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research-UTInternal research report 

Jennifer A. Lockwood - University of Texas at Austin
Department of Educational Psychology

To download the full report in English please click here.

Abstract

Objectives: The aim of this pilot study was to explore whether participation in a three day intervention involving horseback riding in nature– a program specifically designed for autistic children and their families called "Horse Boy Camps" - improves child outcomes in terms of social and cognitive functioning, as well as in parental and sibling well-being.

Methods: Child and family outcomes were measured for 6 families who attended a three-day Horse Boy Camp. There was one autistic child per family who attended the camp (3 male and 3 female; M age = 9.17; SD = 2.23).

Results: The study found marginally significant improvements in terms of autistic children's movement sensitivity and sensory and cognitive awareness. In addition parents reported marginally significant improvements in their marital relationship and a trend towards improvement in their autistic child's relationship with their siblings. A trend towards reduced levels of anxiety in the parent was also found.

Conclusions: Horse Boy Camps are a promising intervention for children with autism and their families.

Aim:

The aim of this research was to explore whether participation in a three day Horse Boy Camp improved child outcomes in terms of social and cognitive functioning, and family outcomes in terms of parental and sibling well-being as well as general family functioning.

Intervention:

The intervention involved participation in a Horse Boy Camp, which is a three day/ two night immersion into the Horse Boy method. During the camp up to four families stayed in cabins, bunk houses or tents and were accompanied by a team of trained Horse Boy staff, volunteers and horses. The camp was led by a trained camp leader who had completed a basic Horse Boy Method training course as well as a Horse Boy Camp training course and participated in more than three prior Horse Boy Camps. The camps took place at a facility that was approved by Horse Boy staff members as a suitable environment for Horse Boy Method.
Each camp day was variable and tailored to the needs of individual families. The location had access to nature trails for riding and hiking, was closed to the general public, and had outside play equipment such as a trampoline and swings, and have a secure place to keep the horses. The therapy was presented in the context of a fun family adventure in nature, involving camping, sitting around a camp fire, nature walks, and intensive horseback riding for all interested family members. In addition, the camp involved several autism families so that they could gain a sense of community and share mutual experiences in a safe and supportive environment.

The camp involved a highly skilled adult rider who sat behind the child in an oversized saddle to accommodate faster gaits like trot and canter (possibly stimulating the cerebellum). This also provided a fun and relaxed context for communication that does not provoke face-to-face anxiety. This rider was approved by Horse Boy Staff members as being trained to a suitably high standard to stimulate language development by using verbal commands to elicit highly motivating actions from the horse such as trot, smile or bow. Sensory therapy, which involves allowing all family members to relax on the horse while it grazes, helping to calm the nervous system, was also provided.

Participants:

Families who had booked to attend a three-day Horse Boy Camp were invited to take part in the research study. The camps were advertised on the Internet and by contacting local and national autism groups. Individuals who signed up for the research study were given a reduced fee to attend a camp. A total of 9 families signed up for the research study. However, 3 did not fully complete the post-study measures and were dropped from the study, leaving a sample size of 6. Of these 6 families, 4 had both parents attending and 2 had only one parent attending. One parent filled out the survey per family (1 male and 5 females; 5 Caucasian and 1 Hispanic). There was one autistic child per family who attended the camp (3 male and 3 female; M age = 9.17; SD = 2.23). 5 of the families had siblings in attendance.

Measures:

Participants were asked to complete an on-line survey one week before and one month after attending a Horse Boy Camp. A variety of measures were used to assess the impact of camp attendance for autistic children and their parents and siblings.

Autism Symptoms. Participants were given the Autism Treatment Evaluation Checklist (ATEC) (Autism Research Institute2, 1999). This is a 77 item questionnaire specifically developed to measure treatment effects in individuals with ASDs. The questionnaire consists of 4 subscales: speech/language/communication (e.g. ‘Knows own name’) (14 items); sociability (e.g. ‘Ignores other people’) (20 items); sensory/cognitive awareness (e.g. ‘Responds to own name’) (18 items) and health/physical behavior (e.g. ‘Bed-wetting’) (25 items).

Sensory Processing. Participants were given the Sensory Profile - Short (Dunn, 1999). The measure addresses the degree to which children exhibit problems in terms of sensory processing, modulation, and behavioral and emotional responses to sensory stimulation. For the purposes of this study, the subscales were used that assessed Tactile Sensitivity (e.g. ‘expresses distress during grooming’), Movement Sensitivity (e.g. ‘becomes anxious or distressed when feet leave the ground’) and Underresponsive/Seeks Sensation (e.g. ‘becomes overly excitable during a movement’) (a total of 17 items).

Family Impact. Participants were given the Family Impact Questionnaire (Donenberg & Baker, 1993), which assesses the impact of parent’s perceptions of their child’s impact on their family compared to ‘most children his/her age.’ For the purpose of this study the subscales that assess; feelings and attitudes towards child (e.g. ‘I feel like I could be a better parent with my child’); impact on marriage (e.g. ‘My spouse and I disagree more about how to raise this child’); impact on siblings (e.g. ‘My child prevents his/her siblings from participating in activities more’); and general impact (e.g. ‘Compared with other children my child's age, the impact of my child on our family is?’) were assessed (33 items total).

Depression, Anxiety, and Stress. Participants were given the DASS-21 (Lovibond & Lovibond, 1995). This is a commonly used 21-item scale measures adults’ levels of depression (e.g. ‘I couldn’t seem to experience any positive feeling at all’), anxiety (e.g. ‘I was aware of dryness of my mouth’) and stress (e.g. ‘I found it hard to wind down’). Responses are given on a scale from 0 (does not apply to me at all) to 3 (applies to me very much). Participants are given a separate score for depression, stress and anxiety with higher scores indicating higher levels.

Results:

Due to the small sample size the decision was made to use non-parametric tests to analyze the data. A series of matched-pair Wilcoxon Signed Rank tests were used to determine whether there were significant pre/post changes in the study variables.

Results indicated that after attending a camp, autistic children showed marginally significant improvements in terms of their movement sensitivity (p=.08) and sensory and cognitive awareness (p=.07). Additional results indicated that attending a camp might improve the relationship between the autistic child and their siblings (p=.11), parents’ marital relationship (p=.10), parental anxiety (p=.11), and family functioning in general (p=.14).

Table 1
Pre-test and Post-test Scores for Child Outcomes Analyzed with Wilcoxon Signed Ranked Non-Parametric Tests

 

Pre-test

Post-test

 

Outcome

M (SD)

M (SD)

p value

Speech/Language/Communication

2.51 (.48)

2.52 (.48)

.45

Sociability

2.30 (.34)

2.34 (.16)

.75

Sensory & Cognitive Awareness

2.15 (.51)

2.32 (.41)

.07*

Health & Physical Behavior

2.78 (.48)

2.92 (.39)

.35

Tactile Sensitivity

3.55 (1.43)

3.37 (1.01)

.75

Movement Sensitivity

3.67 (1.43)

4.17 (1.49)

.08*

Underresponsive/Seeks Sensation

3.31 (1.33)

3.45 (1.00)

.68

ATEC Total Score

9.74 (1.66)

10.12 (1.14)

.25

Sibling A Relationship

3.33 (.67)

3.40 (.75)

.59

Sibling B Relationship

3.05 (.92)

2.70 (.66)

.65

t-test marginally significant at: † p < .08

 

 

Table 2
Pre-test and Post-test Scores for Parent Outcomes Analyzed with Wilcoxon Signed Ranked Non-Parametric Tests

 

 

Pre-test

Post-test

 

Outcome

M (SD)

M (SD)

p value

Depression

24.40 (8.88)

10.67 (5.28)

.50

Anxiety

19.60 (6.23)

15.67 (2.66)

.11 u

Stress

27.20 (10.83)

24.00 (5.06)

.68

Connectedness

4.28 (1.00)

4.40 (1.14)

.50

Self-Compassion

3.45 (.60)

3.48 (.43)

.79

Feelings & Attitudes towards child

36.20 (.53)

41.83 (4.26)

.27

Marital Relationship

20.00 (1.87)

23.60 (5.13)

.10 u

Sibling Relationship

23.33 (4.73)

26.33 (6.35)

.11 u

General Impact on family

5.75 (3.20)

8.20 (2.28)

.14 u

t-test trending towards significance at: u p < .14

 

 

Discussion:
Children displayed improved movement sensitivity after participation in the camp. Movement Sensitivity involves the degree to which children exhibits anxiety and distress in relation to heights or activities where the child’s feet had to leave the ground. Children with autism are frequently observed to experience difficulties with sensory processing, so much so that a recent study found support for the universality of these features across the spectrum (Ben-Sasson et al, 2009). Lane et al. (2010) identified three distinct sensory processing subtypes in autism, one of which was related to movement sensitivity. The researchers also found that movement sensitivity was a unique predictor of maladaptive behaviors, leading them to conclude that the use of sensory-based interventions should be continued in the remediation of communication and behavioral difficulties in autism. The finding that participation in a Horse Boy Camp significantly decreased movement sensitivity suggests that it may be a useful intervention for autistic children who exhibit sensory processing difficulties that are related to movement.

Participants also improved their sensory and cognitive awareness, which refers to the extent to which a child has difficulty processing sensory information and understanding their world. One of the most fundamental and unique aspects of Horse Boy Method is its emphasis on allowing the child to lie body-to-body on the horse and relax there while it grazes. Both observer reports and previous research have indicated that this might help calm the nervous system, especially since the horse tends to provide a gentle rocking motion as it grazes (Solodkin, Hlustik, Buccino, 2007). Additionally, the Horse Boy Method places an emphasis on using the horse as a vehicle to explore the exterior world which is why so much of the riding occurs, not a in a riding arena, but out on the trail. Practitioners are trained to talk as much as possible about the things that they observe and come across on the trail in order to help the child delight in and order the world around them. Previous studies have identified several features within a school classroom that have been observed to impair the sensory functioning of children. These include bight artificial colors and light, pattern glare and echoing (Shabha, 2006), all of which are less likely to be a problem out on the trail than in a riding arena or classroom. It is therefore possible that the use of the horse as a vehicle to explore the natural world coupled with the sensory work is what caused parental reports of improved sensory and cognitive awareness in their children with autism after attending a Horse Boy Camp.

The camp also appeared to enhance sibling relationship for the families attending. Eighty percent of siblings of children with autism have little to no involvement in normal childhood extracurricular activities (Barak-Levey, Goldstein & Weinstock, 2012) which can lead to feelings of anger and frustration (Kaminsky & Dewey, 2002). Recent research on siblings of developmentally challenged children has led clinicians to now advocate the use of family-based, as opposed to child-based, interventions that take into account the needs of the siblings (Schuntermann, 2007). With this in mind it is therefore possible that the focus within Horse Boy Method on the whole family and the inclusion of siblings in all activities might explain this improved relationship. This is an important finding as studies have indicated a non-conflicting sibling relationship is a protective factor for later maladjustment in the siblings of children with developmental disorders (Fisman et al, 1996).

Results indicated that camp participation also improved the marital relationships of parents. Parenting a son or daughter with ASD poses a number of unique challenges, any of which may take their toll on a marriage. While the extent of this toll is yet to be agreed on it is generally assumed that divorce rates are higher amongst parents of special needs children than the population in general (Hartley et al, 2010). These increased divorce rates are thought, in part, to be due to the high-level of parenting demands and stress and subsequent lack of attention devoted to one’s spouse due to the extreme care-giving needs of a child with autism (Shapiro et al., 2000). During a three-day Horse Boy Camp an emphasis is placed on facilitating time and space for couples to spend time together safe in the knowledge that their child is being well-cared for. An example of this would be creating an opportunity for a couple to take a walk alone together while their children are participating in other activities with staff members and volunteers. It could be that taking the time for each other during the camp encourages parents to continue to take the time for each other once they return to the life.
Camp participation also reduced the levels of anxiety reported by parents. Numerous studies have shown that animal assisted therapies, including EAT, can have ameliorative effects on the anxiety levels of both adults and children (Ewing, MacDonald, Taylor, & Bowers, 2007; Klontz, Bivens, Leinart, & Klontz, 2007; Masini, 2010; Schultz, Remick-Barlow, & Robbins, 2007; Yorke, Adams, & Coady, 2008). Additionally the emphasis placed on social support and community at the camps is also likely to have had a positive impact on parental anxiety levels. Studies show that social support is a protective factor for the adaptation of parents of children with autism and informal support (from friends but also other parents of children with disabilities) has been found to be the most critical (Lounds, 2004).
Finally camp participation was also found to lead to a general improvement in family functioning. A key focus of the Horse Boy Camps is on helping family functioning as a whole. All family members take part in various activities that create bonding experiences that bring the family closer together. For instance, parents are always present when the child is interacting with the EAT provider which helps to orient the child to his or her interests. Additionally throughout the camp an emphasis is placed on facilitating time and space for couples to spend time together safe in the knowledge that their child is being well-cared for. An example of this would be creating an opportunity for a couple to take a walk alone together while their children are participating in other activities with staff members and volunteers. Siblings are also encouraged to play and ride at the camp, so that rather than creating friction between sibling’s therapeutic treatment and their own pleasurable activities, the two can be combined into a family activity that is enjoyable for everyone.

Limitations & Future Research:

One of the major limitations of this study is the small sample size, which was in part due to the limited number of places available on each camp and in part due to families not wishing to take part in the study or dropping out of the study half way through. It is possible that some of the trends observed in the current study would have been statistically significant in a larger sample. Another limitation of the study is that it did not compare the Horse Boy Camp intervention to an active control group, which means that study results could have been due to the mere participation of families in any sort of group activity. Additionally, results were based on the self-reports of parents rather than objective observations.

Future research could address these limitations by replicating the study in a larger sample, comparing outcomes after participation in a Horse Boy camp with those of families attending some other sort of group activity. Data should also be collected via methods of direct observation, and siblings could be asked directly about their feelings about their sibling with autism. It might also be useful to have teachers fill out the child outcome measures in order to see if any of the results found generalized to the classroom.

Additionally the Horse Boy Foundation is in the process of developing a method of working with children with autism without horses called Horse Boy Learning. This is based around the same principles of Horse Boy Method, namely facilitating communication and learning through exploration of their environment, but can be taught to parents of children with autism for use in daily life. The premise is that more intensive time working with these methods will facilitate even greater changes in the child. In fact, this was shown in a study by Jenkins, Schuchard & Thompson (2012) that investigated the effects that high versus low intensity home based interventions had on children’s autistic symptoms. Their results indicated that the greatest gains were found when parents administered high intensity interventions to their children. Therefore, evaluation of the impact of participation in the Horse Boy Learning program would be another fruitful avenue for future research.

Despite its limitations, this study provides preliminary support for the use of the Horse Boy Method as an effective therapeutic intervention for children with autism and their families. Horse Boy camps are unique because they involve methods of equine therapy specifically designed for the needs of autistic children. Moreover, their focus on the family as a whole, the fact that the camps take place in a peaceful natural environment, and the variety of activities offered on the camps mean that not only is the intervention effective, it is fun and enjoyable for all.

References

Barak-Levey, Y., Goldstein, E., & Weinstock, M. (2010). Adjustment characteristics of healthy siblings of children with autism. Journal of Family Studies, 16, 155–164.
Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1–11
Donenberg, G., & Baker, B. L. (1993). The impact of young children with externalizing behaviors on their families. Journal of Abnormal Child Psychology, 21, 179-198.
Dunn, W. (1999) Sensory Profile. San Antonio, TX: The Psychological Corporation.
Ewing, C.A., MacDonald, P.M., Taylor, M., & Bowers, M.J. (2007). Equine-facilitated learning for youths with severe emotional disorders: A quantitative and qualitative study. Child and Youth Care Forum, 36, 59-72.
Fisman, S., Wolf, L., Ellison. D., Gillis, B., Freeman, T., & Szatmari, P. (1996). Risk and Protective Factors Affecting the Adjustment of Siblings of Children with Chronic Disabilities. Journal of the American Academy of Child & Adolescent Psychiatry, 35 (11), 1532-1541.
Hartley, S.L., Barker, E.T., Seltzer, M.M., Floyd, F., Greenberg, J., Orsmond. G., & Bolt, D. (2010). The Relative Risk and Timing of Divorce in Families of Children with an Autism Spectrum Disorder. Journal of Family Psychology, 24 (4), 449-457.
Kaminsky, L., & Dewey D. (2002). Psychosocial adjustment in siblings of children with autism. Journal of Psychology and Psychiatry, 43, 225-232.
Klontz, B.T., Bivens, A., Leinart, D., & Klontz, T. (2007). The effectiveness of equine-assisted experiential therapy: Results of an open clinical trial. Society and Animals, 15, 257-226.
Lane, A.E., Young, R.L., Baker, A.E.Z., & Angley, M.T. (2010). Sensory Processing Subtypes in Autism: Association with Adaptive Behavior. Journal of Autism and Developmental Disorders, 40 (1), 112-122.
Lounds, J. (2004). Family Stress and Coping. In T.L. Whitman (Ed), The development of autism: A self-regulatory perspective (pp. 233-278). Jessica Kingsley Publishers, London.
Lovibond, S. H, & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.) Psychology Foundation of Australia, Sydney (AU).
Magiati, I., Moss, J., Yates, R., Charman, T., & Howlin, P. (2011). Is the Autism Treatment Evaluation Checklist a useful tool for monitoring progress in children with autism spectrum disorders? Journal of Intellectual Disability Research, 55 (3), 302-312.
Masini, A. (2010). Equine-assisted psychotherapy in clinical practice. Journal of Psychosocial Nursing and Mental Health Services, 48(10), 30-34.
Schuntermann, P. (2007). The Sibling Experience: Growing Up with a Child Who Has Pervasive Developmental Disorder or Mental Retardation. Harvard Review of Psychiatry, 15 (3), 93-108.
Shabha, G. (2006). An assessment of the impact of the sensory environment on individual’s behavior in special needs schools. Facilities, 24 (1), 31-42.
Shapiro, A.F., Gottman, J.M., & Carrere, S. (2000). The Baby and the Marriage: Identifying Factors that Buffer against decline in Marital Satisfaction after the First Baby Arrives. Journal of Family Psychology, 14, 59–70.
Schultz, P.N., Remick-Barlow, G.A., & Robbins, L. (2007). Equine-assisted psychotherapy: A mental health promotion/intervention modal for children who have experienced intra- family violence. Health and Social Care in the Community, 15, 265-271.
Solodkin, A., Hlustik, P., & Buccino, G. (2007). The anatomy and physiology of the motor system in humans. In J. T. Cacioppo, L. G. Tassinary, G. G. Berntson, J. T. Cacioppo, L. G. Tassinary, G. G. Berntson (Eds.), Handbook of psychophysiology (3rd ed.) (pp. 507-539). New York, NY US: Cambridge University Press.
 Yorke, J., Adams, C., & Coady, N. (2008). Therapeutic value of equine--Human bonding in recovery from trauma. Anthrozoös, 21(1), 17-30.

 

Abstract

Objectives:  The aim of this pilot study was to explore whether participation in a three day intervention involving horseback riding in nature– a program specifically designed for autistic children and their families called “Horse Boy Camps” - improves child outcomes in terms of social and cognitive functioning, as well as in parental and sibling well-being.

Methods: Child and family outcomes were measured for 6 families who attended a three-day Horse Boy Camp. There was one autistic child per family who attended the camp (3 male and 3 female; M age = 9.17; SD = 2.23).  

Results: The study found marginally significant improvements in terms of autistic children’s movement sensitivity and sensory and cognitive awareness. In addition parents reported marginally significant improvements in their marital relationship and a trend towards improvement in their autistic child’s relationship with their siblings. A trend towards reduced levels of anxiety in the parent was also found.

Conclusions:  Horse Boy Camps are a promising intervention for children with autism and their families. 

 


The Long Ride Home

The long awaited sequel of the Horse Boy.

 

longridehome 4

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