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Effects of 4 Weeks of Horseback Riding on Anxiety, Depression, and Self-Esteem in Children with Attention Deficit Hyperactivity Disorder

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Background and Objective: There is no report on the effects of horseback riding on children with attention deficit hyperactivity disorder (ADHD). Therefore, the purpose of this study was to determine the effects of 4 weeks of horseback riding on anxiety, depression, self-esteem, attention, and learning disorder in children with ADHD. Material and Methods: Subjects comprised a convenience sample of 10 children aged 10-12 years with ADHD and 10 children without ADHD. Horseback riding sessions were performed 2 times (40 minutes/day) per week for 4 weeks. Before and after the horseback riding program, we measured the children’s anxiety, depression, self-esteem, attention, and learning disorder. The pre-test and post-test scores were analyzed with repeated-measures analysis of variance. Results: After participating in the 4-week horseback riding program, anxiety (p = 0.013), depression (p = 0.007), attention (p < 0.001), and learning disorder (p < 0.001) were significantly improved in the ADHD group compared to the control group. However, self-esteem was not significantly different between the two groups (p=0.096). Conclusion: These results indicate that the 4-week horseback riding program used in this study was very effective for significantly improving anxiety, depression, and attention in children with ADHD.
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e1
EFFECTS OF 4 WEEKS OF HORSEBACK RIDING ON ANXIETY, DEPRESSION,
AND SELF ESTEEM IN CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY
DISORDER
Wi-Young So1, So-Young Lee2, Yoonjung Park3, Dong-il Seo2
1Associate Professor, Sports and Health Care Major, College of Humanities and Arts, Korea National
University of Transportation, Chungju-si, Republic of Korea
2Researcher, Department of Sport Science, Dongguk University, Gyeongju, Republic of Korea
3Assistant Professor, Department of Health and Human Performance, College of Liberal Arts and Social
Sciences, University of Houston, Texas, USA
2Assistant Professor, Department of Sport Science, Dongguk University, Gyeongju, Republic of Korea
CORRESPONDING AUTHOR: Dong-il Seo: seodi74@dongguk.ac.kr
Submitted: August 26, 2017. Accepted: September 18, 2017. Published: September 28, 2017.
Abstract
Background and Objective
There is no report on the eects of horseback riding on children with attention deficit hyperactivity disorder
(ADHD). Therefore, the purpose of this study was to determine the eects of 4 weeks of horseback riding
on anxiety, depression, self esteem, attention, and learning disorder in children with ADHD.
Materials and Methods
Subjects comprised a convenience sample of 10 children aged 10–12 years with ADHD and 10 children
without ADHD. Horseback riding sessions were performed 2 times (40 minutes/day) per week for 4 weeks.
Before and after the horseback riding program, we measured the children’s anxiety, depression, self esteem,
attention, and learning disorder. The pre-test and post-test scores were analyzed with repeated-measures
analysis of variance.
Results
After participating in the 4-week horseback riding program, anxiety (p = 0.013), depression (p = 0.007),
attention (p < 0.001), and learning disorder (p < 0.001) were significantly improved in the ADHD group
compared to the normal group. However, self esteem was not significantly dierent between the 2 groups
(p = 0.096).
Original Article
DOI: 10.22374/1875-6859.13.2.2
J Mens Health Vol 13(2):e1-e7; September 28, 2017
© 2017 The Dougmar Publishing Group. All rights reserved.
This article is distributed under the terms of the Creative Commons Attribution-Non Commercial
4.0 International License.
Effects Horseback Riding in Children with ADHD
e2
Attention deficit hyperactivity disorder (ADHD) is
a common neurodevelopmental disorder characterized
by developmentally inappropriate levels of inatten-
tion, overactivity, distractibility, and impulsiveness,
which manifest during childhood.1 Recently, ADHD
has become highly prevalent in school-aged children.
According to the Centers for Disease Control and
Prevention report in 2013, the number of children
with ADHD was about 6.8% of the world population.2
In Korea, the number of children with ADHD
is increasing, and special attention is required for
its treatment and prevention. Based on a recent
survey in Korea, about 7.2% (152,640) of students
had symptoms of ADHD in the Student Emotional
and Behavioral Problems Screening Test conducted
in 2,139,243 elementary school, middle school,
and high school students. Especially, among them,
about 6,529 elementary school students were found
to be in the high-risk group that urgently needed
treatment.3
Studies on the improvement and treatment of ADHD
symptoms have been performed in various ways. Some
methods including cognitive treatment, behavioural
(exercise) treatment, pharmacological treatment, and
combinational treatment, etc. have shown positive
results.
4
It has been reported that animal-assisted
therapy positively helps children with mental and
physical disorders in physical, cognitive, and emotional
ways.
5
Horseback riding is a typical exercise that may
improve emotional stability and healthy fitness by
communing with a horse.6 Moreover, studies on the
exercise or mental eects of horseback riding have
been conducted,7–9 but ones on the therapeutic eect
in children with ADHD have not been reported yet.
Therefore, the purpose of this study was to analyze
the changes in anxiety, sense of depression, and self
esteem in children with ADHD who participated in
a horseback riding exercise program for 4 weeks.
METHODS
Participants
In this study, 10 students who were diagnosed as
having ADHD and 10 mentally healthy students who
were selected from physically healthy male elemen-
tary school students participated in this experiment
(Table 1). This study was approved by the Human
Care and Use Committee of the Institute of Sports
Science of Dongguk University. Subjects and their
parents or guardian were informed of the procedures
and provided informed consent before participation.
Study Design
Subjects’ physical characteristics, the ADHD
rating scale score, and learning disorder test results
were obtained from the children’s guardians, and in-
formation about depression, anxiety, and self esteem
was obtained directly from the subjects. All measure-
ments were performed before and after completing
the 4-week horseback riding exercise.
Anthropometric Measurements
Subjects’ height and weight were measured to the
nearest 0.1 cm and 0.1 kg, respectively, by using a
stadiometer, digital electronic scale, and body mass
index (kg/m2).
Conclusion
These results indicate that the 4-week horseback riding program used in this study was very eective for
significantly improving anxiety, depression, and attention in children with ADHD.
Key Words: anxiety, depression, self esteem, attention, attention deficit disorder, horseback riding therapy
Table 1 Participants’ Physical Characteristics
Group nAge (years) Height (cm) Weight (kg) Body mass index (kg/m2)
ADHD 10 10.3 ± 1.8 141.3 ± 4.5 41.9 ± 4.0 21.0 ± 1.7
Normal 10 11.2 ± 1.3 139.9 ± 4.8 41.4 ± 6.6 21.0 ± 1.9
Data expressed as a mean ± standard deviation.
ADHD = attention decit hyperactivity disorder.
J Mens Health Vol 13(2):e1-e7; September 28, 2017
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4.0 International License.
Effects Horseback Riding in Children with ADHD
e3
Assessment of ADHD, Anxiety, Depression, Self
Esteem and Attention and Learning Disorders
The ADHD rating scale was developed by Dupaul
et al.
10
based on The Fourth Edition of the Diagnostic
and Statistical Manual of Mental Disorders. It is useful
for diagnosing ADHD and assessing the eectiveness
of treatment since it is based on sex and age, and it
is observed and written by parents and teacher. The
ADHD Rating Scale-4 consists of 18 questions divided
into inquiries about symptoms of attention deficit
disorder, hyperactivity, and impulsivity. Each ques-
tion is graded from 0 to 3, and ADHD was diagnosed
when parents obtained a total score of 19 points and
teachers obtained a total score of 17 points.
The Child Anxiety Scale is a children’s version
of the Manifest Anxiety Scale for Adults developed
by Taylor in 1953 and used as the Revised Children’s
Manifest Anxiety Scale (RCMAS) by Reynolds and
Richmond in 1978.
11
This scale, which is used to
evaluate anxiety disorder, is composed of 37 questions
in self-report form, and each question is answered as
yes or no by children and adolescents. The total score
is calculated, and higher scores indicate more severe
anxiety symptoms; additionally, the symptoms related
to various types of anxiety are evaluated.
The Center for Epidemiological Studies Depres-
sion Scale (CES-D)12 developed by the United States
Mental Health Research Institute for epidemiological
studies of depression was used to evaluate depression.
This scale consists of 20 questions and is a self-report
scale rated by 0 to 3 points. It can measure depression,
guilt, feelings of selflessness, helplessness, hopeless-
ness, delay of mental movement, loss of appetite, and
sleep disorder. Additionally, it is used to compare the
prevalence of depression among countries, ethnic
groups, age groups, and between men and women.
Scores range from 0 to 60, with a cut-o score of 21
for local epidemiology and a cut-o score of 25 for
diagnosing major depression.
The Self Esteem Scale (SES) developed by Rosen-
berg in 1965 was used to assess self esteem,
13
and
the self-report questionnaire consisted of 5 items of
positive and negative self esteem. A high score on the
4-point scale was diagnosed as a high self esteem.
The learning disorder test was conducted by the
parents as a measure to assess the degree of learning
disorder. Seventeen items were marked as not at all
present, slightly present, fairly present, or very sig-
nificant, and the total was recorded. Generally, more
than 10 points of fairly present or very significant are
likely to indicate a learning disorder.
Horseback Riding Program
The rehabilitative horseback riding program used
in this study was modified and supplemented based
on the program used by the American Equestrian
Therapist Association
14
and the youth equestrian
Table 2 Details of the Rehabilitative Equestrian Program
Time Description Other
Getting ready 5 minutes Wear safety equipment
(a safety vest and helmet)
Say hello to the horse
Stroke the horse
Horseback riding 30 minutes Warm-up
Main exercise
Cool-down
Learn a riding skill by
phase and level 8 times
Organize 5 minutes Stroke the horse
Dismount from the horse
Say goodbye to the
instructor and assistant
Take o safety equipment
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Effects Horseback Riding in Children with ADHD
e4
program designed by the Korea Racing Authority. The
basic framework is shown in Table 2. The frequency
of participation was 4 weeks, twice per week for no
more than 40 minutes, which included the preparation
time from the start to finish.
Statistical Analysis
Descriptive variables are presented as a mean
± standard deviation. Data analysis was performed
using 2 × 2 repeated-measures analysis of variance.
Statistical significance was set at p < 0.05. SPSS 21.0
(SPSS Inc., Chicago, IL, USA) was used to perform
all analyses.
RESULTS
The anxiety score before and after the 4-week
horseback riding program decreased from 20 to 16.9
points in the ADHD group, and this was statistically
significantly dierent compared to the normal group
(p = 0.013) (Table 3). The depression score before and
after the 4-week horseback riding program decreased
from 18.4 to 13.1 in the ADHD group, and this was
statistically significantly dierent compared to that in
the normal group (p = 0.007). The self-esteem score
before and after the 4-week horseback riding program
in the ADHD group increased from 30.1 to 31.8; this
was not statistically significantly dierent compared
to that in the normal group. The attention total score
before and after the 4-week horseback riding program
in the ADHD group decreased from 28.4 points to
22.8 points. The attention deficit component of the
ADHD score decreased from 16.2 to 13.4 points, and
the hyperactivity/impulsivity score decreased from
12.2 to 9.4 points; these findings were statistically
significantly dierent compared to those of the
normal group (p < 0.001). The learning disorder
score
before and after the 4-week horseback riding
program
decreased from 30.2 to 27.2 in the ADHD
group, and
this was statistically significantly
dierent compared
to that in the normal group (p <
0.001). However, self
esteem was not significantly
dierent between the 2 groups (p = 0.096).
DISCUSSION
The result of the RCMAS test, which was used
to evaluate anxiety before and after rehabilitative
horseback riding in this study, decreased from 20
to 16.9 points. This result suggests that the exercise
can be used as an intervention program to reduce the
problematic behaviours of children with ADHD.
15
Performing rehabilitative horseback riding improved
anxiety. This eect seems to be the result of experi-
encing less anxiousness when interacting with an
animal, confidence in that they can move on a horse,
self-ecacy in that they can horseback ride, and the
sense of accomplishment.
Table 3 Changes in ADHD Variables after the 4-Week Horseback Riding Program
Variable Group n Pre-test Post-test Interaction (time × group)
Fp-value
Anxiety ADHD 10 20.0 ± 5.8 16.9 ± 5.2 7.661 0.013*
Normal 10 16.8 ± 8.4 15.6 ± 7.0
Depression ADHD 10 18.4 ± 8.1 13.1 ± 6.1 9.430 0.007**
Normal 10 12.3 ± 7.9 11.8 ± 7.2
Self Esteem ADHD 10 30.1 ± 5.8 31.8 ± 4.5 3.093 0.096
Normal 10 34.4 ± 1.9 35.1 ± 2.1
Attention ADHD 10 28.4 ± 9.7 22.8 ± 11.0 4.826 <0.001***
Normal 10 9.5 ± 5.9 9.0 ± 5.3
Learning
Disorder
ADHD 10 30.2 ± 5.1 27.2 ± 5.1 18.409 <0.001***
Normal 10 22.7 ± 4.5 21.9 ± 4.0
Data are expressed as a mean ± standard deviation.
ADHD = attention decit hyperactivity disorder
*p < 0.05, **p < 0.01, ***p < 0.001, tested by repeated-measures analysis of variance
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Effects Horseback Riding in Children with ADHD
e5
In the CES-D test for depressive symptoms, the
score decreased from 18.4 to 13.1 points. Archer and
Kostrzewa16 reported a relationship between regular
exercise and decreased depression, and that state anxi-
ety can be eectively reduced with physical exercise.
Bowers and McDonald
17
reported that adolescents with
severe emotional disturbances described a decrease
in depression after a rehabilitative horseback riding
program. Iannuzzi and Rowan18 found that adolescent
exercise decreased psychological depression and
improved quality of life. Similar to previous stud-
ies, this study also showed that the performance of
short-term rehabilitative horseback riding decreased
depression. This decrease in depression was due to
the improvement of self esteem through special ex-
periences of working with and communicating with
horses, and sharing special empathy,
19
the relative
reliance of not being alone, and improvement of hap-
piness through skin contact with animals. However,
before and after the rehabilitative horseback riding
program, the experimental group and control group
showed a statistically significant positive eect on the
CES-D test result. However, the results of the CES-D
test were not significant. Therefore, it was confirmed
that participants’ depression in this study was not a
cause for concern.
In the SES test for self esteem, the score tended to
increase from 30.1 to 31.8. A previous study reported
that regular exercise was associated with a decrease
in depression and anxiety, as well as an improvement
in self esteem.20 However, the present study did not
show any statistically significant results, suggesting
that the application of short-term rehabilitative horse-
back riding may have aected the results.
The children who met this study’s criteria were
generally sensitive to the mood and changes in the
program environment. During each session, participants
were asked questions about the horse that they would
ride on, and they were curious about the condition of
the horses and were surprised or even afraid of the
horse’s small, unexpected movements. Participants
were afraid of the horses, which were bigger than
them, but the children’s interest in horses increased.
Thus, after they finished their educational classes,
they approached the horses first, stroked them and
fed them, and described their experience afterward.
We observed participants overcome their fear gradu-
ally in unexpected situations because they began to
trust the riding sta and concentrated on the program
activities. This result suggests that emotional stabil-
ity was achieved through interaction with a horse,
and physical activity had a positive impact on other
social functions.
In this study, the attention deficit score of the
ADHD group decreased from 16.2 to 13.4 points
on the subsection score of the ARS test in the as-
sessment of the concentration of attention before
and after short-term rehabilitative horseback riding.
This result supports that rehabilitative horseback rid-
ing, which had a positive eect on ADHD children’s
attention as a psychological exercise, improves in-
dividual performance through physical activity and
social functioning,21 and aerobic exercise improves
the attention deficit disorder.20 Unlike previous
studies, just participating in the short-term rehabili-
tative horseback riding program showed a positive
result in the improvement of the attention deficit
disorder.
The learning disorder score decreased from 30.2
to 27.2. This result supports that of Iannuzzi and
Rowan’s
18
study, in which the riding exercise positively
aected the quality of life of adolescents, and that of
Hong and Yoon’s
22
study, in which psychotherapy was
performed with a horse, making self-control and the
management of behaviour possible through a non-
verbal relationship with horses. We consider that this
improvement of a learning disorder induced the learn-
ing eects because of the instinct to solve diculties
in new experiences through knowledge acquisition.
Additionally, the horseback riding, which was once
considered dangerous and dicult, became possible
to perform because we induced children’s interest in
learning by building their confidence and sense of
accomplishment. We heard that the parents of the
children who participated in our study were delighted
to talk about their children’s changed attitudes in daily
life at the end of this study; other academic guidance
teachers also perceived the change in these children
since they were interested and concentrated on this
study more than any other therapies.
J Mens Health Vol 13(2):e1-e7; September 28, 2017
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4.0 International License.
Effects Horseback Riding in Children with ADHD
e6
We believe that short-term rehabilitative horseback
riding for children with ADHD has enough elements
to enhance their attention through the very special
experiences of working with horses and developing
a relationship with them.
The limitation of this study was that it did not ana-
lyze the change in physiological variables of children
with ADHD. However, improvement of psychological
variables is very meaningful for children with ADHD.
CONCLUSIONS
We consider that the rehabilitative horseback riding
program conducted in this study was able to improve
the anxiety, depression, concentration of attention, and
learning ability of children with ADHD, although it
was only in the short term. This study’s results show
that there is a need to apply the equestrian training
program to children with ADHD. For eective ADHD
treatment, a horseback riding training program should
be included.
ACKNOWLEDGEMENT
This study was supported by the Dongguk Uni-
versity Research Fund, Gyeongju, Korea.
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... Animals have the capacity to capture attention thereby producing calming effects (Serpell, 1986). Many studies have reported a decrease in anxiety scores after AAT intervention (So et al., 2017;Klink, 2019). The children perceive animals as non-judgemental which helps them lower distress and perform the task without anxiousness. ...
... The children perceive animals as non-judgemental which helps them lower distress and perform the task without anxiousness. Moreover, skin contact with the animals and companionship increase happiness and decrease loneliness which tends to reduce depression in children (So et al. 2017). ...
... A closely related construct of self-esteem was also found to be improved after canine-assisted therapy (Schuck et al., 2018). The sense of efficacy and accomplishment that they can achieve through rehabilitative horse riding has been also noted (So et al., 2017). Impairment of executive functions is frequently reported with ADHD. ...
Chapter
Full-text available
Attention-Deficit Hyperactivity Disorder requires multidisciplinary treatment services for its effective management and treatment. Animal-assisted therapy addresses various aspects of health unlike the other treatment counterparts available in the healthcare industry. In this chapter, we have discussed the potential advantages of the connection between humans and animals. The outline of the chapter includes a brief idea about animal-assisted therapy and its effectiveness with ADHD-diagnosed children with reference to the field research that has been done. The chapter will help the clinicians, parents, and readers to identify the merits of this approach and think about integrating animal-assisted therapy as a form of non-pharmacological intervention for ADHD.
... The immediate feedback that the rider receives from the horse enables physical and mental self-regulation. 27 Finally, an intervention that includes both horses and riders in various forms can be tailored to address many difficulties present among children with ADHD. ...
... TR (n = 4) and EAPT (n = 6) studies have shown that riding offers an opportunity for success that raises global mental functions such as self-confidence, selfesteem, and motivation. 27,[43][44][45] In addition, EAPT studies (n = 3) showed an improvement in specific mental function. For example, a significant increase was found in memory functions of the left bilateral middle frontal cortex, right bilateral middle frontal cortex, and left precentral cortex. ...
... different objective outcome measures (e.g., fMRI, EEG, and blood testing). 27,44,46,52,53 Blood-brain derived neurotrophic factor (BDNF) plays a key role in nerve-cell dopamine receptors, which is thought to affect core symptoms in ADHD. In a study including 16 children that lasted 16 sessions of combined EAPT and neurofeedback training, a significant increase was found in the BDNF level in the research group, which may indicate brain function improvement. ...
Article
Full-text available
Objective: This systematic review evaluated equine-assisted activities and therapies (EAATs), formerly referred to as equine-assisted services (EAS), in children and youth (ages 6-18 years) with attention-deficit/hyperactivity disorder (ADHD), according to the International Classification of Functioning, Disability, and Health. Methods: Electronic database searches were conducted of studies from inception through December 2020. Results: A total of 12 articles were included: 8 noncontrolled prospective studies and 4 randomized-controlled trials (RCTs). Furthermore, seven of moderate methodological quality studies and five of moderate high methodological quality studies were included. Evidence was found for the effectiveness of various forms of EAS, including equine-assisted physical therapy (EAPT) and therapeutic riding (TR). Improvements in body functions and structures (n = 10) were found in the domains of mental and neuromusculoskeletal functions, as well as functions of the cardiovascular system using EAPT (n = 6). Limited evidence was found regarding the positive effect on activity and participation (n = 4) following TR interventions. Quality of life (QoL) was improved in both TR and EAPT (n = 4). Conclusion: There seems to be preliminary evidence that EAS may be beneficial in promoting the physiological functions of body systems for children with ADHD. The influence on participation and QoL still requires further evidence. More generally, further controlled studies, including bigger sample sizes, are needed to understand the specific effects of different EAS on the core symptoms and consequence of ADHD.
... The studies focused on Mounted-EAT participation for a broad range of mental health and behavioural issues across these populations. The issues included persons struggling with substance use (Collingwood et al., 2021;Gatti et al., 2020;Kern-Godal et al., 2015;Kern-Godal, Brenna, Kogstad, et al., 2016); youth at-risk (Bachi et al., 2012;Burgon, 2011); children with ADHD (Aviv et al., 2020;Cuypers et al., 2011;Hyun et al., 2016;Jang et al., 2015;Oh et al., 2018;So et al., 2017;Yoo et al., 2016); youth with self-harming behaviours (Carlsson, 2017); persons with histories of trauma (Craig, 2020;Mueller & McCullough, 2017;Naste et al., 2018;Yorke et al., 2013); veterans with post-traumatic stress disorder (PTSD; Johnson et al., 2018Johnson et al., , 2021Lanning et al., 2017); adults with schizophrenia (Cerino et al., 2011;Collingwood et al., 2021;Corring et al., 2013); women with eating disorders (Lutter & Smith-Osborne, 2011;Sharpe, 2014); youth with severe emotional disorders (Roberts & Honzel, 2020); women who have had breast cancer treatment (Cerulli et al., 2014); and children with stressful home environments already receiving school counselling (Pendry, Carr, et al., 2014;Pendry & Roeter, 2013). ...
... Mounted-EAT participation. Mounted-EAT reduced symptoms of depression (Lutter & Smith-Osborne, 2011); reduced negative symptoms of schizophrenia (Cerino et al., 2011;Collingwood et al., 2021); eating disorders (Lutter & Smith-Osborne, 2011); ADHD (Hyun et al., 2016;Jang et al., 2015;Oh et al., 2018;So et al., 2017); and PTSD and trauma (Johnson et al., 2018;Lanning et al., 2017;Mueller & McCullough, 2017;Naste et al., 2018). (Cuypers et al., 2011;Pelyva et al., 2020); emotional regulation (Craig, 2020;Johnson et al., 2021;Kern-Godal, Brenna, Kogstad, et al., 2016;Lanning et al., 2017); and overall quality of life and executive function (Aviv et al., 2020;Bachi et al., 2012;Cerulli et al., 2014;Cuypers et al., 2011;Lanning et al., 2017;Oh et al., 2018). ...
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Across mental health professionals, there is growing interest in the field of Equine‐Assisted Therapy (EAT). Preliminary evidence suggests EAT is beneficial for a wide spectrum of client populations. EAT programs may be based on groundwork alone, where participants interact with the horses from the ground only, or they may incorporate mounted activities. It remains unclear whether mounted activities add therapeutic benefits to the EAT experience for participants. This scoping review explored whether mounted activities, specifically where the client rides the horse, contribute to distinct therapeutic benefits. Nine databases were searched for studies of EAT programs that included horse riding as a central component of the therapeutic intervention and 36 studies were included in the analysis. The results of these studies suggest that mounted activities positively contribute to a variety of issues experienced by different client groups. However, further quality research is needed to carefully examine riding activities as an independent phenomenon, in order to establish what contribution‐mounted activities, over and above groundwork, make to any therapeutic benefit of the EAT experience.
... In this regard, Mihandoost, showed that students who engaged in an exercise program had a higher potential of being included in society and showed improvement in their academic and social skills [8]. So, Lee, Park, and Seo, examined the impact of horseback riding on anxiety and depression in overactive children and reported similar results [9]. Other studies found that the effects of motor interventions on executive function (working memory) and motor function are positive [10]. ...
... These results show the effectiveness of exercise on cognitive and psychological problems in overactive children, which is supported by previous studies. So et al. reported the positive impact of 4 week horseback riding on anxiety and depression in overactive children aged 10-12 years [9]. Kiluk et al showed that children with ADHD who participated in three or more sports displayed significantly fewer anxiety or depression symptoms than did those who participated in fewer than three sports [35]. ...
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Background: This study investigated the effects of the aerobic exercise with music on anxiety, depression, motor proficiency, and cognitive ability of boys with Attention Deficit Hyperactivity Disorder (ADHD). Methods: This is a quasi-experimental study. Participant’s comprised a convenience sample of 36 boys with ADHD. The experimental group (N=18) practiced in non-linear pedagogy (M years=11.32, SD=1.00), whereas the control group (N=18) performed (M years=11.26, SD=0.92) usual school activities in the traditional method. Results: After participating in the 8-week aerobic training program, motor proficiency, anxiety, depression, working memory, perceptual reasoning, and processing speed were improved in the experimental group compared to the control group (p <0.001). Conclusion: Based on these findings, among the ADHD children, incorporating music into sports can affect children’s anxiety, depression, motor proficiency, and cognitive ability. Increasing participation by incorporating music into sports such as aerobics, can affect children’s anxiety, depression, motor proficiency, and cognitive ability.
... Motor interventions include regular motor activities that aim to reduce motor and cognitive problems and to enhance physical and cognitive skills [15]. In acknowledging the positive impact of motor interventions on the problems of overactive children, Lee et al, examined the impact of horseback riding on motor proficiency, anxiety, and depression in overactive children and reported positive results [16]. Lee et al, showed that play activities are useful for children with ADHD [17]. ...
... Each question is scored from 0 to 3, and a child is identified to have ADHD when the parents obtain a score of 19 points, while teachers obtain 17 points. The Dupaul questionnaire e has high validity and reliability and has been used in recent studies to identify overactive children [16,33]. ...
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Background: This study highlights the effect of nonlinear and linear teaching methods and inclusive education on the self-esteem and motor proficiency of ordinary and overactive children. Methods: This quasi-experimental research involved two groups of girls who had a 9-week intervention. One group consisting of 14 ordinary children (M age =6.53 , SD age =0.49) with one overactive and obese child (age=6 years, height=115 cm and weight=27 kg) were trained using nonlinear pedagogy. The other group comprising of 14 ordinary children (M age =6.58 , SD age =0.52) and one overactive obese child (age=6 years, height=117 cm and weight=28 kg) were trained using a linear method. Quantitative and qualitative instruments were used to collect data. Results: The qualitative results showed control of violence and pleasure of the game, as well as family, educational and social relationships, improved in the obese and overactive child who practiced with the nonlinear pedagogy. Quantitative results indicated that general, family, social and school self-esteem, and motor proficiency increased, but BMI decreased in both children with ADHD. The result of the ANCOVA test indicates that self-esteem (P=0.000, F=27.88) and motor proficiency (P=0.001, F=15.7) improved in the nonlinear pedagogy compared to the linear method. Conclusion: Results emphasized the importance of applying nonlinear pedagogy for motor skills development and in inclusive education to enhance physical activity participation for children with Attention deficit hyperactivity disorder (ADHD). Findings make a strong case for manipulating tasks and eliminating environmental constraints in inclusive settings to develop motor skills of all children.
... Working with horses has shown improvements in children's social functioning and motor movement, particularly in the areas of social functioning (Borgi et al., 2016;Gabriels et al., 2015) and reductions in inattention and distractibility (Bass et al., 2009) in individuals with ASD. Similarly, improvements in inattention, hyperactivity, and impulsivity (Jang et al., 2015;Oh et al., 2018), interpersonal relationships (Gomez et al., 2016, and reductions in anxiety, depression, and inattention (So et al., 2017) have been seen in children with ADHD. Positive effects are not limited to programs that utilize interactions with horses. ...
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Animal-assisted therapy (AAT) has become increasingly popular as an adjunct to treatment across a variety of populations and disciplines. However, minimal empirical documentation for AAT exists in the literature. The purpose of this project was to assess the efficacy of animal-assisted occupational therapy (AAOT) on attention in preschoolers. We hypothesized that the presence of a specially trained canine in the treatment room would increase attention to therapist-directed activities during a table-based occupational therapy activity. A total of 12 preschool-aged children participated in this study during regularly-scheduled occupational therapy sessions. Data were collected based on the percentage of time the student was off-task during the activity. Results demonstrated statistical significance, with the children significantly less off-task on average when a dog was present during instruction than when a dog was not present (t (11) = 2.89, p = .015). This study provides additional research to support the efficacy of AAT with a focus on the preschool population, which is an area that is underrepresented in published literature.
... Cognitive abilities are vital for the development of social competence. Many studies conducted with children indicated an increase in attention span, improvement in concentration, and higher learning effect with animal-assisted therapy (Hediger et al., 2014;Oh et al., 2018;So et al., 2017). According to Wilson's Biophila Hypothesis (Kellert & Wilson, 1993), humans have an innate ability to incline towards animals naturally. ...
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Developmental disorders have a substantial effect on the social competence of children affecting their overall psychosocial functioning. Social competence entails the process of being socially mature by establishing stable and adaptive patterns of social behavior. Animal-assisted therapy, as an alternative treatment modality, has offered some new prospects for improving social cognition. This conceptual paper, thus, attempts to throw light on how animal-assisted therapy can help improve social competence. The paper draws its knowledge from the existing theories and empirical work done to propose a conceptual framework that can enhance social competence by incorporating therapy animals. It can be concluded that animal-assisted therapy has found to improve different dimensions crucial for development of social competence. This further suggests the dire need to explore the effectiveness of human-animal interactions by utilizing it for improving social competence.
... By screening the abstract and the full text, 7,440 papers were further excluded due to non-English literature, no full text, or irrelevance. Finally, nine self-control trials (18,(37)(38)(39)(40)(47)(48)(49)(50), five non-randomized control trials (19,32,33,51,52), and nine randomized control trials (16,20,(34)(35)(36)(53)(54)(55)(56) were eligible for meta-analysis. The screening process is shown in Figure 1. ...
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Objective: To assess the effectiveness of physical activity (PA) intervention on attention-deficit/hyperactivity disorder (ADHD)-related symptoms. Method: Studies that investigated PA intervention for ADHD-related symptoms were identified through searching PubMed, Web of Science, Cochrane Library, and Embase databases from inception through June 2021. Standardized mean difference (SMD) with 95% confidence interval (CI) was used to assess the effectiveness of PA intervention on improving ADHD-related symptoms. The meta-analyses were conducted using fixed-effect or random-effect models according to the heterogeneity of the studies. Results: Nine before–after studies (232 participants) and 14 two-group control studies (162 participants/141 controls) were included in this meta-analysis. Combined results for before–after studies indicated significant improvements on all studied ADHD-related symptoms (inattention: SMD = 0.604, 95% CI: 0.374–0.834, p < 0.001; hyperactivity/impulsivity: SMD = 0.676, 95% CI: 0.401–0.950, p < 0.001; emotional problems: SMD = 0.416, 95% CI: 0.283–0.549, p < 0.001; behavioral problems: SMD = 0.347, 95% CI: 0.202–0.492, p < 0.001). Meta-analyses for two-group control studies further confirmed that PA intervention significantly improved the inattentive symptom (SMD = 0.715, 95% CI: 0.105, 1.325, p = 0.022). Subgroup analyses suggested significant beneficial effect on inattention symptoms in children. Moreover, closed motor skills were beneficial for hyperactive/impulsive problems (SMD = 0.671, p < 0.001), while open motor skills were beneficial for attention problems (SMD = 0.455, p = 0.049). When excluding studies with combined medication, the studies in unmedicated participants in before–after studies still showed significant results in all studied ADHD-related symptoms as in the overall analysis. Given the limited sample size, the best frequency and intensity of PA intervention need further investigation. Conclusion: Our results suggested that PA intervention could possibly improve ADHD-related symptoms, especially inattention symptoms. Closed-skill and open-skill activities could be beneficial for hyperactivity/impulsivity and inattention symptoms, respectively. Further high-quality randomized clinical trials with large sample size are needed.
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Background : This study examines the effects of equine‐assisted activity (EAA) training on executive functioning (EF) (inhibitory control, working memory, and cognitive flexibility) in children aged 7–8 years. Methods : Twenty‐Four healthy children aged 7–8 years with a 1:1 ratio of boys to girls were randomly divided into EAA group (EAAG) or control group (CG). The subjects in EAAG were trained for 12 weeks, and CG participated in normal daily activities. All subjects conducted the Flanker, 1‐Back, and More‐odd shifting tasks at rest and recorded the average reaction times (RTs) and accuracy data of each task. Results : After 12 weeks of EAA intervention, EAAG showed a highly significant increase (p < .01) in mean RTs and accuracy in the Flanker and More‐odd shifting tasks and a highly significant increase (p < .01) in accuracy only in 1‐Back. Conclusion : These findings suggest that 12‐week EAA training can be effective in improving EF and promoting cognitive performance in children aged 7–8 years.
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Background Physical exercise has been recommended as an important nonpharmacological therapeutic strategy for managing attention deficit hyperactivity disorder (ADHD). We conducted a network meta-analysis (NMA) to assess the comparative impact of different physical exercise modalities on enhancing executive functions (EFs) and alleviating symptoms in children and adolescents with ADHD. Methods We searched Web of Science, PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, CNKI, and clinical trials databases from inception to October 20, 2022. Randomized controlled trials (RCTs) and quasi-experimental studies investigating physical exercise for ADHD-related symptoms of hyperactivity/impulsivity and inattention, and executive functions were included. The frequentist random-effect NMA method was applied to pool the results. Results A total of 59 studies (including 39 RCTs, 5 quasi-RCTs, and 15 self-controlled trials) published between 1983 and 2022 were incorporated into the systematic review, of which 44 studies with 1757 participants were eligible for meta-analysis. All types of physical exercise were effective in improving EFs (SMD = 1.15, 95% CI: 0.83 to 1.46), and open-skill activities which require participants to react in a dynamically changing and externally paced environment induced the most incredible benefits for executive functions (SUCRA = 98.0%, SMD = 1.96, and 95% CI: 1.15 to 2.77). Subgroup analyses for EFs revealed varied findings that open-skill activities were the most promising physical exercise type for improving inhibitory control (SUCRA = 99.1%, SMD = 1.94, and 95% CI: 1.24 to 2.64), and closed-skill activities dominated by aerobic exercises had a slightly higher probability of being the most promising physical exercise intervention for working memory (SUCRA = 75.9%, SMD = 1.21, and 95% CI: −0.22 to 2.65), and multicomponent physical exercise tended to be the most effective in cognitive flexibility (SUCRA = 70.3%, SMD = 1.44, and 95% CI: −0.19 to 3.07). Regarding ADHD-related symptoms, closed-skill activities dominated by aerobic exercises might be more advantageous for hyperactivity/impulsivity (SUCRA = 72.5%, SMD = -1.60, and 95% CI: −3.02 to −0.19) and inattention (SUCRA = 96.3%, SMD = -1.51, and 95% CI: −2.33 to −0.69) improvement. Conclusion Physical exercise can significantly help to alleviate the symptoms of ADHD and improve executive functions in children and adolescents with ADHD. Most of all, to promote adherence to treatment, they should be encouraged to perform the physical exercises that they enjoy most.
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Introduction. The aim of this study was to examine the effectiveness of a Selected exercise program on the executive function of children with ADHD. Method. The participants were 40 male students, aged 7-11 years. The participants were randomly assigned into two groups (experimental and control). The experimental group participated in an exercise program for 24 sessions, 90 minutes per session. The control group did not receive any intervention. Before and after the exercise period, all the participants were assessed with Stroop and Go-No-Go tests, and the resulting data were analyzed by using MANCOVA. Result. The results showed that the cognitive inhibition of the children in the experimental group was significantly different compared with the control group (p < 0.05). Additionally, there was a significant difference between the experimental and control groups in the behavioral inhibition (p < 0.05). Conclusion. An organized physical activity helps to improve the executive function in children with ADHD.
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Objective: To compare the effects of multimodal therapy including supervised high-intensity interval training (HIIT) with those of standard multimodal therapy (TRAD) concerning key variables of physical fitness (peak power and oxygen uptake), motor skills, social behavior, and quality of life in boys with ADHD. Method: A single-center, two-arm randomized, controlled design was used, with 28 boys (8-13 years of age, IQ = 83-136) being randomly assigned to multimodal HIIT (three sessions/week, 4 × 4-min intervals at 95% of peak heart rate) or TRAD. The Movement Assessment Battery for Children II evaluated motor skills and the German version of the hyperkinetic disorder questionnaire for external evaluation by the guardians (FBB-HKS) or German version of the hyperkinetic disorder questionnaire for self-assessment by the children (SBB-HKS) and the KINDL-R questionnaires mental health and health-related quality of life. Results: Both interventions enhanced peak power, and HIIT also reduced submaximal oxygen uptake. HIIT was more effective than TRAD in improving the total score for motor skills (including manual dexterity and ball skills;p< .05), self-esteem, friends, and competence (p< .05) and, moreover, improved subjective ratings of attention. Conclusion: Three weeks of multimodal therapy including HIIT improved physical fitness, motor skills, certain aspects of quality of life, competence, and attention in boys with ADHD.
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Context: The aim of this study was to determine the experimental evidence of treatment/intervention programs for deficits in social skills, attention, and behavioral disorder in children and adolescents with attention deficit hyperactivity disorder (ADHD). Evidence acquisition: Meta-analysis procedures were employed to investigate whether children and adolescents with ADHD exhibit deficits in attention and social skills. A total of 17 empirical research studies published between 2000 and 2013 met our inclusion criteria. Attention and social skills measures were categorized according to both modality and type of processing required. Results: Children with ADHD exhibited deficits in multiple components of attention and social skills that were not related to language-learning disorders and weaknesses in general intellectual abilities. The overall percentage effect for attention and social skills in students with ADHD was calculated (effect size = 0. 79, confidence interval = 0.57 - 1.08). This meta-analysis study showed that treatment programs reduced attention deficit and social skills in ADHD children and adolescents. Conclusions: The evidence of attention and social skills deficits in children with ADHD supports recent studies in ADHD deficits. Further research is required to explain in detail the nature, severity, and specificity of the deficits in individuals with ADHD.
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The aim of this study was to compare the effects of Animal-Assisted Therapy (AAT) with a standard treatment protocol in children and adolescents admitted to the psychiatry hospital for acute mental disorders. We used a methodology involving high quality standards for AAT research. A pre-post experimental design with a randomized controlled trial (RCT) in 34 hospitalized patients (17 treatment, 17 control) was carried out. The study focused on improvement in clinical status including, global functioning measured by the Children Global Assessment Scale (C GAS), format of care and ordinary school attendance measured by a rating scale. Our results indicate a statistically significant improvement in global functioning, reduction in format of care and increased ordinary school attendance in the treatment group, but not in the control group. Our results verify that AAT can have significant positive effects on therapeutic progress and the recovery process. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Mental disorders among children are described as "serious deviations from expected cognitive, social, and emotional development" (US Department of Health and Human Services Health Resources and Services Administration, Maternal and Child Health Bureau. Mental health: A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and National Institutes of Health, National Institute of Mental Health; 1999). These disorders are an important public health issue in the United States because of their prevalence, early onset, and impact on the child, family, and community, with an estimated total annual cost of $247 billion. A total of 13%-20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994-2011 has shown the prevalence of these conditions to be increasing. Suicide, which can result from the interaction of mental disorders and other factors, was the second leading cause of death among children aged 12-17 years in 2010. Surveillance efforts are critical for documenting the impact of mental disorders and for informing policy, prevention, and resource allocation. This report summarizes information about ongoing federal surveillance systems that can provide estimates of the prevalence of mental disorders and indicators of mental health among children living in the United States, presents estimates of childhood mental disorders and indicators from these systems during 2005-2011, explains limitations, and identifies gaps in information while presenting strategies to bridge those gaps.
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We examined whether different doses of therapeutic riding influenced parent-nominated target behaviors of children with autism spectrum disorder (ASD) (a) during the session (b) at home, and (c) in the community. We used a single subject multiple Baseline, multiple case design, with dosing of 1, 3, and 5 times/week. Three boys with ASD, 6-8 years of age participated, and counts of target behaviors were collected in each setting and phase of the study. Compared to Baseline, 70 % of the target behaviors were better during Intervention and improvement was retained in 63 % of the behaviors during Withdrawal. Increased doses of therapeutic riding were significant for magnitude of change, and the effect of the therapeutic riding sessions generalized to home and community.
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This study was conducted of students in their youth, who were having behavioral and emotional problems, anxiety, depression, and ADHD in their school. The participants took part in equestrian sports programs(equestrian program and apparatus program) twice a week, for 60 minutes each. To make progress in the study, mainly 4 scales are used as the standards of preliminary and post inspections : emotional and behavioral development scale, anxiety scale, depression scale, and ADHD scale. After conducting two-way ANOVA analysis, the conclusion was made as follows. The equestrian sports and horse riding exercise program which were used in this study did had an positive effect on emotional and behavioral scale, depression scale, anxiety scale, and ADHD scale. Moreover, it is determined that the equestrian sports had more positive effects than the equestrian sports which used apparatus. However, to precisely compare and contrast the effects of equestrian sports programs and apparatus programs, the follow-up studies need to limit the control group.