Equine-Assisted Therapy in the Behavior of Individuals With Autism

Equine-assisted therapy training for individuals with autism is not a standalone method. It is part of a treatment and education program that aims to address the individual's physical, mental, emotional, and spiritual well-being as a whole. In addition to the sensory and motor benefits of being on a horse, basic sports skills practiced on horseback (such as throwing and catching a ball, ring spinning, gross motor imitation skills, hand-eye coordination, directional training, etc.) will also provide physical and physiological benefits to individuals with disabilities. Autism is defined as a neurodevelopmental disorder that develops at birth or in the early years of life, manifesting itself as a lack of social skills, repetitive behaviors, difficulties with verbal and nonverbal communication, and motor performance deficits. The problems and effects observed in individuals with autism vary according to age and developmental level. Limited motor coordination, fine and gross motor function deficits, repetitive movements, auditory and visual hypersensitivity or decreased auditory and visual sensitivity, inability to maintain postural orientation, inability to plan movement, and inability to integrate sensory stimuli are observed in individuals of different ages and developmental levels. At the same time, sensory and perceptual problems and different cognitive developments lead to repetitive, stereotypical, and restricted body movements. Individuals with autism spectrum disorder exhibit deficits in postural control, gait, upper and lower extremity coordination, and fine motor skills. These deficits can lead to difficulties with verbal commands and tool use.The target population for the study consisted of children diagnosed with autism spectrum disorder (ASD) according to the Diagnostic and Statistical Manual of Mental Disorders criteria. For the purpose of the study, homogeneous sampling, a purposive sampling method, was used to include individuals with similar characteristics in the sample. The homogeneous sampling method is used to identify a distinct subgroup by creating a small, similar sample.Training process and post-test phase: Before starting the training, the participating children and their parents were introduced to the therapy center and observed the therapy horses to help them adapt. The participating children received horseback riding and riding training twice a week for 30 minutes over an eight-week period. The training included body and object use skills, relationship building skills, language skills, social and self-care skills, and developing sensory skills, including mounting and dismounting a horse; sitting correctly; holding and using the reins; bustling movements on the horse, forward and backward, sideways, and reaching with the hands; naming printed pictures; reading numbers; throwing objects at targets with the right and left hands; developing dialogue with the trainer; standing up with and without stepping on the stirrups; sitting down and standing; reaching forward and backward and lying down on the horse; petting the horse with one's hands; trying to touch the horse's front legs with the right and left hands; and holding the horse's mane. At the end of the training, the parents of the participating children completed the Autism Behavior Checklist (ABC) under the researcher's supervision. The training sessions were conducted considering the age, gender, and housing status of the autistic children.Research data were collected in three stages. In the first stage, parents of autistic children were provided with detailed information about the study and administered a pre-test of the Autism Behavior Checklist Scale. The pre-test included parents rating their children's behavior before receiving the training. In the second stage, the autistic children were taught how to mount and dismount, sit correctly, hold and use the reins, move left and right and forward and backward while riding, reach forward and backward with their hands, sideways and feet, name printed pictures, read numbers, throw objects with their right and left hands to target targets, develop a dialogue with their trainer, stand up with and without stirrups, sit down and stand up, lie down and lie down on the horse, pet the horse with their hands, try to touch the horse's front legs with their right and left hands, and hold the horse's mane. The post-test included parents rating their children's behavior after receiving the training. In the third stage, children with autism who completed their equine-assisted therapy training continued their normal life and education for two weeks and were observed by their parents. In the tenth week, the Autism Behavior Checklist Scale permanence test measurements were applied to the parents under the supervision of the researcher and the research data collection process was completed.Application of Data Collection Instruments (Experimental Procedure) Participating children received 480 hours of training over an eight-week period, twice a week, for 16 sessions. Each session lasted 30 minutes. The therapy training for children with autism was conducted individually and was conducted by a psychologist, a physiotherapist, a horse trainer, and two walker personnel.

The data collection process consisted of three phases.

1. Pretest Phase: In this phase, the parents of the children included in the study were informed about the tests to be conducted and had them complete the Autism Behavior Checklist (ABC) under the supervision of the researcher and with the parents' active participation.
2. Training Process and Posttest Phase: Before the training began, the participating children and their parents were interviewed and observed therapy horses to familiarize themselves with the therapy center and to help them adapt to the center. Participating children received horseback riding and riding training twice a week, lasting 30 minutes, for an eight-week period. The training included body and object use skills, relationship building skills, language skills, social and self-care skills, and developing sensory skills, including mounting and dismounting a horse; sitting correctly; holding and using the reins; bustling movements on the horse, forward-backward, side-to-side, and reaching movements with the hands; naming printed images shown to the child; reading numbers; throwing objects to targets with the right and left hands; developing dialogue with the trainer; standing up with and without stepping on the stirrups; sitting down and standing; reaching forward and backward and lying down on the horse; petting the horse with one's hands; trying to touch the horse's front legs with the right and left hands; and holding the horse's mane. At the end of the training, the parents of the participating children completed the Autism Behavior Checklist (ABC) scale under the supervision of the researcher. The training was conducted considering the age, gender, and housing status of the autistic children. 3- Testing the permanence of the effect: Children who completed the therapy training were observed by their parents starting from the week the training ended, and after two weeks (in the 10th week), a permanence test was conducted by having the parents fill out the autism behavior checklist (ABC) scale again under the supervision of the researcher.Autism Behavior Checklist (ABC) The Autism Behavior Checklist (ABC) was developed by Krug et al. and its Turkish adaptation and validity and reliability study were conducted by Irmak et al. The ABC scale has five factors and 57 items. The scale factors include 9 items on the sensory dimension, 12 items on relationship building, 12 items on body and object use, 13 items on language skills, and 11 items on social and self-care skills. The highest possible score on this scale is 159, and the lowest is 0. In other words, high scores on the scale indicate a high prevalence of autism symptoms. The Autism Behavior Checklist, also known as the ABC, is one of the most frequently used measurement tools for screening and assessing autismThe advantage of the Autism Behavior Checklist Scale in the application process is that it is a scale that makes it possible to obtain information about autistic children from both educators and parents.

Statistical Analysis Data obtained from the Autism Behavior Checklist (ABC) scale pre-, post-, and retention test measurements were transferred to the IBMM SPSS 25 program. The normal distribution curves of the scores, skewness-kurtosis values, and the Shapiro-Wilk test values used when the group size was less than 30 were examined using histograms obtained from the scale. The data were determined to be normally distributed. The "Repeated Measures Anova" test statistic, used for repeated measurements, was applied to reveal the significance between the Autism Behavior Checklist (ABC) scale pre-test, post-test, and retention test values based on parental opinions. The sphericity assumption was implemented using the Mauchly test, and the "Sphericity Assumed" test values were taken into account. Furthermore, the "Benferroni" test statistic was used in pairwise comparisons to determine between which measurements the statistical difference occurred. The calculation (d) value developed by Cohen was used to interpret the calculated effect size. If the (d) value is less than 0.2, the effect size can be defined as weak; if the (d) value is 0.5, the effect size can be defined as medium; and if the (d) value is greater than 0.8, the effect size can be defined as strong.