Skill and participation enhancement in attention deficit hyperactivity disorder through equine therapy using ASTride protocol.

Objective Summary

• This study assessed the effectiveness of the ASTride protocol, a specialized Equine-Assisted Occupational Therapy (EAOT) intervention, in improving participation, performance skills, and daily function in children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).

Study Design and Participants

• A prospective cohort study utilizing an Interrupted Time-Series design.
• Included 50 children diagnosed with ADHD, with a mean age of 9.51 years (SD = 1.52).
• Assessments occurred at four time points: baseline (Time 1), pre-intervention (Time 2), post-intervention (Time 3), and three-month follow-up (Time 4).

Intervention: The ASTride Protocol

• ASTride is an Equine-Assisted Occupational Therapy intervention combining horse-related activities with occupational therapy techniques.
• Integrates sensory integration therapy, cognitive strategies, and metacognitive training.
• Structured to improve motor, cognitive, communication, and organizational skills.
• Aims to enhance participation and performance in everyday activities for children with ADHD.

Assessment Tools Used

• Child Performance Skill Questionnaire: Measures motor, process, and communication skills essential for task completion.
• Child Participation Questionnaire (CPQ): Assesses frequency, independence, enjoyment of activities, and parental satisfaction.
• Canadian Occupational Performance Measure (COPM): Evaluates performance and satisfaction related to specific intervention goals.

Key Findings

• Repeated measure ANOVA analysis indicated statistically significant improvements from baseline (Time 1) to follow-up (Time 4) across several domains.
• Improvements were noted in the CPQ scales, including:
  • Increased frequency of participation in everyday activities.
  • Greater independence when engaging in tasks.
  • Higher enjoyment of activities.
  • Enhanced parental satisfaction concerning child’s activity participation.
• Marked gains in specific performance skills were demonstrated:
  • Motor skills—improvements in physical coordination and control.
  • Process skills—better organization and task execution.
  • Communication skills—enhanced interaction and social participation.
• COPM scores signified sustained progress post-intervention and at follow-up, showing lasting enhancement in performance and satisfaction related to therapy goals.

Implications of the Findings

• ASTride proves effective in boosting participation and functional skills in children with ADHD.
• The benefits of the intervention are maintained beyond the treatment period, indicating long-term functional gains.
• Equine-Assisted Occupational Therapy through ASTride can be a valuable component in treatment plans targeting ADHD-related challenges.
• Improvements in independence, communication, and organizational capabilities suggest broader impacts on daily living and social integration.

Practical Application and Future Directions

• The ASTride protocol provides a replicable, evidence-based framework suitable for rehabilitation professionals working with children with ADHD.
• By integrating sensory integration, cognitive, and metacognitive elements with equine therapy, ASTride addresses multidimensional aspects of ADHD.
• Incorporating equine therapy may enhance engagement and motivation, contributing to improved participation outcomes.
• Future research can explore scalability, standardization, and integration into broader clinical settings.