The effectiveness of hippotherapy on behavioral disorders and social skills of children with autism spectrum disorders
Autism is a disorder that is affecting more and more people. There are several interventions for this disorder, one of which is the use of animals in treatment, such as horse therapy. Horse therapy is one of the animal therapy methods used for people with various disabilities such as social, cognitive and motor disabilities. The aim of this study was the effectiveness of hippotherapy on behavioral disorders and social skills of autistic children of Imam Ali Comprehensive Rehabilitation and Autism Center in Kerman. The statistical population of this study included 50 children with autism. Among the statistical population, 8 children with autism spectrum were randomly assigned to the experimental group and 15 to the control group. In this study, the WINELEND questionnaire, Ruther Behavioral Disorder (Rutter, 1976), Teachers' Social Skills Questionnaire (Trascott, 1989) and the GARS Questionnaire were completed. Multivariate analysis of covariance in data analysis showed that behavioral disorders and social skills under the influence of hippotherapy in the group of children with autism with the control group showed a significant difference.
Keywords: Hippotherapy, Autism, Behavioral Disorders, Social Skills
Introduction
Until the middle of the twentieth century, there was no name for the disorder now known as autism. Henry Moseley was the first psychiatrist to pay serious attention in 1867 to young children with severe mental disorders and developmental delays. In 1943, Dr. Leo Connor studied a group of 11 children at Hopkins Hospital. Although Connor labeled them children with autism, they were not classified as mentally retarded or childhood schizophrenics until the 1980s. (Rafie 1390).
The main feature of spectrum disorder is persistent lack of communication and two-way social interactions and repetitive and limited patterns of behavior, interests or activities. These symptoms have been present since early childhood and cause disorders or limitations in daily functioning (Rezaei et al., 2015).
This disorder has different symptoms in different people and to distinguish it from other disorders, the term "autism spectrum disorders" or its abbreviation (ASD) is used (Samadi 2013).
Autism is a disorder that is caused by abnormalities in the brain. Research shows
The parts of the brain that process emotions are not growing normally in people with autism. Further research shows that some remote circuits that are responsible for connecting different areas of the brain are also incapable of doing their job. The spectrum of autism spectrum disorders is very wide and varies from severe, ie the state in which the child never opens his tongue to the mild state (Samadi 1394). The role of heredity in autism spectrum disorder is estimated to be about 37% to 90% based on the synchronicity of the twins. There are cultural differences in the norms of social interaction, nonverbal communication, and relationships, but people with spectrum disorders are significantly less likely to fall short of their cultural norms. Cultural and socio-economic factors may affect the age of diagnosis or recognition, for example in the United States, autism disorder in black children is diagnosed later and less than real (Rezaei et al. 2015).
Humans and animals have a natural tendency to communicate with each other (Nimro Landahl, 17) and since the time of early humans, animals, especially horses, have been useful to humans in various roles such as vehicle (Trotter, Chandler, Goodwin). Bund and Casey, 1). Another benefit of animals is their therapeutic use. Animal therapy is associated with neurochemical changes. Decreased spastic contractions in children with cerebral palsy and adults with spinal cord injuries have also been observed in horses (Lancer et al., 1).
Equestrian therapy is one of the animal therapy methods used for people with various disabilities such as social, cognitive and motor disabilities (Payo, ٢٠٠٠). Other research has shown that animal therapy is effective in reducing autism-related behavioral symptoms, increasing socialization and communication, and improving quality of life (Gilgo, ، 29).
Despite impaired social interaction between people with autism and other humans, many reported close and intimate relationships with pets in their lives (O'Hair, 2013).
In addition, researchers such as Niemer and Landahl (17) have conducted meta-analytic research on the effectiveness of animal therapy. The researchers found that treatment with animals had the highest effect on autism spectrum disorders. They also found that the greatest effect on physical problems was due to the treatment of horses. Therefore, equestrian therapy can be used to improve the social skills of children with autism.
Equestrian therapy improves balance and movement while forming a therapeutic relationship between the patient and the horse (Bass, 2009). Hippotherapy is a term used in the literature for equestrian therapy, and according to the American Hippotherapy Association, the use of horse movements as a therapeutic strategy by physiotherapists, occupational therapists, and speech therapists to consider disorders, functional limitations, and disabilities. In skeletal neuromuscular patients, points.
Method
Statistical population, sample and research method
The statistical population of the present study was all children aged 3 to 4 years in Imam Ali Educational and Care Center in Kerman. A total of 4 children, of which 4 were the experimental group and 4 were the control group.
Procedure
The purpose of the study was clearly defined for parents, educators and relevant authorities, questions related to Garz test, Wildland Social Skills Development Questionnaire, Teacher Form Social Skills Rating Scale and Rutter Behavioral Disorder Questionnaire (Teacher Form) were completed by the instructor. Treatment was performed in 2 sessions (two days a week, even days) in two sessions of 9 to 2 and 2 to 4 on the experimental group. Of the 4 children, 12 were boys and 4 were girls, and 3 of these children were able to speak. The training was done individually and the exercises were performed by two psychologists of the training and supervision center.
The content of the training program was: communication and social skills, eye contact and pursuit, commandability, motor skills, self-confidence, anger management and impulsivity, attention and concentration, management of maladaptation and antisocial behaviors and stereotyped movements. The description of the intervention sessions was as follows:
Session 1: Getting to know the horse by walking inside the stables and watching the animal from a distance and the trainer's explanation about the horse. Objective: To get acquainted with the animal, to communicate with it, to make eye contact and to adapt to the club environment.
Session 2: Familiarity with the horse and the horse's limbs and making minor contact with the animal. By touching and petting the animal through the parents and trainer, the child is also encouraged to make minor contact with the horse's body through the fingers. Objective: To get acquainted with the horse and communicate with the horse, increase self-confidence and courage, increase eye contact, increase social skills and establish a friendly relationship with the horse.
Session 3: In addition to contact with the horse's body through touching and caressing, as well as getting acquainted with the horse's limbs while petting, they also became acquainted through the parents' role modeling in treating the horse, and with the help of another person, part They treated the horse's body. Objective: sentence comprehension, role modeling, increase commandability, increase eye pursuit; Take turns, increase social skills, drain energy and reduce antisocial behaviors.
Session 4: The horse was treated by a child but not correctly (the brush was pulled up and down on a part of the horse's body). Objective: Increase in social skills, commandability, self-confidence, eye tracking, perception These include motor skills and attention and reduction of hyperactivity, impulsive behaviors and stereotyped movements.
Session 5: In addition to the treatment, there was an acquaintance with animal food, which was given to the horses by the parents, and the children poured the food into the animal's container. Objective: Familiarity with animal food, modeling, commanding, increasing social skills, increasing eye contact and pursuit, increasing attention and concentration, reducing stereotyped movements, increasing self-confidence, independence and reducing hyperactivity.
Session 6: Feeding the horse by the child in a food container and a number of children were feeding the horse with their hands. Objective: To increase commandability, increase self-confidence, increase social skills, increase motor skills, reduce stereotyped movements and increase eye contact and pursuit.
Session 7: Horse restraint was controlled in a controlled environment with the help of a trainer. Of course, the participants would release the horse once every few moments during the performance, and the trainer had to warn them to take the reins. Objective: To increase commandability, increase sentence comprehension, move in the environment, increase attention and concentration, reduce stereotyped movements, increase social skills and reduce maladaptive and antisocial behaviors.
Session 8: Harnessing the horse without a specific path by taking the horse's mouth by the trainer and also not letting go of the horse by the child. Objective: Increase commandability, energy depletion, sentence comprehension, social skills, self-leadership, reduce stereotyped movements, motor skills.
Session 9: Harnessing in a straight line marked with an obstacle. This exercise was done with the help of parents and a coach. Objective: To increase social skills, to increase commandability, to increase attention and concentration, to drain energy, to increase self-confidence.
Session 10: Riding on a specific straight path and riding a horse while still, and some children who were prevented from riding and were afraid, parents were asked to ride a horse and watch their young, and the leash Kill. Objective: To imitate, reduce stereotyped movements, reduce aggression and hyperactivity, increase attention and concentration, motor skills, increase communication and social skills.
Session 11: Harnessing the path that is marked in a circle and this exercise was done with the help of the instructor and parents. Objective: Attention and concentration, increase commandability, increase motor skills, increase communication, socialization.
Session 12: Spiraling through the obstacles that the autistic person did with the help of a mentor and parents, and riding a number of children without help, on a horse, and moving by a mentor or parent. Objective: Increase attention and concentration, increase commandability, increase social communication, reduce hyperactivity and reduce stereotyped movements.
Session 13: Placing two paths marked with an obstacle, one in a straight line and the other in a circle. The child did these exercises with the help of the instructor and parents. Objective: Increase attention and concentration, increase social skills, reduce aggression, k
Research tools
Garz Questionnaire:
The Garz test is a checklist that helps diagnose people with autism. The test is standardized among 1,199 subjects who report on autism in 46 Colombia, Puerto Rico and Canada. Garz or Garz test is suitable for people 3 to 3 years old. Completing this scale is easy for parents, teachers, those who know these behaviors, and the examiner who has the opportunity to observe. The test consists of four subtests, each consisting of 18 items. Each subtest describes the behaviors that indicate autism.
These subscales include: stereotyped behaviors, communication (verbal and non-verbal behaviors), social interaction, and developmental disorders. In this test, which has a high internal consistency, for the subscale of stereotyped behaviors, social interaction and autism, Cronbach's alpha score of 0.9 and above was obtained. For the correlation subscale, 0.9 was close to 9.9, and for the growth damage subscale, it was 2.7, and for the total score (all 5 questions were 0.95 alpha). The test was performed on a sample of 11 people, including 9 boys and 3 girls with a mean age of 9.7, who had autism, and their test was performed again two weeks later.
All test-retest correlations were obtained at the level of significant ٠1/1, which indicates the high stability of Garz. In this test, the following average coefficients were obtained for the validity of validity: stereotyped behaviors (3.1), correlation (4.1), social interaction (2.9) and developmental disorders (3.1), all of which were statistically significant (3.1). > p) Based on these results, it can be said that Garz clean coefficients are acceptable (Ahmadi et al., 2012)
Teachers' Social Skills Rating Scale Questionnaire:
The Teacher Form Social Skills Rating Scale is a test-phrase that consists of a set of three subscales: Inadequacy, Social Skills, and Peer Relationships. This scale is designed to assess various aspects of effective communication in childhood, including: the ability to lead and follow, the level of active participation in organized activities, self-confidence and stability in social situations, social perception and tact in interpersonal relationships. And used by teachers to determine if the phrase is true of students.
The reliability of the social inadequacy subscale based on the alpha coefficient in the sample group of 18 was reported to be 2.9. In the subscale of social skills scale, based on the alpha coefficient in the sample group of 18 people, 3.1 was reported. The reliability of the re-examination of the social skills subscale was also reported to be 91.91.
The validity of this test, which was conducted to assess the validity of children's personality, showed that this scale distinguished between delinquent, hyperactive, cerebral palsy, somatic disorder, retarded and psychotic groups.
Makes. Other studies indicate the optimal validity of this questionnaire (Trascott, 1969).
Wayland Social Growth Scale Questionnaire:
The Wayland Social Maturity Scale is one of the evolutionary scales that deals with a person's ability to meet his or her practical needs and take responsibility. However, this scale covers the age range of birth up to the age of 25 and has separate questions for each year up to the age of twelve. But from the age of twelve onwards, between the ages of 12 and 18, between the ages of 18 and 18, between the ages of 20 and 28, and from the age of 25 onwards, there are common questions. However, it has been shown to be most effective at younger ages, especially in mentally retarded groups. This scale has 112 items that are divided into one-year groups.
In each article, the required information is obtained not through test situations but through interviews with the subjects themselves. The scale is based on what a person is capable of doing in everyday life. The items on the scale can be divided into eight categories: general self-help, self-help in eating, self-help in dressing, self-employment, employment, language communication, relocation, and socialization, depending on the person's scores on the scale. Calculate the power of social age (SA) and social benefit (SQ). This scale was first translated by Dr. Braheni and Okhot for use in orphanages in Tehran and adapted to the characteristics of Iranian culture.
The validity of this scale is that it has been standardized on 620 people (including ten men and ten women) in each age group from birth to 30 years old. It should be noted that in this sample, the number of people in each age group He was young and, given that most of the subjects were from the middle class, such an example could not be considered representative of the whole community. The reliability coefficient of 123 people was reported to be 0.22 with the explanation that the interval of retesting was from one day to 3 months (Braheni, 2003).
Rutter Behavior Questionnaire for Children - (Teacher Form)
This questionnaire was prepared and revised in 1996 by Michael Rutter et al. (4). The Rutter questionnaire has two forms A (parent form) which is completed by parents and form B (teacher form) which is filled in by the student-teacher. Form A has 2 questions and Form B consists of 3 simple phrases that are completed by the teacher and is one of the most common questionnaires to identify children's mental disorders (Rutter ١ 99-Rutter et al. ٧٠ ٧٠, quoted by Iloje ٢ ٢ ٢ ٢). Each question of this questionnaire is given a minimum score of "٠" and a maximum of "٢":
٠ = The behavior described does not apply to the child.
١ = The behavior described only applies to the child in some cases.
٢ = The behavior described is completely about this child
findings
Multivariate analysis of covariance (MANCOVA) was used to evaluate the effectiveness of equine therapy on social development, social skills, and behavioral disorders in children with autism. This test is a type of non-parametric tests and the necessary assumptions for this test were tested to perform it. In order to establish the assumption of data normality, Shapiro-Wilk and Kolmogorov-Smirnov tests were used and the results showed that the significance level is more than 0.05, so the assumption of normality of research data was provided.
Also, to test the assumption of homogeneity of the dependent variable covariance matrix, the box test was used, which shows that the dependent variable covariance matrix is equal for the independent variable levels (group) (P <0.05). The hypothesis of equality of covariances was also tested by Bartlett sphericity test which showed that this hypothesis is valid and there is sufficient correlation between dependent variables (P <0.05). Mean and standard deviation of social development scores from birth to 6 years of age, subscales of social skills, behavioral disorders and autism symptoms of children with autism in the experimental and control groups in the pre-test and post-test stages are reported in Table
The results of multivariate tests of Red Pillay, Lambada Wilkes T. Hotling and second root zinc showed significant overall effects for the subscales of social growth. To examine the effect of group membership on social development scores in the post-test phase is considered. These findings show that the observed differences between the social growth scores of 1 to 2 years were 0.13 h2p = 0.13, p = 0.049, 4.21 = (1.29) F, 2 to 3 years 0.29 = h2p, p = 0.002, 11.43 = (1.29) F, and Social growth for 3 to 4 years was significant for h2p = 0.27, p = 0.003, F = 10.76 (1.29), in terms of group membership (experimental and control groups) in the post-test phase.
The rate of social growth for 1 to 2 years in the experimental group was significantly higher than (94.0SD =; 20.10M =), in the control group (94.0SD =; 46.7M =), in the post-test phase, and 13% of the changes in social growth. 1 to 2 years old children with autism are created as a result of equine therapy training. In addition, the rate of social growth for 2 to 3 years in the experimental group was significantly higher than (80.0SD =; 73.5M =), in the control group (80.0SD =; 86.1M =), in the post-test phase, and based on The effect size can be said to be 25% of the changes in the social development of children aged 1 to 2 years with autism caused by equine therapy training. Finally, 3 to 4 social growth in the experimental group (70.0SD =; 33.4M =) was significantly higher than the control group (70.0SD =; M = 06.1M), and 27% of this change in growth in 3 to 4 years Created exclusively by equine therapy. Social growth at other levels did not show a significant difference in terms of group membership (experimental and control groups) in the post-test stage (P <0.05).
Table 2. Analysis of covariance of social development by group after adjusting pre-test scores
Source of variable changes
Dependent on the sum of the squares of the degree of freedom of the mean squares of the statistics
F Sig effect size
Birth growth group up to 1 year 1.63 1 1.63 0.20 0.665 0.007
Growth 1 to 2 years old 56.03 1 56.03 4.21 0.049 0.13
Growth 2 to 3 years 112.133 1 112.133 11.43 0.002 0.29
Growth 3 to 4 years old 8.0.03 1 8.0.03 10.76 0.003 0.27
Growth 4 to 5 years 9.63 1 9.63 3.40 0.07 0.10
Growth 5 to 6 years 4.80 1 4.80 2.59 0.19 0.08
The results of multivariate tests of Red Pillay, Lambada Wilkes, T. Hotling and Zinc root showed significant effects on social skills. 0.2 = h2p, p = 0.049, 2.98 = (1.29). Group membership is based on social skills scores in the post-test phase. These findings show that the observed difference between the second subscale of social skills is 0.2 h = 0.21, p = 0.010, F = 7.63 (1.29), in terms of group membership (experimental and control groups) in the post-test stage.
This means that the second subscale of social skills in the experimental group was significantly higher than (58.0SD =; 06.13M =) the control group (58.0SD =; 80.10M =) in the post-test stage, and 21% of the changes in The second subscale of social skills of children with autism is developed through equine therapy training. Social skills at other levels did not show a significant difference in terms of group membership (experimental and control groups) in the post-test (P <0.05).
Table 3. Analysis of covariance of social skills by group after adjusting pre-test scores
Source of variable changes
Dependent on the sum of the squares of the degree of freedom of the mean squares of the F Sig statistic effect size
Inadequacy group 4.033 1 4.033 0.59 0.44 0.021
Social skills 38.533 1 38.533 7.63 0.010 0.214
Communication with peers 0.033 1 0.033 0.012 0.913 0.00
Multivariate tests of Red Pillay, Lambada Wilkes, T. Hotling and zinc root also showed significant effects on behavioral disorders. 0.50 = h2p, p = 0.014, 3.84 (1.29). In Table 4, the results of intergroup effects to evaluate the effect of membership. The group observes behavioral disorders in the post-test stage. These findings show that the observed difference between the depression and anxiety subscale of h2p = 0.25, p = 0.010, F = 7.82 (1.29) is significant in terms of group membership (experimental and control groups) in the post-test phase.
This means that the rate of depression and anxiety in the experimental group was significantly less than (SD = 33.0; 50.3M), in the control group (SD = 33.0; 99.4M =) in the post-test phase, and 25% of the changes in Reducing depression and anxiety in children with autism is caused by equine therapy training. Behavioral disorders at other levels did not show a significant difference in terms of group membership (experimental and control groups) in the post-test stage (P <0.05).
Source of variable changes
Dependent on the sum of the squares of the degree of freedom of the mean squares of the F Sig statistic effect size
Hyperactivity Aggression Group 6.549 1 6.549 1.32 0.261 0.055
Anxiety and Depression 10.437 1 10.437 7.82 0.010 0.254
Social Incompatibility 0.336 1 0.336 0.57 0.456 0.024
Antisocial behavior 8.21 1 8.21 2.74 0.111 0.107
Attention Deficit Disorder 0.227 1 0.227 0.16 0.69 0.007
Table 4. Analysis of covariance of behavioral disorders by group after adjusting for pre-test scores
Finally, the results of multivariate tests of Red Pillay, Lambada Wilkes, T. Hotling and zinc root showed that there are significant effects for autism symptom subscales. 0.2 h2p, p = 0.000, 11.86 (1.29). Intergroup is considered to evaluate the effect of group membership on the scores of autism symptom scales in the post-test stage. These findings show that the observed differences between the scores of the skill subscale h5p = 0.55, p = 0.000, F = 34.07 (1.29), in terms of group membership (experimental and control groups) in the post-test stage are significant.
Discussion
The results of the present study showed that hippotherapy on social skills and communication of autistic children after fifteen sessions of hippotherapy was significant, which is consistent with the results of Pali (٠٢٠) research. Ridfer's (1929) research on animals also showed that it can be effective in improving the social and communication abilities of children with autism. A possible explanation could be the emotional connection that children make with animals and living things, even with special needs. In the sense that they learn the right kind of behavior and actually execute it. Also in the present study, the effect of hippotherapy on behavioral disorders (depression and anxiety) has been significant, which can be consistent with the study, Toner (17), which examined the effect of hippotherapy on patients with pervasive developmental disorders. As children get older, they learn different skills, and if this training is in a natural and step-by-step environment, it can happen more easily, especially in the case of children with special needs. It can be effective in learning behaviors. In this study, the effectiveness of hippotherapy on reducing the symptoms and stereotyped movements of autistic children has also been significant, which is in line with the results of Bass study (٢٠٠9) conducted in Japan on children with developmental infiltration. The stereotypical movements of autistic children are mostly due to their lack of sensory integration. With the movements and activities performed with horses, many vestibular and deep sensations and stimuli can be created in these children and lead them to more sensory integration. As a result, we will see a reduction in stereotyped behaviors in these children.
