‘The Horse Weaves Magic’: Parents and Service Providers on the Benefits of Horse-Based Therapies for Autistic Children—an Australian Qualitative Study

Abstract

Autistic children and adolescents experience a range of co-morbidities, including diagnoses of mental illness. Animal-assisted therapies have advanced rapidly over recent years as an effective and accessible intervention for autistic children and adolescents with various health issues. Horses offer a unique opportunity for interaction as the young person can physically ride the animal, thus creating a therapy with different physical interactions from other animals. This qualitative study had two main aims: first, to understand parents’ experiences of their autistic child’s involvement with horse-based therapies; and second, to understand the experiences of the staff of organisations offering horse-based therapies to those on the autism spectrum. Twelve interviews were conducted with six parents across four interviews (four mothers and two fathers), and eight staff of equine therapy services in eight individual interviews, to understand their perceptions of the child’s experience with horse riding and the perceived mental health impacts. Three emergent themes were prominent among parents and service providers alike: physical and social benefits, including health, self-management skills and social skills; protecting mental health; and recommendations for improvements and accessibility of horse-based therapies. Specifically, service providers with long-standing associations with horse-based therapies saw the actual and potential benefits of horse-based therapies for autistic children, particularly in promoting happiness, calm, resilience, and good mental health.

Introduction

Parents are responsible for decision-making and acting to ensure the welfare and development of their children, until the child reaches the age or level of maturity to be responsible for themselves (Martin et al., 2018). When the child is autistic, this responsibility may continue into adulthood (Parsi & Elster, 2012), particularly when there are co-morbidities such as intellectual impairment or mental illness. Moreover, many parents expand their roles as carers to include advocates, service coordinators, counsellors, researchers, and lobbyists for their children’s physical and psychological well-being and development, supporting the child to achieve their full potential and live meaningful and productive lives (Cleary, West & McLean, 2023).

In addition to their autism diagnosis, autistic children and adolescents may experience a range of co-morbidities, which can include an increased incidence of mental health issues, sleep disorders, and sensory problems. For example, an autistic person is more likely than their neurotypical counterpart to experience mental illness and suicidality (Camm-Crosbie et al., 2018; Schwartzman et al., 2022; South et al., 2021), a risk that is further compounded by reduced social and communication skills (Costescu et al., 2022). To assist those with autism to live more meaningful and productive lives, Parsi and Elster (2012) state that “parents and society have to ensure more opportunities and accommodations for our children” (p. 210). When we understand what parents perceive as opportunities to create more meaningful and productive lives, we are better able to acknowledge how parents define value for their children and how service providers and government agencies can represent and provide this value. One opportunity increasingly utilised to assist autistic children and adolescents is animal-assisted therapies (O'Haire, 2017), either as an intervention on its own or alongside the work of health professionals.

Therapies focused on animals or using animals as tools in traditional therapies are gaining recognition as an effective means of aiding physical development, communication, and socialisation skills. These therapies have achieved positive outcomes with a range of animals (O'Haire, 2017; Rehn et al., 2023; Sissons et al., 2022; Wijker et al., 2019). When we consider the motivations of people who provide these services, as well as the benefits they see others drawing from the experience, we are better able to support these services and maximise volunteerism within services. In turn, this increases the potential for considerable positive outcomes.

Equine therapy provides unique opportunities for the young person because the horse is physically ridden, thus creating a therapy with a different level of interaction than other animals (Højgaard-Bøytler & Argentzell, 2023). The benefits are physical, behavioural, social, and psychological. With regard to the physical benefits, recent studies identified improved gross motor skills (i.e. running and jumping), postural control, balance, coordination, flexibility, and core strength (Boyd & le Roux, 2017; Buchanan & Higgins, 2023). Additionally, horse riding demands heightened focus and strong communication skills from the rider, alongside the ability to physically coordinate and control the horse, which requires refined muscle control (Clayton et al., 2023; Fine, 2019). Horse-based therapy has also led to improvements in social functioning and empathy; and reductions in nonadaptive (Trzmiel et al., 2019; Xiao et al., 2023) and aggressive behaviours (Buchanan & Higgins, 2023; Trzmiel et al., 2019). Moreover, the bond formed between the rider and the horse encourages various physical, behavioural, and social improvements, leading to positive outcomes (Bass et al., 2009; Törmälehto & Korkiamäki, 2020).

From a psychological point of view, equine-assisted therapy has shown promise in enhancing social skills and communication, reducing problematic behaviour, autism severity, and stress in individuals with autism spectrum disorder (Punzo et al., 2022). This is besides improved mindfulness and the positive impacts on self-confidence, self-esteem, a sense of achievement, and perceived joy (Boyd & le Roux, 2017; Buchanan & Higgins, 2023). Interestingly, these positive psychological impacts have also been found in the parents of autistic children (Buchanan & Higgins, 2023).

A recent scoping review on the benefits of horse-based therapies found limited published research on the perceptions of parents and service providers (Cleary et al., 2024), with most of the research identified focusing on the observable or measurable benefits of horse riding for children and adolescents with diagnoses such as autism. Considering the mental health benefits, the review found limited research on the perceptions of parents and no studies on service providers’ views. Of particular concern is the limited research on the views of parents, who are the first to note improvements in an area of their child’s physical health, behaviours, or psychological well-being and the people most likely to reinforce these improvements (Buchanan & Higgins, 2023).

The qualitative study reported in this paper had two aims: first, to understand parents’ experiences of their autistic child’s involvement with horse-based therapies; second, to understand the experiences of the staff of organisations offering horse-based therapies to young people on the autism spectrum. These aims are strongly connected, as parents and service providers work together when supporting autistic children to engage in this therapy. The overall objective of the study was to address an identified gap in knowledge on the specific mental health benefits of horse-based therapies for autistic children and adolescents. Addressing more than one aim and objective is a common approach in qualitative research, focussing on an area of interest where there is a dearth of information on the topic of interest (Barroga & Matanguihan, 2022). Multiple aims and objectives enable a broader exploration to better gauge the related issues.

Methods

Ethics approval to conduct this research in Australia was granted by the CQUniversity Human Research Ethics Committee (Application reference: 0000024610). Following permission from group administrators, posts on autism-related social media (such as Facebook) were used to recruit parents and carers. Recruitment of service providers occurred through a direct approach via email to organisations that offer horse riding to people with special needs across Australia. Inclusion criteria for participation were parents and carers of autistic children who have been involved in horse-based therapies, as well as staff of organisations that offer this service.

Individual semi-structured interviews were conducted by a trained, experienced interviewer (MC) and were held at the participant’s convenience via video conferencing or phone. During February-March 2024, interviews lasted between 21 min and 51 min (average 35 min, excluding pre-interview discussion and post-interview debriefing). All aspects of the study were explained, and consent was obtained prior to commencing the recorded interview. All people expressing an interest in participating in the study were interviewed, resulting in 12 interviews with 14 participants, as two interviews were conducted with both parents present.

Four interviews with six parents commenced with the collection of demographic data before moving on to explore the child’s experience with horse-assisted therapy. Topics (drawn from the research, professionals, and ‘lived experience’ literature) covered the child’s first introduction to horse riding and their initial responses to the experience. Parents and carers were questioned on their perceptions of the benefits or impacts of horse riding on the child. Service providers’ topics included the service itself and horse-based therapies within that service. Providers were asked about the children who use the service and the provider’s perception of the children’s reactions and positive and negative impacts of using the service. As no child or adolescent was interviewed, there was no need to use a specific tool to measure current mental health and words indicative of mental health used in the interviews by parents and service providers were considered to gauge perceptions of mental health impacts.

Braun and Clarke’s (2021a) six-phase process for reflexive thematic analysis was followed to identify codes and find patterns to develop and review themes. Interviews were transcribed, checked for accuracy, and de-identified before being reviewed, then categorised to identify recurring ideas and themes (SW, MC).

Rigour was achieved in this research by consistency in data collection, with one interviewer conducting all interviews and being responsive to the participant’s responses. While an interview guide was used, the questions asked of participants were semi-structured, meaning participants may not have provided answers to precisely the same questions. The usefulness of data saturation as a concept for ensuring validity within the reflexive thematic analysis is questionable, according to Braun and Clarke (2021b). Instead of attempting to achieve saturation, coding was interpretive and reflected the researchers’ deep engagement and reflexive interpretation of the data (Braun & Clarke, 2021b). Direct quotations have been used to demonstrate the essence of the theme to establish validity and credibility.

Guidelines for respectful and accurate reporting on autism and autistic people by the autism advocacy group Amaze (2021) identify the preference for the use of identity-first language (autistic person) and consistent with this, we have used throughout this study to empower autistic people (control the discourse around diagnoses and experiences) (Amaze, 2021; Cleary, West, Kornhaber et al., 2023).

Results

A total of 12 interviews were conducted with parents and staff of equine therapy services to understand their perceptions of the child’s experience with horse riding and the perceived mental health impacts. Eight interviews were with service providers, including volunteer providers, two interviews were with mothers of autistic children or adolescents, and two interviews were with both the mother and father of an autistic child, bringing the total number of participants to 14. All eight service providers interviewed were female.

Three main themes emerged from close analysis of the transcript: physical and social benefits, protecting mental health, and recommendations for improvements and accessibility of horse-based therapies. These themes highlight the common, shared experiences of the parents and service providers, including their depth of understanding of the benefits and challenges for the autistic children. This commonality is perhaps not surprising, as parents and services providers work together when supporting autistic children to engage in this therapy. It also provides insights into the motivations of the parents and services providers, thereby contributing meaningfully to the body of knowledge on this subject.

The findings for each group are presented separately because of the differing contexts and positionalities of the parents and service providers. However, the recommendations are presented together to better support the collaborative work of the parents and services providers in this important area of therapy.

Experiences of the parents

Six parents, four mothers and two fathers, provided an account of their experiences with horse-based therapies for their autistic child or children. To maintain the privacy of these parents, all demographic information is provided in a generalised format, rather than tabulated. Of the four children, three were female and one male, with one of the females self-identifying as non-binary (the parent identified the child as female and used she/her pronouns to describe their child and for the sake of faithfully representing the parent, these are replicated here). One of the children had a twin who was also diagnosed as autistic. The ages of the children ranged from 9 to 17 years, with a diagnosis of autism occurring between the ages of 22 months and 7 years. All four children were currently classed as Level 2 autism (requiring substantial support), with one child initially being diagnosed as Level 1 (requiring support) and another child initially at Level 3 (requiring very substantial support), with both being reclassified as Level 2 at a later stage. Three of the children had an additional diagnosis of attention deficit hyperactivity disorder (ADHD), one had a genetic mutation syndrome, one had a mild intellectual disability, one had formally diagnosed anxiety and one was considered by their parent to have anxiety without a formal diagnosis.

The four children were all engaged in horse-based therapies by their parents, with one initially connecting with horse riding through a school-initiated program and then enrolled independently by the parents after this. Three attended general horse-riding schools, one of which had a specialised disability program. The fourth was a disability-specific school that included physiotherapy and hippotherapy. All four children were involved in horse riding, while three were also engaged in grooming and horse care. In addition, one school offered education, such as a Certificate in Horsemanship.

The parents’ motivations for engaging their children in horse-based therapies and the goals they hoped to achieve were varied. For one parent, their child had always shown an interest in animals and a successful pony party was the catalyst for ongoing lessons. A second parent reconnected with the idea of horse riding by chance, facilitated by the allocation of funding under the Australian Government’s disability insurance scheme specifically for physical and social improvements. Another parent hoped for their child to improve core strength and listening skills, while another parent confessed to liking horses and seeing the possibility of their child to regulate their nervous system.

Parents identified three overarching themes: physical and social benefits, protecting mental health, and recommendations for improvements and accessibility of horse-based therapies.

Physical and social benefits of horse-based therapies

The accounts of the six parents (across four interviews) regarding the physical and social (including communication) benefits explained their experiences as unique, with the perceived benefits equally unique. There was almost no overlap between the parents’ stories. For Participant 1, the most readily identified benefit was that the child was not treated differently or given special dispensations on account of their autism.

They just get her, and they’re like, oh, no, no, no excuses. Just get on and do it. Like there’s no reason why you can’t get on and do it.

This approach brought about an increased sense of responsibility in their child—a benefit also reported by another parent, Participant 4. In addition to responsibility, Participant 4 perceived physical improvements in balance and a change in communication skills. The child had originally been non-verbal but was now described as verbose. Such was the turnaround in the child’s language skills that Participant 4 commented:

…he in the end, after two years, wasn’t eligible to attend there [a specialised language school] anymore because he scored so highly on the… speech and language assessment.

For Participants 11 (a mother and father), the benefits centred heavily around social skills. They identified that their child felt reduced pressure when with horses, as the focus shifted to the horse more than the child. Horse riding had brought the child in contact with other children at the centre with whom she would now interact, something which was not normally achieved in other social settings. This interaction had extended, to some degree, into other areas of the child’s life, with the mother providing the following anecdote:

She does things now, like speaking to a teller [cashier]. If the teller goes, “Oh, how’s your day going?” She’ll go, “Good, thank you.” Whereas she would never have done that.

Like Participant 11’s focus on socialisation skills, the primary benefit Participants 9 (again, a mother and father) perceived was their child’s integration into a new school. The child’s love of horses was shared with another student and formed the basis of a bond between them, thus easing the child’s way into an unfamiliar school setting. The parents measured this benefit by the fact that she had been able to stay at the new school for full days. This was considered part of a bigger overall change in confidence for their child.

…she’s got a way of – I don’t know, almost crumbling into herself. When she’s there [horse riding], she stands up tall, has her head up high…

In addition to social skills, Participants 9 were also cognisant of an increase in their child’s core strength, which they linked to her full engagement with horse riding and doing associated chores at the horse-riding centre. They noted that the readiness to undertake chores was yet to extend to the home.

Protecting mental health

The discussion of mental health benefits or protective factors for good mental health was readily discussed, with all four interviews with parents yielding results on this topic. Participant 1 had a powerful story to relay regarding the direct mental health benefits they attributed to horse riding. Although their child had no formal diagnosis of a mental health disorder, Participant 1 described their child as having significant anxiety associated with their first encounters with horse-based therapy. The participant considered this typical in autistic children, who experiences ‘large emotions’ that they are often unable to manage. Participant 1 believed that children in these circumstances needed to learn how to work through such emotions rather than control them and that horse-based therapy had been the key to achieving this for their child. There had been an experience of suicidal ideation and self-harm with the child, including hospitalisation. However, these experiences had now stabilised:

I honestly can say, and I’m not being overdramatic, that horse riding is the glue that held us together.

Participant 1 saw an increase in resilience in their child, a resilience that was noticed and commented upon by staff at the horse-based therapy centre. This resilience was also observed at home, school, and when training their horse. Anxiety was a formal diagnosis for the child of Participant(s) 11, and horse-based therapy was perceived as the route by which their child had developed resilience in situations that otherwise would have made them anxious:

It’s given her little goals where she can meet the goal and go, “Oh, I did this”.

This was the same experience for Participant 4. They recounted a story of their child sliding off a horse. The parent initially thought the child would be physically injured and responded with fear. However, the child got up immediately and said, “That was fun”, which was unlike their usual response to such situations.

For Participants 9, there were a broader range of perceived benefits. Again, despite no formal diagnosis of a mental health disorder, Participant 9 discussed their child as being in a constant state of ‘fight or flight’ because of anxiety, particularly in the school environment. Their involvement in horse riding was viewed as the tool by which their child had managed to regulate their anxiety and allowed for a more enduring sense of happiness, calmness, and ability to self-regulate:

…we usually do it at the start of the week…and I think it really helps to set her up to have a good emotional week.

Involvement in the social environment of horse-based therapy also improved their child’s sense of social support, and they subsequently felt a stronger determination to be involved in what was happening at the centre.

Experiences of the service providers

Eight people involved in the provision of horse-assisted therapies consented to be interviewed. All worked in a volunteer capacity, with four working as coaches, two in an unspecified volunteer role, one as the secretary of the centre, and one as the owner who provided the services. Seven of the eight identified their centres as specialised disability riding centres and one owned a charity that provided equine-assisted learning. The centres had a mix of school groups and individuals, riders with physical, cognitive, and intellectual disabilities, children and adults, including veterans. Autism featured heavily amongst the users of their service, with a range of 50-90% of users being autistic.

One participant described the aim of their service was to “try and do the minimum we can to help them with the aim of them becoming independent” (Participant 2). For another participant, they were clear in articulating that they did not provide a therapeutic service:

We have no claim or pretence that we’re providing a therapeutic situation. We do have goals but they’re rather simple…? They’re enjoy the ride, build your confidence, have fun, come back next week, be a bit stronger, learn to steer, simple things… (Participant 12).

The centres at which the participants volunteered all provided training to the other volunteers, such as horse handling skills, with four of the eight specifically mentioning training in relation to disabilities and disability handling techniques. Two of eight mentioned their service as having paid employees—an administrative employee (Participant 10) and an autistic person in an unspecified role (Participant 5). One centre (Participant 5) aimed to recruit an occupational therapist to their centre, whilst another (Participant 2) had an officer skilled in government disability funding whose role was to assist parents and service users to have horse-assisted therapies included in their funding packages.

Four of eight mentioned their services having a waitlist, from less than two years up to three years, with one described as “huge” (Participant 10). Only one (Participant 7) said their service had no waitlist.

A consistent discussion point amongst service providers (owners, coaches, or general volunteers) was their background and motivation for volunteering in horse-assisted therapies. All eight mentioned a love of, and history of involvement with horses, including horse riding as a child and horse ownership. One participant (Participant 10) suggested that this love of horses allowed for a natural segue to working with autistic clients:

…working with horses is a bit like working with people on the spectrum, they don’t like surprises. So, I find a lot of people who are good horse people, intuitively work quite well with our clients.

Six of the participants had a background in healthcare, including two retired physiotherapists, a retired manager in the health sector, a retired disability carer, a former crisis counsellor, and a participant who had been the carer of a dying parent until their passing. The two with no mention of a healthcare background both cited seeing joy on the faces of people using the service as a motivating factor to volunteer. One even reduced their paid work by one day a week to volunteer and eventually used a redundancy to establish a horse-assisted learning charity and build the infrastructure required to run it.

Physical and social benefits of horse-based therapies

Service providers articulated perceived benefits for autistic children and adolescents using their service in five key areas: physical improvements, desensitisation, self-care, communication and confidence and assertiveness.

All eight service providers mentioned physical benefits, including improved core strength, coordination, hand-eye coordination, balance, and general reference to horse-assisted therapies being a form of physiotherapy. Participant 5 clarified that they believed improvements in balance and coordination came from the range of activities done during each session rather than just horse riding. Participant 2 linked physical improvements to the ability to control their horse, which led to a sense of independence in the child. They noted that a sense of independence also facilitated improved confidence. Participant 5 perceived confidence as coming from the need to be more assertive with ‘bossy’ horses and provided an anecdote of a client who had used this newfound confidence during a job interview when they were able to utilise breathing techniques and maintain calm during what would otherwise have been a nerve-wracking situation.

Horse-based therapies were perceived by Participant 10 to desensitise some autistic children to some restrictive practices. They gave the examples of a child constantly closing gates and using sessions to slowly leave gates open for longer and longer periods of time or gradually getting a child used to someone touching their leg by asking to manoeuvre them on the horse. The same participant also mentioned children using sessions to develop life skills, such as empathy, self-control and even hygiene through the brushing of the horses, while Participant 5 talked of children being taught the importance of tooth brushing or overall bodily health by referring to the horse’s health.

Three participants (5, 6, 7) mentioned communication as improving through horse-based therapies, including confidence, allowing autistic children to communicate with others, and improved listening. Participant 7 recounted an experience with one autistic boy who had thanked them at the end of a session, which was the first time that child had ever spoken in public.

The speed with which improvements and benefits were noticed was referenced by one participant (5), who said, “There’s not many that haven’t had a fairly big turnaround in the first session”. Despite knowing that horse-based therapies do make physical, communication or other such improvements, Participant 12 surmised that the true underlying ways in which horses brought about such significant changes were still unknown to them:

I know it makes a difference in the moment and you know, we accept that we don’t know…but the horse weaves magic.

Protecting mental health

The eight service providers all perceived and articulated the benefits of horse-based therapies for promoting protective factors for good mental health. No service provider made explicit mention of mental health or mental health disorders, except for Participant 3 who used the term ‘anxious’ to describe the behaviours of one child. However, this was mentioned in the context of fear and resilience, rather than a mental health diagnosis of anxiety.

All service providers, except for Participant 10, readily described improvements in happiness and calmness amongst the autistic children and adolescents engaged in horse-based therapies. There was happiness at being at the centre, smiles and vocalisations of happiness, a calming effect being on the horse, a relaxation as children waited their turn, the use of deep breathing to promote calm, and the perception of a calming effect occurring “instantly” (Participant 8). This sense of calm was noted by one participant (2) to have extended to the school environment, thus indicating a longer-term and more transferable benefit.

Consistent with this theme of happiness and calmness, three service providers mentioned reduced fear and increased resilience (3, 8 and 12). Initial apprehension through to being terrified gave way to demonstrations of happiness and calm and longer-term resilience in the face of similar situations. Participant 8 also added that horse-based therapy helped to improve a child’s self-esteem:

And I think where you can give someone self-esteem and you can give someone the ability to look at themselves in a different way, that has to be a good thing.

Three participants (8, 10 and 12) commented on improvements in the child’s ability to regulate their own behaviour. This often came about naturally after being on a horse or was brought about through targeted activities to reduce triggers, manifesting as increased patience, decreased aggression, and the rarity of meltdowns at the centres. Participant 3, when recalling one child experiencing a meltdown, noted that the horse seemed to instinctively know what was occurring and stood still as the child was assisted off the horse, demonstrating a conscious effort by the horse to aid in this situation:

[The horse] was just amazing. So, I do think they pick up on the different rider’s abilities or anxieties.

Parent and service providers’ recommendations

In addition to asking parents and service providers to discuss their perceptions of how horse-based therapies have helped autistic children and adolescents, the interviewer also asked for and collated recommendations made. Four parents (from three interviews) and six service providers gave such recommendations. As previously noted, these recommendations were collated and provided in combination.

Consistency vs change

The need for change conflicted with the need to avoid change. Participant 1 (a parent) called for each child to have a consistent trainer but not a consistent horse to encourage skills in adapting to and building relationships with a range of horses. However, Participants 2, 10 and 12 (service providers) stated that they deliberately try to give the same horse and/or trainer to minimise change.

Funding and accessibility

The need for horse-based therapies to be funded by the government’s disability insurance scheme rather than directly by parents was, interestingly, mentioned by three service providers (Participants 3, 8, and 12). Participant 8 (service provider) recommended that parents who sought to have horse-based therapies covered by the disability insurance scheme should word the request carefully, stating that mention of ‘enjoyment’ rather than ‘therapy’ would result in a rejection by the scheme. One mother (Participant 9) mentioned that the therapy was value for money and that proactive funding of this by the government would save money further down the line.

Accessibility

Two parents and one service provider discussed different aspects of accessibility. This included geographic accessibility (Participant 1—parent), readable and relevant research about horse-based therapies (Participant 5—service provider), and more accessibility through reduced waitlists or increased numbers of service providers (Participant 9—father).

Other recommendations

Several other recommendations were made. These were: the need to listen to one’s gut feelings on what might be successful for their child (Participant 1—parent); involving parents in horse-based therapies by training them as volunteers (Participant 10—service provider); and having allied health professionals at horse-based therapy centres to aid therapeutic interventions and increase credibility (Participant 5—service provider). Additional recommendations included wider recognition of the physical and psychological value of horse-based therapies (Participant 4—parent); acceptance of horse-based therapies as an essential part of treatment (Participant 9—father); and a belief that horse-based therapies will manifest success (Participant 4—parent).

Discussion

Findings derived from the interviews with six parents and eight horse-based therapy service providers extend the body of knowledge supporting the positive benefits of horse-based therapies, particularly for those on the autism spectrum. Parents and service providers identified many benefits related to mental health, physical health, self-management skills, and social skills.

Parents were the only ones to make explicit reference to mental health and illness (anxiety and suicidal ideation). For factors that protect and promote good mental health, there was high consistency between those discussed by parents and service providers, with happiness, calm, resilience, and self-regulation discussed by both groups of participants. These protective factors correlate with those identified in the research literature, including happiness/calmness (Layous et al., 2014), resilience (Taylor et al., 2022), strong social support (Hedley et al., 2018), self-esteem (Cooper et al., 2017), and self-reassurance/self-regulation (Barcaccia et al., 2022). On the reverse, factors such as masking autistic traits and behaviours are among the most significant in catalysing poor mental health and autistic burnout (Cleary, West, Kornhaber et al., 2023). Neither parents nor service providers mentioned issues with masking by the children while involved in horse-based therapy.

There was much lower consistency between parents and service providers in identifying the physical and social benefits of horse-based therapies for the children. Physical improvements, such as core strength, were the only ones to be discussed by both participant types. Parents tended to focus more on social skills and a sense of responsibility, whilst service providers discussed the benefits of self-care, desensitisation to triggers, improved communication skills and confidence.

Findings of the research indicate that parents and service providers more readily see the benefits of horse-based therapies in generating states of being that support or enable good mental health, rather than pointing to specific improvements in levels of mental health. Parents and service providers seemed to understand how factors such as improved self-esteem, resilience and happiness were beneficial to good mental health. Protective factors for good mental health have featured heavily in autism research (e.g. Emberti Gialloreti et al., 2019; Heselton, 2023). For example, whilst autistic burnout poses significant negative effects on an autistic person’s mental health, this burnout can be reduced through engagement in enjoyable activities, increased self-awareness and coping strategies, social support and a sense of community and connectedness (Mantzalas et al., 2022). All these elements were reflected in the interviews in this study.

The findings were also largely supportive of the relationship between horse-based activity and the perceived benefits, even when the precise reason for these benefits could not be fully understood. Horses were perceived as instinctively understanding the child and their needs, which helped to encourage the sense of bond developing between animal and child. These suggestions are supportive of research on the mental health benefits attributable to a range of animal interventions. For example, a recent scoping review on cat therapy and companionship for autistic children found, consistent with this study, that these animals fostered a sense of responsibility amongst autistic children, advanced understandings of self-care and health, and improved communication and social skills (Cleary, West, Thapa et al., 2023). Another study found frequent reporting of the significance of dog ownership in reducing suicide and suicidality (Barcelos et al., 2021), whilst another found evidence of improvements in social skills and communication amongst autistic children through dolphin-assisted therapies (Griffioen et al., 2019). Again, these findings were consistent with the accounts of parents and service providers in this study.

The benefits derived from horse-based therapies extend beyond autism. Examples of the therapeutic benefits have been found in equine-assisted psychotherapy (Lee & Makela, 2015), in the treatment of trauma (Worms, 2009), in engaging marginalised youth (Waite & Bourke, 2013), and in the treatment of substance abuse (Cody et al., 2011). This points to the extended applicability of the role of horses in supporting therapeutic interventions and hints at the potential scope for further research and application to include the benefits for diverse population groups.

In terms of applying models used elsewhere in mental health, the common factors model in psychotherapy holds that all therapies substantively build upon a therapeutic relationship, regardless of the specific therapy modality (Wampold, 2015). The benefits described here for horse-based therapies seem to build upon the relationships built up with the horses, as well as with the providers and community around the activity, as well as offering the additional sensory and physical value of the riding and grooming. We know that many aspects of social regulation are mammalian, with functional social behaviour fundamental to successful relationships and communities (Kozlowska et al., 2015). It is perhaps not surprising, then, that the social regulation derived from regular contact with an attuned animal and supportive community, as experienced by the autistic child involved in horse-based therapy, is experienced as regulating and/or enables the development of emotional regulation for the child and consequently, their wider family system.

Limitations of study

The most notable limitation of this study was the inability to generate results specific to the aim of understanding mental health benefits. Whilst there was considerable discussion of those factors that might be protective of good mental health, such as resilience or social skills, there was little discussion specific to mental health disorders and the benefits noted in minimising the severity of symptoms or extent of their impact on a person’s quality of life. This was particularly evident in relation to the perceptions of service providers, although this might be expected with the limited time service providers spend interacting with autistic children when compared to their parents. More targeted, perhaps quantitative research, particularly with sample populations that have identified mental health disorders, might provide a greater depth of understanding in this area. It may also involve invoking some of the ideas in psychotherapy and current neurobiology more explicitly and sounding out responses by parents and providers to these. While these ideas are somewhat intuitive, they are not common knowledge, and perhaps some targeted interviewing around them would test whether they sit well with those with lived experience as parents and providers.

The study was also limited in that most parents interviewed were mothers, with only two fathers interviewed alongside their spouses. All service providers were female. While this creates a gender imbalance amongst participants, it is also reflective of the realities of parenting and volunteerism. In Australia, for example, mothers still account for over half of primary caregivers in families with dependent children, with only 4% having a male as the primary caregiver, suggesting mothers are more likely to be involved with the child’s therapies (Department of Prime Minister & Cabinet, 2023). Women are closing the gap with men in volunteering and are increasingly participating in altruistic voluntary activities (Organisation for Economic Co-operation and Development, 2015). Women make up 57% of volunteers globally and are more likely to volunteer in areas of social and health services than men (Borromeo, 2021). This places more likelihood on women volunteering at horse-based therapy centres.

The authors also note that the study has a small sample size of 14 participants across 12 interviews. This sample was limited by the opt-in nature of the research and a restriction that prevented any direct approach to possible participants. This ensured that there was no inference of undue influence on participants. The total number of participants remains unnecessary to achieving rigour in the results, as discussed by Braun and Clarke (2021b). They argue that recurrence is not the only important element in determining the strength of a theme, but that the importance of the theme to the research question is equally as compelling. As the themes produced were shared amongst participants and were directly connected to the research aims, the sample size has achieved the intended outcome.

The study was also somewhat limited by the length of some interviews. The length of interviews was determined by the story(ies) shared by the parents and service providers, and their availability. Many parents of autistic children expressed considerable time constraints, a reality that was described by several of the participants in this study - ‘We are very busy’ (Participant 4); ‘We are kept very busy’ (Participant 5); ‘I’m just—yeah, quite busy, really stressed’ (Participant 9). This lack of time is indicative of the considerable commitment of parents to their caring responsibilities for a child with complex disabilities.

Conclusions

This paper reported the findings of a study exploring the experiences of parents and service providers in supporting autistic children with horse-based therapy. The findings of the study provide a range of insights that adds to the body of knowledge related to animal-assisted interventions, including the physical, social, and emotional benefits. The findings also emphasise that parents and service providers alike are keen to find effective ways to help autistic children achieve the best quality of life possible by using novel ideas and approaches. Findings also highlight the strong volunteer base in the community that aims to combine a love of horses, an interest in healthcare, and a desire to do something meaningful for the betterment of others, particularly children. An often longstanding association with horses allows all service providers to see the potential in horse-based therapies, including the benefits experienced by autistic children, witnessed by parents, and enjoyed by all.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Partially funded by the 2023 CQUniversity Internal Research Grants Round 2 RSH/6793.