Date Presented 04/05/19
Results of this single-case experimental design indicate that children with autism who participated in OT in an equine environment demonstrated improvement in individual occupational performance goals, social motivation, and social communication. Some, but not all, participants demonstrated decreased irritability and hyperactivity. Results suggest that horses and the equine environment can be effectively integrated into OT for children with autism.
Primary Author and Speaker: B. Caitlin Peters
Contributing Authors: Wendy Wood
PURPOSE: Ten percent of children with autism participate in equine-assisted activities and therapies (Lindly, Thorburn, Heisler, Reyes, & Zuckerman, 2017). Yet, empirical support for these interventions, while promising, is limited (McDaniel-Peters & Wood, 2017). The purpose of this study was to assess the effects of occupational therapy in an equine environment on occupational performance, social functioning, and behavior of children with autism.
DESIGN: This study implemented a multiple-baseline single-case experimental design. Participants were randomized to a 6-week or 8-week no-treatment baseline phase, followed by 10 weeks of occupational therapy in an equine environment. Participants included 7 children with autism, age 6 – 13 years old, IQ from 55 – 137, with irritable and hyperactive behaviors.
METHOD: The Canadian Occupational Performance Measure was administered to determine individual occupational performance goals for each child. Children attended weekly 45-60 minute intervention sessions for 10 weeks. A blinded research assistant assessed intervention fidelity of 20% of sessions; average fidelity was 96%. Outcome measures included a) daily parent ratings of occupational performance goals using a visual analog scale (VAS), b) weekly parent ratings of irritable and hyperactive behaviors using the Aberrant Behavior Checklist- Community (ABC-C), and c) a pre-post assessment of social functioning using the Social Responsiveness Scale, Second Edition (SRS-2). Visual inspection (Kratochwill et al., 2013) was used to assess the intervention’s effect on occupational performance, irritability, and hyperactivity. We calculated the nonoverlap of all pairs (NAP; Parker & Vannest, 2009) of each participant’s VAS and ABC-C data, to measure effect size. We conducted a Wilcoxon signed-ranks test to compare SRS-2 scores from before and after the intervention.
RESULTS: Occupational Performance:All participants improved in their occupational performance goals, as demonstrated by positive changes in median VAS ratings (7 participants) and less variability after five weeks of intervention (6 participants). The intervention had a medium to strong effect on occupational performance for all seven participants after five weeks of intervention (NAP 70% - 99%). Irritability and hyperactivity: Two participants did not have clinically significant irritability and hyperactivity at baseline, and did not change with intervention. Of the remaining five participants, four demonstrated improved irritability and hyperactivity, evidenced by changes in mean and trend. The intervention had a strong effect on the irritability and hyperactivity of these four participants after five weeks of intervention (NAP 97% - 100%). Social functioning: Participants demonstrated significant improvements in social motivation (z = 0.00, p = 0.04) and social communication (z= 0.00, p= 0.04). There were no significant changes in social awareness (z= 4.00, p= 0.34), social cognition (z= 5, p= 1.00), or restricted and repetitive behaviors (z= 1.00, p= 0.66).
CONCLUSIONS: Results suggest that occupational therapy in an equine environment may improve occupational performance, social motivation, and social communication of children with autism; medium to strong effect sizes after five weeks suggest clinically significant improvements. Some, but not all, participants demonstrated decreased irritability and hyperactivity. This research suggests horses and the equine environment can be integrated into occupational therapy to address occupational, behavioral, and social outcomes for children with autism. Furthermore, it demonstrates that occupational therapy in an equine environment can be delivered in adherence with a standardized protocol while also individualized to client goals.
References
Lindly, O. J., Thorburn, S., Heisler, K., Reyes, N. M., & Zuckerman, K. E. (2017). Parents’ use of complementary health approaches for young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 1-16.
McDaniel-Peters, B. C., & Wood, W. (2017). Autism and equine-assisted interventions: A systematic mapping review. Journal of Autism and Developmental Disorders, 47(10), 3220-3242.
Kratochwill, T. R., Hitchcock, J. H., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M., & Shadish, W. R. (2013). Single-case intervention research design standards. Remedial and Special Education, 34(1), 26-38.
Parker, R. I., & Vannest, K. (2009). An improved effect size for single-case research: Nonoverlap of all pairs. Behavior Therapy, 40(4), 357-367.
