New research has found that incorporating horses into occupational therapy may help autistic children experience reduced physiological stress while remaining engaged and attentive during treatment.
The study, published in the Journal of Autism and Developmental Disorders on 10 October 2026, found that autistic children participating in horse-based occupational therapy showed significantly greater reductions in cortisol, a hormone associated with the body’s stress response, compared with children receiving conventional clinic-based therapy.
Researchers suggest the findings provide new evidence of how interactions with horses may help create a positive, supportive therapeutic environment.
How Was the Study Conducted?
The randomised controlled trial involved 72 autistic children aged between six and 11 years, who were assigned to either occupational therapy incorporating horses or traditional clinic-based occupational therapy.
Both groups participated in weekly one-hour sessions over a 10-week period, focusing on emotional awareness and regulation skills.
Children in the equine group undertook therapeutic activities while mounted on horses, supported by qualified occupational therapists and trained equine professionals.
Researchers collected saliva samples before, during and after therapy sessions to measure two biological markers:
- Cortisol, a hormone involved in the body’s stress response.
- Salivary alpha-amylase, an enzyme used as an indicator of sympathetic nervous system activity, which can reflect alertness, excitement and engagement.
By monitoring both markers, the researchers aimed to better understand how children responded physiologically to the different therapeutic environments.
Greater Reductions in Cortisol During Horse-Based Therapy
One of the most significant findings was that children receiving horse-based occupational therapy experienced greater reductions in cortisol during individual sessions than those attending clinic-based therapy.
Although cortisol levels decreased in both groups, the equine group demonstrated an additional 23% reduction relative to the clinic group when measured 20 minutes after the session.
The researchers suggest this may indicate that incorporating horses into therapy helps children experience a calmer, more regulated physiological state.
Interestingly, cortisol levels measured before sessions remained relatively stable across the 10-week programme in both groups, suggesting that the benefits observed were primarily associated with individual therapy sessions rather than sustained reductions in baseline cortisol.
Children Remained Alert and Engaged
The researchers also examined changes in salivary alpha-amylase, which can indicate increased activity in the sympathetic nervous system.
Levels increased by approximately 22% during therapy sessions before returning towards baseline afterwards.
This pattern was observed in both the equine and clinic-based therapy groups, with no statistically significant differences between them.
The researchers suggest that the combination of increased physiological arousal during therapy and reduced cortisol may reflect a state in which children are actively engaged and attentive without experiencing heightened distress.
This is particularly relevant because successful occupational therapy relies on children being able to participate in activities, practise skills and respond to therapeutic challenges.
Links to Improvements in Social Functioning
The study also explored whether changes in physiological responses were associated with improvements in behaviour and emotional regulation.
Researchers identified associations between reductions in cortisol and improvements in social functioning, particularly social cognition.
Changes in cortisol were also associated with improvements in dysphoria, which relates to feelings of emotional discomfort or distress.
Although these findings are preliminary, they suggest that the physiological responses observed during horse-based therapy may be connected to some of the positive behavioural outcomes reported following equine-assisted interventions.
The researchers emphasise that further studies involving larger numbers of participants are needed to establish these relationships more clearly.
What Does This Mean for Equine-Assisted Therapy?
The findings add to a growing body of research investigating the potential benefits of incorporating horses into therapeutic interventions.
Previous studies have reported improvements in emotional regulation, communication and social skills among autistic children participating in equine-assisted activities.
However, much of this research has relied on observations and reports from parents or caregivers.
By measuring biological responses during therapy, this latest study provides additional insight into how children may experience interactions with horses at a physiological level.
The researchers suggest that the sensory experiences associated with riding, combined with the interaction between the child and horse, may contribute to a supportive environment that encourages emotional regulation and engagement.
Importantly, the study also highlights the need for further investigation.
Although 72 children were randomised, 56 completed their allocated intervention, with higher dropout rates in the clinic-based group. The researchers acknowledge that this difference, together with the relatively small sample size, limits some interpretations of the findings.
The study also did not investigate the physiological responses or welfare of the horses involved.
Nevertheless, the results provide encouraging evidence that incorporating horses into occupational therapy may offer benefits beyond those observed in conventional clinical settings.
The researchers conclude that equine-assisted occupational therapy may help autistic children achieve a calm, positive physiological state while remaining alert and engaged, potentially supporting improved therapeutic outcomes.
