Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

Qualitative Thematic Analysis Effects of Equine Assisted Services (EAS) on Caregiver Stress Scores of Children with Autism Spectrum Disorder Danielle C. Barron, OMS-IV, ATC 1 ; Madison P. Craft 1 , OMS-IV, IBCLC; Emily R. Florek, OMS-IV, ATC 1 ; Brianna N. Stanley, OMS-IV 1 ; Alexis M. Stoner, PhD, MPH 1 ; Nancy A. Paschall, ESMHL, PATH 2 ; Sarah Newman, MD, CTRI, ESMHL 2 ; David Redden, PhD 1 ; Kimberly I. Tumlin, PhD, MS, MPH 3 1 Edward Via College of Osteopathic Medicine – Carolinas Campus, 2 Healing And Learning Through Equine Relationships (HALTER), 3 University of Kentucky Quantitative Analysis Discussion Introduction

world without me.” aNnadv iMg aatni na gg et mh ee Cn at roef Their Child’s Diagnosis waitlists are very long.” L aS cuCkph opi l fodRr wte fsi otohru TAr chSeDesi ro r

Caregivers of children with chronic illness or disability, such as Autism Spectrum Disorder (ASD), report higher levels of stress, burn out, and depression symptoms when compared to caregivers of children without a chronic illness or disability. 1,2,3 While programs that focus on children with ASD are available, these youth often require additional medical and therapeutic support which contributes to caregiver stress and burnout. 1,2,3,4,5 While animal assisted interventions improve well-being for children with ASD, effects of such programs on caregiver outcomes are a nascent field of inquiry.

Caregivers experienced positive downstream effects resulting from their child’s participation in a therapeutic riding program. While not measured in this study, improved well-being has been linked to greater ability to build relationships, thus our data support that creating meaningful impact for the child can have indirect effects on the caregiver. The HALTER program reported observations in which supportive relationships and community within the caregivers while waiting during EAS are another potential factor in the positive benefits observed in this study (figure 5).

“My main stressor is just trying to make sure that my child is in a place where they will be able to function in the “. . . we do have some resources, but their size doesn’t fully accommodate the children in our community. The

Figure 3. Commonly Identified Themes and Corresponding Caregiver Data . Caregiver data supporting the identified themes as contributing to increased stress levels. they both require totally different things so, balancing between both children can be very stressful.” Caring for Multiple Children within the Same Household " There are times when I would like to enroll my child in additional therapies or other activities , but then the cost prohibits me from enrolling my child.” Managing Finances “I have another child without ASD and

Purpose : To characterize emotional strain and stress in caregivers of children with ASD when their child attended equine-assisted services, specifically a therapeutic riding program (figure 1).

Figure 1. The HALTER Herd . Willie, a horse in the HALTER herd and his rider.

References 1.Maenner MJ. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveillance Summaries [Internet]. 2023 Mar 24;72(2):1 – 14. Available from: https://www.cdc.gov/mmwr/volumes/72/ss/ss7202a1.htm 2.American Psychiatric Association. DSM-5 TM guidebook the essential companion to the Diagnostic and statistical manual of mental disorders, fifth edition. 5th ed. Washington, Dc American Psychiatric Publishing; 2013. 3.Hyman SL, Levy SE, Myers SM. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics [Internet]. 2020 Dec 16;145(1). 4.Farrugia D. Exploring stigma: medical knowledge and the stigmatization of parents of children diagnosed with autism spectrum disorder. Sociology of Health & Illness. 2009 Nov;31(7):1011 – 27. 5.DePape AM, Lindsay S. Parents’ Experiences of Caring for a Child With Autism Spectrum Disorder. Qualitative Health Research. 2014 Sep 22;25(4):569 – 83. Conclusions This pilot study successfully captured the indirect effects of EAS, specifically a therapeutic horsemanship program, in caregivers of children with ASD. Reduction of measured stress, and identification of potential areas for support were key to understanding how and why caregivers can be impacted when their child progresses in interventions. The impact of results from this study support the osteopathic tenet that the body is a unit of mind, body, and spirit. Finally, physicians should recognize the impact the role of caring for a child with disabilities has on the overall well-being of the caregiver. Figure 5: HALTER Community. Banner of caregiver and family member’s one -word descriptions of the relationships and community provided by the HALTER program.

Methods

Quantitative Analysis

• A total of 13 caregiver-child dyads were recruited, and children were enrolled in EAS for 16 weeks. • Children attended one-hour structured EAS on a weekly basis, for 16 wks. (figure 2). • Measures included DASS21-questionnaires, and semi-structured interviews administered prior to beginning EAS and after 16 weeks of activity.

±9.95

10 15 20 25

±10.97

• Data analysis was made using the median change score and interquartile range for the change score. Statistical significance was evaluated using the Wilcox Signed Rank Test. Interview data was analyzed using thematic analysis.

± 5.84

± 6.92

± 4.47

±3.69

± 4.43 ± 4.36

± 3.28

Figure 2. EAS. A child participating in a therapeutic horsemanship class.

-5 0 5

Results • Qualitative thematic analysis identified four common themes as contributing to increased stress levels in caregivers of children with ASD (figure 3). • Caregivers experienced a statistically significant decrease in their stress levels over a single semester of EAS participation demonstrated by a reduction in stress scores of DASS-21. Depression and anxiety scores did not show a statistically significant decrease post-intervention (figure 4).

Acknowledgements

Depression

Anxiety

Stress

This pilot study was approved as exempt by The Edward Via College of Osteopathic Medicine’s Institutional Review Board reference number 2023-171, package number of 2126547-2 on 12/18/2023.

Figure 4. DASS-21 Scores. DASS-21 Score comparison from caregivers prior to and following child involvement in equine-assisted services for 16 weeks. Statistically Significant (p = 0.03)

2025 Research Recognition Day

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