Date Presented 04/04/19
This research aimed to examine the effect of therapeutic riding according to the principals of the Cognitive Orientation to Daily Occupational Performance (CO-OP) on the executive functions (EF) and participation of children ages 6 to 14 diagnosed with ADHD. In this study (N=12) significant improvements were found in EF and on participation. Thus, illustrating the use of the horse and stable as a therapeutic environment that enable the implementation of an effective OT intervention.
Primary Author and Speaker: Yafit Gilboa
Contributing Authors: Anne Helmer
PURPOSE: Currently ADHD is one of the most common diagnosis given to children. Children with ADHD present executive dysfunction that influence their everyday performance. A common treatment for ADHD is medication that has been shown to reduce symptoms. However, residual executive dysfunction has been found in medicated children. Therefore, an evidence-based non-pharmacological intervention targeting everyday performance is needed. In spite of the common use of therapeutic horseback riding, little evidence is found regarding the effectivity of this intervention option to improve daily function of children with ADHD. This research aimed to examine the effect of therapeutic riding according to the principals of the Cognitive Orientation to Daily Occupational Performance (CO-OP) model on the executive functions and participation of children aged 6-14 diagnosed with ADHD.
DESIGN: A pilot pre-post intervention study was completed as a preparation for a large scale quasi-experimental waiting list controlled study. This study included 12 participants recruited from two stables in Israel. The intervention included 10 weekly sessions of 45 minute each with a certified occupational therapist who is also a therapeutic riding instructor. The intervention was performed according to the principals of the CO-OP model, a client centered, performance based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery.
METHOD: In the current study, the participants and their parents defined 3 personal goals using the Canadian Occupational Performance Measure (COPM). In addition, parents filled The Behavior Rating Inventory of Executive Function (BRIEF) questionnaire to assess their children's executive function. Pre and Post intervention data was analyzes using the Related-samples Wilcoxon Signed Rank test. In the next stage of the study we will additionally use, the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE) and The Academic Competence Evaluation Scales (ACES). Moreover, we will add a 3-month follow-up assessment. In order to examine the effect and the maintenance of the intervention on the child participation at home and at school.
RESULTS: The pilot study included 12 participants (3 girls, 9 boys, age: 7.8-12.3, M=9.41±1.75), completed the post intervention assessments. Results showed significant improvements in executive functions according to the parents report of the BRIEF questionnaire on General executive composite (GEC; Z=1.37, p<.05), Meta cognitive index (MI; Z=.75, p<.05) and in Working memory (Z=.99, p<.01) and Initiation (Z=1.51, p<.05) sub scales. In addition, the results of the performance scale of COPM showed a significant clinical improvement (≥2 point change) for the mean of the three goals set from baseline (M=3.8±0.77) to post intervention (M=5.90±0.42).
CONCLUSION: The current study results show improvement in executive functions according to the parents report and in attainment of personal goals.
This study illustrates the use of the horse and the stable as a therapeutic environment that enable the implementation of an effective occupational therapy intervention. The use of outcome measures targeting daily life environments demonstrate the challenging transfer of the results from the therapeutic session to everyday function.
Thus, this is the first step toward suppling an evidence-based unique approach for improving executive function and participation for children with ADHD using horseback riding.
References
Mandich, A., & Polatajko, H. J. (2004). Enabling occupation in children: The cognitive orientation to daily occupational performance (CO-OP) approach. Canadian Association of Occupational Therapists.
So, W. Y., Lee, S. Y., Park, Y., & Seo, D. I. (2017). Effects of 4 Weeks of Horseback Riding on Anxiety, Depression, and Self-Esteem in Children with Attention Deficit Hyperactivity Disorder. Journal of Mens Health, 13(2), e1-e7.
Gabriels, R. L., Pan, Z., Dechant, B., Agnew, J. A., Brim, N., & Mesibov, G. (2015). Randomized controlled trial of therapeutic horseback riding in children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 54(7), 541-549.
