Self-Management Intervention for Attention and Executive Functions Using Equine-Assisted Occupational Therapy among Children Aged 6-14 Diagnosed with Attention Deficit/Hyperactivity Disorder

Background: Attention deficit/hyperactivity disorder (ADHD), characterized by inattention, hyperactivity, and impulsivity, is currently one of the most common diagnoses given to children. Children with ADHD have a unique cognitive profile that involves difficulties in executive functions (EFs) and in the self-management system of the brain, and are at higher risk for educational failure, social and emotional difficulties, and high risk behavior. Objectives: The purpose of this study was to examine the effectiveness of self-management intervention for attention and executive functions using equine-assisted occupational therapy (STABLE-OT) for school-aged children with ADHD. Design: A pre-post design was used in the intervention. Setting/location: The study was conducted at two riding school stables is Israel. Subjects: Twenty-five 6-14-year-old children (3 girls, 22 boys, age: 7.8-12.3 years, M = 9.41 ± 1.75) diagnosed with ADHD participated in a therapeutic equestrian riding intervention. Intervention: The intervention included structured 45-min sessions for 12 weeks, while integrating child- and family-centered strategy acquisition and immediate feedback principles. Outcome measures: Their EF and occupational performance were evaluated pre- and post-intervention, using The Behavior Rating Inventory of Executive Function (BRIEF) and the Canadian Occupational Performance Measure (COPM). Results: Results showed a significant improvement in EF, as reflected by statistically significant decreases in the Global Executive Composite (GEC; t = 2.801; p = 0.01), metacognitive index (t = 3.873; p = 0.001), working memory (t = 2.476; p = 0.021), monitor (t = 2.359; p = 0.027), and initiation (t = 3.204; p = 0.004) subscales of the BRIEF questionnaire. A statistically (p < 0.001) and clinically significant improvement was also found in the COPM performance and satisfaction scales. Conclusions: This study provides key preliminary evidence supporting the effectiveness of an individual equine-assisted OT intervention for children with ADHD. It constitutes an initial step toward clinical implementation of such therapeutic approaches, and is expected to spark further research in this area.