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Home / Equine Research Bank / Child Adolesc Psychiatry Ment Health / Horses and ADHD: the ASTride intervention for cognitive and ...
Child and adolescent psychiatry and mental health2025; 19(1); 131; doi: 10.1186/s13034-025-00990-6

Horses and ADHD: the ASTride intervention for cognitive and emotional growth.

Abstract: This study aimed to evaluate the efficacy of the Attention Skill Training (ASTride) protocol, an Equine-Assisted Occupational Therapy (EAOT) intervention, for children diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) in enhancing and promoting cognitive and emotional aspects including executive functions, self-efficacy, anxiety and hope perception. Methods: A prospective cohort study with an Interrupted Time-Series design was conducted. Fifty participants (mean age = 9.51 years, SD = 1.52) were assessed at four time points: baseline, pre-test (following a 12-week waiting period), post-test (after 12 weeks of intervention), and after three-month follow-up. The intervention was administered by a licensed equine assisted occupational therapists, and assessments were conducted by a blinded occupational therapist. Measures included The Behavior Rating Inventory of Executive Function (BRIEF) for executive functions, and the Hope, Child Anxiety Related Emotional Disorders (SCARED), and The New General Self-Efficacy Scale (NGSE) questionnaires for emotional factors. Results: Significant improvements were found in executive functions, hope perception, and self-efficacy. Anxiety levels significantly decreased post-intervention. Conclusions: The ASTride intervention showed efficacy in improving executive functions, hope, and self-efficacy, while reducing anxiety in children with ADHD, supporting its potential as a comprehensive therapeutic approach. Trial registration The research is registered at Clinical Trials.gov, identifier number NCT05869253, first registration at 22/5/2023.
© 2025. The Author(s).
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Publication Date: 2025-11-21 PubMed ID: 41272733PubMed Central: PMC12639777DOI: 10.1186/s13034-025-00990-6Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This study evaluates the effectiveness of the ASTride protocol, an Equine-Assisted Occupational Therapy intervention, in improving cognitive and emotional functions in children with ADHD.
  • The intervention aims to enhance executive functions, self-efficacy, hope perception, and reduce anxiety among the participants.

Study Objective and Design

  • Objective: To assess the efficacy of the ASTride protocol in promoting cognitive and emotional improvements in children diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD).
  • Study Design: A prospective cohort study utilizing an Interrupted Time-Series design.
  • Participants: 50 children with ADHD, average age approximately 9.5 years.
  • Assessment Time Points:
    • Baseline (initial measurement)
    • Pre-test (after a 12-week waiting period)
    • Post-test (after 12 weeks of intervention)
    • Three-month follow-up (to assess lasting effects)

Intervention Details

  • ASTride Protocol:
    • Delivered through Equine-Assisted Occupational Therapy (EAOT), which involves therapeutic activities with horses.
    • Administered by licensed equine-assisted occupational therapists.
    • Aimed at enhancing executive functions, emotional well-being, self-efficacy, hope, and reducing anxiety.
  • Assessment:
    • Conducted by a blinded occupational therapist to avoid bias.

Measures Used in the Study

  • Executive Functions: Measured by The Behavior Rating Inventory of Executive Function (BRIEF)
  • Emotional Factors:
    • Hope Perception: Assessed via the Hope Questionnaire
    • Anxiety Levels: Measured by the Child Anxiety Related Emotional Disorders (SCARED) scale
    • Self-Efficacy: Evaluated using The New General Self-Efficacy Scale (NGSE)

Key Findings

  • Significant improvements were observed in:
    • Executive functions (better cognitive control, attention, and task management)
    • Hope perception (increased positive outlook and goal-directed thinking)
    • Self-efficacy (enhanced belief in one’s ability to execute actions successfully)
  • Anxiety levels showed a statistically significant decrease after the intervention, indicating improved emotional regulation and reduced stress symptoms.
  • The improvements were sustained at the three-month follow-up, suggesting lasting benefits.

Conclusions and Implications

  • The ASTride intervention demonstrates efficacy as a comprehensive therapeutic approach for children with ADHD, addressing both cognitive and emotional domains.
  • Equine-Assisted Occupational Therapy can serve as a valuable complement or alternative to traditional ADHD interventions.
  • By enhancing executive function and emotional well-being, the intervention may contribute to improved daily functioning and quality of life for affected children.
  • The study supports further research and potential clinical adoption of this intervention model.

Additional Information

  • The research is registered with ClinicalTrials.gov under the identifier NCT05869253.
  • First registration date was May 22, 2023.

Cite This Article

APA
Helmer A, Delore E, Bart O. (2025). Horses and ADHD: the ASTride intervention for cognitive and emotional growth. Child Adolesc Psychiatry Ment Health, 19(1), 131. https://doi.org/10.1186/s13034-025-00990-6

Publication

Child and adolescent psychiatry and mental health
ISSN: 1753-2000
NlmUniqueID: 101297974
Country: England
Language: English
Volume: 19
Issue: 1
Pages: 131
PII: 131

Researcher Affiliations

Helmer, Anne
  • Department of Occupational Therapy, School of Health Professions, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel.
  • Mount Judeah stable, Tzur Hadassah, Israel.
Delore, Elaina
  • Department of Occupational Therapy, School of Health Professions, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel.
  • Elwyn Israel, Jerusalem, Israel.
Bart, Orit
  • Department of Occupational Therapy, School of Health Professions, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel. oritbert@tauex.tau.ac.il.

Conflict of Interest Statement

Declarations. Ethics approval and consent to participate: Ethical approval was received from the Sackler Faculty of Medicine of Tel-Aviv University IRB No:0003949-2. All methods were approved and carried out in accordance with the IRB guidelines. Informed consent was obtained from Parents or Legally Authorized Representative of the child participants before conducting the study. Human or animal rights: The experiment with equines were approved by the Sackler Faculty of Medicine of Tel-Aviv University IRB No:0003949-2. All methods were approved and carried out in accordance with the IRB guidelines and ARRIVE guidelines for reporting research involving animals [35]. Competing interests: The authors declare no competing interests.

References

This article includes 35 references
  1. Wehmeier PM, Schacht A, Barkley RA. Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life.. J Adolesc Health 2010;46(3):209–17.
    doi: 10.1016/j.jadohealth.2009.09.009pubmed: 20159496google scholar: lookup
  2. Cortese S, Sabé M, Chen C, Perroud N, Solmi M. Half a century of research on attention-deficit/hyperactivity disorder: a scientometric study.. Neurosci Biobehav Rev 2022;2023(140):104769.
    doi: 10.1016/j.neubiorev.2022.104769pubmed: 35798128google scholar: lookup
  3. Friedman N, Miyake A. Unity and diversity of executive functions: Individual differences as a window on cognitive structure.. Cortex 2017;86:186–204.
    doi: 10.1016/j.cortex.2016.04.023pmc: PMC5104682pubmed: 27251123google scholar: lookup
  4. Astenvald R, Frick MA, Neufeld J, Bölte S, Isaksson J. Emotion dysregulation in ADHD and other neurodevelopmental conditions: a co-twin control study.. Child Adolesc Psychiatry Mental Health 2022;16(1):92.
    doi: 10.1186/s13034-022-00528-0pmc: PMC9706824pubmed: 36443776google scholar: lookup
  5. Molavi P, Nadermohammadi M, Vicario CM, Nitsche MA, Salehinejad MA. Cognitive correlates of ADHD subtypes and its association with self-esteem: a quantitative difference.. Res Square 2020.
    doi: 10.21203/rs.3.rs-21331/v1pmc: PMC7549239pubmed: 33046041google scholar: lookup
  6. Wolraich M, Hagan J, Allan C, Chan E. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents.. Pediatrics 2019;144(4):e20192528.
    doi: 10.1542/peds.2019-2528pmc: PMC7067282pubmed: 31570648google scholar: lookup
  7. Dovis S, Van Der Oord S, Wiers RW, Prins PJM. Improving executive functioning in children with ADHD: training multiple executive functions within the context of a computer game. A randomized double-blind placebo controlled trial.. PLoS ONE 2015;10(4):e0121651.
    doi: 10.1371/journal.pone.0121651pmc: PMC4386826pubmed: 25844638google scholar: lookup
  8. Hahn-Markowitz J, Berger I, Manor I. Efficacy of cognitive-functional (Cog-Fun) occupational therapy intervention among children with ADHD: An RCT.. J Atten Disord 2020;24(5):655–66.
    doi: 10.1177/1087054716666955pubmed: 27637735google scholar: lookup
  9. Pelham WE Jr, Fabiano GA. Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder.. J Clin Child Adolesc Psychol 2008;37(1):184–214.
    doi: 10.1080/15374410701818681pubmed: 18444058google scholar: lookup
  10. Wood W, Alm K, Benjamin J, Thomas L, Anderson D, Pohl L. Optimal terminology for services in the United States that incorporate horses to benefit people: a consensus document.. J Alternat Complement Med 2021;27(1):88–95.
    doi: 10.1089/acm.2020.0415pubmed: 33252244google scholar: lookup
  11. Kendall E, Maujean A, Pepping CA, Downes M, Lakhani A, Byrne J. A systematic review of the efficacy of equine-assisted interventions on psychological outcomes.. Eur J Psychother Counsell 2015;17(1):57–79.
    doi: 10.1080/13642537.2014.996169google scholar: lookup
  12. Pérez-Gómez J, Amigo-Gamero H, Collado-Mateo D, Barrios-Fernandez S, Muñoz-Bermejo L, Garcia-Gordillo MÁ. Equine-assisted activities and therapies in children with attention-deficit/hyperactivity disorder: a systematic review.. J Psychiatr Mental Health Nurs 2021;28(6):1079–91.
    doi: 10.1111/jpm.12710pubmed: 33171006google scholar: lookup
  13. Helmer A, Wechsler T, Gilboa Y. Equine-assisted services for children with attention-deficit/hyperactivity disorder: a systematic review.. J Altern Complement Med 2021;27(6):477–88.
    doi: 10.1089/acm.2020.0482pubmed: 33835856google scholar: lookup
  14. Helmer A, Delore E, Bart O. Equine assisted occupational therapy for children with adhd (astride): protocol development and preliminary study.. Clin Neuropsychiatry 2024;21(1):88.
    pmc: PMC10979790pubmed: 38559433
  15. Toglia J, Katz N. The dynamic interactional model of cognition in cognitive rehabilitation.. .
  16. Polatajko HJ, Mandich AD, Missiuna C, Miller LT, Macnab JJ, Malloy-Miller T, et al. Cognitive orientation to daily occupational performance(CO-OP) part II the evidence. Phys Occupat Therapy Pediatr. 2001;20(42038):107–23. 10.1080/J006v20n02_07.
    doi: 10.1080/J006v20n02_07pubmed: 11345506google scholar: lookup
  17. J Ayres. Sensory integration and learning disorders. Am J Occup Therapy. 1972, https://cir.nii.ac.jp/crid/1130282273180619136.
  18. Bracher M. Therapeutic horse riding: what has this to do with occupational therapists? Br J Occup Ther. 2000;63(6):277–82.
    doi: 10.1177/030802260006300606google scholar: lookup
  19. Gioia GA, Isquith PK, Guy SC, Kenworthy L. Test review behavior rating inventory of executive function. Child Neuropsychol. 2000;6(3):235–8.
    doi: 10.1076/chin.6.3.235.3152pubmed: 11419452google scholar: lookup
  20. Hahn-Markowitz J, Berger I, Manor I, Maeir A. Impact of the Cognitive-Functional (Cog–Fun) intervention on executive functions and participation among children with attention deficit hyperactivity disorder: a randomized controlled trial. Am J Occup Therapy. 2017;71(5):7105220010p1–9.
    doi: 10.5014/ajot.2017.022053pubmed: 28809658google scholar: lookup
  21. Snyder CR. Hope theory: rainbows in the mind. Psychol Inq. 2002;13(4):249–75.
    doi: 10.1207/S15327965PLI1304_01google scholar: lookup
  22. Snyder CR, Hoza B, Pelham WE, Rapoff M, Ware L, Danovsky M, et al. The development and validation of the children’s hope scale 1. J Pediatr Psychol. 1997;22(3):399–421.
    doi: 10.1093/jpepsy/22.3.399pubmed: 9212556google scholar: lookup
  23. Chen G, Gully SM, Eden D. Validation of a new general self-efficacy scale. Organ Res Methods. 2001;4(1):62–83.
    doi: 10.1177/109442810141004google scholar: lookup
  24. Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, et al. The screen for child anxiety related emotional disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry. 1997;36(4):545–53.
    doi: 10.1097/00004583-199704000-00018pubmed: 9100430google scholar: lookup
  25. Schelly D, Ohl A. Examining clinical meaningfulness in randomized controlled trials: revisiting the well elderly II. Am J Occup Therapy. 2019;73(1):7301205120p1-13.
    doi: 10.5014/ajot.2019.030874pubmed: 30839267google scholar: lookup
  26. Abikoff H. An evaluation of cognitive behavior therapy for hyperactive children. In: Advances in clinical child psychology. Springer; 1987. p. 171–216.
  27. Tottori N, Morita N, Ueta K, Fujita S. Effects of high intensity interval training on executive function in children aged 8–12 years. Int J Environ Res Public Health. 2019;16(21):4127.
    doi: 10.3390/ijerph16214127pmc: PMC6862681pubmed: 31717739google scholar: lookup
  28. White E, Zippel J, Kumar S. The effect of equine-assisted therapies on behavioural, psychological and physical symptoms for children with attention deficit/hyperactivity disorder: a systematic review. Complement Ther Clin Pract. 2020;1:39.
    pubmed: 32379642
  29. Margalit M, Leyser Y, Ankonina D. Community support in Israeli kibbutz and city families of children with disabilities: family climate and parental coherence. J Spec Educ. 1991. 10.1177/002246699102400404.
    doi: 10.1177/002246699102400404google scholar: lookup
  30. Dixson DD, Scalcucci SG. Psychosocial perceptions and executive functioning: hope and school belonging predict students’ executive functioning. Psychol Sch. 2021;58(5):853–72.
    doi: 10.1002/pits.22475google scholar: lookup
  31. Bass MM, Duchowny CA, Llabre MM. The effect of therapeutic horseback riding on social functioning in children with autism. J Autism Dev Disord. 2009;39(9):1261–7.
    doi: 10.1007/s10803-009-0734-3pubmed: 19350376google scholar: lookup
  32. Scopa C, Contalbrigo L, Greco A, Lanatà A, Scilingo EP, Baragli P. Emotional transfer in human–horse interaction: new perspectives on equine assisted interventions. Animals. 2019;9(12):1030.
    doi: 10.3390/ani9121030pmc: PMC6941042pubmed: 31779120google scholar: lookup
  33. Weiss-Dagan S, Naim-Levi N, Brafman D. Therapeutic horseback riding for at-risk adolescents in residential care. Child Adolesc Psychiatry Ment Health. 2022;16(1):90. 10.1186/s13034-022-00523-5.
    doi: 10.1186/s13034-022-00523-5pmc: PMC9686044pubmed: 36419104google scholar: lookup
  34. Hategeka C, Ruton H, Karamouzian M, Lynd LD, Law MR. Use of interrupted time series methods in the evaluation of health system quality improvement interventions: a methodological systematic review. BMJ Glob Health. 2020;5(10):3567.
    doi: 10.1136/bmjgh-2020-003567pmc: PMC7559052pubmed: 33055094google scholar: lookup
  35. NC3RS. https://arriveguidelines.org/. 2023. ARRIVE Guidlines (Animal Research: Reporting of In Vivo Experiments).

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