in sensory processing, emotional regulation, or social motivation, using more direct assessment methods. Randomized controlled trials (RCTs) are the gold standard for establishing causality and should be prioritized in future research to confirm the efficacy of EAT for children with ASD.

Conclusion: A Promising Avenue Requiring Further Investigation

In conclusion, this longitudinal study provides preliminary evidence suggesting that an eight-week equine-assisted therapy program may be associated with positive changes in parent-reported behavioral outcomes among children with Autism Spectrum Disorder. Significant improvements were noted across sensory, relationship-building, body and object use, social and self-care, and language domains, with some changes showing partial persistence at a short-term follow-up.

However, due to the single-group design and reliance on parent reports, these findings should be interpreted as indicative of behavioral change patterns over time rather than definitive causal intervention effects. The study underscores the need for more rigorous research, including randomized controlled trials with diverse populations, extended follow-up periods, and multidimensional assessment approaches, to fully elucidate the efficacy, specificity, and long-term impact of equine-assisted therapy for children with ASD. While EAT presents a promising complementary approach, further robust scientific inquiry is essential to solidify its place within evidence-based interventions for ASD.