Equine-assisted therapy on autistic people is an autism therapy that uses a mediating horse or pony. A session can take place on foot or on horseback. Equine-assisted therapy is one of the few animal-assisted therapies regularly studied for its effectiveness, and the most popular of all autism therapies.
Equine-assisted therapy was popularized by the 2009 book and film The Horse Boy, which documents the progress of author Rupert Isaacson's autistic son during a trip to Mongolia. Previously, the effects of contact with horses on autistic people was limited to testimonials, such as that of Temple Grandin in her 1996 autobiography Emergence: Labeled Autistic. Since 2005, various studies have examined the effectiveness of this therapy, which was upgraded from "controversial" to "promising" status in 2007.
Equine-assisted therapy offers clinically significant reductions in disability in the areas of communication, perception, attention and emotional regulation. It increases volition, reduces hyperactivity and improves sensory integration in autistic people. In 2016, the scientific community agreed that it was the most effective animal-assisted therapy available to autistic people. However, it is only targeted to specific needs and does not benefit all autistic people. Furthermore, the sessions are relatively expensive, and require considerable human resources.
Definition
The horse is the pioneering animal in animal-assisted therapy, and by far the most widely used in this type of therapy. At the same time, equine-assisted therapy is the most popular animal-assisted therapy for autism.
This therapy is described and conceived as a form of care, and not as a leisure activity or horseback-riding lessons adapted to autistic people. Its aim is to provide therapeutic assistance. The horse becomes a mediator between the autistic person and the therapist. Ideally, an equine-assisted therapy session should be led by one or more trained therapists, with both solid equestrian skills and experience in supporting disabled people.
Therapeutic areas concerned Equine-assisted therapy acts on the neuromuscular, relational, perceptive, attentional and emotional levels. The horse stimulates various areas: communication (laughter, speech, etc.), relationships with others, motor behavior, attention, action planning, body awareness, self-confidence, relaxation, emotional regulation and sharing of emotions. The relationship with the horse is highly "sensorial", charged with scents, contact and a variety of sensations, making the equine-assisted therapy session a multi-sensory experience. The kinesthetic stimulation offered by the horse is unique among the animal therapies available to autistic people, since the horse (or pony) is the only mediating animal that can offer it.
Relationship between horses and autistic people
French equine expert Isabelle Claude believes that the behavior of autistic people is close in some respects to that of the horse, notably in terms of sensory perception, tactile sensitivity, olfactory need and attention to details and micro-signals. She adds that, like the horse, the autistic person is accustomed to expressing their emotional states, particularly their anger. The ASBL Anthe-Anthesis (Belgian national association for therapy with horses) also likens the perception of autistic people to that of horses, in that both are situated in "the world of feeling".
Grandin, an autistic American university professor, likens the behavior of an autistic child to that of a wild horse in the process of being tamed: the reaction to touch and the way in which they are approached are, in her view, very similar. Furthermore, in her book Animals in Translation, she compares the mode of consciousness and thought of animals to that of a so-called "learned" autistic person, asserting that spoken language is not necessary for thought, and that horses, among other animals, use a visual thinking similar to that of certain autistic people.
In her psychology thesis (Université Rennes-II, 2010), Marine Grandgeorge notes that autistic children are generally more spontaneously interested in images of animals, including horses, than in images of objects.
History Since the end of the 20th century, there have been consistent but isolated accounts of the benefits that autistic people derive from contact with horses. Grandin testifies to having spent a great deal of time observing horses and cows since childhood. She started riding in the 1960s, realizing that these large animals are often mistreated out of ignorance. Riding and contact with horses calmed her anxieties and hyperactivity, and she testifies that galloping calms her. In France, several therapists work with autistic children using horses or ponies as mediators, including Claude since the 1980s in Lorraine, Claudine Pelletier-Milet at her riding hall in La Chapelle-Montligeon since 1999, and Isabelle Chaveneau in Sevrey. In 1989, D. Athy described the case of a horse that had been retired from racing and taken in by a home for autistic children. By caring for and riding the animal, the children's symptoms diminished. At the same time, the horse regained its performance and began racing again, its winnings being used to finance the center, in particular the purchase of other therapy horses for autistic children.
American Hana May Brown published a testimonial about a non-speaking autistic child at her therapeutic riding center in Houston, who began to speak and made such progress that schooling became possible. Concordant testimonials led her to officially present horseback riding as a valid therapeutic option for autistic children in 1994. In 1995–1996, Charlotte Daubrée observed five autistic children as part of her veterinary doctorate thesis in Clermont-Ferrand. This work enabled her to observe real progress, but the numbers involved were far too small to draw any conclusions.
Impact of The Horse Boy In 2009, the autobiographical book and documentary The Horse Boy were released by British journalist Rupert Isaacson. In it, he described how contact with a neighbor's horse resulted in significant benefits to his autistic son, Rowan. This led him and his wife Kristin Neff to take Rowan on a trip to Mongolia, in hopes of further improvement. During the trip, they were able to establish communication with Rowan, who had been nonverbal, through horses, travel and shamanism. Since then, he has said, Rowan no longer "suffers from the dysfunctions associated with his disorder". As of 2022, Rowan is functional and living independently.
It is a "convincing plea for equine-assisted therapy", and motivates parents to try this therapy. Isaacson does not use the word "cure," but speaks of recovery and healing. Press coverage of the book and film raised the question of whether the company of a horse could help all autistic children. Since then, Isaacson has developed a method of helping autistic children through contact with horses, in Texas."Several children have made capital progress during their passage, some even pronouncing their first words on horseback, to the amazement of their parents."Contemporaneously commenting on The Horse Boy, pediatrician Paul A. Offit warned of the lack of studies on the effectiveness of contact with horses, and the temptation to spend large sums on ineffective, poorly supervised therapies.
First scientific evaluations In 2005, there was no scientific literature on this therapy, which meant that the scientific community was unable to comment on its effectiveness. In 2008, pediatrician Lisa A. Kurtz listed equine-assisted therapy as one of the "controversial" therapies, noting that some publications supported its efficacy as a complementary therapy. Similarly, in her thesis published in 2008, French veterinary surgeon Laurence Duval-Desnoes stated, "[T]here is very little truly scientific evidence today to show the beneficial effects that an autistic person can derive from contact with an animal. It's more often a question of observations, of isolated facts".
The first scientific assessments of this therapy were published in 2008 and 2009. According to an article published in The Guardian in February 2012, a growing number of health professionals were recognizing the effectiveness of equine-assisted therapy in helping autistic people. According to French child psychiatrist Dr Laurence Hameury, of the CHRU (Centre hospitalier régional universitaire by its extension in French) de Tours (2017), "therapies including animal mediation are currently in full development, and their benefits are recognized and validated by scientific studies evaluating the results".
Accessibility and practices In 2018, an Indian woman came to France for training to develop equine-assisted therapy with the autistic public in India.
In 2012, according to the French recommendations of the Haute Autorité de santé and the Agence nationale de l'évaluation et de la qualité des établissements et services sociaux et médico-sociaux (French national agency for the evaluation and quality of social and medico-social establishments and services) "activities carried out with animals cannot be considered, in the current state of knowledge, as therapeutic, but constitute practices that can participate in the personal and social development of certain children/adolescents with [autism spectrum disorder], according to their centers of interest, if they benefit from specific support".
Procedure
An equine-assisted therapy session can involve a variety of disorders or disabilities. There are also sessions entirely adapted to the specific needs of autistic people. Claudine Pelletier-Milet finds that children's sessions with ponies take place in a joyful, relaxed atmosphere. These sessions can take place on foot or on horseback. The notion of equine-assisted therapy covers both types of therapy. Many autistic people are able to develop quite advanced riding skills during their sessions, so that the latter are often more akin to conventional riding lessons than therapeutic care. A session is also an opportunity to share knowledge about the horse.
According to Claude, the sessions most often involve "deficit" autistic children (non-speaking or with numerous behavioral disorders), due to the high demand from families and health professionals, and much more rarely "Asperger's" autistic people. American Linda Kohanov has used an "emotional message interpretation grid" when working with "Asperger's" adults. Pelletier-Milet encourages her patients to anchor themselves in the present moment, and to transcribe the emotions they feel into words.
Walking sessions Equine-assisted therapy sessions usually begin on foot, away from the animal. The autistic person then creates an emotional bridge with the animal by grooming and touching it. Sessions on foot are used to work on cognition, attention and social skills. Sandrine Willems recounts having witnessed a case where an autistic child unable to wash himself learned to do so, presumably by grooming his horse during the on-foot equine-assisted therapy sessions.
Mounted sessions During mounted sessions, the horse's movement is used to work on mobility. They can involve the therapist and up to three other people for individual therapy: one person to guide the horse, the therapist to move the rider and give instructions, and two people on the horse's sides to prevent falls resulting from loss of balance.
Advantages and disadvantages