Replication Pilot Trial of Therapeutic Horseback Riding and Cortisol Collection With Children on the Autism Spectrum

Abstract

We aimed to determine whether results of our prior randomized control trial [RCT; NCT02301195, (1)] of Therapeutic Horseback Riding (THR) for children and adolescents with autism spectrum disorder (ASD) could be replicated at a different riding center and if treatment effects also included differences in the expression of associations between problem behavior and the activity of the hypothalamic-pituitary-adrenal (HPA) axis. Participants with ASD (N = 16) ages 6-16 years were randomized by nonverbal intelligence quotient to either a 10-week THR group (n = 8) or no horse interaction barn activity (BA) control group (n = 8). Outcome measures were a standard speech-language sample and caregiver-report of aberrant and social behaviors. Participants' saliva was sampled weekly at a consistent afternoon time immediately pre- and 20 min' post-condition (later assayed for cortisol). Intent-to-treat analysis revealed that compared to controls, THR participants had significant improvements in hyperactivity, and social awareness, and significant improvements at the 0.1 significance level in irritability and social communication behaviors. There were no significant improvements in number of words or new words spoken during the standard language sample. Linear mixed effects model analysis indicated that greater weekly pre-lesson irritability levels were associated with smaller post-lesson reduction in salivary cortisol levels, and greater weekly pre-lesson hyperactivity levels were associated with smaller cortisol reduction in the THR group, but not in the BA control group. The findings represent a partial replication of prior results (1), extend prior observations to include THR effects on biobehavioral relationships and suggest that cortisol could be a target mediator for THR effects on irritability and hyperactivity behaviors in youth with ASD.Clinical Trial Registration: Trial of Therapeutic Horseback Riding in Children and Adolescents with Autism Spectrum Disorder; http://clinicaltrials.gov, identifier: NCT02301195

Therapeutic Riding or Mindfulness: Comparative Effectiveness of Two Recreational Therapy Interventions for Adolescents with Autism

“…When comparing individual sessions, there was a significant decrease in salivary cortisol concentration after the intervention in all of the THR sessions and seven of the HM sessions, and the overall post-session median cortisol concentration was significantly decreased from pre-session for both treatments, indicating that salivary cortisol was reduced through both interventions. Similarly, in a pilot study of children with ASD, Pan et al ( 2019 ) found that salivary cortisol concentrations decreased following THR lessons; however, in that study there was no difference from the control group practicing unmounted activities in the barn using a stuffed horse. Barker et al ( 2010 ) found that 30-min interaction with an unfamiliar dog or the participant’s own dog was found to be associated with decreases in salivary cortisol, blood pressure, and heart rate below no-dog baseline measures following exposure to a stressor.…”

“…Parents reported a substantial increase in fidgetiness in the control phase, but a slight decrease in difficulty relating to peers and not understanding cause and effect. Pan et al ( 2019 ) found a decrease in hyperactivity and irritability with therapeutic riding but not control. In this study, fidgetiness actually increased during the control phase with an absence of any intervention.…”

“…Therapeutic horseback riding is a subset of EAS. Research with younger children with ASD, ages 2–16, suggests that THR improves spontaneous verbalization (Holm et al, 2014 ), inattention, distractibility (Bass et al, 2009 ), irritability, hyperactivity, self-regulation (Abishira et al, 2020 ; Gabriels et al, 2012 , 2015 ; Pan et al, 2019 ), autistic behaviors, adaptive behaviors, and receptive communication skills (Ajzenman et al, 2013 ; Lanning et al, 2014 ), social functioning (Abishira et al, 2020 ; Anderson & Meints, 2016 ; Harris & Williams, 2017 ) and quality of life (Kern, 2011 ). Using meta-analytic technique, Trzmiel et al ( 2019 ) found evidence that for ages 6–16, EAS promoted improved socialization, engagement, and decreased maladaptive behaviors.…”

“…A few comparison studies do currently exist. The results of randomized control trials comparing THR to a barn no-horse control for children up to 16 years with ASD are promising for THR, indicating improvements in measures of irritability, social communication, social cognition, and hyperactivity (Gabriels et al, 2015 ; Pan et al, 2019 ). A prospective study found a reduction in severity of autism symptoms for children with ASD following THR treatment (Kern et al, 2011 ).…”

Human-Animal Interaction Research: Progress and Possibilities

“…The 13 studies in the Research Topic employed a wide range of measures, including salivary cortisol to assess Hypothalamic Pituitary Adrenal (HPA) axis reactivity and stress levels (Pendry et al, 2018;Pan et al, 2019), survey questions (Bures et al, 2019), and a genetic assay to look at the relationship between a single polymorphism in the oxytocin receptor and individual differences in response to HAI activities (Kertes et al, 2018).…”