Preliminary efficacy of occupational therapy integrating horses on self-regulation in youth with autism spectrum disorder

项目摘要 在美国，每54个孩子中就有一个患有自闭症谱系障碍（ASD），被定义为社会交往障碍 和限制性的重复行为自我调节受损被认为是ASD固有的，如以下所示： 情绪管理困难，对日常活动的生理反应增强， 行为如多动症、易怒、攻击性、私奔和自伤。越来越多的证据表明 与动物的互动促进了患有ASD的年轻人的自我调节。把动物，比如马， 治疗青少年ASD可能会改善结果。然而，关于其功效知之甚少。 将马纳入ASD青少年的职业治疗，尽管其在实践中越来越普遍。 这种知识差距导致缺乏经验信息来指导职业治疗，并造成障碍， 获得服务，因为许多第三方付款人不报销整合马匹的职业治疗。 因此，迫切需要确定如何最好地将马纳入职业治疗， 青少年ASD，并实证证明了马对治疗结果的附加效益。 我们的长期目标是将马匹纳入职业治疗作为一种循证实践 来提高ASD青少年的自我调节能力我们的团队创造了一种理论驱动的标准化干预 一本名为《马环境中的职业治疗：利用职业进行自我调节》的手册 技能”（OTEE HORS）。OTEE HORS将马匹有目的地融入职业 治疗干预，以优化自我调节技能的发展。我们还将临床治疗 方案，诊所职业治疗（OT诊所），作为所有非动物的对照条件 干预的要素。我们已经证明，OTEE HORS和OT Clinic都是可行的， 实施并为家长、青少年和职业治疗师所接受。我们的初步疗效数据 表明两种OTEE HORS都可以改善ASD青年的自我调节，但我们还没有比较 OTEE HORS呼叫OT诊所本项目的目标是量化集成的独特优势 职业治疗中的马与诊所中的职业治疗相比（即，OTEE HORS与OT 临床），以改善自闭症青年的自我调节。 64名6-11岁的ASD青少年将被随机分配至OTEE HORS（N=32）或OT诊所（N=32）。 具体目的是：1）与OT Clinic相比，评估OTEE HORS对自我治疗的初步疗效， 调节，和2）确定潜在的生理机制，解释如何整合马， 职业治疗影响自我调节（唾液皮质醇和唾液α-淀粉酶）。我们预期的 结果包括初步的疗效数据和生理机制，解释如何识别 将马纳入职业治疗影响ASD青年的自我调节。

PROJECT SUMMARY One in 54 children have Autism Spectrum Disorder (ASD) in the U.S., defined by impaired social interaction and restricted, repetitive behaviors. Impaired self-regulation is believed to be inherent in ASD, as evidenced by difficulty managing emotions, heightened physiological reactivity to daily activities, and increased problem behaviors such as hyperactivity, irritability, aggression, elopement, and self-injury. Growing evidence suggests that interacting with animals promotes self-regulation in youth with ASD. Integrating animals, such as horses, into therapy for youth with ASD may improve outcomes. However, very little is known about the efficacy of integrating horses into occupational therapy for youth with ASD, despite its growing prevalence in practice. This knowledge gap results in scant empirical information to guide occupational therapy and creates barriers to access services, as many third-party payers do not reimburse for occupational therapy that integrates horses. Consequently, there is a critical need to establish how to best integrate horses into occupational therapy for youth ASD, and empirically demonstrate the additive benefit horses have on therapy outcomes. Our long-term goal is to establish integrating horses into occupational therapy as an evidence-based practice to improve self-regulation in youth with ASD. Our team has created a theory-driven, standardized intervention manual called “Occupational Therapy in an Equine Environment: Harnessing Occupation for self-Regulation Skills” (OTEE HORS). OTEE HORS operationalizes the purposeful integration of horses into an occupational therapy intervention to optimize development of self-regulation skills. We also manualized a clinical treatment protocol, Occupational Therapy in a Clinic (OT Clinic), to serve as a control condition for all non-animal elements of the intervention. We have demonstrated that both OTEE HORS and OT Clinic are feasible to implement and acceptable to parents, youth, and occupational therapists. Our preliminary efficacy data suggest that both OTEE HORS may improve self-regulation in youth with ASD, but we have not yet compared OTEE HORS to OT Clinic. The goal of this project is to quantify the unique benefits of integrating horses in occupational therapy compared to occupational therapy in the clinic (i.e., OTEE HORS vs. OT Clinic) for improving self-regulation in youth with ASD. Sixty-four youth with ASD ages 6-11 years old will be randomized to OTEE HORS (N=32) or OT clinic (N=32). The specific aims are to 1) estimate the preliminary efficacy of OTEE HORS compared to OT Clinic on self- regulation, and 2) identify potential physiological mechanisms that explain how integration of horses in occupational therapy impacts self-regulation (salivary cortisol and salivary alpha-amylase). Our expected outcomes include preliminary efficacy data and identification of physiological mechanisms that explain how integrating horses into occupational therapy impacts self-regulation in youth with ASD.