Impact of Equine Therapy on Emotional Awareness in Autistic Children
Introduction
Autism spectrum disorder is a neurodevelopmental disorder with considerable genetic and biological etiology. Different physical factors that impede the development of brain systems, and thus the affected child or adult is unable to perform everyday functions (Bhat, Landa & Galloway 2011, pp.1116-1129). Other problems that affect people with autism include meltdowns and mood instability, and sleep difficulties. People with autism also have problems discerning what others feel or think. They also cannot correctly interpret social cues, body language, and facial expressions (Baranek, Parham & Bodfish 2005, pp.831-857). In addition, autism affects learning because it impedes language development and causes speech delays.
Children with autism also suffer from inappropriate social interaction, monotonous or flat speech, delay in learning to speak, deficits in language comprehension, and behavioral disturbances (Fournier et al.2010, pp.1227-1240). Other autism spectrum disorder signs and symptoms include poor eye contact, avoidance of eye contact, abnormal tone of voice, and abnormal facial expressions, or body posturing. A child diagnosed with autism spectrum disorder may also show early signs such as lack of communication and speech, lack of response to verbal commands, abnormal aggressive behavior and biting, a tendency to scream or be fussy in public places, repetitive banging of the head, and hand-flapping (Achenbach & Edelbrock 1991, pp. 371-392). Moreover, regarding red flags related to social communication issues in autism spectrum disorder, a child who does not demonstrate or understand nonverbal communication lacks play with others or from relationships, lacks interest in his or her environment, and shows repetitive movements.
The treatments for autism spectrum disorder include occupational therapy, nutritional therapy, medication treatment, and joint attention therapy (Dawson et al. 2004, pp.271). Other existing spectrum disorders include school-based and educational therapies, early intervention, cognitive behavior therapy, and behavioral management therapy (Ben-Sasson et al.2009, pp.1-11). However, there is currently no standard therapy available to treat autism spectrum disorder. There are, nonetheless, multiple methods of maximizing the abilities and minimizing the symptoms. The most effective interventions and therapies are usually different for each individual. Also, children with autism spectrum disorder improve most in response to highly specialized and structured and specialized programs. In some instances, the health outcome can be so positive that the child can function at near-normal levels.
Additionally, equine therapy, also called equine-assisted psychotherapy, equine-assisted therapy, and horse therapy involves getting patients to have experience with horses (AHA,2017). This form of experimental therapy includes walking a horse, haltering horses, feeding a horse, and even grooming horses. Also, equine therapy involves the cooperation of a horse professional and a mental health practitioner. The equine therapist takes note of the behavioral processes and patterns that the patient shows during their interaction with horses. The patients, in their interactions with horses, are also expected to learn how to process emotions and thoughts, and as the therapy goes on, the therapist also observes how the patients form their thought and express their emotions (AHA,2017). Taking care of horses requires the building of trust, and learning to calm it, requires social skills such as interpreting emotion and social cues. The child, thus, learns how to approach the animal, and in extension, other humans, and form positive relationships with them (Anderson & Meints 2016). The horse can also assist the child to overcome motor and sensory deficits because its movement relaxes and stretches the muscles of the child.
In addition, the child gains the capacity to improve posture and gain body strength and muscle tone. This kind of therapy aims to assist patients to develop needed attributes and skills, such as self-control, problem-solving skills, self-confidence, responsibility, and accountability. Also, this type of therapy provides a platform on which the patient and the therapist can isolate and deal with a variety of behavioral and emotional issues. The benefits of equine therapy include substantial improvements in interpersonal relationships, social responsibility, self-regard, independence, self-actualization, and problem-solving skills. Other areas in which equine therapy yields marked improvement include impulse control, flexibility, stress tolerance, empathy, emotional awareness, and assertiveness behaviors (Mazefsky, Pelphrey & Dahl 2012, pp.92-97). Furthermore, it is crucial to consider that horses have a unique personality that is significantly useful to children with an autism spectrum disorder.
For instance, horses show the ability to effectively mirror the behaviors and attitudes of the individuals with whom they are working. Horses also lack preconceived motives or expectations and more importantly, are non-judgmental. Also, patients under equine therapy have an effective and unique opportunity to observe their propensity to participate in negative actions and thoughts, or self-defeating behavior. Therefore, equine therapy is considered crucial for the development of emotional awareness in children. This study seeks to establish whether equine therapy increases emotional awareness in autistic children.
Literature Review
Moreover, a study by Ajzenman, Standeven, and Shurtleff (2013) found that children with autism spectrum disorder demonstrated improvements in daily activity participation, coping, receptive communication, and postural stability after being exposed to equine therapy for 45-minute sessions in 12 weeks. The increase in emotional awareness in the participants played a crucial role in enhancing the interpersonal skills, written communication skills, and expressive communication skills seen in the participants. Furthermore, according to Cumella and Simpson (2007), equine therapy carries many psychotherapeutic benefits including an increase in confidence as a result of being able to handle a horse, self-efficacy resulting from the capacity to learn to communicate with a horse and achieve harmony with a horse, and increased concept of self resulting from the awareness of their size in relation the horse.
The authors also found that recipients of equine therapy demonstrated greater spiritual growth, creative freedom, improved capacity to create boundaries with people who included abusers, and increased assertiveness. In addition, the study found that recipients of equine therapy showed improved impulse modulation, self-acceptance, decreasing isolation, and reduced anxiety problems. Additionally, a study by Earles, Vernon, and Yetz (2015) on the impact of equine therapy on a sample of sixteen people who had experienced traumatic events such as car accidents or rape, and who were positively diagnosed with PTSD, found that equine therapy could lead to effective recovery for patients with symptoms of anxiety and PTSD. Another study that supports the role of equine therapy in enhancing the emotional awareness of children with autism spectrum disorder involved the observation of three horsemen and four recipients of equine therapy.
The study intended to find out whether the horse would provoke emotional awareness in the humans interacting with it considering that horses can read their own emotions. Thus, the authors found that equine therapy improved the capacity of the participants to have a relationship built on respect, trust, and empathy (Bass, Duchowny & Llabre 2009, pp. 1261-1267). Concerning, the age group that could best benefit from equine therapy, Kern et al. (2011) demonstrated that early equine interventions, including those done before school or during preschool, are more likely to have substantial positive impacts on later skills and symptoms. Moreover, because there arise overlaps in symptoms between other disorders and autism spectrum disorder, such as attention deficit hyperactivity disorder, it is crucial that therapy focuses on an individual’s needs, and not the labels they are diagnosed by.
Thus, therapies like speech-language therapy, physical therapy, nutritional therapy, educational and school-based therapies, and cognitive behavior therapy target specific deficits experienced in autism spectrum disorder. Ward et al. (2013, pp.2190-2198) also found that equine therapy is effective in improving the ability if autistic children to interpret both verbal and non-verbal cues and to attach emotional meaning to the information they interpret. In addition, a comprehensive literature review by Mapes and Rosén (2016, pp.377-386) found that equine therapy was highly effective in improving self-regulation, adaptive skills, sensory sensitivity, and social functioning among children with an autism spectrum disorder. Borgi et al. (2016, pp. 1-9) also found that horse therapy may have multiple benefits concerning the ability to control emotions and avoid aberrant behavior among children with autism spectrum disorder.
Also, according to a study done by Srinivasan, Cavagnino, and Bhat (2018, pp.156-175), equine therapy when applied even in the short-term has substantial benefits regarding behavioral skills in autism spectrum disorder. The authors’ literature review used 15 articles to evaluate the effect of equine therapies on a variety of distinct outcomes in adolescents and children with autism spectrum disorder. The authors found that even though there was substantial variability between research papers concerning assessment and outcome tools, intervention characteristics, sample characteristics, as well as the direction and magnitude of the impacts of treatment reported for various types of outcomes, there is adequate evidence that equine therapy enhances perceptuo-motor and social communication in people with autism spectrum disorder. The study used both quantitative and qualitative analyses to investigate whether equine therapy has positive impacts of equine therapy on functional skills, cognitive, and perceptuo-motor.
Their review used studies that were searched from five databases related to fi9elds of education, allied health, psychology, and health. The terms “autism” and “equine therapy” were used to include research papers for the study. 294 participants out of the 428 included in the study had been subjected to equine therapy while the remaining participants had been subjected to a form of control intervention. However, the articles used in the study did not follow the long-term benefits of equine experiences of patients with autism spectrum disorders. Also, even though the study found that there was evidence that equine experiences can impact multiple subsystems. Nonetheless, the study did not focus on emotional awareness in children but multiple skills.
Another study that looked into the longevity of the positive impacts of equine experiences on the sensory reactions of children and their social communication found that the therapy decreased the severity of symptoms related to autism spectrum disorder, improved their sensory processing and increased their social interaction (Tsantefski, et al 2017, pp.1247-1256). Even though the study found that there were substantial benefits to be gained from equine therapy on children, it also found that the improvements in sensory processing and social communication were not sustained continuously after two breaks that lasted six weeks each. Instead, the gains would depreciate and only be recovered after equine therapy was reinstated.
Moreover, according to a more focused study by Tabares et al. (2012, pp.311-316), equine experiences when availed to children with autism spectrum disorder generate improved social attitudes and substantial regulation of the hormones involved in the social behavior of children with the disorder. The study focused on hormonal interactions and causes the emotion of children with an autism spectrum disorder. The authors used non-invasive methods that included testing salivary samples of progesterone and cortisol. The study involved testing the balance between progesterone and cortisol before and after equine therapy and found that the levels of these hormones reduced significantly after equine therapy. This study thus relieved that equine therapy has a hormonal component in the way that it leads to improvements in the emotional awareness in children.
In addition, according to a study by Wiese, Simpson, and Kumar (2016, pp.12) on the effectiveness of equine experiences in the treatment of behavioral and social aspects of children with autism spectrum disorder focused on a study sample aged between 4 and 16 years. The authors reviewed the impact of the therapy using eight research papers of different research methodological quality and research designs that met the inclusion criteria for the study. A critical appraisal was applied to evaluate methodological quality. Also, the authors used a study sample that only included children with autism spectrum disorder that was diagnosed by a professional. They found that these studies contained evidence that equine therapy has the potential to significantly improve the social interactions and behaviors of autistic children. However, the authors also determined that the existing literature on the matter is limited by a lack of standardized outcome measures, crude sampling methods, lack of comparator, and small sample sizes.
Also, the authors discovered that parents of children with autism spectrum disorder who participated in the equine experiences, after a parent report and survey, found that the vast majority of parents were pleased with the program and the improvement observed in their children. Children who participated in the equine therapy reported that they generally were happy with the use of horses and were satisfied with the experience. Therefore, this study found that the personal views of the participants are essential in establishing the benefits of equine therapy on autistic symptoms.
Furthermore, according to Wuang et al. (2010, pp.113-126), the therapeutic impact of equine experiences, if applied for an average of twenty weeks, can be sustained for a minimum of 6 months. The study also found that simulated developmental horse-riding in children with autism carries immense benefits concerning sensory integration functions and enhanced motor proficiency. The research conducted by the authors focused on the establishment of the impact of a twenty-week simulated developmental horse-riding program by applying a creative exercise tool on the sensory integrative functions and motor proficiency on a sample of sixty children. The study sample was divided into two groups-one that consisted of 30 children who received equine therapy for twenty weeks, and the second group that was only subjected to occupational therapy. Thereafter, the arrangement was reversed in the second phase of the study such that the group that received equine therapy in the first phase was limited to occupational therapy in the second phase. Consistent with assumptions about equine therapy, the recipients of equine therapy showed substantial improvements in their interaction with their environment, response to voice, and motor skills. However, the study did not specifically focus on improvements in emotional awareness.
Additionally, a systematic mapping review by Peter and Woods (2017, pp.3220-3242) focused on identifying existing knowledge of equine-assisted interventions for people with autism to assist in guiding future research and practice. The study by the authors reviewed thirty-three research papers that involved a study sample of adolescents and children with autism-three of these studies had diagnoses that were approved by professionals before the study. Also, five kinds of equine-assisted activities were identified across more than 20 studies, with recorded improvements in communication, social interaction, and behavior. The study also identified four kinds of equine-assisted therapies, with substantial enhancements in self-care and motor control. Using its review of various approaches to hippotherapy and therapeutic riding, this study provided extensive evidence that interventions can offer immense gains to children with autism spectrum disorder. The study thus supported the idea that the benefits accrued from equine therapy are not only many but effective. Thus, the authors concluded that there is a need for increased efficacy, appropriateness, and standardization because of the promising results from equine therapy.
Similarly, Lentini and Knox (2015, pp. 278-305) suggested in their study on the equine-facilitated psychotherapy with adolescents and children that existing literature on the usefulness of equine experiences is limited by the substantial difficulty in translating it into effective treatment recommendations and guidelines for patients. The study acknowledged that the difficulty in applying existing knowledge related to the positive effects of equine therapy had their origin in the diversity in the types of publications, samples, and methods. Also, the study focused on a study sample of children and youth who had confirmed diagnoses of autism spectrum disorder, thus increasing its credibility.
However, despite existing doubts on the appropriateness and indication of equine-based therapies, some studies have provided adequate information on the impact of equine experiences on the emotional stability of children with autism spectrum disorder. For instance, a study by Lanning et al. (2014, pp.1897-1907) examined the impact of equine experiences on children with autism spectrum disorders. The study sample used in the study was divided into two groups-one that received equine interventions and another that receive interventions that were not equine-based. Parents reported that were major improvements in their children’s social, emotional, and physical functioning following the first six weeks of equine-assisted activities. Of significant importance, the group that received non-equine interventions showed improvement at a lower level, suggesting that equine therapy has a significant impact on the health outcomes with children with autism spectrum disorder.
Furthermore, a study by Jenkins and Reed (2013, pp.721-740) demonstrated that the benefits of equine therapy go beyond improvements in emotional awareness-the therapy has been reported by multiple studies to have multiple benefits regarding signs and symptoms of autism spectrum disorder. The fact that children who undergo equine experiences also report enjoyment and increased satisfaction demonstrates that equine therapy is a form of therapy that could draw both the interest and willing participation of both parents and children. These factors alone can enhance the health outcomes of children with autism because they encourage compliance.
Research Aim and objectives:
This research aims to establish whether equine therapy increases emotional awareness in autistic children aged between 6 and 12 years old.
Therefore, the objectives of this study include:
- To establish the impact of equine therapy on emotional awareness in autistic children.
- To establish the impact of equine therapy on anxiety in autistic children.
- To establish the impact of equine therapy on the concept of self in autistic children.
- To establish the impact of equine therapy on the emotional quotient in autistic children.
The research questions include:
- Does equine therapy increase emotional awareness in autistic children?
- Does equine therapy decrease anxiety in autistic children?
- Does equine therapy improve the concept of self in autistic children?
- Does equine therapy increase the emotional quotient of autistic children?
Methodology:
Design: The study will be quantitative. A closed-ended questionnaire will be used to collect quantitative data from participants.
Participants: The study will involve 70 children between ages 6 and 12. Half the children will be subjected to equine therapy for 50-minute sessions in 11 weeks. The other half will then be subjected to non-equine interventions for the same period. Before the beginning of the study and at the end of the study, both the control group and the test group will be assessed for emotional awareness.
Data Collection Methods: To assess emotional awareness in autistic children, the study will use a close-ended questionnaire that will be filled by both parents and children. The questionnaire will score the children’s emotional awareness using variables such as their ability to interpret their own emotions, the ability to interpret the emotions of the horse, their ability to express emotions, and their ability to read human emotions as expressed by their parents.
Analysis: The data will be processed using the SPSS (Statistical Package for the Social Sciences). The Pearson r was used to compute the research’s inferential statistics.
Ethical Considerations: A consent form will be availed to parents so that they approve of the participation of their children in the study. Parents who will opt out of the study will be allowed to abandon the study at any point. Also, before engaging in the study, parents will be informed of the principles and methods used in equine therapy.
Contribution to knowledge: There is limited literature on the impacts of equine therapy on emotional awareness. Most studies focus on motor, sensory and speech skills in autistic children. This study will provide information on the aspects of emotional awareness that could be improved among autistic children through equine therapy.
References
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