# Preliminary efficacy of occupational therapy integrating horses on self-regulation in youth with autism spectrum disorder

> **NIH NIH R21** · COLORADO STATE UNIVERSITY · 2022 · $195,689

## Abstract

PROJECT SUMMARY
One in 54 children have Autism Spectrum Disorder (ASD) in the U.S., defined by impaired social interaction
and restricted, repetitive behaviors. Impaired self-regulation is believed to be inherent in ASD, as evidenced by
difficulty managing emotions, heightened physiological reactivity to daily activities, and increased problem
behaviors such as hyperactivity, irritability, aggression, elopement, and self-injury. Growing evidence suggests
that interacting with animals promotes self-regulation in youth with ASD. Integrating animals, such as horses,
into therapy for youth with ASD may improve outcomes. However, very little is known about the efficacy of
integrating horses into occupational therapy for youth with ASD, despite its growing prevalence in practice.
This knowledge gap results in scant empirical information to guide occupational therapy and creates barriers to
access services, as many third-party payers do not reimburse for occupational therapy that integrates horses.
Consequently, there is a critical need to establish how to best integrate horses into occupational therapy for
youth ASD, and empirically demonstrate the additive benefit horses have on therapy outcomes.
Our long-term goal is to establish integrating horses into occupational therapy as an evidence-based practice
to improve self-regulation in youth with ASD. Our team has created a theory-driven, standardized intervention
manual called “Occupational Therapy in an Equine Environment: Harnessing Occupation for self-Regulation
Skills” (OTEE HORS). OTEE HORS operationalizes the purposeful integration of horses into an occupational
therapy intervention to optimize development of self-regulation skills. We also manualized a clinical treatment
protocol, Occupational Therapy in a Clinic (OT Clinic), to serve as a control condition for all non-animal
elements of the intervention. We have demonstrated that both OTEE HORS and OT Clinic are feasible to
implement and acceptable to parents, youth, and occupational therapists. Our preliminary efficacy data
suggest that both OTEE HORS may improve self-regulation in youth with ASD, but we have not yet compared
OTEE HORS to OT Clinic. The goal of this project is to quantify the unique benefits of integrating
horses in occupational therapy compared to occupational therapy in the clinic (i.e., OTEE HORS vs. OT
Clinic) for improving self-regulation in youth with ASD.
Sixty-four youth with ASD ages 6-11 years old will be randomized to OTEE HORS (N=32) or OT clinic (N=32).
The specific aims are to 1) estimate the preliminary efficacy of OTEE HORS compared to OT Clinic on self-
regulation, and 2) identify potential physiological mechanisms that explain how integration of horses in
occupational therapy impacts self-regulation (salivary cortisol and salivary alpha-amylase). Our expected
outcomes include preliminary efficacy data and identification of physiological mechanisms that explain how
integrating horses into occupational therapy ...

## Key facts

- **NIH application ID:** 10533220
- **Project number:** 1R21HD109957-01
- **Recipient organization:** COLORADO STATE UNIVERSITY
- **Principal Investigator:** Brittany Caitlin Peters
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $195,689
- **Award type:** 1
- **Project period:** 2022-09-21 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10533220

## Citation

> US National Institutes of Health, RePORTER application 10533220, Preliminary efficacy of occupational therapy integrating horses on self-regulation in youth with autism spectrum disorder (1R21HD109957-01). Retrieved via AI Analytics 2026-06-02 from https://api.ai-analytics.org/grant/nih/10533220. Licensed CC0.

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