Therapeutic horse riding and autism

Therapeutic Horse Riding (THR) is already well-known, by both professionals and parents, as having very good effects in developing the social skills of some children with Autism Spectrum Disorder (ASD). Some smaller studies have provided evidence for these improvements, but research on THR with a larger-scale population has been missing.

child horseriding

This recent study by Robin Gabriels and others involved a wider cohort and provides results which confirm the observations of previous studies. The researchers recruited 127 participants with ASD aged 6-16 years who were separated into two groups. Participants were randomly allocated to these groups, with one receiving a THR intervention for a period of 10 weeks and a control group participating in barn activities (BA) that did not involve horses. Participants were evaluated within one month before and after the study by raters blinded to the intervention, and their behaviour was rated weekly by their carers.

Compared to the BA group, children in the THR group showed significant improvements in measures of irritability and hyperactivity. The THR intervention was also shown to have a positive effect on social cognition, social communication and language. These results remained after allowing for differences in factors such as age and IQ.

This study provides yet more evidence for the effectiveness of animal therapy for children with ASD, helping them across a range of domains.

Thanks to Paul Whitely for his review of this study.

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Having a second child after a diagnosis of ASD

We are often consulted by parents whose first child has received a diagnosis of autism and who are considering having a second child. These parents are concerned about the increased risk that their second child would also be diagnosed with the condition. While they may love and appreciate their first born, they wonder how they will cope if their second child also has this diagnosis.

There is strong evidence that having an older sibling who has received a diagnosis of ASD does increase the risk that subsequent siblings may share this disorder. For example, a 2013 Danish study put this increased risk at 7%. This figure is lower than some other studies, but the Danish results may be a more accurate as this is from a population-wide study, while other studies tend to be based upon families which present at clinics.

There is indeed evidence that an awareness of this risk is affecting parents’ decisions to have a second child. A study reported in JAMA Psychiatry last year suggested that parents whose first child has received a diagnosis of autism may be a third less likely to have a second child. The study looked at birth rates in 19,710 Californian families in which the first born had received an ASD diagnosis. The researchers compared the incidence of second births in this group, with 36,215 families in which the first child was developing normally. Second births happened with the same frequency in both groups for the first three years, but then decreased in frequency by a third after that for families with the autistic first child. The significance of three years is that this may be the point at which a diagnosis of ASD was confirmed for the first child and that following this some parents decided not to have a second child.

Parents are understandably concerned when they consider whether or not to have a second child following a diagnosis of autism for their first child. They are aware of the risk that the second child may also receive this diagnosis. They also may be concerned that in meeting the needs of their first born, they will not have the necessary emotional and other resources needed for a subsequent child. Alternatively, they may fear that the demands of a second child may have a negative impact upon the care that they are able to give to the first.

However, many parents in this situation do have a second child. No matter what the needs of this second child, these parents can come to appreciate the special qualities of both their children. What remains important is to see each child as a unique individual who can make her or his own contribution to the family. It is also important, of course, to seek advice and help at the earliest stage if there are concerns about any child.

The results of the Californian study are briefly discussed in Medscape (free registration required to view article).

Do contact our clinic if you have any concerns about your child.

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Lasting outcomes of early intervention for ASD

Yet another study has shown that early interventions may make a positive difference for the autistic child.

The study by Annette Estes and others was recently reported in the Journal of the American Academy of Child and Adolescent Psychiatry. This was a randomized clinical trial that looked at the effectiveness of the Early Start Denver Model (ESDM). The study recruited 39 children under the age of 30 months who had received a diagnosis of an Autistic Spectrum Disorder. Some of these children were allocated to an ESDM intervention for two years and some received community-intervention-as-usual (COM).

The ESDM approach to treatment emphasises early and intensive interventions, with strong parental involvement and which take place within positive, affect-based relationships.

At the end of the treatment no differences in core autism symptoms were found between the two groups, however the group receiving the ESDM intervention showed improvements in several areas, including overall intellectual ability, adaptive behaviour, symptom severity and challenging behaviour. Significantly, though, when tested two years later the ESDM group did show an improvement in core autism symptoms as compared to the COM group. Children from the ESDM group had also maintained many of the benefits that were evident at the end of the treatment.

The two groups had received equivalent hours of intervention during the original study and the clinicians undertaking the follow up did not know to which group each child had originally been allocated.

There are at least two significant take away messages from this study. The first is that early intensive interventions do produce significant benefits for children with ASD, in this case these benefits were in intellectual ability and improved behaviour. The second is that the ESDM treatment seemed to set the two groups of children on to different developmental paths, with children from the ESDM group showing a decrease in core autism symptoms two years after the treatment had ceased. This latter effect was especially significant in that children from the ESDM group tended to have a lower level of support during this later period.

This study provides yet more evidence for the effectiveness of early interventions for autism. For a recent overview of one type of early intervention – the Naturalistic Developmental Behavioral Intervention approach – please see our earlier post.

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Do difficulties remain once a diagnosis of autism is lost?

It used to be thought that autism was a lifetime condition, but more recent experience shows that some children can lose that diagnosis. A recent study looked to see if children who lose the diagnosis still experience some possibly related difficulties. The study’s lead author, Dr. Lisa Shulman, is a developmental pediatrician at Albert Einstein College of Medicine/Children’s Hospital, New York. A report on the study was presented at the Pediatric Academic Societies’ annual meeting in San Diego. A summary can be found here.

A proportion of toddlers who are diagnosed with Autism Spectrum Disorder (ASD) lose that diagnosis later. This seems not to be just a matter of an earlier misdiagnosis. See, for example, the Fein study, which looked at a group of children who had lost their ASD diagnosis. These children started off with symptoms comparable to a group of children who retained their diagnosis of ASD, but later had mean scores that did not differ from some typically developing children in areas such as socialization, communication, face recognition and language.1

It seems that the later loss of diagnosis can represent a real change for these children. This present study set out to assess whether or not children who have lost their ASD diagnosis still have recognisable learning, cognitive, emotional/behavioral and educational needs.

The study looked at 38 children who had been diagnosed with ASD (at an average age of 2.6 years), but who four years later no longer met the diagnostic criteria. These were around one in fourteen of the 569 children diagnosed with ASD in the hospital’s early intervention program between 2003 and 2013.

At enrolment the children in the study showed a range of associated difficulties including an intellectual disability (33%) or a borderline condition (23%). Four years later, in addition to losing their ASD diagnosis, none of the children showed an intellectual disability and jonly 6% were borderline. However, in contrast to this marked reduction in some difficulties, 68% had language/learning disability, 49% externalizing problems (Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Disruptive Behavior Disorder), 24% internalizing problems (mood, anxiety, OCD, selective mutism). Five percent had a significant mental health diagnosis.

A key issue for many children is their ability to enter into mainstream educational provision. Of the children in this study, 39% were in a mainstream setting, although a third of these were receiving additional support; 29% were in integrated settings, and 21% were in self-contained classes.

The loss of the ASD diagnosis was a significant gain for these children, with considerable implications for the course of their future lives. The study also showed that several other difficulties were considerably reduced for these children and that two fifths were able to attend mainstream provision. However, the study did show that some areas of difficulty remained, including educational needs experienced by the majority.

These are important findings that suggest that the loss of a diagnosis of ASD may not be an all or nothing matter. While the loss of a diagnosis implies a significantly altered outlook for the child, some difficulties may still remain that need to be addressed by parents, clinicians and educationalists.

1 Fein, D., Barton, M., Eigsti, I.-M., Kelley, E., Naigles, L., Schultz, R. T., Stevens, M., Helt, M., Orinstein, A., Rosenthal, M., Troyb, E. and Tyson, K. (2013), Optimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry, 54: 195–205. doi: 10.1111/jcpp.12037

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