Effects of Equine Therapy on Individuals with Autism Spectrum Disorder: a Systematic Review

  • Sudha M. Srinivasan
  • David T. Cavagnino
  • Anjana N. BhatEmail author
Review Paper


Literature on effects of equine therapy in individuals with autism spectrum disorder (ASD) has grown in recent times. Equine therapy is an alternative multimodal intervention that involves utilizing a horse to remediate core impairments in ASD. Recent systematic reviews in this area have several limitations including inclusion of populations other than ASD, assessment of a variety of animal-assisted interventions other than equine therapy, and a failure to conduct quantitative analyses to provide accurate effect size estimates. We conducted a focused systematic review to address these limitations. Our review suggested that equine therapy has beneficial effects on behavioral and to some extent on social communication skills in ASD. The evidence for positive effects of equine therapy on perceptuo-motor, cognitive, and functional skills is currently limited.


Equine therapy Hippotherapy Therapeutic horseback riding Social communication Behavior Autism 



DC and AB’s work on this manuscript was supported by the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) grant from the Maternal & Child Health Bureau (MCHB) of the Health Resources and Service Administration (HRSA) under grant number T73MC30116 (PI: Beth Mineo and Co-I: Brian Freedman). AB’s work on this manuscript was also supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (PI: Binder-Macleod).

Compliance with Ethical Standards

Conflict of Interest

The author declare that they have no conflict of interest.


  1. Ajzenman, H. F., Standeven, J. W., & Shurtleff, T. L. (2013). Effect of hippotherapy on motor control, adaptive behaviors, and participation in children with autism spectrum disorder: a pilot study. American Journal of Occupational Therapy, 67(6), 653–663. Scholar
  2. American Hippotherapy Association. Hippotherapy as a treatment. Available at: http://www.americanhippotherapy Accessed June 16, 2017.
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.CrossRefGoogle Scholar
  4. Anderson, S., & Meints, K. (2016). Brief report: the effects of equine-assisted activities on the social functioning in children and adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(10), 3344–3352. Scholar
  5. Bass, M. M., Duchowny, C. A., & Llabre, M. M. (2009). The effect of therapeutic horseback riding on social functioning in children with autism. Journal of Autism and Developmental Disorders, 39(9), 1261–1267. Scholar
  6. Baranek, G., Parham, L., & Bodfish, J. (2005). Sensory and motor features in autism: assessment and intervention. In F. P. R. Volkmar, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (pp. 831–857). Hoboken: Wiley.Google Scholar
  7. Bedford, R., Pickles, A., & Lord, C. (2016). Early gross motor skills predict the subsequent development of language in children with autism spectrum disorder. Autism Research, 9(9), 993–1001. Scholar
  8. Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 1–11. Scholar
  9. Bhat, A., Landa, R., & Galloway, J. C. (2011). Perspectives on motor problems in infants, children, and adults with autism spectrum disorders. Physical Therapy, 91(7), 1116–1129. Scholar
  10. Bodfish, J. W., Symons, F. J., Parker, D. E., & Lewis, M. H. (2000). Varieties of repetitive behavior in autism: comparisons to mental retardation. Journal of Autism and Developmental Disorders, 30(3), 237–243. Scholar
  11. Bondy, A., & Frost, A. (2003). Communication strategies for visual learners. In O. I. Lovaas (Ed.), Teaching individuals with developmental delays: basic intervention techniques (pp. 291–304). Austin: Pro-Ed.Google Scholar
  12. Borgi, M., Loliva, D., Cerino, S., Chiarotti, F., Venerosi, A., Bramini, M., .. Cirulli, F. (2016). Effectiveness of a standardized equine-assisted therapy program for children with autism spectrum disorder. Journal of Autism and Developmental Disorders 46(1):1–9. doi:
  13. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.).Google Scholar
  14. Dawson, G., Toth, K., Abbott, R., Osterling, J., Munson, J., Estes, A., & Liaw, J. (2004). Early social attention impairments in autism: social orienting, joint attention, and attention to distress. Developmental Psychology, 40(2), 271–283. Scholar
  15. Dewey, D., Cantell, M., & Crawford, S. G. (2007). Motor and gestural performance in children with autism spectrum disorders, developmental coordination disorder, and or attention deficit hyperactivity disorder. Journal of the International Neuropsychological Society, 13, 246–256. Scholar
  16. Dziuk, M. A., Gidley Larson, J. C., Apostu, A., Mahone, E. M., Denckla, M., & Mostofsky, S. H. (2007). Dyspraxia in autism: association with motor, social, and communicative deficits. Developmental Medicine and Child Neurology, 49, 734–739. Scholar
  17. Fournier, K. A., Hass, C. J., Naik, S. K., Lodha, N., & Cauraugh, J. H. (2010). Motor coordination in autism spectrum disorders: a synthesis and meta-analysis. Journal of Autism and Developmental Disorders, 40, 1227–1240. Scholar
  18. Gabriels, R. L., Agnew, J. A., Holt, K. D., Shoffner, A., Zhaoxing, P., Ruzzano, S., et al. (2012). Pilot study measuring the effects of therapeutic horseback riding on school-age children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 6(2), 578–588.CrossRefGoogle Scholar
  19. Gabriels, R. L., Pan, Z., Dechant, B., Agnew, J. A., Brim, N., & Mesibov, G. (2015). Randomized controlled trial of therapeutic horseback riding in children and adolescents with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54(7), 541–549. Scholar
  20. Garcia-Gomez, A., Risco, M. L., Rubio, J. C., & Garcia-Pena, I. M. (2014). Effects of a program of adaptive therapeutic horse-riding in a group of ASD children. Electronic Journal of Research in Educational Psychology, 12(1), 107–128.Google Scholar
  21. Green, D., Charman, T., Pickles, A., Chandler, S., Loucas, T., Simonoff, E., & Baird, G. (2009). Impairment in movement skills of children with autistic spectrum disorders. Developmental Medicine and Child Neurology, 51(4), 311–316. Scholar
  22. Greenspan, S. I., & Wieder, S. (1997). Developmental patterns and outcomes in infants and children with disorders in relating and communicating: A chart review of 200 cases of children with autistic spectrum diagnoses. Journal of Developmental and Learning Disorders, 1, 87–142.Google Scholar
  23. Hallett, M., Lebiedowska, M. K., Thomas, S. L., Stanhope, S. J., Denckla, M. B., & Rumsey, J. (1993). Locomotion of autistic adults. Archives of Neurology, 50(12), 1304–1308.CrossRefPubMedGoogle Scholar
  24. Hedges, L. V. (1981). Distribution theory for Glass’s estimator of effect size and related estimators. Journal of Educational Statistics, 6(2), 107–128.CrossRefGoogle Scholar
  25. Huedo-Medina, T. B., & Johnson, B. T. (2011). Estimating the standardized mean difference effect size and its variance from different data sources: a spreadsheet. Storrs: Authors.Google Scholar
  26. Jansiewicz, E. M., Goldberg, M. C., Newschaffer, C. J., Denckla, M. B., Landa, R., & Mostofsky, S. H. (2006). Motor signs distinguish children with high functioning autism and Asperger’s syndrome from controls. Journal of Autism and Developmental Disorders, 36(5), 613–621. Scholar
  27. Jenkins, S. R., & Reed, F. D. D. (2013). An experimental analysis of the effects of therapeutic horseback riding on the behavior of children with autism. Research in Autism Spectrum Disorders, 7(6), 721–740.CrossRefGoogle Scholar
  28. Kasari, C., Paparella, T., Freeman, S., & Jahromi, L. B. (2008). Language outcome in autism: randomized comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology, 76(1), 125–137. Scholar
  29. Kern, J. K., Fletcher, C. R., Garver, C. R., Mehta, J. A., Grannemann, B. D., Knox, K. R., & Trivedi, M. H. (2011). Prospective trial of equine-assisted activities in autism spectrum disorder. Alternative Therapies, 17(3), 14–20 http://www.ncbi. Scholar
  30. Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism: Communication, social, and academic development. Baltimore, MD: Paul H Brookes Publishing.Google Scholar
  31. Landa, R. J., Holman, K. C., O’neill, A. H., & Stuart, E. A. (2011). Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 52(1), 13–21.CrossRefPubMedGoogle Scholar
  32. Lanning, B. A., Baier, M. E., Ivey-Hatz, J., Krenek, N., & Tubbs, J. D. (2014). Effects of equine assisted activities on autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(8), 1897–1907. Scholar
  33. Llambias, C., Magill-Evans, J., Smith, V., & Warren, S. (2016). Equine-assisted occupational therapy: increasing engagement for children with autism spectrum disorder. American Journal of Occupational Therapy, 70(6), 7006220040p1–7006220040p9. Scholar
  34. Leary, M. R., & Hill, D. A. (1996). Moving on: autism and movement disturbance. Mental Retardation, 34, 39–53.PubMedGoogle Scholar
  35. Lecavalier, L. (2006). Behavioral and emotional problems in young people with pervasive developmental disorders: relative prevalence, effects of subject characteristics, and empirical classification. Journal of Autism and Developmental Disorders, (8), 1101–1114.
  36. Lentini, J. A., & Knox, M. S. (2015). Equine-facilitated psychotherapy with children and adolescents: an update and literature review. Journal of Creativity in Mental Health, 10, 278–305. Scholar
  37. Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks: Sage Publications.Google Scholar
  38. Loh, A., Soman, T., Brian, J., Bryson, S. E., Roberts, W., Szatmari, P., Smith, I. M., & Zwaigenbaum, L. (2007). Stereotyped motor behaviors associated with autism in high-risk infants: a pilot videotape analysis of a sibling sample. Journal of Autism and Developmental Disorders, 37(1), 25–36. Scholar
  39. Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3–9.CrossRefPubMedGoogle Scholar
  40. MacDonald, M., Lord, C., & Ulrich, D. A. (2014). Motor skills and calibrated autism severity in young children with autism spectrum disorder. Adapted Physical Activity Quarterly, 31(2), 95–105. Scholar
  41. McDaniel, P., & Wood, W. (2017). Autism and equine-assisted interventions: a systematic mapping review. Journal of Autism and Developmental Disorders, 47(10), 3220–3242. Scholar
  42. Moseley, A. M., Herbert, R. D., Sherrington, C., & Maher, C. G. (2002). Evidence for physiotherapy practice: a survey of the Physiotehrapy Evidence Database (PEDro). The Australian Journal of Physiotherapy, 48, 43–49.CrossRefPubMedGoogle Scholar
  43. Mazefsky, C. A., Pelphrey, K. A., & Dahl, R. E. (2012). The need for a broader approach to emotion regulation research in autism. Child Development Perspectives, 6, 92–97. Scholar
  44. Mesibov, G. B., Shea, V., & Schopler, E. (2005). The TEACCH approach to autism spectrum disorders. Springer Science & Business Media.Google Scholar
  45. Minshew, N. J., Sung, K. B., Jones, B. L., & Furman, J. M. (2004). Underdevelopment of the postural control system in autism. Neurology, 63(11), 2056–2061. Scholar
  46. Mostofsky, S. H., Dubey, P., Jerath, V. K., Jansiewicz, E. M., Goldberg, M. C., & Denckla, M. B. (2006). Developmental dyspraxia is not limited to imitation in children with autism spectrum disorders. Journal of the International Neuropsychological Society, 12(3), 314–326. Scholar
  47. Mundy, P., & Newell, L. (2007). Attention, joint attention, and social cognition. Current Directions in Psychological Science, 16, 269–274. Scholar
  48. O’Haire, M. E. (2013). Animal-assisted intervention for autism spectrum disorder: a systematic literature review. Journal of Autism and Developmental Disorders, 43(7), 1606–1622. Scholar
  49. O’Haire, M. E. (2017). Research on animal-assisted intervention and autism spectrum disorder, 2012–2015. Applied Developmental Science, 21(3), 200–216.CrossRefGoogle Scholar
  50. Ozonoff, S., Pennington, B. F., & Rogers, S. J. (2006). Executive function deficits in high-functioning autistic individuals: relationship to theory of mind. Journal of Child Psychology and Psychiatry, 32(7), 1081–1105. Scholar
  51. PATH International. PATH International home page. 2011. Available at: 2017. Accessed June 16, 2017.
  52. Prizant, B. M. (2006). The SCERTS model: A comprehensive educational approach for children with autism Spectrum disorders volume II Program Planning & Intervention. Baltimore: Paul H. Brookes Publishing Company.Google Scholar
  53. Rogers, S. J., & Dawson, G. (2009). Play and engagement in early autism: The early start Denver model. New York: Guilford.Google Scholar
  54. Sackett, D., Rosenberg, J., Muir, G., Haynes, B., & Richardson, W. (1996). Evidence based medicine: what it is and what it isn’t. British Medical Journal, 312, 71–72. Scholar
  55. Srinivasan, S., Kaur, M., Park, I., Gifford, T., Marsh, K., & Bhat, A. (2015). The effects of rhythm and robotic interventions on the imitation/praxis, interpersonal synchrony, and motor performance of children with autism spectrum disorder (ASD): a pilot randomized controlled trial. Autism Research and Treatment, 2015, 736516, 18 pages. Scholar
  56. Steiner, H., & Kertesz, Z. (2015). Effects of therapeutic horse riding on gait cycle parameters and some aspects of behavior of children with autism. Acta Physiologica Hungarica, 102(3), 324–335. Scholar
  57. Sullivan, G. M., & Feinn, R. (2012). Using effect size—Or why the P value is not enough. Journal of Graduate Medical Education, 4(3), 279–282.CrossRefPubMedPubMedCentralGoogle Scholar
  58. Tabares, C., Vicente, F., Sanchez, S., Aparicioc, S., Alejoc, S., & Cuberob, J. (2012). Quantification of hormonal changes by effects of hippotherapy in the autistic population. Clinical Neurochemistry Neurochemical Journal, 6(4), 311–316.CrossRefGoogle Scholar
  59. Tager-Flusberg, H. (1999). A psychological approach to understanding the social and language impairments in autism. International Review of Psychiatry, 11(4), 325–334.CrossRefPubMedPubMedCentralGoogle Scholar
  60. Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: a comparative study using the short sensory profile. The American Journal of Occupational Therapy, 61(2), 190–200.CrossRefPubMedGoogle Scholar
  61. Vilensky, J. A., Damasio, A. R., & Maurer, R. G. (1981). Gait disturbances in patients with autistic behavior: a preliminary study. Archives of Neurology, 38(10), 646–649.CrossRefPubMedGoogle Scholar
  62. Ward, S. C., Whalon, K., Rusnak, K., Wendell, K., & Paschall, N. (2013). The association between therapeutic horseback riding and the social communication and sensory reactions of children with autism. Journal of Autism and Developmental Disorders, 43(9), 2190–2198. Scholar
  63. Weise, C., Simpson, R., & Kumar, S. (2016). The effectiveness of equine-based therapy in the treatment of social and behavioural aspects of children with autism Spectrum disorder: a systematic review. Internet Journal of Allied Health Sciences and Practice, 14(3), 12.Google Scholar
  64. Wieder, S., & Greenspan, S. I. (2003). Climbing the symbolic ladder in the DIR model through floor time/interactive play. Autism, 7(4), 425–435.CrossRefPubMedGoogle Scholar
  65. Williams, D. L., Goldstein, G., & Minshew, N. J. (2006). The profile of memory function in children with autism. Neuropsychology, 20(1), 21–29.CrossRefPubMedPubMedCentralGoogle Scholar
  66. Wuang, Y. P., Wang, C. C., Huang, M. H., & Su, C. Y. (2010). The effectiveness of simulated developmental horse-riding program in children with autism. Adapted Physical Activity Quarterly, 27(2), 113–126.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sudha M. Srinivasan
    • 1
  • David T. Cavagnino
    • 2
  • Anjana N. Bhat
    • 2
    • 3
    Email author
  1. 1.IDC School of DesignIndian Institute of Technology BombayMumbaiIndia
  2. 2.Department of Physical TherapyUniversity of DelawareNewarkUSA
  3. 3.Department of Psychological & Brain SciencesUniversity of DelawareNewarkUSA

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