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Home / Equine Research Bank / Front Psychiatry / The feasibility of occupational therapy using Zones of Regul...
Frontiers in psychiatry2024; 15; 1401222; doi: 10.3389/fpsyt.2024.1401222

The feasibility of occupational therapy using Zones of Regulation™ Concepts in an equine environment.

Abstract: The current paper aimed to assess the feasibility of a modified intervention protocol named "Occupational Therapy using Zones of Regulation Concepts in an Equine Environment" (OT-ZOR Equine). Unassigned: A single arm A-B feasibility study was conducted, involving 14 autistic youth ages 6-13 years who first received 10-weeks of occupational therapy without horses (OT-ZOR Clinic) followed by 10-weeks of OT-ZOR Equine. Unassigned: All participants completed the study and attended 95% of OT-ZOR Equine sessions. Occupational therapists maintained 91% fidelity to the OT-ZOR Equine intervention protocol and there were no serious adverse events. All participants' caregivers and study occupational therapists rated being satisfied or very satisfied with the OT-ZOR Equine intervention. Youth demonstrated improved self-regulation following participation in the OT-ZOR Clinic and OT-ZOR Equine interventions. However, participants' social functioning only improved after OT-ZOR Equine. Unassigned: This study demonstrated that OT-ZOR Equine is feasible to implement, acceptable to recipients and providers, and may offer additive benefits in social functioning compared to occupational therapy intervention without horses. The current study provides a foundation for future efficacy research aimed at quantifying additive benefits of integrating horses into occupational therapy for autistic youth.
Copyright © 2024 Peters, Gabriels, Schmid, Pan, Merritt, Hoffman and Hepburn.
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Publication Date: 2024-09-03 PubMed ID: 39290298PubMed Central: PMC11405308DOI: 10.3389/fpsyt.2024.1401222Google 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.

This research evaluates an occupational therapy intervention called “Zones of Regulation” but performed in an equine environment, for autistic youth. The results demonstrate that this therapy is feasible, satisfactory to recipients and providers, and may offer additional social benefits over traditional occupational therapy.

Study Methodology and Participants

  • A feasibility study was conducted using an unassigned single arm A-B model.
  • The study involved 14 young individuals diagnosed with Autism Spectrum Disorder (ASD), aged between 6 and 13 years old.
  • All participants first undertook a 10-week period of standard occupational therapy (termed as OT-ZOR Clinic in the study) before following it up with another 10 weeks of the equine-based occupational therapy (OT-ZOR Equine).

Completion and Adherence Rates

  • All the participants successfully completed the study.
  • A very high attendance rate of 95% was achieved for the OT-ZOR Equine therapy sessions.
  • The sample group comprised of occupational therapists who were able to maintain a 91% adherence rate to the OT-ZOR Equine intervention protocol. This shows a high feasibility and acceptability of the protocol amongst healthcare providers.
  • No serious adverse events were reported during the course of the study, indicating that the intervention is safe.

Feedback and Efficacy of the Protocol

  • Both participants’ caregivers and the study’s occupational therapists have reported high levels of satisfaction with the OT-ZOR Equine intervention.
  • Improvements were seen in self-regulation skills after both the OT-ZOR Clinic and OT-ZOR Equine therapies.
  • However, improvements in their social functioning were witnessed only following the equine-based sessions, suggesting additional benefits of this method compared to the stand-alone occupational therapy.

Implications and Future Directions

  • This pilot study proves the feasibility of the inclusion of equine environment in occupational therapy, with no serious adverse effects, high acceptance from recipients and providers, and additional social benefits.
  • These findings set a precedent for future research in ascertaining the additional benefits of using horses as a therapeutic aid in the occupational therapy of autistic children.

Cite This Article

APA
Peters BC, Gabriels RL, Schmid AA, Pan Z, Merritt T, Hoffman A, Hepburn S. (2024). The feasibility of occupational therapy using Zones of Regulation™ Concepts in an equine environment. Front Psychiatry, 15, 1401222. https://doi.org/10.3389/fpsyt.2024.1401222

Publication

Frontiers in psychiatry
ISSN: 1664-0640
NlmUniqueID: 101545006
Country: Switzerland
Language: English
Volume: 15
Pages: 1401222
PII: 1401222

Researcher Affiliations

Peters, B Caitlin
  • Temple Grandin Equine Center, Department of Animal Sciences, Colorado State University, Fort Collins, CO, United States.
  • Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States.
Gabriels, Robin L
  • Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Schmid, Arlene A
  • Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States.
Pan, Zhaoxing
  • Biostatistics Core of Children's Hospital Colorado Research Institute, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Merritt, Tamara
  • Hearts & Horses, Inc. Director of Program Innovation and Research, Loveland, CO, United States.
Hoffman, Arielle
  • Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States.
Hepburn, Susan
  • Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States.

Grant Funding

  • UL1 TR002535 / NCATS NIH HHS

Conflict of Interest Statement

Author TM was employed by Hearts & Horses, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

This article includes 58 references
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5. Washington, DC: American Psychiatric Publishing; (2013).
  2. Bottema-Beutel K, Kapp SK, Lester JN, Sasson NJ, Hand BN. Avoiding ableist language: Suggestions for autism researchers. Autism Adulthood (2021) 3:18–29.
    doi: 10.1089/aut.2020.0014pmc: PMC8992888pubmed: 36601265google scholar: lookup
  3. Meilleur A-AS, Jelenic P, Mottron L. Prevalence of clinically and empirically defined talents and strengths in autism. J Autism Dev Disord (2015) 45:1354–67.
    doi: 10.1007/s10803-014-2296-2pmc: PMC4544492pubmed: 25374134google scholar: lookup
  4. Devenish B, Mantilla A, Bowe S, Grundy E, Rinehart N. Can common strengths be identified in autistic young people? A systematic review and meta-analysis. Res Autism Spectr Disord (2022) 98:102025.
    doi: 10.1016/j.rasd.2022.102025google scholar: lookup
  5. Laurent AC, Gorman K. Development of emotion self-regulation among young children with autism spectrum disorders: The role of parents. J Autism Dev Disord (2018) 48:1249–60.
    doi: 10.1007/s10803-017-3430-8pubmed: 29249011google scholar: lookup
  6. Hofmann W, Schmeichel BJ, Baddeley AD. Executive functions and self-regulation. Trends Cogn Sci (2012) 16:174–80.
    doi: 10.1016/j.tics.2012.01.006pubmed: 22336729google scholar: lookup
  7. Cai RY, Richdale AL, Uljarević M, Dissanayake C, Samson AC. Emotion regulation in autism spectrum disorder: Where we are and where we need to go. Autism Res (2018) 11:962–78.
    doi: 10.1002/aur.1968pubmed: 29979494google scholar: lookup
  8. Corbett BA, Mendoza S, Abdullah M, Wegelin JA, Levine S. Cortisol circadian rhythms and response to stress in children with autism. Psychoneuroendocrinology (2006) 31:59–68.
    doi: 10.1016/j.psyneuen.2005.05.011pubmed: 16005570google scholar: lookup
  9. Spratt EG, Nicholas JS, Brady KT, Carpenter LA, Hatcher CR, Meekins KA. Enhanced cortisol response to stress in children in autism. J Autism Dev Disord (2012) 42:75–81.
    doi: 10.1007/s10803-011-1214-0pmc: PMC3245359pubmed: 21424864google scholar: lookup
  10. Doehring P, Reichow B, Palka T, Phillips C, Hagopian L. Behavioral approaches to managing severe problem behaviors in children with autism spectrum and related developmental disorders: A descriptive analysis. Child Adolesc Psychiatr Clinics (2014) 23:25–40.
    doi: 10.1016/j.chc.2013.08.001pubmed: 24231165google scholar: lookup
  11. Mazefsky CA, Borue X, Day TN, Minshew NJ. Emotion regulation patterns in adolescents with high-functioning autism spectrum disorder: comparison to typically developing adolescents and association with psychiatric symptoms. Autism Res (2014) 7:344–54.
    doi: 10.1002/aur.1366pmc: PMC4136477pubmed: 24610869google scholar: lookup
  12. Swain D, Scarpa A, White S, Laugeson E. Emotion dysregulation and anxiety in adults with ASD: Does social motivation play a role?. J Autism Dev Disord (2015) 45:3971–7.
    doi: 10.1007/s10803-015-2567-6pubmed: 26319254google scholar: lookup
  13. Nader-Grosbois N, Mazzone S. Emotion regulation, personality and social adjustment in children with autism spectrum disorders. Psychology (2014) 5:1750.
    doi: 10.4236/psych.2014.515182google scholar: lookup
  14. Konstantareas MM, Stewart K. Affect regulation and temperament in children with autism spectrum disorder. J Autism Dev Disord (2006) 36:143–54.
    doi: 10.1007/s10803-005-0051-4pubmed: 16456727google scholar: lookup
  15. Gabriels RL, Pan Z, Dechant B, Agnew JA, Brim N, Mesibov G. Randomized controlled trial of therapeutic horseback riding in children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry (2015) 54:541–9.
    doi: 10.1016/j.jaac.2015.04.007pmc: PMC4475278pubmed: 26088658google scholar: lookup
  16. O’Haire ME. Research on animal-assisted intervention and autism spectrum disorder, 2012–2015. Appl Dev Sci (2017) 21:200–16.
    doi: 10.1080/10888691.2016.1243988pmc: PMC6510492pubmed: 31080343google scholar: lookup
  17. Nieforth LO, Schwichtenberg A, O’Haire ME. Animal-assisted interventions for autism spectrum disorder: A systematic review of the literature from 2016 to 2020. Rev J Autism Dev Disord (2023) 10:255–80.
    doi: 10.1007/s40489-021-00291-6pmc: PMC10259834pubmed: 37313251google scholar: lookup
  18. 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 Altern Complementary Med (2021) 27:88–95.
    doi: 10.1089/acm.2020.0415pubmed: 33252244google scholar: lookup
  19. Professional Association of Therapeutic Horsemanship International. 2020 Fact Sheet: Professional Association of Therapeutic Horsemanship International. (2022).
  20. McDaniel-Peters BC, Wood W. Autism and equine-assisted interventions: A systematic mapping review. J Autism Dev Disord (2017) 47:3220–42.
    doi: 10.1007/s10803-017-3219-9pubmed: 28733851google scholar: lookup
  21. Ajzenman HF, Standeven JW, Shurtleff TL. Effect of hippotherapy on motor control, adaptive behaviors, and participation in children with autism spectrum disorder: A pilot study. Am J Occup Ther (2013) 67:653–63.
    doi: 10.5014/ajot.2013.008383pubmed: 24195899google scholar: lookup
  22. Liddiard J. Hands up for hippotherapy: An investigation into the use of hippotherapy to promote handwriting legibility for children who have disabilities. Scientfic Educ J Ther Riding (2009) 19:72–94.
  23. Llambias C, Magill-Evans J, Smith V, Warren S. Equine-assisted occupational therapy: Increasing engagement for children with autism spectrum disorder. Am J Occup Ther (2016) 70:7006220040p1–7006220040p9.
    doi: 10.5014/ajot.2016.020701pubmed: 27767943google scholar: lookup
  24. Memishevikj H, Hodzhikj S. The Effects of Equine-Assisted Therapy in improving psychological functioning in children with autism. J Special Educ Rehabil (2010) 11:57–67.
  25. Peters BC, Wood W, Hepburn S, Moody EJ. Preliminary efficacy of occupational therapy in an equine environment for youth with autism spectrum disorder. J Autism Dev Disord (2022) 52:4114–28.
    doi: 10.1007/s10803-021-05278-0pubmed: 34557985google scholar: lookup
  26. Tomchek S, Koenig K. Occupational therapy practice guidelines for children and adolescents with autism spectrum disorders. Bethesda, MD: AOTA Press; (2016).
  27. Peters BC, Wood W, Hepburn S, Merritt T. The feasibility and acceptability of occupational therapy in an equine environment for youth with autism spectrum disorder. Res Autism Spectr Disord (2021) 80:101695.
    doi: 10.1016/j.rasd.2020.101695google scholar: lookup
  28. Peters BC, Gabriels R, Schmid AA, Lassell RKF, Pan Z, Hoffman A. Occupational therapy using Zones of RegulationTM Concepts: A feasibility study. OTJR: Occupation Participation Health (2024).
    doi: 10.1177/15394492241246549pubmed: 38659367google scholar: lookup
  29. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: The new Medical Research Council guidance. Br Med J (2008) 337:979–83.
    doi: 10.1136/bmj.a1655pmc: PMC2769032pubmed: 18824488google scholar: lookup
  30. Orsmond GI, Cohn ES. The distinctive features of a feasibility study: Objectives and guiding questions. OTJR: Occupation Participation Health (2015) 35:169–77.
    doi: 10.1177/1539449215578649pubmed: 26594739google scholar: lookup
  31. National Center for Complementary Integrative Health. Pilot studies: common uses and misuses: NCCIH. (2021).
  32. Abouzeid N, Rivard M, Mello C, Mestari Z, Boulé M, Guay C. Parent coaching intervention program based on the Early Start Denver Model for children with autism spectrum disorder: Feasibility and acceptability study. Res Dev Disabilities (2020) 105:103747.
    doi: 10.1016/j.ridd.2020.103747pubmed: 32763654google scholar: lookup
  33. Beadle-Brown J, Wilkinson D, Richardson L, Shaughnessy N, Trimingham M, Leigh J. Imagining Autism: Feasibility of a drama-based intervention on the social, communicative and imaginative behaviour of children with autism. Autism (2018) 22:915–27.
    doi: 10.1177/1362361317710797pubmed: 28901162google scholar: lookup
  34. Brian JA, Smith IM, Zwaigenbaum L, Roberts W, Bryson SE. The Social ABCs caregiver-mediated intervention for toddlers with autism spectrum disorder: Feasibility, acceptability, and evidence of promise from a multisite study. Autism Res (2016) 9:899–912.
    doi: 10.1002/aur.1582pmc: PMC5064621pubmed: 26688077google scholar: lookup
  35. Iadarola S, Pellecchia M, Stahmer A, Lee HS, Hauptman L, Hassrick EM. Mind the gap: An intervention to support caregivers with a new autism spectrum disorder diagnosis is feasible and acceptable. Pilot Feasibility Stud (2020) 6:1–13.
    doi: 10.1186/s40814-020-00662-6pmc: PMC7487627pubmed: 32944273google scholar: lookup
  36. Kuypers LM. The Zones of Regulation. San Jose, CA: Think Social Publishing, Incorporated; (2011).
  37. Aman MG, Singh NN. Aberrant Behavior Checklist, Second Edition: Community residential manual. New York: Slosson Educational Publications, Inc; (2017).
  38. Arnold LE, Vitiello B, Mcdougle C, Scahill L, Shah B, Gonzalez NM. Parent-defined target symptoms respond to risperidone in RUPP autism study: Customer approach to clinical trials. J Am Acad Child Adolesc Psychiatry (2003) 42:1443–50.
    doi: 10.1097/00004583-200312000-00011pubmed: 14627879google scholar: lookup
  39. Mazefsky CA, Yu L, White SW, Siegel M, Pilkonis PA. The Emotion Dysregulation Inventory: Psychometric properties and item response theory calibration in an autism spectrum disorder sample. Autism Res (2018).
    doi: 10.1037/t71153-000pmc: PMC6026073pubmed: 29624893google scholar: lookup
  40. Constantino JN. The Social Responsiveness Scale, Second Edition. Los Angeles, CA: Western Psychological Services; (2012).
  41. Bruni TP. Test review: social responsiveness scale–second edition (SRS-2). J Psychoeducational Assessment (2014) 32:365–9.
    doi: 10.1177/0734282913517525google scholar: lookup
  42. WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. psychol Med (1998) 28:551–8.
    doi: 10.1017/S0033291798006667pubmed: 9626712google scholar: lookup
  43. Dardas LA, Ahmad MM. Validation of the World Health Organization’s quality of life questionnaire with parents of children with autistic disorder. J Autism Dev Disord (2014) 44:2257–63.
    doi: 10.1007/s10803-014-2110-1pubmed: 24696377google scholar: lookup
  44. Kramer JM, Liljenquist K, Coster WJ. Validity, reliability, and usability of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test for autism spectrum disorders. Dev Med Child Neurol (2016) 58:255–61.
    doi: 10.1111/dmcn.12837pmc: PMC4688240pubmed: 26104112google scholar: lookup
  45. Ruble L, McGrew JH, Toland MD. Goal attainment scaling as an outcome measure in randomized controlled trials of psychosocial interventions in autism. J Autism Dev Disord (2012) 42:1974–83.
    doi: 10.1007/s10803-012-1446-7pmc: PMC3358457pubmed: 22271197google scholar: lookup
  46. McDougall J, King G. Goal attainment scaling: Description, utility, and applications in pediatric therapy services. ON, Canada: Thames Valley Children’s Centre; (2007).
  47. Mailloux Z, May-Benson TA, Summers CA, Miller LJ, Brett-Green B, Burke JP. Goal attainment scaling as a measure of meaningful outcomes for children with sensory integration disorders. Am J Occup Ther (2007) 61:254–9.
    doi: 10.5014/ajot.61.2.254pubmed: 17436848google scholar: lookup
  48. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res (2005) 15:1277–88.
    doi: 10.1177/1049732305276687pubmed: 16204405google scholar: lookup
  49. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D. How we design feasibility studies. Am J Prev Med (2009) 36:452–7.
    doi: 10.1016/j.amepre.2009.02.002pmc: PMC2859314pubmed: 19362699google scholar: lookup
  50. Watkins EE, Zimmermann ZJ, Poling A. The gender of participants in published research involving people with autism spectrum disorders. Res Autism Spectr Disord (2014) 8:143–6.
    doi: 10.1016/j.rasd.2013.10.010google scholar: lookup
  51. Barnard-Brak L, Richman D, Almekdash MH. How many girls are we missing in ASD? An examination from a clinic-and community-based sample. Adv Autism (2019) 5:214–24.
    doi: 10.1108/AIA-11-2018-0048google scholar: lookup
  52. D’Mello AM, Frosch IR, Li CE, Cardinaux AL, Gabrieli JD. Exclusion of females in autism research: Empirical evidence for a “leaky” recruitment-to-research pipeline. Autism Res (2022) 15:1929–40.
    doi: 10.1002/aur.2795pmc: PMC9804357pubmed: 36054081google scholar: lookup
  53. Hiller RM, Young RL, Weber N. Sex differences in autism spectrum disorder based on DSM-5 criteria: evidence from clinician and teacher reporting. J Abnormal Child Psychol (2014) 42:1381–93.
    doi: 10.1007/s10802-014-9881-xpubmed: 24882502google scholar: lookup
  54. McFayden T, Albright J, Muskett A, Scarpa A. Brief report: Sex differences in ASD diagnosis—A brief report on restricted interests and repetitive behaviors. J Autism Dev Disord (2019) 49:1693–9.
    doi: 10.1007/s10803-018-3838-9pubmed: 30488150google scholar: lookup
  55. Smith T, Scahill L, Dawson G, Guthrie D, Lord C, Odom S. Designing research studies on psychosocial interventions in autism. J Autism Dev Disord (2007) 37:354–66.
    doi: 10.1007/s10803-006-0173-3pubmed: 16897380google scholar: lookup
  56. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework. BMC Health Serv Res (2017) 17:1–13.
    doi: 10.1186/s12913-017-2031-8pmc: PMC5267473pubmed: 28126032google scholar: lookup
  57. American Occupational Therapy Association. Occupational therapy practice framework: Domain & process, 4th Edition. Am J Occup Ther (2020) 74:7412410010p1–p87.
    pubmed: 34780625doi: 10.5014.ajot.2020.74s2001google scholar: lookup
  58. Madigand J, Rio M, Vandevelde A. Equine assisted services impact on social skills in autism spectrum disorder: A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry (2023) 125:110765.
    doi: 10.1016/j.pnpbp.2023.110765pubmed: 37031948google scholar: lookup

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