The Feasibility and Acceptability of Occupational Therapy in an Equine Environment for Youth with Autism Spectrum Disorder

Background: Equine-assisted services are promising, yet supporting research is limited. This Phase 2 study sought to assess the feasibility and acceptability of the newly manualized intervention and assessment protocol for occupational therapy in an equine environment for youth with autism spectrum disorder (ASD). Method: A multi-site randomized controlled design was implemented. Twenty-four youth with ASD, age 6-13, were randomized to receive occupational therapy in an equine environment or in a garden environment. Feasibility indicators included rates of recruitment, treatment delivery, attendance, attrition, fidelity, and assessment completion. Acceptability was assessed with satisfaction surveys (parents and therapists) and focus groups (therapists). Results: Twenty-three participants completed the study, attending 89% of occupational therapy sessions in the equine environment, and 88% in the garden environment. Providers achieved 93.7% fidelity to the experimental intervention, and 94.0% fidelity to the control condition. Parents and study staff completed 100% of outcome assessments, however only 54% and 80% of blinded raters in the experimental and control conditions completed all assessments. Parental satisfaction was highest for the experimental intervention (89.7%). Occupational therapists expressed satisfaction with the evaluation (90.7%) and intervention (93.3%), and provided recommendations for future studies. Conclusions: The manualized intervention and assessment protocol is feasible to implement and acceptable to parents and therapists. Future studies can schedule make-up sessions, improve blinded rater assessment completion, and make minor modifications to the study protocol.