Horse Worx Horse Worx Equitherapy Centres
Research & Evidence

What the published research says about equine-assisted therapy.

A summary of peer-reviewed and professional-body sources on equine-assisted therapy, hippotherapy and sensory integration — with links to the original documents so you can read them yourself.

How to read this page: equine-assisted therapy is an active, growing area of research. Several reviews below describe results as "promising" rather than conclusively proven for every outcome — we've kept that nuance rather than overstating it. As with any therapeutic approach, results vary by child. These sources are provided for transparency, not as a guarantee of specific outcomes.

Sensory integration & learning

An 8-session hippotherapy intervention produced overall improvement in sensory integration among children with autism spectrum disorder in this pilot study.

Effect of Hippotherapy on Sensory Integration Among Children With Autism Spectrum Disorder: A Pilot Study
American Journal of Occupational Therapy (AOTA) — https://research.aota.org/ajot/article/75/Supplement_2/7512515368p1/12841/Effect-of-Hippotherapy-on-Sensory-Integration

Reviews the evidence base for Ayres Sensory Integration therapy — the foundational approach behind sensory-integration-based interventions — finding it meets evidence-based practice criteria set by the Council for Exceptional Children.

This review covers sensory integration therapy generally, not equine-assisted delivery specifically, but underpins the sensory-integration approach Horse Worx programmes are built around.

A Systematic Review of Ayres Sensory Integration Intervention for Children With Autism
PMC (National Library of Medicine) — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590432/

Autism spectrum disorder

Found that equine-assisted activities and therapies can substantially improve social and behavioural functioning and language abilities in children with autism spectrum disorder.

Results were inconsistent across some sub-domains — the review is a meta-analysis of multiple smaller studies, not a single definitive trial.

Effects of Equine-Assisted Activities and Therapies for Individuals with Autism Spectrum Disorder: Systematic Review and Meta-Analysis
International Journal of Environmental Research and Public Health (MDPI) / PMC — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9915993/

ADHD

Identified positive trends across behavioural, psychological and physical outcome measures for children with ADHD following equine-assisted therapy participation.

The review notes these positive trends were not consistently statistically significant across studies — described as a 'promising complementary intervention' rather than a proven standalone treatment.

The Effect of Equine-Assisted Therapies on Behavioural, Psychological and Physical Symptoms for Children with Attention Deficit/Hyperactivity Disorder: A Systematic Review
ScienceDirect (Complementary Therapies in Clinical Practice) — https://www.sciencedirect.com/science/article/abs/pii/S1744388119306838

Stress & anxiety reduction

A randomised trial of youth aged 6–16 with mild-to-moderate anxiety found significant improvements in anxiety and self-efficacy for those in a CBT-based equine-assisted riding programme, compared to a control group.

Reducing Anxiety and Stress among Youth in a CBT-Based Equine-Assisted Adaptive Riding Program
PMC (National Library of Medicine) — https://pmc.ncbi.nlm.nih.gov/articles/PMC9558534/

Children who took part in a 12-week equine-facilitated learning programme showed significantly lower stress-hormone (cortisol) levels through the day compared to a waitlisted comparison group.

A separate follow-up study of a different CBT-based equine programme found anxiety improved but cortisol levels specifically did not change significantly over 10 weeks — the physiological evidence is promising but not fully consistent across every study design.

Equine-Assisted Therapy and Its Impact on Cortisol Levels of Children and Horses: A Pilot Study and Meta-Analysis
Research summarised from Washington State University study — https://www.researchgate.net/publication/254228436_Equine-assisted_therapy_and_its_impact_on_cortisol_levels_of_children_and_horses_A_pilot_study_and_meta-analysis

A broader review of animal-assisted therapy (including but not limited to horses) supporting anxiety reduction in children and adolescents.

Effects of Animal-Assisted Therapy for Anxiety Reduction in Children and Adolescents: A Systematic Review
PMC (National Library of Medicine) — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722555/

Broader evidence overview

A broad review concluding equine-assisted therapy shows benefit across balance, gross motor function, gait, spasticity and coordination outcomes, alongside other domains.

Effects of Equine-Assisted Therapy: A Systematic Review and Meta-Analysis
PMC (National Library of Medicine) — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12156428/

Want the details? Every link above goes to the original published source. If your school's therapy team or SENCO wants to review the underlying methodology before signing up, we're happy to share this list directly — get in touch.