Effectiveness of Equine-Assisted Activities and Therapies for Children with Autism Spectrum Disorder: An Update
Abstract
:1. Introduction
Aim
2. Materials and Methods
2.1. Subjects
2.2. Equine-Assisted Activities and Therapies
2.3. Vineland Test
2.4. PSI (Parental Stress Index)-SF
2.5. Statistical Analysis
2.6. Ethics
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Beopoulos, A.; Géa, M.; Fasano, A.; Iris, F. Autism spectrum disorders pathogenesis: Toward a comprehensive model based on neuroanatomic and neurodevelopment considerations. Front. Neurosci. 2022, 16, 988735. [Google Scholar] [CrossRef] [PubMed]
- Waizbard-Bartov, E.; Fein, D.; Lord, C.; Amaral, D.G. Autism severity and its relationship to disability. Autism Res. 2023, 16, 685–696. [Google Scholar] [CrossRef] [PubMed]
- Shenoy, M.D.; Indla, V.; Reddy, H. Comprehensive Management of Autism: Current Evidence. Indian J. Psychol. Med. 2017, 39, 727–731. [Google Scholar] [CrossRef] [PubMed]
- Sharma, S.R.; Gonda, X.; Tarazi, F.I. Autism Spectrum Disorder: Classification, diagnosis and therapy. Pharmacol. Ther. 2018, 190, 91–104. [Google Scholar] [CrossRef]
- Aishworiya, R.; Valica, T.; Hagerman, R.; Restrepo, B. An Update on Psychopharmacological Treatment of Autism Spectrum Disorder. Neurotherapeutics 2022, 19, 248–262. [Google Scholar] [CrossRef]
- DeFilippis, M.; Wagner, K.D. Treatment of Autism Spectrum Disorder in Children and Adolescents. Psychopharmacol. Bull. 2016, 46, 18–41. [Google Scholar]
- Zoccante, L.; Marconi, M.; Ciceri, M.L.; Gagliardoni, S.; Gozzi, L.A.; Sabaini, S.; Di Gennaro, G.; Colizzi, M. Effectiveness of Equine-Assisted Activities and Therapies for Improving Adaptive Behavior and Motor Function in Autism Spectrum Disorder. J. Clin. Med. 2021, 10, 1726. [Google Scholar] [CrossRef]
- Srinivasan, S.M.; Cavagnino, D.T.; Bhat, A.N. Effects of Equine Therapy on Individuals with Autism Spectrum Disorder: A Systematic Review. Rev. J. Autism Dev. Disord. 2018, 5, 156–175. [Google Scholar] [CrossRef]
- Trzmiel, T.; Purandare, B.; Michalak, M.; Zasadzka, E.; Pawlaczyk, M. Equine assisted activities and therapies in children with autism spectrum disorder: A systematic review and a meta-analysis. Complement. Ther. Med. 2019, 42, 104–113. [Google Scholar] [CrossRef]
- Volkmar, F.; Siegel, M.; Woodbury-Smith, M.; King, B.; McCracken, J.; State, M. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J. Am. Acad. Child. Adolesc. Psychiatry 2014, 53, 237–257. [Google Scholar] [CrossRef]
- de Bildt, A.; Kraijer, D.; Sytema, S.; Minderaa, R. The psychometric properties of the Vineland Adaptive Behavior Scales in children and adolescents with mental retardation. J. Autism Dev. Disord. 2005, 35, 53–62. [Google Scholar] [CrossRef] [PubMed]
- Farmer, C.; Adedipe, D.; Bal, V.H.; Chlebowski, C.; Thurm, A. Concordance of the Vineland Adaptive Behavior Scales, second and third editions. J. Intellect. Disabil. Res. 2020, 64, 18–26. [Google Scholar] [CrossRef] [PubMed]
- Ríos, M.; Zekri, S.; Alonso-Esteban, Y.; Navarro-Pardo, E. Parental Stress Assessment with the Parenting Stress Index (PSI): A Systematic Review of Its Psychometric Properties. Children 2022, 9, 1649. [Google Scholar] [CrossRef] [PubMed]
- Hatakeyama, T.; Matsumura, K.; Tsuchida, A.; Inadera, H. Factor structure of the Parenting Stress Index-Short Form used in the Japan Environment and Children’s Study. Sci. Rep. 2022, 12, 19123. [Google Scholar] [CrossRef] [PubMed]
- Haskett, M.E.; Ahern, L.S.; Ward, C.S.; Allaire, J.C. Factor structure and validity of the parenting stress index-short form. J. Clin. Child. Adolesc. Psychol. 2006, 35, 302–312. [Google Scholar] [CrossRef]
- Thiese, M.S.; Ronna, B.; Ott, U. P value interpretations and considerations. J. Thorac. Dis. 2016, 8, E928–E931. [Google Scholar] [CrossRef]
- World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Nurs. Ethics 2002, 9, 105–109. [Google Scholar] [CrossRef]
- Magiati, I.; Tay, X.W.; Howlin, P. Cognitive, language, social and behavioural outcomes in adults with autism spectrum disorders: A systematic review of longitudinal follow-up studies in adulthood. Clin. Psychol. Rev. 2014, 34, 73–86. [Google Scholar] [CrossRef]
- Vogindroukas, I.; Stankova, M.; Chelas, E.N.; Proedrou, A. Language and Speech Characteristics in Autism. Neuropsychiatr. Dis. Treat. 2022, 18, 2367–2377. [Google Scholar] [CrossRef]
- Ibrahimagic, A.; Patkovic, N.; Radic, B.; Hadzic, S. Communication and Language Skills of Autistic Spectrum Disorders in Children and Their Parents’ Emotions. Mater. Sociomed. 2021, 33, 250–256. [Google Scholar] [CrossRef]
- Bal, V.H.; Kim, S.H.; Cheong, D.; Lord, C. Daily living skills in individuals with autism spectrum disorder from 2 to 21 years of age. Autism 2015, 19, 774–784. [Google Scholar] [CrossRef] [PubMed]
- Kilincaslan, A.; Kocas, S.; Bozkurt, S.; Kaya, I.; Derin, S.; Aydin, R. Daily living skills in children with autism spectrum disorder and intellectual disability: A comparative study from Turkey. Res. Dev. Disabil. 2019, 85, 187–196. [Google Scholar] [CrossRef] [PubMed]
- Hunsche, M.C.; Cervin, M.; Storch, E.A.; Kendall, P.C.; Wood, J.J.; Kerns, C.M. Social functioning and the presentation of anxiety in children on the autism spectrum: A multimethod, multiinformant analysis. J. Psychopathol. Clin. Sci. 2022, 131, 198–208. [Google Scholar] [CrossRef] [PubMed]
- Lobban-Shymko, J.; Im-Bolter, N.; Freeman, N. Early social communicative skills as predictors of symptom severity in autism spectrum disorder. Autism Dev. Lang. Impair. 2017, 2, 2396941517743418. [Google Scholar] [CrossRef]
- Li, F.; Tang, Y.; Fang, S.; Liu, X.; Tao, M.; Wu, D.; Jiang, L. Psychological distress in parents of children with autism spectrum disorder: A cross-sectional study based on 683 mother-father dyads. J. Pediatr. Nurs. 2022, 65, e49–e55. [Google Scholar] [CrossRef] [PubMed]
- Bonis, S. Stress and Parents of Children with Autism: A Review of Literature. Issues Ment. Health Nurs. 2016, 37, 153–163. [Google Scholar] [CrossRef]
- Uljarević, M.; Spackman, E.K.; Cai, R.Y.; Paszek, K.J.; Hardan, A.Y.; Frazier, T.W. Daily living skills scale: Development and preliminary validation of a new, open-source assessment of daily living skills. Front. Psychiatry 2022, 13, 1108471. [Google Scholar] [CrossRef]
- Teh, S.E.; Vo, L.T.V.; Bal, V.H. Factors that Influence the Daily Living Skills of Autistic Adults: The Importance of Opportunity. J. Autism Dev. Disord. 2024, 54, 4432–4443. [Google Scholar] [CrossRef]
- Duncan, A.; Ruble, L.A.; Meinzen-Derr, J.; Thomas, C.; Stark, L.J. Preliminary efficacy of a daily living skills intervention for adolescents with high-functioning autism spectrum disorder. Autism 2018, 22, 983–994. [Google Scholar] [CrossRef]
- Glover, M.; Liddle, M.; Fassler, C.; Duncan, A. Microanalysis of Daily Living Skills in adolescents with Autism Spectrum Disorder without an intellectual disability. J. Autism Dev. Disord. 2023, 53, 2600–2612. [Google Scholar] [CrossRef]
- Borgi, M.; Loliva, D.; Cerino, S.; Chiarotti, F.; Venerosi, A.; Bramini, M.; Nonnis, E.; Marcelli, M.; Vinti, C.; De Santis, C.; et al. Effectiveness of a Standardized Equine-Assisted Therapy Program for Children with Autism Spectrum Disorder. J. Autism Dev. Disord. 2016, 46, 1–9. [Google Scholar] [CrossRef] [PubMed]
- Craig, F.; Lorenzo, A.; Lucarelli, E.; Russo, L.; Fanizza, I.; Trabacca, A. Motor competency and social communication skills in preschool children with autism spectrum disorder. Autism Res. 2018, 11, 893–902. [Google Scholar] [CrossRef] [PubMed]
- Travers, B.G.; Lee, L.; Klans, N.; Engeldinger, A.; Taylor, D.; Ausderau, K.; Skaletski, E.C.; Brown, J. Associations Among Daily Living Skills, Motor, and Sensory Difficulties in Autistic and Nonautistic Children. Am. J. Occup. Ther. 2022, 76, 7602205020. [Google Scholar] [CrossRef] [PubMed]
- Kern, J.K.; Fletcher, C.L.; Garver, C.R.; Mehta, J.A.; Grannemann, B.D.; Knox, K.R.; Richardson, T.A.; Trivedi, M.H. Prospective trial of equine-assisted activities in autism spectrum disorder. Altern. Ther. Health Med. 2011, 17, 14–20. [Google Scholar]
- Gabriels, R.L.; Pan, Z.; Dechant, B.; Agnew, J.A.; Brim, N.; Mesibov, G. Randomized Controlled Trial of Therapeutic Horseback Riding in Children and Adolescents With Autism Spectrum Disorder. J. Am. Acad. Child. Adolesc. Psychiatry 2015, 54, 541–549. [Google Scholar] [CrossRef]
Variable (Pre-Treatment) | Mean ± S.D. (ASD Level 1) | 95% C.I. | Mean ± S.D. (ASD Level 2) | 95% C.I. | Mean ± S.D. (ASD Level 3) | 95% C.I. | ANOVA One Way, p-Value | Multiple HSD Comparisons by Tukey |
---|---|---|---|---|---|---|---|---|
N. (%) | 43 (50) | 24 (27.9) | 19 (22.1) | |||||
Males n. (%) | 10 (23.3) | 9 (37.5) | 6 (31.6) | |||||
Age (Years) | 9.4 ± 2.1 | 8.7–10.8 | 8.9 ± 2.4 | 7.9–9.9 | 8.9 ± 2.0 | 8.0–9.9 | 0.604 | N.S. |
Motor Skills and Coordination | 41.0 ± 13.5 | 36.9–45.1 | 42.8 ± 13.8 | 36.9–48.6 | 34.1 ± 11.1 | 28.8–39.5 | 0.079 | N.S. |
Vineland Communication Subdomain * | 56.9 ± 28.2 | 48.3–65.4 | 50.7 ± 21.8 | 41.5–59.9 | 29.8 ± 11.2 | 24.4–35.2 | <0.001 | Level 1 vs. 3: p < 0.001; level 2 vs. 3: p = 0.015 |
Vineland Daily Living Skills Subdomain | 65.2 ± 26.8 | 57.1–73.4 | 59.9 ± 22.8 | 50.2–69.5 | 40.2 ± 16.3 | 32.3–48.0 | 0.001 | Level 1 vs. 3 p < 0.001; level 2 vs. 3: p = 0.023 |
Vineland Socialisation Subdomain | 63.2 ± 24.5 | 55.7–70.6 | 54.9 ± 23.6 | 44.9–64.9 | 38.5 ± 14.9 | 31.3–45.7 | 0.001 | Level 1 vs. 3: p= 0.001 |
PSI-SF Parental Distress | 31.9 ± 11.2 | 28.5–35.3 | 30.5 ± 10.9 | 26.0–35.1 | 35.4 ± 10.3 | 30.4–40.4 | 0.350 | N.S. |
PSI-SF Parent–Child Dysfunctional Interaction | 28.3 ± 9.3 | 25.5–31.1 | 29.5 ± 8.8 | 25.7–33.2 | 29.9 ± 9.3 | 25.4–34.4 | 0.821 | N.S. |
PSI-SF Difficult Child | 32.6 ± 9.1 | 29.8–35.4 | 31.8 ± 7.5 | 28.6–34.9 | 33.1 ± 7.1 | 29.7–36.5 | 0.851 | N.S. |
PSI-SF Total Score | 93.1 ± 26.1 | 85.1–101.0 | 91.8 ± 24.0 | 81.6–101.9 | 98.4 ± 21.9 | 87.8–108.9 | 0.669 | N.S. |
Variable (Post-Treatment) | Mean ± S.D. (ASD Level 1) | 95% C.I. | Mean ± S.D. (ASD Level 2) | 95% C.I. | Mean ± S.D. (ASD Level 3) | 95% C.I. | ANOVA One Way, p-Value | Multiple HSD Comparisons by Tukey |
---|---|---|---|---|---|---|---|---|
Age (Years) | 9.6 ± 2.1 | 8.9–10.2 | 9.1 ± 2.3 | 8.1–10.1 | 9.2 ± 1.9 | 8.3–10.1 | 0.645 | N.S. |
Motor Skills and Coordination | 41.8 ± 14.0 | 37.5–46.1 | 44.0 (12.0 | 38.9–49.0 | 35.8 (10.0 | 31.1–40.6 | 0.105 | N.S. |
Vineland Communication Subdomain * | 67.1 ± 29.0 | 58.1–76.0 | 53.9 ± 21.8 | 44.7–63.1 | 30.0 ± 12.6 | 23.9–36.0 | <0.001 | Level 1 vs. 3: p < 0.001; level 2 vs. 3: p = 0.005 |
Vineland Daily Living Skills Subdomain | 81.0 ± 26.8 | 72.8–89.3 | 62.3 ± 24.7 | 51.9–72.7 | 42.6 ± 18.1 | 33.9–51.3 | <0.001 | Level 1 vs. 2: p = 0.010; level 1 vs. 3: p < 0.001; level 2 vs. 3: p = 0.029 |
Vineland Socialisation Subdomain | 72.2 ± 23.2 | 65.1–79.4 | 56.4 ± 21.7 | 47.2–65.5 | 37.3 ± 14.2 | 30.4–44.1 | <0.001 | Level 1 vs. 2: p = 0.012; level 1 vs. 3: p < 0.001; level 2 vs. 3: p = 0.012 |
PSI-SF Parental Distress | 31.4 ± 11.5 | 28.0–35.0 | 28.8 ± 11.1 | 24.1–33.5 | 38.0 ± 10.9 | 32.7–43.2 | 0.029 | Level 2 vs. 3: p = 0.025 |
PSI-SF Parent–Child Dysfunctional Interaction * | 29.6 ± 11.7 | 26.0–33.2 | 28.2 ± 9.0 | 24.4–32.0 | 31.8 ± 8.2 | 27.9–35.8 | 0.518 | N.S. |
PSI-SF Difficult Child | 32.7 ± 8.5 | 30.1–35.4 | 30.6 ± 7.2 | 27.5–33.6 | 33.6 ± 5.1 | 31.1–36.0 | 0.380 | N.S. |
PSI-SF Total Score | 93.1 ± 28.9 | 84.2–102.0 | 87.8 ± 24.5 | 77.4–98.1 | 103.4 ± 20.2 | 93.6–113.1 | 0.149 | N.S. |
Variable | Mean ± S.D. (Pre-Treatment) | 95% C.I. | Mean ± S.D. (Post-Treatment) | 95% C.I. | ANOVA One Way, p-Value |
---|---|---|---|---|---|
Age (Years) | 9.0 ± 2.2 | 8.6–9.5 | 9.3 ± 2.2 | 8.8–9.8 | 0.472 |
Motor Skills and Coordination | 40.0 ± 13.4 | 37.1–42.8 | 41.0 ± 12.8 | 38.3–43.7 | 0.607 |
Vineland Communication Subdomain | 49.2 ± 25.8 | 43.8–54.7 | 55.3 ± 28.0 | 49.4–61.3 | 0.138 |
Vineland Daily Living Skills Subdomain | 58.3 ± 25.5 | 52.8–63.7 | 67.8 ± 29.0 | 61.6–74.0 | 0.023 |
Vineland Socialisation Subdomain | 55.5 ± 24.3 | 50.3–60.7 | 60.2 ± 25.0 | 54.9–65.5 | 0.210 |
PSI-SF Parental Distress | 32.3 ± 10.9 | 29.9–34.6 | 31.9 ± 11.7 | 29.4–34.4 | 0.831 |
PSI-SF Dysfunctional Parent–Child interaction | 29.0 ± 9.1 | 27.0–30.9 | 29.6 ± 10.3 | 27.4–31.8 | 0.673 |
PSI-SF Difficult Child | 32.5 ± 8.2 | 30.7–34.2 | 32.2 ± 7.6 | 30.6–33.8 | 0.810 |
PSI-SF Total Score | 93.9 ± 24.5 | 88.6–99.1 | 93.4 ± 26.5 | 87.8–99.1 | 0.910 |
ASD Level 1 | Mean ± S.D. (Pre-Treatment) | 95% C.I. (Pre-Treatment) | Mean ± S.D. (Post-Treatment) | 95% C.I. (Post-Treatment) | ANOVA One Way, p-Value |
---|---|---|---|---|---|
Age (Years) | 9.4 ± 2.1 | 8.7–10.0 | 9.6 ± 2.1 | 8.9–10.2 | 0.619 |
Motor Skills and Coordination | 41.2 ± 13.6 | 37.0–45.4 | 41.8 ± 14.0 | 37.5–46.1 | 0.845 |
Vineland Communication Subdomain | 56.9 ± 28.6 | 48.1–65.7 | 67.1 ± 29.0 | 58.1–76.0 | 0.105 |
Vineland Daily Living Skills Subdomain | 65.7 ± 26.9 | 57.4–74.0 | 81.0 ± 26.8 | 72.5–89.3 | 0.010 |
Vineland Socialisation Subdomain | 62.8 ± 24.7 | 55.2–70.4 | 72.2 ± 23.2 | 65.1–79.4 | 0.073 |
PSI-SF Parental Distress | 32.1 ± 11.3 | 28.6–35.5 | 31.4 ± 11.5 | 27.9–34.9 | 0.798 |
PSI-SF Dysfunctional Parent–Child Interaction | 28.4 ± 9.3 | 25.6–31.3 | 29.6 ± 11.7 | 26.0–33.2 | 0.619 |
PSI-SF Difficult Child | 32.7 ± 9.2 | 29.9–35.6 | 32.7 ± 8.5 | 30.1–35.4 | 0.990 |
PSI-SF Total Score | 93.5 ± 26.2 | 85.4–101.6 | 93.1 ± 28.9 | 84.2–102.0 | 0.987 |
ASD Level 2 | Mean ± S.D. (Pre-Treatment) | 95% C.I. (Pre-Treatment) | Mean ± S.D. (Post-Treatment) | 95% C.I. (Post-Treatment) | ANOVA One Way, p-Value |
---|---|---|---|---|---|
Age (Years) | 8.9 ± 2.4 | 7.9–9.9 | 9.1 ± 2.3 | 8.1–10.1 | 0.720 |
Motor Skills and Coordination | 42.8 ± 13.8 | 36.9–48.6 | 44.0 ± 12.0 | 38.9–49.0 | 0.748 |
Vineland Communication Subdomain | 50.7 ± 21.8 | 41.5–59.9 | 53.9 ± 21.8 | 44.7–63.1 | 0.608 |
Vineland Daily Living Skills Subdomain | 59.9 ± 22.8 | 50.2–69.5 | 62.3 ± 24.7 | 51.9–72.7 | 0.727 |
Vineland Socialisation Subdomain | 54.9 ± 23.6 | 44.9–64.9 | 56.4 ± 21.7 | 47.2–65.5 | 0.825 |
PSI-SF Parental Distress | 30.5 ± 10.9 | 26.0–35.1 | 28.8 ± 11.1 | 24.1–33.5 | 0.575 |
PSI-SF Dysfunctional Parent–Child Interaction | 29.5 ± 8.8 | 25.7–33.2 | 28.2 ± 9.0 | 24.4–32.0 | 0.630 |
PSI-SF Difficult Child | 31.8 ± 7.5 | 28.6–34.9 | 30.6 ± 7.2 | 27.5–33.6 | 0.585 |
PSI-SF Total Score | 91.8 ± 24.0 | 81.6–101.9 | 87.8 ± 24.5 | 77.4–98.1 | 0.570 |
ASD Level 3 | Mean ± S.D. (Pre-Treatment) | 95% C.I. (Pre-Treatment) | Mean ± S.D. (Follow-Up) | 95% C.I. (Follow-Up) | ANOVA One Way, p-Value |
---|---|---|---|---|---|
Age (Years) | 8.9 ± 2.0 | 8.0–9.9 | 9.2 ± 1.9 | 8.3–10.2 | 0.648 |
Motor Skills and Coordination | 34.1 ± 11.1 | 28.8–39.4 | 35.8 ± 10.0 | 31.1–40.6 | 0.615 |
Vineland Communication Subdomain | 29.8 ± 11.2 | 24.4–35.2 | 30.0 ± 12.6 | 23.9–36.0 | 0.968 |
Vineland Daily Living Skills Subdomain | 40.2 ± 16.3 | 32.3–48.0 | 42.6 ± 18.1 | 33.9–51.3 | 0.668 |
Vineland Socialisation Subdomain | 38.5 ± 14.9 | 31.3–45.7 | 37.3 ± 14.2 | 30.4–44.1 | 0.799 |
PSI-SF Parental Distress | 35.4 ± 10.3 | 30.4–40.4 | 38.0 ± 10.9 | 32.7–43.2 | 0.458 |
PSI-SF Parent–Child Dysfunctional Interaction | 29.9 ± 9.3 | 25.4–34.4 | 31.8 ± 8.2 | 27.9–35.8 | 0.499 |
PSI-SF Difficult Child | 33.1 ± 7.1 | 29.7–36.5 | 33.6 ± 5.1 | 31.1–36.0 | 0.813 |
PSI-SF Total Score | 98.4 ± 21.9 | 87.8–108.9 | 103.4 ± 20.2 | 93.6–113.1 | 0.469 |
Dependent Variable *, Pre-Treatment = 0, Post-Treatment = 1 | T | E.S. | Wald | p-Value | Exp(B) | 95% I.C. per Exp(B) |
---|---|---|---|---|---|---|
Variable included in the model | ||||||
Vineland Daily Living Skills Subdomain | 0.012 | 0.006 | 4.383 | 0.036 | 1.012 | 1.001–1.023 |
Constant | −0.751 | 0.390 | 3.707 | 0.054 | 0.472 |
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Share and Cite
Zoccante, L.; Sabaini, S.; Bonatti, S.M.; Rigotti, E.; Lintas, C.; Marconi, M.; Zaffanello, M. Effectiveness of Equine-Assisted Activities and Therapies for Children with Autism Spectrum Disorder: An Update. Children 2024, 11, 1494. https://doi.org/10.3390/children11121494
Zoccante L, Sabaini S, Bonatti SM, Rigotti E, Lintas C, Marconi M, Zaffanello M. Effectiveness of Equine-Assisted Activities and Therapies for Children with Autism Spectrum Disorder: An Update. Children. 2024; 11(12):1494. https://doi.org/10.3390/children11121494
Chicago/Turabian StyleZoccante, Leonardo, Sara Sabaini, Sophia Marlene Bonatti, Erika Rigotti, Camilla Lintas, Michele Marconi, and Marco Zaffanello. 2024. "Effectiveness of Equine-Assisted Activities and Therapies for Children with Autism Spectrum Disorder: An Update" Children 11, no. 12: 1494. https://doi.org/10.3390/children11121494
APA StyleZoccante, L., Sabaini, S., Bonatti, S. M., Rigotti, E., Lintas, C., Marconi, M., & Zaffanello, M. (2024). Effectiveness of Equine-Assisted Activities and Therapies for Children with Autism Spectrum Disorder: An Update. Children, 11(12), 1494. https://doi.org/10.3390/children11121494