Something About a Horse: Finding Benefits in Therapeutic Riding
American frontier tales promote the magical connection between a man and his trusty steed. A rider communicates with his horse through words and movements, forming a bond in which each "reads" the other. Horse enthusiasts have said these bonds help people with autism, a disorder affecting social and communication skills, but they didn't have much rigorous research to back them up – until now.
A new study, coming from the old frontier state of Colorado, shows that children with autism who took therapeutic horseback riding lessons became less irritable, less hyperactive, spoke more words, and showed other improvements, compared to children who didn't ride.1
Other studies have found various benefits to therapeutic riding,2 or other interventions involving animals, but many of those studies were small or had problems with the way they were conducted.3, 4, 5 "High quality research" is hard to find for animal interventions in autism, one review said.3
What makes the Colorado study noteworthy is its size and scientific design. Researchers conducted a large randomized controlled trial, a type of study that removes factors that could unfairly sway the results. They randomly assigned 116 children with 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 group against which the riders were compared.1
"There's something about riding a horse"
The riders did better than the non-riders on several tests. "There's something about riding the horse that seems to be important," said lead researcher Robin L. Gabriels, PsyD, an investigator with the Autism Inpatient Community , and director of Children's Hospital Colorado Neuropsychiatric Special Care. She was joined in this research by Gary Mesibov, PhD, former director of the TEACCH autism program at the University of North Carolina.
This research is welcome news to advocates of therapeutic riding for people with special needs. "We know this works. We know these kids are having great results, but now there's actual proof," said Erica Zimmerman, a therapeutic riding instructor at Colorado Therapeutic Riding Center Inc. in Longmont, where the research took place. "When it comes to equine[horse]-assisted activities, people see it as a 'hooey' kind of field. This shows us there is a reason for doing this therapy, and it puts those hard facts into play."
In the popular press, therapeutic horseback riding has been lumped together with swimming with dolphins and other animal activities for people with disabilities, even though some of those interventions may have little or no research behind them. It's hard to know which ones work and which might be "hooey."
"We have few evidence-based treatments for autism," penned Dr. L. Eugene Arnold in "The Alone Rangers and Silver," an editorial about Dr. Gabriels' study in the Journal of the American Academy of Child and Adolescent Psychiatry. "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
Dr. Gabriels' team tested children on several measures before and after the study. A speech therapist, occupational therapist, and a research assistant rated their language, physical skills, and daily living skills, respectively, using standard assessments. (Physical skills include coordination, finger dexterity, and agility). They were not told whether the children were in the control or riding group, to prevent that information from influencing their ratings.
The parents or caregivers 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. That knowledge could have affected 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, Dr. Arnold noted that therapeutic riding has "about half" of the effect on one symptom, irritability, as an antipsychotic medication during the same period of time.6
Some parents, who were not involved in the study, are not surprised by its findings. Kerrie Lloyd said her son, 11, has been participating in therapeutic riding for years. "It's been good for so many reasons," said Ms. Lloyd, a participant in IAN Research from California. "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." Since then, his strength and gait have improved, among other things. She believes therapeutic riding helped her son by stimulating his senses of sight, smell, touch, and movement or motion. "It opens up their brain and neurology to communication and ultimately has an impact on their self-esteem," she said. "He's like John Wayne," the actor who tried to tame the Wild West in films of the mid-20th Century.
Dr. Gabriels' study offers possible explanations for its results. Horses constantly respond to a rider's 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. Or perhaps the sensory experience of riding may be calming to people with autism, leading to behavior changes. Temple Grandin, the animal science professor who has autism, has said she believes the teamwork between rider and horse reduces anxious feelings and behavior.1 Researchers hope future studies will answer those questions and others.
Why study riding?
Sometimes potential therapies do not get studied because scientists lack the funds to do so, or are not interested in the topic. In the case of Dr. Gabriels and therapeutic riding, both an interest and funding happily collided. "I've always loved animals and had an interest in studying novel treatments for this population of children with autism," she said in a podcast with the journal that published the study. "But I had never considered combining these interests until about 2008, when the Children's Hospital Colorado Foundation received a large donation to specifically investigate the benefits of therapeutic horseback riding." The donation came from Greenspring Christian Church.
The Foundation accepted her research proposal, which allowed her to design a preliminary (pilot) study. Scientists use pilot studies to test the best procedures to be used in a larger, final study, which her team did.
The research was conducted at a riding center affiliated with Professional Association of Therapeutic Horsemanship International (PATH), a U.S.-based nonprofit that certifies instructors and accredits riding centers that meet its professional standards for equine-assisted activities and therapies (EAAT). EAAT is an umbrella term that includes therapeutic riding, hippotherapy, and equine-assisted psychotherapy.
In equine-assisted psychotherapy, patients work with a mental health professional and horse specialist on therapy goals while grooming or caring for horses.7
In hippotherapy, a therapist performs occupational, physical, or speech therapy while the patient is on a horse. But patients are not taught to ride a horse: that is the purpose of therapeutic riding, explained Ms. Zimmerman. A therapeutic riding instructor is trained to teach riding and horsemanship skills to people with physical and developmental disabilities. According to PATH, people with autism make up the largest category of participants served, followed by people with developmental delay, and those with Attention Deficit Hyperactivity Disorder.
Ms. Lloyd encouraged parents of would-be riders to check the credentials of riding centers. "It's very, very important to be sure the people who are managing the program are trained in therapeutic riding, and it's not just a general riding facility that wants to do this because it's a fantastic idea." Her son rides at J.F. Shea Therapeutic Riding Center in Orange County, California, which is accredited by PATH. (To find out how to tell if a program is accredited, see Additional Resources.)
The Future of Therapeutic Riding Research
Dr. Gabriels' study is not the last word on therapeutic riding; in fact, she is continuing to research the topic. Science requires that studies be reproduced, or replicated, to prove that the results were not a fluke or caused by other factors. "I would like to see more objective measures used, as well as a replication of our measures at other sites," she said.
She is working with Marguerite E. O'Haire, an assistant professor at Purdue University College of Veterinary Medicine, on a system of rating people's behavior, when studying their response to animal interventions. This system is being used in another therapeutic riding study, by people who don't know whether the children were in the riding or control group, Dr. O'Haire said.
Dr. Gabriels also is working on a study that measured levels of cortisol in participants' saliva before and 20 minutes after horseback riding, compared to a barn-activities group that had no contact with horses. Called the "stress hormone," cortisol levels change in response to a person's stress.8 New studies also could use a control group that receives no barn or horse-related activity, or could look at whether riding a mechanical horse would produce the same results as a live one.
Regardless of what future research may say about behavior or language, some parents point out that therapeutic riding offers another benefit: it's something fun to do with friends.
Connie Sproul Bonarigo said her daughter with autism spectrum disorder began hippotherapy and therapeutic riding while very young. Like many riders, it was not her only therapy. She also participated in 30 hours per week of Applied Behavior Analysis, an autism intervention. Her daughter, now 18, currently enjoys recreational horseback riding, said Ms. Bonarigo, an IAN Research participant from New Jersey. "It's something that she enjoys, something that she can do with her peers," she said.
What about cost?
Therapeutic riding centers set their own prices. Most PATH International centers are nonprofit and have fees on a sliding scale for riders who cannot afford the full price, explained Cher Smith, a spokeswoman for PATH. Some centers offer scholarships, she said. Also, some charities or state disability agencies offer funds for therapeutic riding. One price example: a PATH center in the Washington-Baltimore area charges $42 for one hour of group therapeutic riding. Please see the Additional Resources section to learn more about the cost of therapeutic riding in your area.
These organizations provide information about, or lists of, the horse facilities, therapies, or professionals that they certify.
- PATH International certifies, accredits and registers instructors and equine-related professionals and riding centers. For lists of centers in the United States and other countries, visit http://www.pathintl.org/. You may contact one near you for information on costs and possible sources of funding, grants or scholarships.
- Equine Assisted Growth and Learning Association (EAGALA) is an international nonprofit association for professionals using horses to address clients' mental health and personal development needs. To find an affiliated program, visit EAGALA.
- The Canadian Therapeutic Riding Association provides education and instructor certification.
- The American Hippotherapy Association lists clinical specialists and member therapists.
- Federation of Horses in Education and Therapy International AISBL, registered in Belgium, publishes a calendar of conferences in Europe.
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IAN article on Dogs, Horses and ASD: What Are Animal-Assisted Therapies?
Dr. Gabriels' study was supported by Grant R01NR012736 from the National Institute of Nursing Research and NIH/Mars-WALTHAM partnership.
Photo credits: 1) Kerrie Lloyd, 2) Children's Hospital Colorado, 3) Elisabeth Mekosh/Tara Katherine Photography LLC, 4) Kerrie Lloyd, 5) Elisabeth Mekosh/Tara Katherine Photography LLC
- 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 and Adolescent Psychiatry, 54(7), 541-549. doi:10.1016/j.jaac.2015.04.007 [doi]
- Bass, M. M., Duchowny, C. A., & Llabre, M. M. (2009). The effect of therapeutic horseback riding on social functioning in children with autism. Journal of Autism and Developmental Disorders, 39(9), 1261-1267. doi:10.1007/s10803-009-0734-3
- Anestis, M. D., Anestis, J. C., Zawilinski, L. L., Hopkins, T. A., & Lilienfeld, S. O. (2014). Equine-related treatments for mental disorders lack empirical support: A systematic review of empirical investigations. Journal of Clinical Psychology, 70(12), 1115-1132. Abstract.
- O'Haire, M. E. (2013). Animal-assisted intervention for autism spectrum disorder: A systematic literature review. Journal of Autism and Developmental Disorders, 43(7), 1606-1622. doi:10.1007/s10803-012-1707-5 [doi]
- Palley, L. S., O'Rourke, P. P., & Niemi, S. M. (2010). Mainstreaming animal-assisted therapy. ILAR Journal / National Research Council, Institute of Laboratory Animal Resources, 51(3), 199-207. Abstract.
- Arnold, L. E. (2015). The alone rangers and silver. Journal of the American Academy of Child and Adolescent Psychiatry, 54(7), 535-536. doi:10.1016/j.jaac.2015.04.010 [doi]
- Equine Assisted Growth and Learning Association (EAGALA).The EAGALA model. Retrieved from http://www.eagala.org/about/model
- King, S. L., & Hegadoren, K. M. (2002). Stress hormones: How do they measure up? Biological Research for Nursing, 4(2), 92-103. Abstract.