The Effect of Equine Assisted Therapy on the Social Functioning of

Children with Autism

Elaine Coffey

1596826

Submitted in partial fulfilment of the requirements of the BA Hons in Psychology at Dublin

Business School, School of Arts, Dublin.

Supervisor: Dr. Patricia Frazier

Head of Department: Dr S. Eccles

March 2014

Department of Psychology

Dublin Business School

1

CONTENTS

ACKNOWLEDGEMENTS .......................................................................................................... 4

ABSTRACT .................................................................................................................................. 5

INTRODUCTION ........................................................................................................................ 6

Autism............................................................................................................................. 6

Animal Assisted Therapy ............................................................................................... 8

Equine Assisted Therapy ................................................................................................ 10

Equine Assisted Therapy and Physical Disabilities ........................................................ 11

Equine Assisted Therapy and Autism ............................................................................. 12

Measures ......................................................................................................................... 14

Use of Observational Components ................................................................................. 15

Rationale ......................................................................................................................... 15

Hypothesis ...................................................................................................................... 15

METHOLOGIES .......................................................................................................................... 17

Participants ..................................................................................................................... 17

Design ............................................................................................................................. 17

Materials ......................................................................................................................... 17

Short Sensory Profile ........................................................................................ 19

Autism Treatment Evaluation Checklist .......................................................... 20

Observations ..................................................................................................... 20

Procedure ........................................................................................................................ 21

RESULTS ..................................................................................................................................... 24

Quantitative Data ............................................................................................................ 24

Hypothesis One ................................................................................................ 24

Hypothesis Two ................................................................................................ 25

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Qualitative Data .............................................................................................................. 27

Child One .......................................................................................................... 27

Child Six ........................................................................................................... 28

Child Eight ........................................................................................................ 29

Child Nine ........................................................................................................ 29

Child Eleven ..................................................................................................... 30

Child Fourteen .................................................................................................. 30

DISCUSSION ............................................................................................................................... 32

Limitations ...................................................................................................................... 36

Implications and Applications ........................................................................................ 37

Conclusion ...................................................................................................................... 38

REFERENCES ............................................................................................................................. 39

APPENDIX

Appendix 1 – Short Sensory Profile ............................................................................... 49

Appendix 2 – Autism Treatment Evaluation Checklist .................................................. 51

Appendix 3 – Information letter for parents ................................................................... 52

Appendix 4 – Letter of consent from school .................................................................. 54

Appendix 5 – Parents’ consent form .............................................................................. 55

Appendix 6 -

6.1 – Enclosed arena ......................................................................................... 61

6.2 – Enclosed arena, with pony tacked up with saddle pad and vaulting

roller ................................................................................................................. 62

Appendix 7 –

7.1 – Start of sensory trial ................................................................................. 59

7.2 – Sensory trial ............................................................................................. 60

7.3 – Sensory trial ............................................................................................. 61

7.4 – Sensory trial, showing stream to walk through ....................................... 62

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Appendix 8 – Grooming brushes (body brush, dandy brush, curry comb & hoof

pick) and paints used for the participants ....................................................................... 63

Appendix 9 – Hand prints on one of the horses, painted by a participant ...................... 63

Appendix 10 – Observation sheets ................................................................................. 64

Appendix 11 – Rosette .................................................................................................... 65

Appendix 12 – Certificate of achievement ..................................................................... 66

INDEX OF TABLES AND FIGURES

Tables

Table 1: A Paired Samples T-test table displaying the differences between time one and time

two for the Short Sensory Profile and Autism Treatment Evaluation Checklist ............ 26

Figures

Figure 1: Clustered bar charts highlighting positive decrease’s in behaviours .............. 27

Figure 2: Clustered bar charts highlighting positive increase in behaviours .................. 28

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ACKNOWLEDGEMENTS

Firstly I want to thank the entire group of participants who took part in my study. Without

you it could not have been possible. And of course to the parents who allowed their children

to participate. I have met so many amazing children during the duration of the study and I am

so grateful to have gotten that chance, and I have the up most respect from them and their

families.

I want to thank my supervisor, Patricia Frazier, for her patience and guidance throughout this

whole process. Pauline and John Hyland who helped guided me through the process at the

start, and to all the tutors throughout my studies.

I want to give a massive thank you to Emma Donoghue, the yard owner and therapeutic

coach. Emma, you made my dream of completing this study happen. I will always be

extremely grateful to you. You are an amazing person and coach and I have learned so much

from my time with you.

I want to thanks Sheila Clarke, Olivia Tenanty-Locke, Leanne Lock and Niamh Connaughton

for all your hard work throughout the study.

I want to thank all my wonderful classmates and the new friends who I have made through

this journey. I hope we can find time for each other in the future.

Lastly I want to thank my partner, Damien, for your patience, understanding and

encouragement, and my beautiful daughter, Aoibhinn, for just being you.

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ABSTRACT

This study examined the effects on equine assisted therapy on the social functioning

of children with autism. It was hypothesised that a positive change will occur over time and

between groups. 15 children attended half-hour sessions weekly for six weeks and were split

into riding, handling or mixed group. The Short Sensory Profile and Autism Treatment

Evaluation Checklist questionnaires were completed pre and post intervention. A qualitative

analysis was discussed from an observational comment. Significant improvements were

found in SSP overall score but non-significant in ATEC scores. Qualitative analysis found

improvements in areas of undesirable/positive behaviours, tactile over-sensitivity, speech,

anxiety and confidence. No significant difference was found between groups. EAT may be a

viable intervention for children with autism.

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INTRODUCTION

The aim of the current study was to observe the effects of equine therapy on the social

functioning of children with autism and observe which aspect of equine therapy has the most

positive effect, whether it be handling, riding or a combination of both. It aims to add to the

limited data base of research in this area.

Autism is a development disorder which affects around 1 in every 100 children in

Ireland (Irish Autism Action). It is characterised by deficits in social communication and

interaction (Weber & Westmoquette, 2010), a lack of social responsiveness (Passer et al,

2009), problems with areas associated with sensory modulation (Hilton et al, 2010: Lane,

young, Baker, & Angley, 2010) and motor deficits (Sams, Fortney & Willenbring, 2006). The

cause of autism is still unknown and due to the uniqueness of each individual with this

condition, parents and caregivers are trying many different types of interventions (Epp,

2008). Interventions such as social skills classes, workshops & individual therapy are

becoming increasing popular (Epp, 2008) with animals assisted therapy beginning to grow in

popularity also. Equine assisted therapy is a form of animal therapy using the horse as the

therapeutic instrument. Equine therapy is used for children with autism in the form of

therapeutic horseback riding and equine assisted learning. Equine assisted therapy is used as a

tool to improve posture, balance and bi-lateral coordination (Bass, Duchowny & Llabre,

2009: Van Den Hout & Brangonje, 2010), provide an experience which is multi-sensory and

engagement with the animal and also the coach (Bass & Llabre, 2010). The research that has

been conducted has shown a positive impact on the participants but to date it is limited.

Autism

The Diagnostic And Statistical Manual Of Mental Disorders classify the “presence of

abnormal or impaired development in social interaction and communication and a markedly

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restricted repertoire of activities and interests” as the main criteria for the diagnosis of autism

(APA 2000 p66). Autism is a complex neuro-developmental disorder which affects the brain

to varying degrees (Autism speaks; Irish autism Action). The symptoms emerge between the

ages of two to three with some parent’s noticing earlier. The prevalence in boys is four/five

times more likely, with an estimated 1-54 boy compared to 1-252 girls being diagnosed

(Autism Speaks). Leo Kanner (1943) was the first to identify autism as a specific disorder.

He defined three distinct characteristics that are still used in today’s criteria – social isolation,

impairment of language and insistence on sameness (Mesibov, Adams & Schopler, 2000).

In May 2013, the DSM-IV-TR was revised to produce the Diagnostic and Statistical

Manual of Mental Disorders (DSM-5), which provides a more accurate, scientifically and

medically, way of diagnosing persons with autism related disorders (DSM 2013). They are

now classified under Autism spectrum disorder (ASD), and it contains four separate

disorders: autistic disorder, Asperger’s disorder, childhood disintegrative disorder, or the

catch-all diagnosis of pervasive developmental disorder not otherwise specified (DSM 2013).

The DSM 5 criteria for diagnosis of ASD are: Persistent deficits in social communication and

social interaction across multiple contexts such as - deficits in social-emotional reciprocity,

deficits in nonverbal communicative behaviours used for social interaction, and deficits in

developing, maintaining, and understanding relationships. Symptoms must be present in early

childhood development and must be clinically significant and not better explained by

intellectual disability (Autism speaks 2013).

A well know author and researcher Temple Grandin, who herself suffers from autism,

talks about sensory issue that people diagnosed with autism can suffer from, she discusses

sensory over/under load from one or more of sensory process (Grandin, 2010). Hilton et al

(2010) conduct a study on sensory responsiveness and its ability to predict social severity in

autistic children. They talk about three sensory modulation disorders in children with autism

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and describe under/over responsiveness and sensory seeking behaviour and how it may be

related to behaviours that are common in autism suffers (Hilton et al 2010). They found that

there was a strong relationship between the level of the child’s social impairment and their

atypical sensory responsiveness.

Animal Assisted Therapy

Because of the unknown aetiology of autism, both caregivers and professional are

interested in trying a range of options for children diagnosed with Autism. They range from

medication, food, vitamins to auditory training, psychotherapy or behavioural therapy

(Krskova, Talarovicove & Olexova, 2010). Another method which is growing in popularity is

animal assisted therapy (AAT). European Society for Animal Assisted Therapy (ESAAT,

2011, para. 1) define animal assisted therapy as

Animal-assisted therapy includes deliberately planned pedagogic,

psychological and socially integrative interventions with animals for children,

youths, adults and senior citizens with cognitive, social-emotional and motoric

disabilities, and behavioural problems, and for focused support. It also

includes health-promoting, preventive and rehabilitative measures

AAT is a goal directed therapy involving interaction between the animal and the

human. It can be used in many settings and is used by many different professionals from

physical therapists to psychotherapists. Its aims are to assist with physical, cognitive and

emotional functions, improve wellbeing, support the therapist in helping the clients cope with

life situations and assist with activities and treatments (ESSAT, 2011). It can be used in a

group setting or an individual basis. The term AAT is very generic and many different

therapies come under this banner. Animals such as dog’s cats and horses are used but there

have also been studies with other animals such as guinea pigs (Krskova et al 2010).

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Lubbe & Schoitz (2013) investigated AAT and the benefit it may have in psychology.

They used a case study of one boy and believe that AAT could be used in psychology as a

therapeutic tool. They found that “using an animal (dog) in the therapeutic process appears to

promote the formation of a personal and caring relationship with the child” (p.128). They

identified five themes in their study. They were: Facilitating relationship bonding, enabling

communication by working indirectly, experiencing physical affection through the therapy

dog, socialisation skills and enhanced self-esteem (p.120). A study conducted by Banks &

Banks (2005) suggests that the use of AAT in a residential setting will reduce the loneliness

of long term residents. Physical symptoms have also reported to have been helped by AAT

(Friedmann, Katcher, Lynch, & Thomas, 1980: Cole, Gawlinski, Steers, Kothlerman, 2007).

A study using AAT in a pain management clinic found that after a visit from the therapy dog,

pain was significantly reduced, with 23% of the patients “reporting clinically meaningful pain

relief” (Marcus et al 2012 p.53). While other studies have found decreases in cardiovascular

problems (Friedmann et al, 1980: Cole et al, 2007) and a reduction of systolic blood pressure

of hospitalised children (Chia-Chin, T., Friedmann, E. & Thomas, S.A., 2010).

Studies of AAT and children with autism show positive results with more social

interactions and better communication when around animals (Sams et al, 2006: Krskova et al,

2010: O’Haire, McKenzie, Beck & Slaughter, 2013). Krskova et al (2010) conducted a study

using guinea pigs. They found that the children had more social interactions with their peers

while in the presence of the guinea pig. They had one very positive interaction where two

children, while stroking the animal, they touched hands, winked and had verbal

communication (p.148). Prothann et al conducted a study to test whether autistic children

would interact more with a dog, human or an object (Prothmann, Ettrich & Prothmann,

2009). They found that the children had most interactions with the dog, then the person and

finally the object (p.167). They observed that the children were interested in “complex social

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stimuli”, which was in the form of the dog and less so the person (p168). Another similar

study conducted by O’Haire et al (2013) found when children were in the presence of animals

they displayed more social behaviours compared with when they were in the presence of

toys. They observed children laughing and smiling more often, less negative behaviours,

looked more at human faces, made more eye contact and talked more to humans (p8).

Equine Assisted Therapy

A sub category of AAT is equine assisted therapy (EAT). EAT is a therapeutic

treatment using the horse to develop skills and behaviours and is used as treatment for

physical and mental disabilities (Bass et al 2009) with many physical, emotional and

psychosocial benefits being found from the therapy (Elliot, Funderburk & Holland, 2008:

Keino, Funahashi, Miwa, Hosokawa & Kawakita, 2009: Kern et al, 2011). EAT offers

different aspects than other AAT activities, it not only offers the connection of being around

the animal and the interaction but it offers the physical act of riding also. The horses large

size and unique characteristic and its ability to read body language are benefits of the EAT

over more general AAT programmes (Klontz et al., 2007). It is thought that riding motivates

and engages the child (Bass et al., 2009; Benda, Mcgibbon & Grant, 2003; Rothe et al, 2004)

and the action of riding and control of posture aids in balance and coordination training (Van

den Hout & Bragonje 2010; Araujo, Silva, Costa, Pereira & Safons, 2011). The movement of

the horse is a similar gait to the human walk, and the movement may encourage erect posture

(Cherng, Liao, Leung & Hwang, 2004) and stimulate different sensory systems (Hardy,

2011.) Where with equine assisted psychotherapy the horse acts a mirror, and they are used to

change the person’s disability to an ability (Robinson, 1999; Rothe et al., 2004) and develop

areas such as self-esteem, confidence and general wellbeing (Holmes, Goodwin, Redhead, &

Goymour, 2012; Lanning & Krenek, 2013).

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There are many aspects of EAT, which range from hippotherapy, EAT, equine

assisted activities (EAA), equine assisted psychotherapy (EAP) and equine assisted learning

(EAL). EAP is used to help with mental health issues. EAGALA state that it is “a powerful

and effective therapeutic approach that has an incredible impact on individuals, youth,

families, and groups” (2013). The American hippotherapy association define hippotherapy as

“a physical, occupational, and speech-language therapy treatment strategy that utilizes equine

movement as part of an integrated intervention program to achieve functional outcomes”

(AHA 2012). It is used to improve many physical and cognitive abilities such as balance,

strength, endurance and also aiding in speech therapy (AHA 2013). The horses’ gait is similar

to our own, which is rhythmical and repetitive, and it allows sensory input and develops core

strength (EAGALA 2013). EAL is based on learning, although still involving mental health

professional working alongside the equine specialists (EAGALA 2013). EFETA Ireland

describe therapeutic horse riding as “the use of horses and equine related activities to achieve

a variety of therapeutic goals... incorporating areas such as psychology, speech, occupational

or physiotherapy” (2013). In the current study both EAL and Therapeutic horse riding will be

used. Eat can be used as an intervention for autism, ADD, down syndrome, MS and many

more (EFETA 2013).

Equine Assisted Therapy and Physical Disabilities

Physical disabilities and EAT are well documented (Hout & Brangonje 2010).

Silkwood-Sherer et al conducted a study on Hippotheray and children with movement

disorders. They found that children who participated in their study showed “significant

improvements in balance” (p713) and” functional performance of daily life skills”

(Silkwood-Sherer, Killian, Long & Martin, 2012, p 716). A study on patients suffering from

MS found that their quality of life improved and they had improved balance (Bronson,

Brewerton, Ong, Palanca & Sullivan, 2010). Studies on cerebral palsy patients have positive

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results with many finding improvements in gross motor skills, increased muscle strength,

balance and co-ordination (Snider, Korner-Bitensky, Kammann, Warner & Saleh, 2007:

Sterba, 2007: Cherng et al, 2004). Benda et al (2003) found that children with cerebral palsy

showed improvement after hippotherapy. It helped posture and overactive muscles which in

turn promoted relaxation and aided in easing leg stiffness (Benda et al, 2003). While Wuang

et all conducted a stimulated riding programme and found benefits in areas of motor

proficiency (Wuang, Wang, Huang & Su, 2010). Psychosocial benefits have also been noted,

with self-esteem being increased (Hardy, 2011), improving of self-concept and the formation

of attachments (Bachi, 2012), reduction in anxiety (Holmes et al, 2012), and psychological

stress (Klontz, Bivens, Leinart & Klontz, 2007).

Equine Assisted Therapy and Autism

There are many anecdotal stories of horses helping children with autism and the

special bonds they form, but there is little empirical evidence to justify this. The research that

has been conducted so far shows promising results. There have been improvements in in

areas such as social functioning, sensitivity, emotional behaviours, self-regulation and

maintaining reactions (Bass & Llabre 2010: Ghorban et al 2013: Gabriels et al 2011:

Lanning, Baier, Ivey-Hatz, Krenck & Tubbs, 2014). Bass et all (2009) conducted a

pioneering study to examine the effects of EAT on the social function of children with

autism. They conducted a therapeutic horseback riding intervention, consisting or a one hour

session for duration of twelve weeks. They recruited 34 children (experimental group n=19,

control group n=15) with diagnosed with ASD, with pre and post parent evaluations

conducted. The one hour session consisted of mounting/dismounting, exercises to help the

children to stretch and relax, riding skills including learning how to ride and how to vocalise

the commands, mounted games and horsemanship where they learned to care for the animals.

They found a significant improvement in areas such as sensory integration, sensory

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sensitivity, inattention/distractibility and directed attention. They found the children engaged

actively and were able to listen and verbalise commands and they were able to have a

continuous level of attention. They conducted a follow up study (2010), consisting of fifty

children who participated in a twelve week programme, with each session one hour and

fifteen minutes long. The study was conducted in a similar pattern of their previous research

with an added follow up evaluation. They found positive results in the post test and follow up

evaluations in areas such as sensory seeking, cognition, communication, motivation,

sensitivity, emotional reactive and distractibility.

A study in 2010 by Hout and Bragonje tested sixty children with ASD, aged between

2 and 14 years, over a ten week period with one session a week. They used the sport horse

riding programme which involves specific steps to assist with the therapy. Their results

suggest that the sprit horse riding programme may be effective in reducing symptoms in ASD

children. They found that the more session they had the better the outcome and the less

severe participants benefited most. They areas that most improved from the therapy were

sociability and sensory/cognitive awareness, while communication, and physical behaviour

also improved.

A study conducted by Gabriels et al (2011) also found promising outcomes. They

recruited forty-two participants between six and sixteen years (36 male, 6 female) to

participate in a ten week THR course, with each lesson lasting one hour. They found

significant improvements in areas related to self-regulation, language and motor skills. They

also found improvements in stereotypical behaviours, hyperactivity and irritability. A recent

study by Ghorban et al (2013) also found positive results. They found the social skills of the

autistic children significantly improved. The findings of these studies are all consistent with

each other and there appears to be a very beneficial therapeutic effect between the children

and horse.

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Although the research is in its early stages and previous research demonstrates

positive effects from EAT, there is no research done on what area of EAT is most beneficial

to children with autism. The following study aims to expand on research findings and

accesses whether there is a difference between the therapies. The study is based on a six week

equine therapy programme. It will consist of therapeutic horse riding and equine assisted

learning. The participants will be split into three groups: one will be having therapeutic riding

sessions, the second will be taking part in equine assisted learning and the third group will

have a combination of both. The overall outcome of the intervention will be analysed and the

difference between each group will be looked at. This study aims to look at whether it is the

presence of the horse and the interaction with these animals or the actual movement and

riding of the horse, or does a combination of both have provide the best therapeutic benefits.

The sessions are routine based, with the participants arriving at an allotted time for the

duration of the study, with every effort made to allow the participant to work with the same

horse each week. It has been shown that children thrive on routines (Bridley & Jordan, 2012:

Fiese, 2006: Pressman & Imber, 2011)

Measures

The short sensory profile (SSP) (McIntosh, Miller & Shyu, 1999) and the Autism

Treatment Evaluation Checklist (ATEC) (Autism Research Institute, 1999) were used pre and

post intervention, and completed by the caregiver. The SSP (Appendix 1) is a 38 item

questionnaire, divided into seven sub-sections. It is scored on a five point scale: always - 1,

frequently - 2, occasionally - 3, seldom - 4 and never - 5. Its overall scores are from 190-155,

which is expected of typical performance, 154-142 probable difference and 141-38 definite

difference in performance. Previous studies conducted on EAT and autism has used the full

length Sensory profile (Bass et al. 2009: Bass & Llbre, 2010). The ATEC (Appendix 2) is

one paged 78 item questionnaire that is divided into four subsections. Subsection one is

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scored 2 – not true, 1 – somewhat true and 0 – very true. The second section is scored 0 – not

descriptive, 1 – somewhat descriptive and 2 – very descriptive. The third section is scored 2 –

not descriptive, 1 somewhat descriptive and 0 – very descriptive. The last subsection is

scored 0 – not a problem, 1 – minor problem, 2 moderate problem and 3 serious problem. The

total scores range from 0 – 179 with lower scores showing more typical performance.

Previous studies conducted on equine therapy and autism found is a sufficient tool to measure

functioning of children with autism (Memishevikij & Hodzhikj, 2010: Van den Hout &

Brangonje, 2010)

Use of observational methods

Bachi discusses how the findings of some studies do not match to the feedback from

the participants, parents or the staff (2012). They discovered that the staff and parents found a

difference from the participation in the study but this did not correlate with the results. To

allow for this there is an observation component added and each child will be observed for

the duration of the programme. This will provide somewhat missing data in previous

research, by showing how the participants react and improve/deteriorate each week.

Rationale

There is limited quality empirical evidence for the use of equine therapy for children

with autism and none defining which aspect benefits them the most. The use of the

observational component will add a new dimension, which had not been looked at before.

This study aims increase findings in the data base and offer suggestions for future research.

Hypothesis

It is hypothesised that there will be a positive change over time in levels of social

functioning among children who participate in the equine assisted therapy.

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It is hypothesised there will be a difference relating to social functioning among

children who participate in Equine assisted therapy, between the riding group, handling group

or the combination group.

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METHODOLOGIES

Participants

Fifteen children, aged between 3 and 13 (M=7.27, SD=3.35), diagnosed with autism

participated in the study, which took place in a specialised therapeutic equestrian centre.

Participants were recruited through special education schools in the area. Emails were sent,

with a brief explanation explaining the study, to the principal of the school requesting

permission for information letters to be sent to parents offering their child a placement in the

study (Appendix 3). Once permission was sought from the school (Appendix 4), letters were

sent home to parents and returned with a signed consent form and doctors note. The first

fifteen suitable participants, whose consent forms (Appendix 5) were received, were allocated

a place in the study. Parents consented to pre and post testing for the duration of 6 week.

Once the children were confirmed in the study, they were randomly assigned into one

of three groups. The handling group consisted of five boys ranging in age from 4 to 13

(M=7.6. SD=4.5). The riding group consisted of four boys and one girl ranging in age from 4

to 11 (M=7.6, SD=2.19) and the mixed group consisted of four boys and one girl ranging in

age from 3 to 10 (M=6.4. SD=3.36). All parents filled out consent forms and doctor’s notes

were also required. The sessions were all conducted free of charge to all participants.

Design

This is a longitudinal quasi-experimental design with observation components, using

an opportunity sample. It is a between/within groups design as there will be an overall

evaluation of the EAT and a discussion regarding the difference between each group. The

dependent variable being measured will be the social functioning of each child with autism.

For hypothesis one the independent variable will be the equine therapy. For hypothesis two

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the independent variable will be which aspect of the EAT they take part in, whether it be

riding, handling or a mixture of both. Demographic variables were also taken, i.e. age &

gender. There will a total of three groups with five children in each group. They were

randomly assigned by names being picked from a hat by the researcher and the therapeutic

coach.

Each child received six half hour individual sessions, once a week on a Saturday. The

riding group participated in only riding for the duration. They started in the enclosed arena

(Appendix 6.1) and carried on their session down the sensory trail (Appendix 7). It involved

nature, games, communication and sensory stimulation. The handling group spent time with

the horse on the ground. They fed the horse, groomed the horse, learning about each brush

they used (Appendix 8), feeling different textures and being thought how to groom, they

painted the horse (Appendix 9) and were thought how to lead, and led the horse down the

sensory trail. It involves communication with the horse and the coach. The mixed group

participate in a mixture of both the riding and the handling, with time being split between

both.

Each child will be observed throughout the course of the six week. The parents gave

consent for the observations to be obtained and used within the study. The observation will

start from the beginning of each session and continue for the full length of the session

(Appendix 10).

Materials

The Short Sensory Profile (SSP) and the Autism Treatment Evaluation Checklist

(ATEC) were used to evaluate the social functioning of each child, pre and post intervention.

19

Short Sensory profile

The sensory profile (SP) was developed by Dr. W Dunne (1999). It is a 125-question

profile that reports the child’s frequency to sensory experiences (Pearsons, 2014). It was

developed from extensive research of over 1000 children (Dunne, 1999). The Short Sensory

profile (McIntosh et al, 1999) is a 38 item questionnaire, delivered by caregivers, which was

developed from the SP through extensive research (Ahn, Miller, Milberger & McIntosh,

2004). The 7 sections of the SSP are Tactile Sensitivity, Taste/Smell Sensitivity, Movement

Sensitivity, Under-responsive/Seeks Sensation, Auditory Filtering, Low Energy/Weak, and

Visual/Auditory Sensitivity. The scores on the total scale range from 38 to 190, with a more

normal performance achieving a higher score. Internal reliability range from .90 to .95, with

consistency on the sub-scales ranging from .70 to .90. Internal validity, with a significance of

p<.01, range from .25 to .76 (Dunn, 1999). From these findings, it has been found to be a

valid measure for measuring sensory processing (Tomchek & Dunn, 2007).

Autism Treatment Evaluation Checklist (ATEC)

The ATEC was developed by Bernard Rimland and Stephen Edelson (Autism

Research Institute, 1999). It is a one page questionnaire used specifically to evaluate the

effectiveness of treatments in individuals with autism. It is divided into 4 different sub-scales:

1. Speech/Language – consisting of 14 items, 2. Sociability – consisting of 20 items, 3.

Sensory/Cognitive awareness – 18 items and 4. Health/Physical behaviour – consisting of 25

items. The ATEC can score from 0 to a maximum of 179 on these subscales. It has been

designed to be completed by parents, caregivers or teachers and is administered pre and post

intervention. Studies on ATEC have found it to be a valid measure of evaluating change in

ASD symptoms over time (Hossein Magiati, Moss, Yates, Charmon & Howlin, 2011) and

measuring how effective various interventions are (Memari et al, 2013). Hossein Memari et

20

al (2013) found it had high internal consistency at 0.77 (Cronbachs Alpha) and Magiati et al

(2011) found it ranged from 86. to .94.

Observations

Each child session will be observed for the duration of the study. The observations

sheets are split up into five minute slots, with a section at the beginning and the end for any

additional notes (See appendix 10). The observers were the researcher and an assistant, and

once completed the observation were checked for inter-rater reliability. During the sessions

for the handling group the observer stood a safe distance away from the horse, in a position

where they were able to see both participant and coach. In the arena section of the riding, the

observer stood on the inside of the arena, walking alongside the horse, at a safe distance

while being aware of any communication or behaviour. Whilst the participant was on the

sensory trial, the observer walked along behind the horse, at a safe distance, observing any

communication, interactions or behaviours. The observers did not communicate with the

participants unless participants initiated an interaction.

Each child presented with their own unique idiosyncratic behaviours, therefore not all

participants scored on each observations. The observation was divided into sections, where

observers were looking for specific components. Speech and communication, how much they

interacted with the horse, coach and helpers. They also looked to see how much the

participant spoke with and without being prompted. Anxiety levels were noted. Tactile over-

sensitivity was observed, as there were many different textures and surfaces to feel. How

much and how easily the children were distracted. Positive behaviours such as listening and

completing tasks as best they could. Undesirable behaviours, such as aggression, meltdowns

and not participating/concentrating with/on the coach. The level of enjoyment through the

course of sessions was also looked at.

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Procedure

Each child was given an allocated time slot to arrive in the yard on a Saturday for six

weeks. On the first arrival in the yard the coach assessed the child’s height and weight and

assigned each child a horse. They were informed of which group they were placed in and

then brought to meet the horse. The parents of each participant were asked if it were ok for

someone to observe each session and take notes for the observational component. At the end

of the study each participant received a rosette and certificate of achievement (Appendix 11

& 12).

Riding group

In the riding group the child was taken into the arena and assisted in mounting the

horse using a mounting block. The participants sat on a saddle pad which was secured by a

vaulting roller, which the participants held onto (see Appendix 6.2). The first five minutes

involve stretching exercises. Through guidance of the coach and side walkers they were

shown repeated exercises to aid in relaxation and stretching of muscles. This was conducted

while the horse walked around the area, preparing them for the session. They were then asked

to sit backwards on the horse whilst walking around the arena.

Scattered around the arena, on barrels, were a variety of toys (See appendix 6.1). Each

session the children were brought to each barrel where they were offer the toys, and they had

a choice whether to take them. All the time the coach is interacting with the participant and

trying to engage them in conversation about what is happening and promote communication.

The second fifteen minutes is spent on the sensory trail (see Appendix 7.1). The trail is

located in a wooded area and took approximately fifteen minutes to walk through and back

see Appendix 7.2 & 7.3). Along the trail, at specific points, buckets are placed in the trees

which contain a variety of animals for the children to take out and touch and talk about. The

22

trail also contained a stream which the horse walked through (see Appendix 7.4). The

participants were encouraged to touch the trees, bark and leaves and engage in the guessing

of animals from the buckets.

Handling group

The participants in the handling group were first introduced to their horse. They were

asked to feed the horse and it was explained that they eat hay, which they then carried down

to give to the horse. They were shown how to groom the horse, and how to execute it

correctly. They used three different brushes to groom the horse (body and dandy brush and

plastic curry comb), showed what areas they were each used for and how to pick out the

horse’s hooves using a hoof pick. While grooming the horse the coach was constantly

reiterating what was being said. The participant was asked to feel and describe the horse, how

its coat felt before and after grooming (if verbal) and also asked to smell the horse. After

grooming the participants painted the horse. They were encouraged to use their whole hand

and mix the colours together. The participants were then shown how to lead the horse and

walked the horse down the sensory trail, with the assistance of the helpers if needed. They

finished up bringing the horse back into the shelter and assisting in tying him up.

Mixed group

The mixed group started off their session handling. They were introduced to the horse

and were shown how to groom and what brushes used and they also painted the horse (as

above). The participants lead the horse to the arena where they were assisted in mounting.

They walked two laps around the area and continued onto the sensory trail (as above).

All participants were encouraged regularly to communicate with the horse and coach.

Communication was encouraged through the use of song, from the coach and the assistants.

23

They were asked to touch and pat the horse, and at the end of each session to thank the horse

and give him a hug. Throughout the sessions the participant were reinforced for positive

behaviours, by praise and high fives and the coach made an attempt to keep regular eye

contact. The elements of the EAT were specifically designed to stimulate sensory seeking, as

well as gross and fine motor skills and develop communication skills.

24

RESULTS

Quantitative Data

Fifteen participants took part in this study. One participants post intervention

questionnaires was not received back. The means and standard deviations for all participants

were reported (Table 1).

Hypothesis one:

The first hypothesis postulated there would be a difference in the overall score of the

social functioning of children with autism after completing an equine therapy intervention.

Paired samples t-tests were conducted on the overall scores of the SSP and ATEC

questionnaires.

Short Sensory Profile

Paired samples t-test was conducted and a statistical significance was found from the

SSP from time 1 (Mean=122.93, SD=15.65) to time 2 (Mean=131.64, SD=17.42) conditions

t(13) = -3.51: p = .004. Paired sample t-tests also found statistically significant effects in the

subscales, tactile sensitivity t(13) = -3.56, p < .003, tastes/smell sensitivity t(13) = -2.38, p =

.03, and underresponsivness/seekssensation t(13) = -2.35, p = .03.

Autism Treatment Evaluation Checklist

The mean score for ATEC time 1 was 55.33 (SD=20.47), with the mean ATEC time 2

score 51.78 (SD=20.52). The 95% confidence limits show that the population mean

difference of the variables lies somewhere between -1.42 and 10.57. There was no statistical

significance found in the ATEC overall scores between time 1 and time 2, t(13) = 1.65: p =

25

.12, but statistical significance found in the area of sensory/cognitive awareness t(13) = 2.21,

p = .04.

Table 1: A Paired Samples T-test table displaying the differences between time one and time two for the Short Sensory Profile and

Autism Treatment Evaluation Checklist

Variables Mean SD T Df p

SSP Time1 122.93 15.65 -3.51 13 .004

Time2 131.64 17.42

ATEC Time1 55.33 20.47 1.65 13 .12

Time2 51.78 20.52

Hypothesis two:

The second hypothesis postulated there would be a difference between the scores on

social functioning of the three groups after the equine therapy intervention. Statistical

analysis could not be completed using t-tests due to the small sample size in each group (n-5).

Bar graphs are used to show decrease and increase in behaviours.

Overall the children improved in most areas. A positive decrease was found in areas

of undesirable behaviours, tactile over-sensitivity and anxiety levels, with distractibility

decreasing slightly over all (Figure 1). The mixed group improved in areas of undesirable

behaviours, tactile sensitivity and distractibility marginally more than the two other groups,

with the riding group improving slightly more in the area of anxiety.

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There were positive increases in speech and communication, positive behaviours and

enjoyment, with slight increase in confidence levels noted (Figure 2). The mixed group

improved slightly more in areas of speech/communication and enjoyment, with the riding

group improving marginally more in positive behaviours.

Although there were slight differences between the groups in all areas, they were not

significant enough to indicate which group were benefited most from the equine therapy.

Therefore hypothesis two will have to be rejected and the null hypothesis accepted.

(Time 1= Blue, Time 2= Green, Time 3= Brown, Time 4= Purple, Time 5= Yellow, Time 6= Red)

Figure 1: Bar Charts Highlighting Positive Decrease’s in Behaviour’s

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(Time 1= Blue, Time 2= Green, Time 3= Brown, Time 4= Purple, Time 5= Yellow, Time 6= Red)

Figure 2: Bar Charts Highlighting Positive Increase in Behaviour’s

Qualitative data

The overall results for the observational component were very positive. The

participants improved in areas of undesirable behaviours, positive behaviours, tactile

sensitivity, anxiety levels, speech and communication and overall enjoyment (Figure 1 & 2).

Child 1

C1 presented as happy and excited to be starting his session. He was placed in the

handling group, which his parent was not happy about as he had been told, by his mother, that

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he was going to be riding. He was extremely communicative, and was asking about riding the

horse, which persisted for the duration of the study. During the duration of the study C1

plateaued on areas of undesirable and positive behaviours. He became extremely distracted at

times and the coach found it hard to keep his attention. He often did not listen to what was

being requested and at times seems bored. The coach kept the lesson moving forward each

week to keep his attention but he seemed to lack interest. He improved slightly on his tactile

over-sensitivity, and by week 6 enjoyed using his whole hand to paint the horse and was not

worried about the dirt of it.

Child 6

C6 was placed in the riding group. He was very anxious when first placed on the

horse. The coach/assistant was given lollies to give him, when he became anxious. During the

duration of the sessions C6 needed the lollies less and on the last session he was given the

lolly but did not request for it to be opened. He communicated and interacted more without

the lollies, and his speech made positive progression. C6 became extremely relaxed and

happy whilst on the horse. He communicated with the horse by singing songs, saying go and

clicking when he wanted the horse to move. He interacted more each week the coach,

naming the animals as best he could, making animal noises and singing. C6 had been horse

riding before and never allowed a hat to be placed on his head, at the beginning of the second

session he allowed an assistant to fit one on and each week repeated this, without hesitation.

C6 had one meltdown during the week four sessions. Due to unforeseen circumstances he had

a wait of thirty minutes. He became extremely anxious and worried and at one point tried to

jump of the horse. The session was cut short as it was becoming dangerous to the participant,

and he was walked back quietly to the area to dismount. When he arrived back for the next

sessions he was not affected and got straight up on the horse and interacted very well.

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Child 8

C8 arrived at the yard and presented with behavioural problems and aggression to his

family, coach and assistants. He seemed unhappy and agitated, and behaved very negatively

towards the horse and the coach for the first two sessions. The coach focused on controlling

the behaviour and C8 was asked to have manners and listen to what the coach was asking him

to do. By the third week the aggression had subsided immensely. C8 was interacting in a

more positive manor and participating in the tasks asked of him. During the last sessions C8

showed no signs of aggression towards the coach, assistants or horse. His mood and

behaviour also increased and he appeared extremely happy while on the horse. At the end of

session 5, the participant finished up the sessions with a big smile and thanked the horse and

gave everyone a big hug. He also repeated this on his last session. He made dramatic

improvements throughout the course of the study in behaviour, aggression and enjoyment

levels.

Child 9

C9 was extremely nervous when beginning her sessions. She was shaking getting up on the

horse and was reluctant to participate in any of her activities. By the end of the six sessions

her confidence grew immensely. She spent time looking up vaulting on YouTube and wanted

to have a go. She was willing to try anything that was asked of her. Her parents informed the

coach that C9 was having a very hard time in school and was being bullied and since

commencing her sessions, her confidence has improved enormously, and she has found a

massive difference overall in her child.

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Child 11

C11 was placed in the mixed group. He was nonverbal 3 year old boy. Over the

duration of the session C11 became extremely relaxed and happy to be on the horse. At week

four he made his first attempt to say ‘go go go’. Over the next two sessions he made attempts

at talking several time, making sounds or noise directed at the horse or his mother and at one

point saying something that was not picked up/understood. He started off being a little

distracted but by week six his attention was focused on the horse and lessor extent the coach.

While he painted the horse he became completely calm and seemed to be enjoying it

immensely. He often drifted off into his own world starring off to space. He showed great

enjoyment throughout his time and was repeatedly seen with a big smile on his face.

Child 14

C14 was placed in the mixed group. At the first session, the participant had a very

negative reaction to the session. She became very distressed and extremely anxious. She was

completely disinterested in the horse and coach and was gravitating towards her parents the

whole time. Her mum then partook in the session and they knelt down beside the horse and

the participant becomes calmer. She then continued with the session and mounted the horse

for a short time. During the duration of the sessions the participant started her session straight

away, starting off with riding, with the coach then working on handling at the end. By the

third week C14 is participating in the games along the sensory trial. She is non-verbal but

makes noises of the animals and starts to interact with the coach. At week four when asked to

get Eric to go (coach ask C14 to say ‘go Eric go’), she makes sounds to get the horse to move

and wiggles her legs, this improves each week, to the point she does not have to be prompted.

C14 would not partake in the handling section at the beginning; she panicked and made loud

crying sounds. From week two she started to lead the pony around the arena and as each

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week went on spent a little while longer with the pony. She did not take part in any grooming

or painting, but the coach had to go with what the participant was able to undertake. Her

anxiety levels disinterest and communication improved greatly during the sessions.

Other participants improved in the area of tactile over-sensitivity. Many of the

children in the study showed signs of this, with not many wanting to touch certain objects

often throwing them back on the ground. C2 did not want to touch the hay or grooming

equipment, and would throw it to the ground after a short period. By the end of the six weeks

he was holding the brushes for extended periods and placing them on the ground as asked. He

did not want to touch the paint; he started off using only one finger and quickly wiping it on

his jacket. By the end of the study, he used his whole hand and painted nearly the whole back

end of the horse (see Appendix 9.). He gathered hay for the horse before and after his

sessions and made great improvements in this area.

Some parental comments were made during the study to the coach. One parent had

tears in her eyes after watching her child’s session and commented on how she couldn’t

believe that he was interacting so well with both the horse and the coach, how calm he was

and how well he was doing. She noted that he always got so excited when he got in the car on

his way to the session. Another parent advised us that her child’s speech had improved

immensely and there was a massive reduction in his stemming. While the majority of the

comments were positive, one parent noted that she did not see the point of the study and how

it would help her son being in the handling group, with a belief that they would only benefit

from the riding aspect.

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DISCUSSION

The aim of this study was to investigate the effects of equine assisted therapy on the

social functioning of children with autism. The results showed mixed reports for hypothesis

one. The SSP showed significant improvements in the overall score with the participants

improving in areas of tactile sensitivity, taste/smell sensitivity, and

underresponsivness/seekssensation. The overall results for the ATEC were not significant but

there were significant improvements in one area of sensory/cognitive awareness. The

observational component showed positive results in areas of undesirable behaviours, positive

behaviours, tactile over-sensitivity, anxiety levels, speech and communication and overall

enjoyment. Hypothesis one was both accepted and rejected by this inconsistency of these

results. Hypothesis two was rejected as there was no significant difference found between

each group, but with each child benefiting from certain aspects of each session.

The different result in the questionnaires may be in the detail of the questions

themselves. The SSP has 5 point scale of scoring, while the ATEC only has 3 point scale,

with the last question having 4 point scale. The short duration time of the study may have

lead the SSP’s detail into making it significant while the ATEC not being significant. If the

intervention had been for a longer period of time then perhaps the ATEC sores would have

been significant. This may plausible as one section of the ATEC was found to be significant

and in previous research using the ATEC, positive results were found from the intervention

(Van den Hout & Braangonje, 2010)

There were improvements in the area of tactile over-sensitivity and taste/smell

sensitivity. The environment of an equestrian centre provides an array of sensory smells and

surfaces to touch. The smells from the yard, which vary from hay, horse and manure, may be

new to the participants, and the large amount of these new smells may have aided in this

33

improvement. They were encouraged to smell their horse each week and discuss what he

smelt like. The participants were encouraged to touch and feel objects throughout the

duration of the study. They used paint, touched the horses, the hay and the grooming

equipment. This variety of textures may have enhanced this improvement.

The ATEC results were not significant with only area of cognitive/sensory awareness

showing improvements. As Van den Hout and Bragonje consider this subsection of the

ATEC offers questions that in other questionnaires are in the social functioning subsection

(2010). This may contribute to why this area was significant in this study. If the intervention

was conducted over a longer period this may enhance the results and show more significant

effect.

It has been postulated that horse riding alone is stimulus enough for children with

autism (Bass et al. 2009: Keino et al, 2009). Bass et al discuss how horseback riding may be a

rewarding enough stimulus to the children, and it may account for high levels of motivation

and social engagement (2009, p.1266). Wuang et all conducted a study on stimulated horse

riding and found that it offered additional benefits in areas of sensory integration and motor

proficiency, compared to traditional therapy programme (2010). While Keino et all suggest it

may be from movement of the Broca area that is rhythmical and systemised, that assists in the

development of social skills in children with autism (2009). This current study seems to show

that horseback riding does benefit children with autism. This could be due to the horse riding

being very stimulating, physically demanding and a new stimulus. The study also offers

contradiction to this, as it appears that it is not just the horse riding that provides the stimulus,

with each group showing similar results. It may be the exposure to the new environment, new

animals and the horses that provided multisensory experience that the participants seem to

benefit from. Bass et all believe that autism is linked to dysfunction in cerebellum activity

and horse riding stimulates this area due to motor learning, motor control and social

34

engagement (2009, p.1266). This not only occurs in horse riding, it also occurs in the

handling aspect, as motor control and learning and social engagement and communication are

a major part of each session.

Participants in each group had to show concentration and attention as found in

previous studies (Bass et al, 2009). Overall they showed improvements in this area

throughout the weeks. It may due to the fact that the therapy was novel and there was so

much going on that the coach was able to keep their attention. They were instructed

continuously throughout their session to communicate and interact with both the horse and

the coach, and this may also have aided in their sustained level of attention. Each session,

although planed, developed to suit the child and as it was based in a yard with other animals

there were continual unique visual and audial occurrences.

There were slight differences in the observations results for each group with the

handling group showing slightly more of a decrease in undesirable behaviours, tactile over-

sensitivity and distractibility. The mixture of both the riding and the ground work may have

offered more stimulation to the participants, better opportunity to touch and smell new

objects and caused this result. A slightly more positive decrease in anxiety levels was found

in the riding group. When the participants were anxious on the horse, the coach calmed

everything down, with less interaction and some quiet time, to allow the participants to relax.

Gabriel’s et al discuss how the horse helps to calm down children with ASD, through

facilitating organization and input of sensory information (2011). This seems possible with

the participant’s anxiety levels decreasing quicker, causing an overall better result. It may

also be due to the fact that one participant in particular became extremely anxious during the

first lessons with her anxiety levels decreasing dramatically throughout. This may have

brought down the whole groups total anxiety levels.

35

The mixed group had slightly higher results for speech/communication, positive

behaviours and enjoyment levels. This again may be due to the combination of both the

riding and the handling, allowing the participant to experience both aspects. Previous

research use both riding and handling aspects within their study, with the outcomes showing

positive results (Bass et al, 2009: Bass & Llabre, 2010: Gabriels, 2012: Ghoran et al, 2013).

The addition of the observational component added a new insight to how each child

behaved throughout the study. It’s showed improvements in areas mentioned above and

allowed the researcher to obtain some parental feedback. This matches some of Gabriels

feedback from parents after the sessions, regarding the children being calm, relaxed, less

anxious, getting on better overall and improvements in speech (2012). The fact that this is a

new component that has allowed a look at how the children behave and interact is a very

positive one. The parents interacted with the coach after the session and offered valuable

information on how their child was responding.

Overall the study found positive benefits for equine therapy and children with autism.

The multisensory experience of being around animals in a novel environment allowed for

positive changes in behaviour. The interaction with the horse and coach, and being prompted

to command the horse verbally to control it seems to have allowed for development

communication skills and speech (Gariels et al, 2012: Ghorban et al, 2013). Enjoyment levels

increased throughout the study, leading to increased positive behaviours. The fun factor

allowed for learning and development at the participants own level. Previous studies have

found enjoyment levels have improved speech and positive emotions directed towards

caregivers (Ghorban et al, 2013: Keino et al, 2009).

36

Limitations

There are several limitations that need to be mentioned for the present study. The lack

of control group means the results cannot be attributed to the intervention. The size of the

sample was quite small, and when divided in to each group it was too small to conduct

statistical analysis. Bachi talks about this being one of the big problems within the research

area of EAT (2012). The duration of the study was short with only six weeks of sessions and

each session only lasting thirty minutes. Previous research studies were conducted over a

longer time frame, with sessions lasting an hour or more and with larger sample sizes (Bass et

al, 2009: Bass & Llabre, 2010: Gabriels et al, 2012: Kern et al. 2011: Lanning et al, 2014).

Future research needs to include a control group, a larger sample size and increase the

duration of the programme with each session lasting for a longer length of time. There was no

control over external interventions the participants were involved and due to ethical issue

they cannot be prevented from attending these. There was no list of medications taken before,

during or after the study. The addition or change of medication could have also altered the

results.

Half the questionnaires were not received back at the required time from the parents.

With an approximate wait time of a month before all were received back, this is seen as a

limitation. The time period alone from the completion of the study to the questionaries’ being

filled out was believed to be too long, but it also happened to be after the Christmas break

they were received back. Children’s routines are broken around this time and their behaviour

changes due to this. Family routines provide structure and emotional support through

development in childhood (Fiese, 2006), and aid in reducing behavioural problems by

providing a predictable lifestyle (Bridley & Jordan, 2012). Pressman & Imber found very

strong correlations between bad bedtime routines and children having tantrums and

meltdowns, aggressive behaviours, lack of self-confidence and bad school reports about

37

behaviour (2011). The fact that the children’s routine is broken for a number of weeks over

Christmas, and more so the fact they eat differently and are given presents will affect their

sleep habits, mood and behaviour. Children with autism thrive on routine and this may have

been quite significant limitation for this particular study.

Implication and applications

The current study adds to the limed data base of empirical evidence in the area of

equine therapy and autism. It contained a small sample size over a short duration but showed

some positive results. Future research could continue with the design, using parental

questionnaires and an observational component, a larger number of participants, over a longer

time period. The observation component allows for a new light to be added into the research,

with the opportunity to add some extra data from parental reports from interviews pre and

post intervention. Bachi (2012) discussed how results do not always reflect the positive

outcome of the intervention and along with observation this can be changed. These results

shed a positive light on the growing area of equine therapy, and allow for parents and

caregivers to be shown evidence that it may benefit their child.

Conclusion

Equine assisted therapy is a growing area of expertise and as horses have been used

for people with autism for a number of years, the area requires evidence based data to back

up the therapy. The multisensory experience of the equestrian centre and being around the

horse, both riding and handling, seem to allow for positive outcomes for children with

autism. The horses, who are sensitive to human behaviour and emotions, allow for

development of social skills and communication (Keino et al, 2009), improvements in

sensory sensitivity, attention and distractibility (Bass et al, 2009: Bass & Llabre, 2010), assist

38

in improvements in autistic symptoms (Kern et al, 2011), and aid in the learning styles and

development of autistic children (Ghoran et al, 2013).

39

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APPENDIX

Appendix 1:

50

51

52

Appendix 2:

53

Appendix 3:

INFORMATION SHEET FOR PARENTS

The effects of Equine Assisted Therapy on the Social Functioning of children with Autism

Researcher: Elaine Coffey, Student Researcher, [ contact details ]

Dr. Patricia Frazer [contact details ]

Background and Purpose: In my research I am interested in finding out how Equine Assisted Therapy

(EAT) will affect the social functioning of children with Autism. There is little research done in this

area but any research conducted shows positive results. I am interested in finding out not only if

there is a benefit but also which aspect of the EAT is of most benefit to the children, i.e. riding the

horse or just generally being around them that will produce the best results. I am doing this as part

for my thesis for my Honours degree in Psychology at DBS. I am working with John Hyland, whose

contact details are above.

What happens if my child takes part? Your child will be placed into one of three groups, riding,

handling or a combination of both, and they will have one session a week for a period of eight weeks

in a local equestrian centre specializing in EAT. The children will be assigned a horse and the session

will take about 30 – 40 minutes. You will be asked to fill out questionnaires before the start of the

study and then again at the end. I can be contacted by phone with any queries you may have before

the study begins and will be happy to answer any of your questions.

What will happen to the results of the study? The information from the children’s EAT session will

be analysed and they will tell us if the sessions were of benefit and which area was most beneficial.

The results will aid further research in this area by telling us whether there is any improvement in

the children. A copy of the summary of the results will be given to the parents, school and equine

assisted coach at the end of the study.

How will my child’s information be protected? The children’s identity will be protected at all times.

They will be given pseudo names. Any information that will link names will be kept in a secure

location in DBS until the research is completed. Quotes may be used form the observation

component of the study but and child whose quote will be used will be given a pseudo name. Once

54

the study has been completed your child’s name will be removed and all the data will be destroyed

after 10 years.

Voluntary Participation: It is up to you and your child to decide whether your child is going to take

part or not. Participation is completely voluntary. Your child is free to withdraw at any time. I will

remind the children of this when I meet them.

Important: The consent form! There is a consent form attached to this information sheet. Every child

participating must have a consent form which you have signed. Please note that research practice

guidelines do not allow me to make any exceptions, and verbal permission cannot replace the signed

consent form. It is important to remember to return the signed form to school as without it your

child will not be allowed to take part. A doctor’s note confirming medical clearance for the physical

activities should be attached to the consent form.

Further Information: This research is being conducted to assist researchers with finding out about

The effects of EAT and Autism. We very much hope that you will agree to let your child take part in

the research. If you require any assistance or have any questions about the research study, please

feel free to contact me.

Thank you very much for supporting this research study. Please keep this information for your records.

55

Appendix 4:

9th August 2013

Dublin Business School

13-14 Aungier St

Dublin 2

To Whom It May Concern

Re: Elaine Coffey

Equestrian Assisted Therapy Internship

St. Mary Special School is willing to participate in the Equestrian Assisted Therapy

programme that will be run by Elaine Coffey a student currently studying at your institution.

She has proposed that the programme will be over an eight week period one day for the

week. There should be 15 pupils with Autism between the ages of 4+ years to 12 years who

could avail of this programme.

Regards,

Jean-Marie Thompson

Deputy Principal

Principal - Ambrose Lavery Deputy Principal - Jean-Marie Thompson

Tel: (046)9023745 Fax: (046)9023448 email: smsp@eircom.net

56

Appendix 5:

PARENT’S CONSENT FORM

Title of Study: The effects of Equine Assisted Therapy on the Social Functioning of children with Autism

Researcher: Elaine Coffey, Student Researcher, 0857868360, ecinoz@yahoo.co.uk

John Hyland, Supervisor, John.Hyland@dbs.ie

Parents Name:

_______________________________________________________________

Child’s Name: _______________________________________________________________

I confirm that I have read and understood the Information Leaflet for Parents

for the above research study and have received an explanation of the nature,

purpose and duration of the study. I understand what my child’s involvement

will be.

I have had time to consider whether I want my child to take part in this study.

Any questions have been answered satisfactorily.

I have explained this study to my child and I am happy that he/she understands

what is involved.

57

I understand that my child’s participation is voluntary (that my child and I have

a choice as to whether she/he participates) and that my child is free to

withdraw at any time if she/he chooses to do so.

I also understand that my child may be asked to participate in a follow-up

interview. I give my permission for this request to be made. I understand that

taking part in the interview is also voluntary.

I understand that quotes form my child during the sessions may be used in the

study, and I have explained this to my child and I am happy that she/he

understands.

I understand that the information collected may be presented and/or

published in academic journals and at conferences, but that no child will be

identifiable from the information.

I agree for my child to take part in the above study.

……………………………….. …………… ………………...................

Name of Parent (in block letters) Date Signature

58

Appendix 6.1

59

Appendix 6.2

60

Appendix 7.1

61

Appendix 7.2

62

Appendix 7.3

63

Appendix 7.4

64

Appendix 8:

Appendix 9:

65

Appendix 10

Observation Record Sheet

Name of participant: _______________________ Name of horse:___________

Date and Time: ____________________ Observer: _________________________

Behaviour at

commencement of

lesson

0-5 minutes

5-10 minutes

10-15 minutes

15-20 minutes

20-25 minutes

25-30 minutes

Any additional

interaction/comm

unication noticed

66

Appendix 11:

67

Appendix 12

OLD ROAD EQUESTRIAN

THERAPUTIC RIDING

CERTIFICATE OF ACHIEVEMENT

THIS CERTIFICATE IS AWARDED TO:

FOR COMPLETEING THE EQUINE ASSISTED

THERAPY PROGRAMME 2013

Emma Donoghue

Elaine Coffey

30th November 2013