Effectiveness of a 6-week Hippotherapy Program in Children With Autism Spectrum Disorder

Study Overview
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Brief Summary
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The prevalence of autism spectrum disorders (ASD) has increased dramatically in the last decade. The increasing occurrence of ASD creates an imperative need to test the effectiveness and efficacy mechanisms of appropriate interventions. Hippotherapy (HPOT) is a treatment option that has been show beneficial for children with ASD as well as other children with developmental disorders. The current projects focuses on understanding the mechanisms of HPOT efficacy and evaluating a short-term HPOT program for children with ASD.

Detailed Description
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The incidence of autism spectrum disorders (ASD) has increased dramatically in the last decade. The latest report from the Centers for Disease Control and Prevention state that 1 in 59 children are being diagnosed with ASD and it is four times more prevalent in boys than girls. Common treatments for children with ASD are applied behavioral therapy, occupational and speech therapy, which are used solely or in combination. Hippotherapy (HPOT) is another treatment option that has been shown to positively impact various aspects of behavior. This pilot project aims to determine the effects of a 6-week HPOT program on movement and social behavior of children with ASD and to investigate the underlying mechanisms of why HPOT is successful for ASD through the coupling of physiological and temperamental responses between horse and rider. The approach involves examining these skills pre, during, and post HPOT intervention in children diagnosed with ASD. A group of aged matched children with typical development will serve as the control group. Innovative measures of physiological coupling and temperament between horse and rider as well as objective and quantitative measures of movement and social behavior and caregiver perception will be collected. The investigators anticipate that following completion of the proposed study, they will provide the necessary foundation to understand the mechanisms of HPOT, and thus provide a new framework to test clinical trials of HPOT and human-animal interaction, and ultimately improve the lives of those diagnosed with ASD and their families.

Official Title
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Effectiveness of a 6-week Hippotherapy Program in Children With Autism Spectrum Disorder

Conditions
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Autism Spectrum Disorder

Intervention / Treatment
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* Behavioral: Hippotherapy


Participation Criteria
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Eligibility Criteria
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For the children with Autism Spectrum Disorders: Inclusion Criteria: diagnosis of ASD based upon the Autism Diagnostic Observation Schedule and parent interview, medical approval for participation in the HPOT activity, no other medical or psychiatric diagnoses besides ASD tolerate helmet on head and attachments of the movement and heart rate sensors. The inclusion criteria for the TD children will be: no diagnosis or family history of ASD no other neurodevelopmental or musculoskeletal disorder tolerate helmet on head and attachments of the movement and heart rate sensors. medical approval for participation in the HPOT activity, Exclusion Criteria: under 5 years of age or over 10 years of age has a serious comorbid medical diagnosis major vision or hearing impairments severe behavioral problems an orthopedic or genetic diagnosis

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hippotherapy<br>Both children with autism spectrum disorder and with typical development will receive a 6 week (once per week) hippotherapy protocol. During the hippotherapy session, the researchers will monitor the heart rate variability of the horse and the rider. Both horse and rider will wear an electrode strap around the upper thorax. Heart rate recordings will be started simultaneously at the beginning of the HPOT session. To assess movement coupling between the horse and rider, five tri-axial inertial sensors (OPAL, APDM, Inc, Portland, OR) will be used. The sensors will collect actively synchronized tri-axial accelerometer and gyroscope data. One inertial sensor will be placed dorsal at the rider's pelvis, one frontal at the top of the forehead, and one frontal at the top of the sternum. The sensors on the horse will be fixed on the back of the horse on the spine level between T8 and T10 and on the head. | Behavioral: Hippotherapy<br>* The hippotherapy involves occupational therapy while being on a horse.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Social Responsiveness Scale (SRS) | The SRS provides a clear picture of a child's social impairments, assessing social awareness, social information processing, capacity for reciprocal social communication, social anxiety/avoidance, and autistic preoccupations and traits. | Change from baseline to 6 weeks | 
| Postural control, center of pressure measures (range, root mean square, sway path, sample entropy) | Postural control assessment with a force platform with eyes open and eyes closed | Change from baseline to 6 weeks after the hippotherarpy | 
| Coherence and Cross Sample Entropy between the movement sensors and heart rate sensors of the horse and rider | We will use the movement sensors and heart rate sensors to estimate the coupling between the horse and the rider. | During week 1, week 3 and week 6 of the treatment sessions | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between horse temperament and therapeutic outcomes | Correlation estimate between horse temperament and treatment effectiveness | from baseline to 6 weeks | 
| Aberrant Behavior Checklist | This is a questionnaire completed by the caregivers that assesses irritability, social withdrawal, stereotypic behavior, hyperactive/noncompliance, inappropriate speech | Change from baseline to 6 weeks |