By Nestor Lopez-Duran PhD
As we move towards the implementation of day-themes in Child-Psych.org, we decided to dedicate every Wednesday to Autism. We are doing this as a way to thank the loyal readers of Translating Autism who followed us on our journey to Child-Psych. In our first Autism Wednesday column, we review a study that examines the effectiveness of horseback riding therapy for the promotion of social skills in autism.
One of the complaints I heard most often from parents of children of autism is how difficult it is to obtain information about which therapeutic interventions actually have empirical support. Sometimes parents have difficulty finding empirical support for alternative treatments because such support is simply not there. That is, some treatments may not have any scientific evidence supporting their effectiveness. Fortunately however, during the last few years there has been an increase in the number of scientific studies examining the efficacy of some of these alternative and new treatments (see for example our recent reviews of studies on
Hyperbaric treatment for children with autism, pressure vests, oral immunoglobulin, and Risperdone.
In an upcoming issue of the Journal of Autism and Developmental disorders, a team from the University of Miami reports on an examination of therapeutic horseback riding as therapy to promote social functioning in children with autism. Animal-based therapy have been used extensively as a complementary treatment for many conditions and situations, from conduct problems to childhood anxiety. Usually the animals are used as a tool to promote a specific outcome, such as empathy among people in prisons, or reduced anxiety in children. However, the alternative nature of these interventions make them less likely to be a target for research by academic researchers and thus the empirical support for the efficacy of these interventions is sometimes minimal.
The current study included 34 children (age 5 to 10) with an ADS diagnosis who underwent a 12-week horseback therapy program at a Florida-based center. 19 children were assigned to a therapy condition and 15 children were assigned to a control (waiting list) group. One major strength of this study is that included children with low and high functioning autism. In fact, more than 50% of the participants were non-verbal.
Social behaviors were measured before and after the therapy program via the parent-completed Social Responsiveness Scale and the Sensory Profile scale. The therapy program lasted 1 hour per week for 12 weeks. The actual therapy consisted of equestrian exercises, mounted games, and horsemanship activities (grooming the horses, etc).
When compared to the wait list group, children in the horseback therapy condition showed significant improvements in sensory seeking, inattention, sensory sensitivity, sedentary activities, social responsivity and social motivation. No improvements were noted in social cognition, social awareness, and fine motor functioning/perception.
The results provide preliminary support for the possible efficacy of horseback riding therapy in promoting social behaviors in children with autism. From a clinical perspective, I am not surprised that the use of animals as a therapeutic tool may be effective in advancing the goals of therapy. Some readers may be skeptical of the concept of horse therapy, but I would encourage readers to take into account one issue: the authors are not claiming that horse therapy can cure autism. As many therapy interventions, this program is designed to use animals as a tool in the promotion of social skills and social behaviors. There may be multiple mechanism of action, from helping children concentrate on the social interactions with their peers and horses, to simply serving as a structured venue for social skill practice.
Despite the evidence provided by this study, there are two major methodological limitations. The nature of the therapy makes it extremely difficult, if not impossible, to conduct an ideal placebo-controlled blind study. Instead, the parents and the children knew who was and who was not participating in the therapy and the reported improvements may reflect an expectation of efficacy instead of a real effect of the therapy (the placebo effect). That is, one way the placebo effect work is by increasing the expectation of efficacy, and this expectation then leads to change. However, some would argue that in some cases such type of placebo effect is not that problematic (the old argument that if it works and there are no risks, who cares why it works- just let it work). However, the placebo effect may not be affecting actual change but a perception of change. Remember that parental reports are based on the parental perception of the behaviors, which may or may not truly reflect what the child actually does. It is then possible that, although parents were reporting improvement, the actual behaviors did not improve. Ideally, future results will base their results on direct observation of behaviors in multiple settings by third parties (e.g. teachers) that are blind to whether the child is in the horseback riding condition or the waiting list group.
Reference:Bass, M., Duchowny, C., & Llabre, M. (2009). The Effect of Therapeutic Horseback Riding on Social Functioning in Children with Autism Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-009-0734-3