Animal-assisted therapy has become a fast-growing and effective approach for remediating core impairments of children with ASD; however, recent systematic review studies on the effects of AAT in children with ASD have some limitations, including referral to a variety of animal-assisted interventions rather than to horseback-riding therapy alone and the absence of any meta-analysis in systematic reviews. A complete systematic review of the studies that describe the use of THR as an intervention is needed to specifically target the core impairments of children with ASD. The purpose of this study was to employ the systematic review method to synthesize research findings regarding the effects of THR programs on the social interaction and communication skills of children with ASD. We conducted a structured search in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for potentially relevant studies in five databases (Web of Science, PubMed, CINAHL, Scopus, and SPORTDiscus) from inception until February 2022. In addition, we manually searched the bibliographies of the included studies to find articles that might otherwise have been missed. We considered articles eligible or ineligible if they satisfied specific inclusion or exclusion criteria. Our results showed that the THR program is an effective direct and alternative therapeutic program that can considerably improve the social behaviors and communication skills of children with ASD and can effectively impact autistic impairments in areas such as social awareness, social cognition, social motivation, and social communication. These findings are in line with those of previous studies; however, we did not find statistical evidence of any effect of THR on the autistic behaviors of irritability, stereotypy, and inappropriate speech. In conclusion, the findings produced by this meta-analysis study provide evidence that THR programs can considerably improve the social behaviors and communication skills of children with ASD.
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