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Something about a Horse: Finding Benefits for Autism in Therapeutic Riding

Marina Sarris

Date published: February 11, 2020

Can riding a horse really help someone who has autism? Advocates of therapeutic riding say so. They claim that the bond that riders often form with their horses can be a bridge to better social or communication skills for people on the autism spectrum.

But until a few years ago, they didn’t have much solid research to rely upon. A psychologist at Children’s Hospital Colorado, Robin L. Gabriels, is starting to change that. She is bringing the rigors of science to, of all places, the barn.

In 2015, her research into therapeutic horseback riding for youth who have autism attracted attention when it was published in a medical journal. Her team found that children and teens with autism who rode horses showed improvements in speech, social skills, hyperactivity, and irritability, compared with similar youth who didn’t ride.1

Other studies have found benefits to therapies involving horses2 or other animals, but many of those studies were small or had problems with the way they were conducted.3, 4, 5

What made Gabriels’ research noteworthy was its scientific design. Her team conducted a large “randomized controlled trial,” a type of study that removes factors that could sway the results.

Researchers randomly assigned 116 children who have autism, ages 6 to 16, into two equal groups. Half received lessons with a certified therapeutic riding instructor for one hour per week for 10 weeks. The other half spent the same time learning about horses, using a stuffed model of a pony, in a farmhouse at the riding center. Their lessons largely mirrored that of the riders, and they got the same amount of adult attention. But they had no contact with real horses or riding. In that way, they served as a “control,” or comparison, group for the riders.1

‘There’s something about riding a horse’

In the end, the riders did better than the non-riders on several tests. “There’s something about riding the horse that seems to be important,” says Gabriels, who is also professor of psychiatry at the University of Colorado School of Medicine.

In therapeutic riding, a trained instructor teaches riding and horsemanship skills to people who have a disability. “We know this works. We know these kids are having great results, but now there’s actual proof,” says Erica Zimmerman, a therapeutic riding instructor at Colorado Therapeutic Riding Center Inc. in Longmont.

Riding advocates were not the only people happy to see this research.

“We have few evidence-based treatments for autism,” penned L. Eugene Arnold, M.D., in an editorial about Gabriels’ study.6 “Further, those that exist are not universally effective and are laborious and expensive or risky (and expensive). We need good studies of safer, easier, and cost-effective treatments to fill the therapeutic gaps. In the absence of evidence, desperate parents are at the mercy of unsubstantiated claims and hopes.” So the Colorado riding study, he concluded, is “a welcome addition to the evidence base.”6

The research took place at a riding center affiliated with Professional Association of Therapeutic Horsemanship International, a U.S.-based nonprofit that certifies instructors and accredits centers that meet its professional standards.

In Gabriels’ study, her team tested the children with several measures before and after the intervention. For example, a speech therapist rated their language. The therapist was not told whether the children were in the control or riding group, to prevent that information from influencing the assessments.

The parents or caregivers also rated their children’s behavior before, during, and after the study, using forms often used to assess outcomes in drug studies. Parents knew their children’s group assignment since they brought them to the riding center, which could have influenced their ratings, the study said.

Tallying the Study’s Results on Communication and Behavior

When results were tallied after 10 weeks, the riders had a larger increase in the number of new words and total words spoken than the control group. They also did better on standardized measures of their social communication and ability to interpret social cues. Beginning at the fifth week, the riders showed greater improvements in hyperactivity and irritability than the controls. To put that in perspective, Arnold noted that therapeutic riding has “about half” of the effect on  irritability as taking an antipsychotic medication during the same 8 to 10 week period.6 Several antipsychotics have been approved to treat irritability in autism.

Some parents, who were not involved in the study, say riding has helped their children. Kerrie Lloyd, of California, said her son has been participating in therapeutic riding for 11 years. “It’s been good for so many reasons,” she says. “Adam happens to be deaf with autism. He started riding when he was 3. He didn’t have a lot of core strength, and his gait was a little unstable.” The teenager has made improvements in both areas.

Another parent, Rico Winston, said riding has helped “empower” his son, Israel, 10, who has autism. “He’s more vocal and verbal, and he can advocate for himself. That’s a process I believe started with teaching him how to control and direct the horse. You learn to direct the horse to stop or turn left or right, the same type of skills you use when advocating,” he says. Israel often rides an Arabian horse named Storm at the City Ranch Inc. outside Baltimore, Maryland, where the family lives. The Winstons participate in the SPARK autism study.

Explaining Why Riding May Benefit Youth Who Have Autism

Gabriels’ team offered possible explanations for her study’s results. Horses respond to riders’ body language, and riders learn to work in sync with the horse. “This nonverbal communication between the horse and the rider may include the fact that horses constantly mirror and respond to the rider’s body language.”1 This learning may carry over into children’s communication off the horse. Perhaps the sensory experience of riding may be calming and lead to behavior changes.

Those are theories; Gabriels wanted more evidence. She launched several follow-up studies and analyzed the data. In January 2020, she was awarded a $2.5 million federal grant for a five-year study to examine why therapeutic riding might help youth who have autism.

“We got these great outcomes, but how can we explain that?” Gabriels asks. She suspects that riding may produce a calm but alert state of mind, similar to that created during a type of therapy called mindfulness.

To test that theory, her research team will measure participants’ alertness and stress levels during the new study. Youth will wear heart monitors, along with wristbands that measure “electrodermal activity,” or changes in the body’s emotional response to an event. Researchers also will take saliva samples before and 20 minutes after the interventions to measure levels of the “stress hormone” cortisol. Cortisol levels change in response to a person’s stress.7

The study will include 142 children ages 6 to 16 at riding centers in Colorado and Maine, where research team member, Matthew Siegel, M.D., works. In addition to the riding and barn activity groups, researchers will add a control group of youth who are waiting to take part in the study. That way, the team can compare the responses of youth who are receiving an intervention with youth who are not.

The new study will focus on a group that Gabriels believes may benefit the most from riding: youth who have both autism and a psychiatric condition, such as anxiety, depression, or attention deficit hyperactivity disorder. A majority of youth with autism have at least one psychiatric condition, according to estimates by Gabriels and other researchers.8, 9

Can horseback riding help these children and teens manage their emotions better? “If we can show horseback riding is emotionally regulating, perhaps we can reduce the need for so much medication and help keep them out of the hospital,” says Gabriels, who in 2004 started a hospital unit at Children’s Hospital Colorado for youth who have autism and psychiatric problems. The study also aims to see how long the effects of therapeutic riding last.

Regardless of the study’s outcomes, some parents say that riding has another benefit: it’s something fun to do with others.

“We do play dates around therapeutic riding,” says Winston, Israel’s father. “Israel likes interacting with the horses and interacting with other children.” In fact, he says, the riders are not the only ones having a good time. Horses are social themselves. “Some horses are more sociable than others and will approach you. Horses have uniquely individual personalities, just like every child and individual on the autism spectrum, and every human being.”

A version of this article appeared on IANcommunity.org in 2016. It was updated in 2020 for SPARK.

Additional Resources

These horse-related organizations have information about facilities, instructors, or therapists who meet the groups’ professional standards.

  • PATH International certifies, accredits, and registers instructors and equine-related professionals and riding centers.
  • American Hippotherapy Association lists specialists and member therapists. In hippotherapy, a therapist performs occupational, physical, or speech therapy while the patient is on a horse.

Watch a SPARK video of Rico and Israel Winston that includes horseback riding.

References

  1. Gabriels R.L. et al. J. Am. Acad. Child Adolesc. Psychiatry 54, 541-549 (2015) PubMed
  2. Bass M.M. et al. J. Autism Dev. Disord. 39, 1261-1267 (2009) PubMed
  3. Anestis M.D. et al. J. Clin. Psychol. 70, 1115-1132 (2014) PubMed
  4. O’Haire M.E. J. Autism Dev. Disord. 43, 1606-1622 (2013) PubMed
  5. Palley L.S. et al. ILAR J. 51, 199-207 (2010) PubMed
  6. Arnold L.E. J. Am. Acad. Child Adolesc. Psychiatry 54, 535-536 (2015) PubMed
  7. King, S.L. and K.M. Hegadoren Biol. Res. Nurs. 4, 92-103 (2002) PubMed
  8. Leyfer O.T. et al. J. Autism Dev. Disord. 36, 849-861 (2006) PubMed
  9. Simonoff E. et al. J. Am. Acad. Child Adolesc. Psychiatry 47, 921-929 (2008) PubMed