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Saliva samples (later assayed for cortisol and alpha-amylase, [sAA]) were collected before (pre-session), during (within-session), immediately after (post-session), and 20-minutes after (post-session\u2009+\u200920) each 1-hour weekly session. Data were analyzed with a generalized linear mixed-effects model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across the 10 sessions, pre-session sAA significantly increased (\n                      <jats:italic>exp(b)<\/jats:italic>\n                      \u2009=\u20091.02 per week,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Within sessions, sAA increased (\n                      <jats:italic>exp(b)<\/jats:italic>\n                      \u2009=\u20091.22;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) during therapy and recovered post-session\u2009+\u200920. Group differences in sAA changes were non-significant. By contrast, pre-session cortisol concentrations were stable across the 10-weeks (\n                      <jats:italic>exp(b)<\/jats:italic>\n                      \u2009=\u20091.01;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Within session, however, cortisol concentrations decreased from pre- to post- and post-session\u2009+\u200920, with greater reductions among OT-Equine participants (\n                      <jats:italic>exp<\/jats:italic>\n                      (b)\u2009=\u20090.77;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Changes in cortisol were associated with improved treatment outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The pattern of reactivity and recovery in sAA suggests that children experienced autonomic\/sympathetic arousal in response to therapy sessions, perhaps associated with excitement and positive affect. Moreover, stable pre-session cortisol concentrations across sessions for both groups, and declining cortisol concentrations within sessions for the OT-Equine group, suggests OT-Equine participants also held subjective experiences characterized by familiarity and low levels of distress. Taken together, findings suggest the integration of horses into occupational therapy for autistic children creates an exciting positive therapeutic environment, associated with improved treatment outcomes. The study was registered as a clinical trial at clinicaltrials.gov (NCT05846932, registered April 26, 2023).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10803-026-07540-9","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:32:42Z","timestamp":1791667962000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Incorporating Horses into Occupational Therapy on Adrenocortical and Sympathetic Nervous System Reactivity and Regulation in Autistic Children: A Randomized Controlled Trial"],"prefix":"10.1007","clinical-trial-number":[{"clinical-trial-number":"nct05846932","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Ellen M.","family":"Rankins","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Aichele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas A.","family":"Granger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Hepburn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Gabriels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arlene A.","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5145-2929","authenticated-orcid":false,"given":"B. 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No other authors have competing interests to declare that are relevant to the content of this article.","order":1,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All procedures were approved by the Colorado State University Institutional Review Board (Approved March 8, 2023, Protocol #4049) and Institutional Care and Use Committee (Approved January 3, 2023, Protocol #4071). Parents of children in the study provided informed consent and children provided informed assent before participating in the study.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}