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

项目概要 在美国，每 54 名儿童中就有 1 名患有自闭症谱系障碍 (ASD)，其定义是社交互动受损 以及受限的、重复的行为。自我调节受损被认为是自闭症谱系障碍所固有的，这一点可以通过 难以管理情绪、对日常活动的生理反应增强以及问题增多 多动、易怒、攻击性、私奔和自残等行为。越来越多的证据表明 与动物互动可以促进自闭症谱系障碍青少年的自我调节。整合动物，例如马， 对患有自闭症谱系障碍 (ASD) 的青少年进行治疗可能会改善结果。然而，人们对它的功效知之甚少 尽管自闭症谱系障碍在实践中越来越流行，但仍将马纳入青少年自闭症谱系障碍的职业治疗中。 这种知识差距导致缺乏指导职业治疗的经验信息，并为职业治疗创造了障碍。 获得服务，因为许多第三方付款人不报销结合马匹的职业治疗费用。 因此，迫切需要确定如何最好地将马纳入职业治疗中 青年自闭症谱系障碍者，并凭经验证明马对治疗结果的附加益处。 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 提高自闭症谱系障碍青少年的自我调节能力。我们的团队创建了理论驱动的标准化干预措施 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 将马匹有目的地整合到职业中 治疗干预以优化自我调节技能的发展。我们还手动进行了临床治疗 诊所职业治疗（OT 诊所）协议，作为所有非动物的控制条件 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 OTEE HORS 可能会改善患有 ASD 的青少年的自我调节能力，但我们尚未进行比较 OTEE HORS 前往 OT 诊所。该项目的目标是量化集成的独特优势 马匹接受职业治疗与临床职业治疗的比较（即 OTEE HORS 与 OT 诊所），以改善患有自闭症谱系障碍（ASD）青少年的自我调节。 64 名 6-11 岁患有自闭症谱系障碍 (ASD) 的青少年将被随机分配到 OTEE HORS (N=32) 或 OT 诊所 (N=32)。 具体目标是 1) 评估 OTEE HORS 与 OT Clinic 相比对自我治疗的初步疗效 调节，2）确定潜在的生理机制，解释马如何整合 职业治疗影响自我调节（唾液皮质醇和唾液α-淀粉酶）。我们的预期 结果包括初步功效数据和生理机制的识别，这些机制解释了如何 将马纳入职业治疗会影响自闭症谱系障碍青少年的自我调节。

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.