The Effects of Hippotherapy on Repetitive Behaviors and Verbalization in Children with Autism Spectrum Disorder.
Communication impairments and repetitive/maladaptive behaviors (RMBs) are the hallmarks of Autism Spectrum Disorder (ASD) according to the DSM V (American Psychiatric Association, 2013). However, children with ASD often present with significant sensory processing and motor impairments such as atypical sensory preferences and poor motor coordination and balance. These comorbidities are not addressed in standard ASD interventions that mainly focus on communication and behavior. Hippotherapy, a treatment tool used by trained Occupational Therapists, Physical Therapists, and Speech Language Pathologists, addresses the core impairments of ASD while integrating treatment for the sensory processing and motor impairments as well. There are limited studies on the effects of hippotherapy for children with ASD and the effects it has on communication impairments and repetitive/maladaptive behaviors are largely still unknown.
In the present study, we evaluated the effects of an 8-week hippotherapy intervention on the repetitive/maladaptive behaviors and communication skills of school-age children with ASD.
Nine children with ASDs between 3 and 8 years of age were observed for 8 weeks with pretest and the posttest visits conducted in the first and last weeks of the study respectively. ASD diagnosis was confirmed with medical and/or school records. While majority of the children were low verbal, two children were highly verbal. Treatment, including hippotherapy, was provided 1 time/week for 45 min to 1 hour for 8 weeks. Each therapy session was videotaped and included: a play activity; warm up; pace changes; school figures; transfers; forward, backward and sideways positioning on the horse; a client-centered coordination activity astride the horse; and preparation and feeding of the horse. We coded the videos for the frequency of repetitive/maladaptive behaviors per minute, words per minute, and verbalization quality during an early, mid, and late therapy session. Repetitive/maladaptive behaviors were categorized into arm/leg stereotypies, object-related stereotypes, and negative behaviors.
The average frequency and duration of RMBs decreased significantly from early to late sessions across all children. In the early sessions, negative and inappropriate behaviors made up approximately 55% of all coded behaviors, but at the late sessions, they only made up approximately 35% of all coded behaviors. In addition to the treatment variables, we also found some decrease in the frequency of RMBs from pre-test to post-test. Lastly, there were some improvements in spontaneous and responsive verbalizations following the 8-week intervention.
We found a significant decrease in the frequency of RMBs from early to late treatment sessions and from pre-test to post-test. We also found that the percentage of negative and inappropriate behaviors decreased by about 20% from the early to late session and some improvement in verbalizations was also noted. Our findings support the growing body of literature that hippotherapy reduces repetitive/negative behaviors and may improve verbalization in children with ASD.