Equine- and animal-assisted therapies offer structured interactions with horses or other animals to support confidence, regulation and communication. Although widely used in community and charity settings, these approaches are not recommended as core autism interventions in national clinical guidance. NICE CG170 and NICE CG142 do not include equine or animal-assisted therapies, and they do not appear on NHS.uk autism support pages. Updated NICE surveillance also found no new evidence strong enough to change this position according to 2021 review.
What research shows about benefits
A growing research base suggests that equine-assisted interventions may help some autistic people, especially children, develop social, emotional and motor skills.
- A 2022 systematic review found consistent improvements in social functioning after equine-assisted or therapeutic riding sessions, with some gains continuing beyond the intervention.
- A 2018 equine therapy review reported improvements in behavioural skills, social communication and some motor outcomes, though many studies were small and unblind.
- New evidence from 2025 prospective study shows gains in adaptive behaviour, communication, and daily living skills after 20 structured sessions.
- A 2024 systematic review found consistent improvements in balance, posture, and coordination.
Not all evidence is positive: some experimental analysis report little or no change in core autistic behaviours.
How these therapies work
Recent theoretical work suggests several mechanisms that may explain emerging benefits:
- A theoretical framework of Rhythmic horse movement may support postural control and balance.
- Shared focus on the horse can act as a natural motivator for communication and turn-taking.
- Structured routines provide predictability, which many autistic people find regulating.
- Calming sensory experiences around animals may support emotional regulation and engagement.
These mechanisms are promising but still require more robust testing.
Use in UK services and charities
Equine-assisted activities are offered by charities such as the Riding for the Disabled Association, which reports improvements in confidence, enjoyment and social participation based on internal outcome monitoring. UK autism organisations, including entries in the NAS service directory, position these activities as enriching experiences rather than evidence-based autism treatments.
Limitations, risks and accessibility
- Evidence is emerging, with small samples and limited long-term follow-up.
- Research largely focuses on children, with minimal data for autistic adults.
- Accessibility may be limited by the cost, location, and availability of trained staff.
- Physical risks (falls, allergies) and safeguarding requirements mean programmes must be delivered by qualified practitioners.
Takeaway
Equine- and animal-assisted therapies can enrich wellbeing and support social and motor development for some autistic people. But they remain complementary or experimental approaches, not core autism interventions recommended by NICE and NHS. They work best as optional, goal-focused activities within a broader, personalised support plan.
