Equine-assisted activities and therapies (EAAT) is a term used to describe any kind of intervention based around the use of horses and/or the horses' environment.
Equine-assisted activities include a wide range of horse-related activities (such as therapeutic horseback riding, interactive vaulting, and therapeutic carriage driving, as well as grooming and stable management).
Equine-assisted therapies include hippotherapy (use of a horse to improve neurological function and sensory processing) and equine-assisted psychotherapy (use of a horse to improve mental health).
Some people believe that EEAT can help autistic people cope better with a wide range of problems. For example, they believe that therapeutic horseback riding can help with issues such as social and communication difficulties, hyperactivity and irritability. They also believe that hippotherapy can help with issues such as posture, adaptive behaviours, and self-care.
There is a reasonable amount of research evidence (10 group studies and eight single-case design studies with three or more participants) into the use of equine-assisted activities and therapies for autistic individuals.
This research suggests that therapeutic horseback riding may provide some benefits to some autistic children and young people. Those benefits include increased social communication and interaction, alongside increased concentration and decreased hyperactivity and irritability.
There is insufficient evidence to determine if therapeutic horseback riding provides any benefits to autistic adults.
There is insufficient evidence to determine if hippotherapy provides any benefits to autistic individuals.
There is no research to suggest other forms of equine-assisted activities and therapies, such as equine-assisted psychotherapy, provide any benefits to autistic individuals.
There is a need for more research into equine-assisted activities and therapies which uses scientifically robust, experimental methodologies with larger numbers of more diverse participants. That research should investigate whether equine-assisted activities and therapies are more or less effective than other interventions designed to provide the same benefits, and whether specific individuals are more likely to benefit from specific forms of EEAT than other individuals.
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EAAT are used with a wide range of people, including people with cerebral palsy, traumatic brain injury, Down syndrome and so on.
The Professional Association of Therapeutic Horsemanship International states that autistic children and adults can participate in a variety of EAAT including riding, driving, vaulting, hippotherapy, and equine-facilitated psychotherapy (EFP).
Some organisations, such as the Three Gaits, Inc. Therapeutic Horsemanship Center, recommend that EAAT is not used for children under the age of two. This is because their neurological systems are not mature enough to deal with the sensory input which is produced by sitting astride a moving horse and because they may lack the neck control necessary to hold up the head with the additional weight of a helmet when on a moving horse.
All equine-assisted activities and therapies are designed to achieve some kind of therapeutic benefit (beyond the sheer pleasure of being on or around the horse).
Therapeutic horseback riding is primarily designed to improve physical, psychological, cognitive, and social skills, as well as to improve horsemanship skills. It is used with a wide variety of people with a range of different conditions.
Hippotherapy is primarily designed to improve neurological function and sensory processing. It is often used with people who have neurological or sensory processing difficulties, such as people with cerebral palsy or brain injury.
Equine-facilitated psychotherapy is primarily designed to help personal exploration (for example, awareness of thoughts, emotions, and behaviours) through interactions with the horse. It is often used with people with emotional, behavioural or mental health problems.
There have been various claims made for EAAT. For example, the Professional Association of Therapeutic Horsemanship International claims that
“Both equine-assisted activities such as riding or vaulting and equine-assisted therapy such as hippotherapy or psychotherapy can impact the life of a person with autism.”
There have been a number of studies which claim that therapeutic horseback riding can help some autistic individuals. For example, Gabriels (2012) reported
“Specifically, participants in the THR intervention group made significant improvements from baseline to post-evaluations on measures of self-regulation (Irritability, Lethargy, Stereotypic Behavior, and Hyperactivity), adaptive expressive language skills, motor skills, and verbal praxis/motor planning skills.”
There have been a few studies which claim that hippotherapy can help some autistic individuals. For example, Ajzenman et al (2013) reported
“Postural sway significantly decreased postintervention. Significant increases were observed in overall adaptive behaviors (receptive communication and coping) and in participation in self-care, low-demand leisure, and social interactions.”
We have been unable to identify any claims for the use of equine-facilitated psychotherapy as a treatment for autistic individuals.
The cost of using EAAT will depend on a number of factors including the supplier, the type of EAAT being provided, the length and frequency of treatment and the needs of the individual participant. There may also be additional costs for the initial evaluation, travel and equipment.
Some providers will charge per session, others will charge by the month and others will charge for a full course of treatment. For example, when we did an online search on 1 June 2018 we found suppliers charging between £45 and £75 per hour for a single session, although the costs were less if you booked multiple sessions at the same time. It is sometimes possible to get therapeutic riding for free via voluntary bodies such as Riding for the Disabled.
The length and frequency of EAAT may vary depending on the specific form of EATT, the particular programme being followed, and the needs of the individual client. For example, an individual therapeutic horseback riding programme may run over several weeks (anything between 6-30 weeks) and include one or two sessions a week, each session lasting between 45-60 minutes. Those sessions may be split between preparation work, work on the horse, and then further activity afterwards.
Parents are not normally directly involved in most forms of EAAT but they may have to spend time driving their children to and from the facility and waiting for them while they undertake the EAAT.
Potential hazards are similar to those of other therapies involving the use of animals. In this instance the dangers are magnified by the size of the animal, the risks of serious injury in the event of a fall or if the horse steps on a child.
Some organisations, such as the Three Gaits, Inc. Therapeutic Horsemanship Center, recommend that EAAT is not used for children under the age of two. This is because their neurological systems are not mature enough to deal with the sensory input which is produced by sitting astride a moving horse and because they may lack the neck control necessary to hold up the head with the additional weight of a helmet when on a moving horse.
They also suggest that EAAT may not be appropriate for some people with specific conditions such as
If in doubt, you should consult your doctor and/or therapist.
Cranial deficits (deficits in the brain cavity); hemophilia (condition characterised by inability to make blood clots); hydrocephalus (excessive fluid in the brain); shunt (hole or a small passage which moves, or allows movement of, fluid from one part of the body to another); seizures, spina bifida (condition characterised by incomplete closing of the backbone and membranes around the spinal cord); subluxation (dislocation).
There are a number of EAAT providers in the UK, the USA and other countries.
Riding for the Disabled provides information about riding centres in the UK.
The Professional Association of Therapeutic Horsemanship International provides information about riding centres in the USA.
There are some nationally recognised qualifications for providers of EAAT. For example:
In the UK, the Association of Chartered Physiotherapists in Therapeutic Riding runs a one year course for chartered physiotherapists who wish to deliver hippotherapy and/or therapeutic horseback riding. In practice, some providers of EAAT (such as some physiotherapists) may be regulated by other bodies, such as the Health and Care Professions Council.
In the USA, hippotherapy sessions must be conducted by a licensed occupational, physical or speech therapist or therapy assistant with additional specialised training in using the movement of the horse. The therapist should be a registered NARAH Therapist or a Hippotherapy Clinical Specialist (HPCS). If the therapist does not have such credentials he must be supervised by an HPCS therapist.
Derived from the Greek hippos (horse), "hippotherapy" literally refers to treatment or therapy aided by a horse with the earliest recorded mention in the writings of Hippocrates.
In the UK Agnes Hunt began using therapeutic horseback riding at the Orthopaedic Hospital in Oswestry in 1901. Olive Sands took her horses to the Oxford Hospital to provide riding for the rehabilitation of soldiers wounded in the trenches during the First World War. In 1952 Lis Hartel, a Danish wheelchair user, won Olympic medals with her horse.
In the USA, the North American Riding for the Handicapped Association was established in 1969 and is now known as the Professional Association of Therapeutic Horsemanship International. It promotes safety and optimal outcomes in equine-assisted activities and therapies for individuals with special needs. The American Hippotherapy Association (AHA) was established in 1992 and does something very similar.
In the UK, the Riding for the Disabled Association was set up in 1969. It now acts as the unifying voice of a number of smaller groups offering various forms of EAAT.
The Federation of Horses in Education and Therapy International was set up in 1974. It was created to provide a means of sharing and enhancing technical and educational expertise at the international level in the field of therapeutic riding.
We have identified 18 articles* published in English-language, peer-reviewed journals which evaluate the efficacy of equine-assisted activities and therapies as an intervention for autistic people. Two of those articles (Gabriels et al, 2015; Petty et al, 2017) appear to describe the same study.
The studies we identified included more than 400 autistic individuals aged from three to 16, although 126 of these individuals were from the same study (Gabriels et al, 2015). Some of these individuals had specific diagnoses, such as autistic disorder or Asperger syndrome. Some of the individuals were described by the researchers as having mild, moderate or severe autism. Some of the individuals were described by the researchers as having an average IQ and having some verbal abilities. Some of the others were described by the researchers as having a below-average IQ and/or very limited verbal skills.
The length of intervention varied between one month and six months, although in most cases the intervention lasted between two to three months. In one case the intervention lasted for three hours each week but, in most cases, the intervention lasted between 30 and 60 minutes each week,
The majority of the studies looked at therapeutic horseback riding while three studies (Ajzenman et al, 2013; Steiner and Kertesz, 2015; Taylor et al, 2009) looked at hippotherapy. We have been unable to identify any studies of equine-assisted psychotherapy or other forms of EAAT.
The majority of the studies took place in equestrian centres, were run by professional instructors and followed protocols established by organisations such as The Professional Association of Therapeutic Horsemanship International. In most cases this meant that the sessions were overseen by a qualified instructor, with each participant being taught alongside one or two other children, each of whom was helped by two or three adult helpers while they were on the horse.
Nine of the studies used a group design, usually comparing a group of people receiving EAAT to a different group receiving something else or not receiving an intervention at all. Eight of the studies used a single-case design (where there was no group receiving something else).
One of the studies (Petty et al, 2017) was a questionnaire survey which looked at whether the participants in another study (Gabriels et al, 2015) were more likely to take more care of their own pets at home after undertaking therapeutic horseback riding.
Some of the participants in some of the studies were receiving one or more other interventions (such as speech and language therapy or medication) at the same time as they received the EAAT.
*Please note: We have not included articles with less than three autistic participants, articles which did not examine the efficacy of equine-assisted activities and therapies as an intervention for autistic people, or articles which did not include real horses.
The overwhelming majority of the studies reported positive results. One study (Memishevikj and Hodzhikj, 2010) reported mixed effects. Two studies (García-Gómez et al, 2014; Jenkins et al, 2013) reported no significant benefits.
The studies on therapeutic horseback riding reported a number of benefits including: improvements in self-regulation, irritability, lethargy, stereotypic behavior, and hyperactivity, adaptive expressive language skills, motor skills, and verbal praxis/motor planning skills.
The studies on hippotherapy reported a number of benefits including: improved posture, adaptive behaviours, self-care and volition.
At this stage, we cannot determine if any particular group of participants benefited most from any particular form of EAAT.
There are a number of limitations to all of the research studies on equine-assisted activities and therapies published to date.
Some studies used relatively weak methodologies or did not adequately describe the methodologies they used. For example
Some studies had limited numbers of participants, selected participants in ways that could have biased the outcomes or did not adequately describe the participants or how they were selected. For example
Some of the researchers delivered the interventions in ways that could have biased the outcomes or did not adequately describe how the interventions were delivered. For example,
Some group studies did not compare like with like or did not provide sufficient detail about any differences in the experimental and control groups and the interventions each received. For example,
Some researchers did not use the most appropriate outcome measures or did not adequately describe those outcome measures and any limitations they might have had. For example,
Some researchers did not use the most appropriate statistical tools and techniques to analyse the data from their studies or did not adequately describe those tools and techniques and any limitations these may have had.
Some research studies included other flaws that could have biased the outcomes. For example,
For a comprehensive list of potential flaws in research studies, please see Why some autism research studies are flawed
We have identified the following studies into equine-assisted activities and therapies that are currently underway. If you know of any other studies we should include please email info@researchautism.net with the details.
The Sheba Medical Center is running a trial into the efficacy of hippotherapy for children with developmental disabilities. Clinical Trials Gov Ref: NCT00717392. For more details, please see Evaluation of the efficacy of hippotherapy for children with developmental disorders Full Item(Open in New Window)
There is a reasonable amount of research evidence (10 group studies and eight single-case design studies with three or more participants) into the use of equine-assisted activities and therapies for autistic individuals.
This research suggests that therapeutic horseback riding may provide some benefits to some autistic children and young people. Those benefits include increased social communication and interaction, alongside increased concentration and decreased hyperactivity and irritability.
There is insufficient evidence to determine if therapeutic horseback riding provides any benefits to autistic adults.
There is insufficient evidence to determine if hippotherapy provides any benefits to autistic individuals.
There is no research to suggest other forms of equine-assisted activities and therapies, such as equine-assisted psychotherapy, provide any benefits to autistic individuals.
There is a need for more research into equine-assisted activities and therapies which uses scientifically robust, experimental methodologies with larger numbers of autistic participants.
That research should
This section provides details of scientific studies into the effectiveness of equine-assisted activities and therapies for autistic people which have been published in English-language, peer-reviewed journals.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.
This section provides details of other publications on this topic.
You can find more publications on this topic in our publications database.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.