Kern et al observed an overall improvement in behaviors

Kern et al observed an overall improvement in behaviors typical for autism during TR. They used the Childhood Autism Rating Score (CARS), to determine the intensity of the change and found lower CARS values after 3 (t(21) = 2.73, p < 0.02) and 6 (t(16) = 3.33, p < 0.005) months of therapy. No changes in the results were noted when two other tools were applied: the Timberlawn Parent – Child Interaction Scale, and the Sensory Profile. Lanning et al noted an improved quality of life (QoL) evaluated with the use of two instruments: the Pediatric Quality of Life 4.0 (PedsQL 4.0)generic core scales and Child Health Questionnaire (CHQ) in autistic children undergoing EAA. Improved CHO scores for QoL were observed both, in the EAA group and controls (the latter were involved in social circles, which allowed for the children to take part in educational activities facilitated by students of psychology). The highest improvement for the controls and the EAA group was observed in the domains of self-esteem (M1 = 56.25 ± 18.77, M9 = 67.71, ±21.56) and general behavior (M1 = 52.08, ±19.37; M9 = 67.50, ±12.70), respectively. An increase in the psychosocial CHQ summary scores was reported for the control group (M1 = 34.80, ±;M9 = 39.58, ±7.39), while higher physical and psychosocial summary scores were observed in the EAA group (respectively, M1 = 40.80, ±13.43;M9 = 44.51 ± 16.72 and M1 = 37.22, ±15.23;M9 = 39.08, ±14.54). PedsQL scores of QoL were higher in the EAA group but FLAG Peptide comparison of differences in QoL improvement in both groups, evaluated with PedsQL and CHQ, did not reveal any statistical significance (p ≤ 0.05). Memishevikj and Hodzhikj measured the effects of EAT using the Autism Treatment Evaluation Checklist (ATEC). ATEC scores in individual subscales were improved as compared to baseline (respectively, 0–25% for the speech/language/communication domains, 3–30% for sociability, 0–35% for sensory/cognitive awareness, and 0–11% for health/physical/behavior), although not in all subjects. Regardless, the summary scores were improved after therapy in all cases (by 1–25%). Only Jenkins et al found no evidence for statistically significant beneficial impact of TR on the affect, linguistic competence, spontaneous initiations, or problem behavior of autistic children. Given the results of their study, these authors believe pepsin TR should be treated as a leisure activity rather than therapy. However, we are of the opinion that their study, being only a single report, should not belittle the significance of the evidence on the beneficial effects of EAAT.
VABS meta –results of the analysis The meta-analysis revealed no statistical significance for the investigated effects, either for the VABS summary scores or the Socialization and Communication subscales (Table 4, Table 5, Table 6). Egger's Test showed no publication bias for any of the cases.
Discussion In our study, a systematic review of the studies with comparison groups which evaluated the effectiveness of EAAT in ASD therapy was conducted. The meta-analysis proved to be a challenge due to significant differences between research tools and result presentation in all of the analyzed texts. Most publications on the effectiveness of EAAT concern children with cerebral palsy, the most common neurodevelopmental disorder in that age group.50, 51, 52In comparison, the number of studies on ASD is relatively small. ASD is less common, although the number of cases continues to rise, especially in the developed countries, and constitutes a challenge for the parents, caregivers, and health care system., Publications on EAAT effectiveness in ASD individuals focus on the behavioral aspects and interaction with the environment, as the impaired areas associated with social functioning, communication, response to stimuli, and engagement constitute the primary diagnostic criteria.55, 56, 57Aggressive behavior is another typical feature of ASD and may affect as much as 68% of the ASD population. Garcia-Gomez et al reported lower levels of aggressiveness after TR, which is consistent with the findings of Nurenberg et al who investigated chronic psychiatric inpatients with violent behavior undergoing Equine Assisted Psychotherapy or Animal Assisted Therapy. In another study among children with Attention –Deficit Hyperactivity Disorder (ADHD), Garcia-Gomez et al observed a notable improvement in aggressive behavior variables after using EAT. The results of both abovementioned studies, indicate that EAAT has a beneficial effect and reduces aggressiveness, which is consistent with the findings of Garcia-Gomez et al