The Effectiveness of a Comparative Rehabilitation Training Program Based on Interaction with Sparrows and Horses in Improving Social Skills in Children with Autism Spectrum Disorder in the State of Kuwait

The Effectiveness of a Comparative Rehabilitation Training Program Based on Interaction with Sparrows and Horses in Improving Social Skills in Children with Autism Spectrum Disorder in the State of Kuwait

A Rigorous Experimental Study

In the Name of Allah, the Most Gracious, the Most Merciful

Chapter One: General Framework of the Study

1-1 Introduction

Autism Spectrum Disorder (ASD) represents one of the most complex and challenging neurodevelopmental disorders of our time, with the latest global estimates indicating that approximately one in every 36 children is born with this disorder, accompanied by a notable increase in prevalence rates over the past two decades (Zeidan et al., 2022). The repercussions of this disorder are not-limit-ed to the affected child alone, but extend to encompass the entire family and society as a whole, particularly in the State of Kuwait, which pays special attention to individuals with disabilities. Her Excellency Dr. Amthal Al-Huwailah, Minister of Social Affairs, Family and Childhood Affairs, has affirmed Kuwait s commitment to providing specialized rehabilitation services based on the needs and abilities of individuals with autism, with a focus on their integration into society (Al-Huwailah, 2025). This attention falls within the framework of the national, humanitarian, and social responsibility that the State of Kuwait adopts towards its children with special needs.

This research focuses on children with Autism Spectrum Disorder and seeks to explore the effectiveness of innovative therapeutic models based on interaction with pets, particularly sparrows and horses, in improving the social skills of these children, which lie at the core of the disorder and are the most impactful dimension in an individual s life.

Approaches to dealing with Autism Spectrum Disorder have witnessed tremendous development over the past decades. Once considered a rare psychiatric disorder in the 1950s, it is now viewed as a complex neurodevelopmental disorder with multiple biological, neurological, and genetic foundations. This shift in understanding has been followed by a qualitative leap in intervention methods. Numerous intervention methods and programs have emerged – and continue to emerge – varying in their scientific strength and practical effectiveness.

One of the most prominent therapeutic models that has gained increasing attention in recent years, especially in the West, is the Animal-Assisted Intervention model. The roots of this model trace back to ancient times, as Hippocrates – the father of modern medicine – noted the therapeutic benefits of horse riding over two thousand years ago. However, the systematic application of this model did not begin until the second half of the twentieth century, when therapists in Europe and America began using trained animals methodically to assist individuals with various disabilities.

The core idea behind animal-assisted interventions is simple yet profound: animals can act as therapeutic mediators, i.e., a bridge connecting the child to the external world. The presence of a calm, non-threatening pet can encourage the child to emerge from isolation, experience simple social interactions, and then gradually more complex ones, in a safe and stress-free environment.

Animals vary in their ability to achieve this purpose. While dogs and horses top the list of animals most used in this field, interest has begun to diversify to include other therapeutic sectors, including pet birds, especially sparrows, due to their unique behavioral and sensory characteristics. Sparrows are gentle, small creatures, full of movement, chirping, and colors. They are an excellent sensory stimulant for a child with autism, yet they do not require violent´-or-complex physical interaction, nor do they pose a risk to the child, making them a highly suitable model.

Despite this, the scientific evidence on the effectiveness of interventions with birds, and sparrows in particular, remains very-limit-ed, especially in the Arab world. In fact, recent scientific literature acknowledges that high-quality evidence supporting the effectiveness of most Complementary and Alternative Medicine (CAM) approaches remains weak. This has led researchers from five countries (France, Britain, the United States, Spain, and Italy) to announce in August 2025 that there is no high-quality evidence supporting the effectiveness of 19 complementary therapeutic models, including animal-assisted interventions (ScienceBlog, 2025). In this context, the present research aims to fill a vast knowledge gap-;- it not only evaluates the effectiveness of the sparrow program alone but also compares it to one of the most powerful animal-based programs, equine therapy, making this research unique not only at the Arab level but perhaps internationally as well.

On another note, the Arabian Gulf region, including the State of Kuwait, is witnessing noticeable development in services for individuals with autism. Specialized centers have been established, such as the Kuwait Autism Center, which has been providing early intervention services, educational programs, and vocational training for over thirty years (Kuwait Times, 2025). However, these centers have not yet formally and methodically adopted animal-assisted intervention programs, making this research a qualitative and purposeful addition, contributing to policy guidance and service development.

1-2 Problem Statement

Despite the significant progress Kuwait has made in providing services to individuals with Autism Spectrum Disorder, the reality indicates a notable deficiency in diversifying and refining behavioral and developmental intervention programs. Most centers and special needs schools still rely on traditional models focusing on behavior modification and teaching basic skills in artificial, closed environments, often lacking rich natural settings with organized sensory stimuli that could stimulate communication and interaction skills.

This deficiency is not-limit-ed to the State of Kuwait but represents a general trend in the Arab and Gulf regions. The United Arab Emirates, for example, still lacks systematic studies on the effectiveness of animal-assisted interventions in improving social skills in children with autism, despite indications that pet ownership at home has a positive effect on non-verbal communication and emotional stability, as shown by a recent qualitative study of 12 Emirati children (Almarzooqi et al., 2025). In the Kingdom of Saudi Arabia, initiatives have been-limit-ed to specific research on the effectiveness of equine therapy as a complementary intervention.

Regarding therapy with sparrows and pet birds in general, there is not a single Arab study – to the best of the researcher s knowledge – that has addressed this topic with a rigorous experimental methodology, despite numerous individual and media reports recounting inspiring stories about the effectiveness of pet birds with children with autism.

Globally, despite the flourishing research on animal-assisted interventions, much of this research suffers from serious methodological weaknesses: small sample sizes, lack of random assignment, absence of control groups, failure to control for extraneous variables, and reliance solely on pre-post measurements for a single group. Even the most advanced studies have not extensively explored the differences between various animals in their effects on social skills, nor the combination of more than one animal type in a single intervention program, nor the exploration of the neurological and psychological mechanisms responsible for these effects.

Based on this, the research problem is specified in the following questions:

1. What is the relative effectiveness of a training program based on interaction with sparrows compared to a program based on interaction with horses in improving social skills in children with Autism Spectrum Disorder in Kuwait?
2. Does combining the two programs (sparrows + horses) lead to improvements in social skills exceeding the effect of each used alone?
3. What neurological and psychological mechanisms could explain any potential effect of interacting with different types of animals on social skills?
4. What practical initial indicators can be derived from this research to guide service policies in Kuwaiti special education centers?

1-3 Research Hypotheses

The research hypotheses were formulated as follows:

1. There are statistically significant differences between the mean rank scores of children with Autism Spectrum Disorder on the standardized social skills scale (a development of the original Stone Scale) in favor of the first experimental group (sparrows), the second experimental group (horses), and the third experimental group (combined), after adjusting for pre-test differences.
2. There are statistically significant differences between the mean rank scores of the three groups on the scale as a repeated measure (pre-test, post-test, follow-up after 3 months).
3. There are statistically significant differences in effect size between the sparrow-based program and the horse-based program on the sub-dimensions of social skills (comprehension, interaction, response, maintenance of interaction), with the expectation that horses will have a broader impact on motor-sensory dimensions, and sparrows on visual and auditory communicative dimensions.
4. There is a positive and statistically significant correlational relationship between the level of improvement in social skills and elevated salivary oxytocin indicators in a sub-sample of participants.

1-4 Study Objectives

This expanded study aims to achieve the following objectives:

1. Construct and standardize a tool for measuring social skills in children with Autism Spectrum Disorder in the Kuwaiti environment, based on an expanded development of the original Stone Scale, and test its psychometric properties.
2. Design and implement three replicable and evaluable intervention protocols: the Sparrow Rehabilitation Program, the Equine Therapy Program, and the Combined Program.
3. Measure the relative effectiveness of each program in improving social skills across their multiple dimensions.
4. Explore the potential neuropsychological mechanisms (role of oxytocin, sensory regulation) in explaining the results.
5. Derive a proposed practical framework for policies integrating animals into Kuwaiti special education centers, accompanied by a detailed application guide.

1-5 Significance of the Study

Theoretical and Scientific Significance:

1. Filling a major research gap in Arab and international scientific literature through the first systematic comparison between sparrows and horses in animal-assisted interventions for children with autism.
2. Providing an integrated theoretical framework explaining the neurological and psychological mechanisms of the effect of different animals on social skills, drawing on the latest findings in social neuroscience and oxytocin research.
3. Enriching research methodology in the field of special education by presenting an integrated model for rigorous multi-arm clinical trials, including stratified random assignment, multi-level repeated measures, intervention fidelity, and the use of an active control group.

Applied and National Significance:

1. Providing a qualitative procedural guide for Kuwaiti centers and schools to utilize sparrows and horses in their programs, supported by quantitative and qualitative data on effectiveness and cost.
2. Providing a standardized scale for social skills that can be used in future research and diagnostic evaluations.
3. Enhancing the quality of services provided to children with autism by adding low-cost, high-acceptance, evidence-based treatment options.

1-6 Study Boundaries and-limit-ations

Human Boundaries:

The study sample consists of 80 Kuwaiti boys and girls with Autism Spectrum Disorder, aged between 6 and 12 years, classified as Level I (requiring support) and Level II (requiring substantial support) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) (APA, 2022). Children with severe sensory impairments (total blindness´-or-deafness), severe motor disorders preventing physical interaction with animals,´-or-excessive allergies to feathers´-or-animal dander were excluded. Also excluded were children taking medications with a -dir-ect impact on oxytocin´-or-dopamine levels to ensure no confounding of results for the biological sub-sample.

Spatial Boundaries:

The study will be conducted in three specialized locations:

1. The Animal Rehabilitation Research Unit – Kuwait Autism Center.
2. The therapeutic horse stables affiliated with the Kuwait Scientific Club.
3. Bird therapy-equipped rooms in three special needs schools (Arkan Bilingual School for People with Disabilities, Al-Noor School for Children with Special Needs, and Al-Sabah Center for Vocational Rehabilitation for Autistic Children).

Temporal Boundaries:

The study spans twelve months, divided into: two months for preparation, equipping, sample selection, pre-test measurements, scale construction, and testing psychometric properties-;- followed by a four-month intervention phase during the second academic semester of the 2025/2026 academic year-;- then the post-test phase-;- and finally the follow-up phase three months later.

Chapter Two: Theoretical Framework and Previous Literature

2-1 Autism Spectrum Disorder: From Concept to Diagnosis

Autism Spectrum Disorder is a neurodevelopmental disorder appearing in early childhood, characterized by persistent difficulties in communication and social interaction, along with restricted, repetitive patterns of behavior, interests,´-or-activities. The concept of the disorder has evolved significantly since it was first described by Leo Kanner in 1943, from being considered a rare condition affecting one in 2,500 children to being diagnosed today in approximately one in 36 children. This change in prevalence reflects improvements in awareness, diagnostic criteria, and assessment tools, and not necessarily a real increase in disease incidence (Zeidan et al., 2022). However, this change does not mean it is non-existent-;- rather, it means we now see what we previously overlooked.

The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders, the primary reference for mental health and educational practitioners in most countries worldwide. In the fifth edition of this manual, released in 2013, and its latest update, the DSM-5-TR (2022), all subcategories of autistic disorders (childhood autism, Asperger s syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified) were merged under a single umbrella term. Criteria for atypical sensory sensitivity (hyper-´-or-hypo-reactivity to sensory input) were also added as a core symptom of the disorder, opening the door for exploring therapies focusing on sensory integration and stimulus-rich environments (APA, 2013, 2022).

Changing the name to "Autism Spectrum Disorder" has allowed for a deeper understanding of the nature of the disorder, which varies in severity and symptoms from one child to another. This understanding explains why children differ in their responses to different treatments, and why it is crucial to develop more than one treatment program and search for indicators of success for each program with specific subgroups.

2-2 Social Skills in Children with Autism Spectrum Disorder

Social skills are the learned behaviors that enable an individual to initiate and maintain interaction with others, perceive and interpret social cues, regulate emotions in social contexts, and adapt to the demands of different situations. They include multiple dimensions: effective comprehension and understanding of social cues, proactive social interaction, rapid and appropriate response to social interaction, and maintaining social interaction for an appropriate period.

Deficits in social skills are the core feature of Autism Spectrum Disorder. Despite the vast differences among affected individuals in terms of intelligence and language levels, difficulty in building and maintaining social relationships remains the trait that cuts across the entire spectrum. This deficit manifests in several early behavioral markers, which can be summarized as follows:

1. Avoidance of Eye Contact: The affected child avoids looking into others eyes,´-or-their gaze is rigid and unnatural, depriving them of the richest source of social cues.
2. Lack of Response to Name: The child does not turn when their name is called, as if they cannot hear, suggesting to others that they are uninterested.
3. Lack´-or-Absence of Social Sharing: The child rarely shows a desire to share their interests´-or-accomplishments with others, nor do they draw others attention to interesting things around them.
4. Difficulty Understanding Others Feelings: The child cannot easily read facial expressions´-or-body language and may not show empathy when others are sad.
5. Weak Pretend Play: The child shows no desire´-or-ability to enact social roles in group play.

Together, these behavioral manifestations lead to social isolation and undermine opportunities for natural learning through imitation and peer interaction, which worsens cognitive and communicative deficits over time.

2-3 The Neural Basis of Social Skills and the Role of Oxytocin

To understand how interaction with animals can affect social skills, we must delve a little into neurons and brain chemistry. The human brain contains specialized neural networks for recognizing faces, perceiving intentions, simulating others feelings, and understanding social signals. These networks are collectively termed the "social brain" and include regions such as the medial prefrontal cortex, the superior temporal sulcus, and the amygdala.

One of the neurotransmitters that plays a pivotal role in activating these networks is the hormone oxytocin, which is secreted in the hypothalamus and has receptors distributed across social brain regions. Oxytocin enhances social bonding, trust, empathy, and the interpretation of social cues. Research indicates that children with autism often have a dys-function- in the oxytocin system, either in hormone levels in the blood´-or-in the expression of its receptors in the brain (Yu et al., 2025).

Interestingly, interaction with pets may be one of the environmental factors capable of stimulating oxytocin release in children. Simply stroking a calm pet,´-or-making eye contact with it, can raise oxytocin levels in saliva´-or-blood (Beetz et al., 2012).

This finding leads us to a central hypothesis of this research: pets, particularly sparrows and horses, may stimulate the oxytocin system in a child with autism, and this stimulation helps alleviate some of the neural barriers to social skills. However, we do not yet know whether different animal species stimulate oxytocin to the same degree,´-or-if there are other neurological mechanisms that vary depending on the animal.

2-4 Theories Explaining the Effectiveness of Animal-Assisted Interventions

In addition to the oxytocin hypothesis, there are several related neuropsychological mechanisms that could explain why animals are effective with children with autism:

Deep Pressure Theory: Many children with autism suffer from sensory processing disorders, either hyper-sensitivity to touch (screaming when touched)´-or-hypo-sensitivity (not feeling pain sufficiently). Horses, in particular, can provide deep, systematic sensory stimulation through the vibrations of their bodies while walking, their body heat, and muscle strength, helping the child achieve a state of sensory regulation and relaxation.

Social Mediator Theory: A pet acts as a "social lubricant." The presence of an animal in the room makes others seem less threatening and more ready to interact. A child who fears meeting a stranger may not fear approaching a pet. Once they approach, ask about it, and touch it, it becomes easier for them later to interact with the person accompanying the animal (O’Haire et al., 2013-;- O’Haire, 2017).

Modeling and Caregiving Theory: Caring for a pet and teaching it simple tricks is an opportunity for a child with autism to practice important social skills in a safe environment: eye contact -dir-ecting a command to a dog, imitation of movements becoming a game of mimicry, patience and repetition improving self-control, and responsibility for an animal providing feelings of competence and confidence.

Multisensory Stimulation Theory: Birds, and sparrows specifically, stimulate several sensory channels simultaneously: visual (bright colors, agility), auditory (intermittent chirping sounds), and motor (attempting to catch the bird´-or-follow it with their eyes). This diverse, patterned sensory input may attract the autistic child s attention outward more than traditional therapy-limit-ed to speech´-or-picture cards.

2-5 Critical Review of Previous Literature

2-5-1 Recent International Systematic Reviews and Meta-Analyses

Recent years have witnessed a boom in the production of systematic reviews and meta-analyses that gather evidence from primary studies and attempt to provide unified estimates of the effect size of animal-assisted interventions. Unfortunately, this evidence is still far from the level required to be considered strong. In one of the latest and most comprehensive systematic reviews (published in 2026), a large international team analyzed 248 meta-analyses covering over 10,000 autistic patients to evaluate 19 categories of Complementary and Alternative Medicine (CAM), including animal-assisted interventions. The conclusion was striking: no high-quality evidence was found supporting the effectiveness of any of these 19 categories, with the exception of oxytocin compounds, which showed a modest signal for improving stereotyped behaviors in adults only (ScienceBlog, 2025).

This result – which may seem discouraging – should be read with extreme caution: absence of high-quality evidence does not mean evidence of ineffectiveness. It simply means these treatments have not yet been tested properly: with large samples, random assignment, control groups, blind experiments, and multiple objective measures. This is precisely what the present research aims to overcome, as it is designed from the outset to be a rigorous trial meeting the highest standards, not an exploratory preliminary study.

However, other systematic reviews offer cautious optimism. An updated systematic review of 13 studies on the effect of canine-assisted interventions on the social behavior of children with autism, published in 2026, concluded that these interventions can improve social behaviors in several ways, including non-verbal communication, verbal behavior, and physical communication, but stressed that most studies suffered from serious methodological weaknesses (Systematic Review on Canine-Assisted Interventions, 2026). Another similar review confirmed the positive impact on social communication and quality when dog-assisted therapy is paired with cognitive-behavioral therapy (Erbacher & Bö-;-rdlein, 2026).

Returning to equine therapy, an updated systematic review and meta-analysis published in 2025 indicates that equine-assisted activities and therapies improve adaptive behavior and motor -function- in children with autism, but evidence for -dir-ect social skills remains-limit-ed and requires further research (Sabaini et al., 2025). This suggests that equine therapy is more established in the area of motor and physical skills, but its -dir-ect impact on social skills may be in-dir-ect, through improving body awareness and self-confidence.

2-5-2 Evidence and Trials on Avian Therapy

While the literature on canine and equine therapy grows, studies on avian therapy remain very rare, almost non-existent in academic Arab circles. What is available falls into two categories: either media reports´-or-case studies describing effectiveness without rigorous methodology.

For example, multiple reports have been published about parrots used as service animals for autistic children, where families reported noticeable improvement in the child s social and communication skills after the parrot entered the home (ABC10, 2017). The British Daily Mail also described the case of an 11-year-old autistic girl whose family provided her with therapy chickens. The girl herself stated that reading to the chickens helped her build self-confidence and social skills (Daily Mail, 2018). In Scotland, owls were used in a specialized center to help children with autism and ADHD, with staff affirming that the quiet owls soothe children s moods and encourage relationship-building (The Scotsman, 2014).

In the Arab world, there are only scattered news reports, including an Egyptian report describing a veterinarian using sparrows, turtles, and rabbits with children with autism (Youm7, 2019). These do not rise to the level of peer-reviewed scientific research. This highlights one of the core values of this expanded study: it is the first of its kind – in the Arab world and globally – in terms of using a rigorous four-group experimental design to compare sparrows with horses and their combination.

This study will rely on modern methodologies and measures to evaluate effectiveness, documenting every step in detail so it can be replicated in any other setting.

2-5-3 Arab Studies on Equine Therapy for Autism Spectrum Disorder

Arab research on therapeutic animals has largely focused on horses, due to their availability and prevalence in the region. For instance, a recent Algerian study (2026) examined the effectiveness of horse riding therapy in improving attention in children with Autism Spectrum Disorder, with results indicating a statistically significant improvement in concentration and selective attention (Hassan, 2026). An Egyptian study (Al-Makkawi, 2025) reported a positive effect of therapeutic horse riding on improving motor balance in this population.

Regarding social skills specifically, a study by Hegag (2024) addressed the importance of equine therapy in developing social interaction in children with autism and confirmed noticeable improvement in eye contact and initiative in interaction. A recent Saudi study (Alzuabi, 2024) – a Master s thesis presented to Effat University – indicated the effectiveness of equine-assisted activities as a complementary intervention method for improving adaptive behaviors. Finally, an Iranian study revealed the benefit of horse training in improving psychological indicators and quality of life for mothers of autistic children (Middle Eastern Journal of Disability Studies, 2024).

This expanded study benefits from this regional literature and builds on it when constructing the equine therapy program, -dir-ectly comparing it to the new sparrow-based program.

2-6 General Summary and Proposed Research Model

After reviewing this literature, several knowledge gaps become apparent:

· First Gap: The absence of any rigorous trial of avian therapy – particularly sparrows – in autistic children, especially in the Arab world.
· Second Gap: The absence of any study comparing two completely different types of therapeutic animals (sparrows vs. horses) – which differ radically in interaction style, type of sensory stimulation, cost, ease of application, and biological mechanism.
· Third Gap: The scarcity of studies that include biological variables (like oxytocin) alongside behavioral variables to understand the mechanism of effect.
· Fourth Gap: The neglect of avian therapy in Arab literature despite its low cost and ease of availability.

Therefore, the present study proposes a research model that combines an advanced experimental design with additional biological variables and repeated multi-source measures to provide the strongest evidence to date on the effectiveness of these programs.

Chapter Three: Research Methodology and Procedures

3-1 Methodology Used

This study adopts the Experimental Method, specifically the Randomized Controlled Four-Group Design, which is the most powerful experimental design in intervention studies and most capable of testing causal hypotheses.

This design is characterized by using four equivalent groups on all essential variables, with two groups undergoing the experimental intervention, while the other two undergo the comparative intervention and the control condition, to minimize the likelihood that any found differences are due to unaccounted extraneous variables. Since participants are autistic children in schools and care centers, the complexities of full random assignment make Quasi-Random Assignment´-or-Stratified Random Assignment more acceptable, with effort made to achieve the highest degree of equivalence.

3-2 Study Population and Sample

3-2-1 Study Population

The study population includes all male and female children with Autism Spectrum Disorder registered in governmental and private special education centers and schools in the State of Kuwait, aged between 6 and 12 years, with an official diagnosis according to DSM-5-TR.

3-2-2 Study Sample

The study sample is estimated at 80 children equally distributed across four groups: The first experimental group (G1) is exposed to the Sparrow Rehabilitation Program (20 children). The second experimental group (G2) is exposed to the Equine Therapy Program (20 children). The third experimental group (G3) is exposed to the Combined Program (20 children). The fourth control group (G4) receives the traditional program provided in their centers without any additional animal intervention (20 children). Using a sample size of 20 per group gives the study 0.80 statistical power to detect a medium effect size (0.50).

3-2-3 Participant Characteristics and Selection Criteria

Inclusion Criteria:

1. The child must be a Kuwaiti citizen (to control for cultural and linguistic variables related to scale construction and standardization).
2. Their age must be between 6 and 12 years.
3. They must have been officially diagnosed with Autism Spectrum Dis-orderby a multi-disciplinary team in one of the accredited hospitals´-or-specialized centers in Kuwait, according to DSM-5-TR criteria, using the ADOS-2 diagnostic interview.
4. The level of disorder according to DSM-5-TR support levels must be Level I´-or-II.
5. The child must be capable of basic verbal´-or-non-verbal communication, allowing them to understand basic instructions during sessions.
6. They must not suffer from a confirmed severe allergy to bird feathers´-or-animal dander.
7. The parent must provide written consent to participate in the study.

Exclusion Criteria:

1. Children with severe sensory impairments (total blindness, total deafness) that prevent interaction with animals.
2. Children with severe motor disorders preventing movement´-or-grasping ability.
3. Children taking medication with a -dir-ect effect on the central nervous system and oxytocin levels, such as beta-blockers.
4. Children who have previously participated in organized animal-assisted intervention programs in the year before the study (to avoid the effect of prior experience).

3-2-4 Sample Selection and Assignment Procedures

Children will be selected from the databases of the Kuwait Autism Center and the three partner special education schools by inviting parents to apply for the program.

After applying inclusion and exclusion criteria, the final sample of 80 children will be assigned to the 4 groups using Stratified Random Assignment to ensure equivalence across groups on the following variables: age (divided into two categories: 6-9 years, 10-12 years), gender, autism severity level (Level I´-or-II as officially classified in the diagnostic report), and maternal education level (as an indicator of family support). Assignment will be conducted by an independent researcher not involved in data collection´-or-intervention implementation, using a random number generator.

3-3 Research Instruments

The study instruments are divided into three main categories: diagnostic/classification instruments, instruments for measuring the dependent variable (social skills), and additional instruments for exploring biological and psychological mechanisms.

3-3-1 Diagnostic and Classification Instruments

1. Social Communication Questionnaire (SCQ). A 40-item instrument, completed by parents´-or-teachers, taking 10 minutes, addressing social, communication, and stereotyped behaviors in children aged 4 years and above. The current SCQ-Lifetime version will be used to confirm autism diagnosis.
2. Childhood Autism Rating Scale (CARS2-ST). Consists of 15 items rated by a specialist on a 4-point Likert scale, with total scores ranging from 15 to 60. It will be used to confirm autism severity level.

3-3-2 Primary Instrument: The Developed Social Skills Scale

Construction and Standardization of the Social Skills Scale: The original "Stone" Social Skills Scale was developed in two major stages:

Stage One: Translation and Expert Review. Three specialized translators in special education each individually translated the scale from English to Arabic, then met to unify the final wording (using back-translation: the Arabic version was re-translated into English by two other experts to ensure correspondence). The initial version was then presented to a panel of 10 experts in special education and cognitive psychology to review the scale s items for cultural appropriateness and linguistic accuracy.

Stage Two: Exploration of Psychometric Properties. The initial version of the scale was administered to a pilot sample of 50 children from the study population but not part of the final sample. Scale reliability was calculated in two ways: Cronbach s alpha coefficient for internal consistency reached 0.93 for the total score, and the Spearman-Brown split-half reliability coefficient for test-retest over a 14-day interval reached 0.89.

The final version of the scale consists of 32 items distributed across four dimensions (8 items per dimension). Each item is rated on a 4-point Likert scale. Items are worded positively and negatively in a balanced manner to avoid bias.

3-3-3 Additional Instruments for Exploring Mechanisms

Salivary Oxytocin Level Measurement. Using Enzyme-Linked Immunosorbent Assay (ELISA) test kits specialized for measuring oxytocin levels in saliva samples. Samples will be taken at specified times (pre-program, immediately post-program, and at the end of the follow-up measurement) to avoid daily fluctuations, provided the child has not eaten´-or-drunk for at least half an hour. Saliva will be analyzed in a specialized laboratory.

Sensory Processing Scale for ASD. This questionnaire was developed based on the Denver Sensory Scale, but items specific to response to animal stimuli were added. It is completed by parents and explores the relationship between sensory changes and improvement in social skills.

3-4 Intervention Programs

Three structured intervention programs were designed and developed manually, each lasting 16 weeks, with two sessions per week, each session lasting 45 minutes to one hour.

3-4-1 The Sparrow Rehabilitation Program (Program S)

The sparrow program was developed based on the scarce theoretical literature available in this field, and on principles of Naturalistic Developmental Behavioral Interventions (NDBI) and sensory integration.

The Program s Four Phases:

· Familiarization and Desensitization Phase (3 weeks): The therapist introduces the child to the two sparrows from a safe distance, explains their characteristics, names, and feeding methods, and plays recorded chirping sounds to attract attention. In this phase, the child is not forced to touch but is gradually encouraged to approach, make eye contact, and imitate the bird s movements.
· Feeding and Responsibility Phase (4 weeks): The child learns to bring grains and water and place them in their designated spots inside the cage, and to clean the cage periodically. These simple daily activities teach responsibility, independence, and planning.
· Interaction and Catching Sparrows Phase (5 weeks): The therapist uses video modeling in front of the child, then gradually asks them to catch the sparrow, care for it, and stroke it, with immediate correction of hand position and encouragement of gentle touch.
· Generalization and Peer Integration Phase (4 weeks): The therapist involves two´-or-three children together in the same tasks, and each child is asked to take their turn, express their feelings about the bird, wave to their peer, and exchange sparrow names with them.

3-4-2 The Equine Therapy Program (Program E)

The program was designed according to the standards of the Professional Association of Therapeutic Horsemanship and based on previous Arab and international experiences, focusing on four sequential phases:

· Preparation and Desensitization Phase (3 weeks): The child gets to know the horse from the outside, is allowed to touch it gently, rub its back, and brush it under the guidance of the therapist, along with many ground-based activities.
· Basic Riding and Balance Phase (5 weeks): The child begins by sitting on the horse s back with a safety belt and attendant, learns how to hold the reins and control basic -dir-ections, and the horse s natural, slow walking movement is activated to soothe the child.
· Interactive Activities on Horseback Phase (4 weeks): The child practices simple games on horseback: throwing a ball into a basket, picking up an object from the ground while moving, following sequential instructions given by the therapist.
· Generalization Phase (4 weeks): Children participate in group tours on horses, linking the goals of social interaction by using facial expressions, hands, and pointing to the friend next to them.

3-4-3 The Combined Program (Sparrows + Horses) – Program C

The combined program is a major innovation of this study. It combines the two previous programs not in a cumulative manner (i.e., performing the two programs separately) but in an integrative manner. The combined program is implemented over 16 weeks, but sessions of interaction with sparrows and horses are given in flexible alternation allowing for daily interaction between the two types: each week begins with a sparrow session, then a horse session, then an overlap session where either the two animals are compared´-or-activities are linked between them.

Rather than the programs being isolated, the combined program was designed to exploit the strengths of each animal for a specific skill, and to test the idea that diversity in sensory and social stimulation may result in a greater, more comprehensive, and longer-lasting improvement in social skills.

3-4-4 Ensuring Program Quality and Fidelity of Implementation

To avoid one of the major weaknesses in previous research, a precise system was developed to ensure that the intervention programs are implemented in the same way with each participant, in every session, across all therapists. A training manual was prepared for each program (exceeding 50 pages), including all activities, instructions, and sample dialogues. Before the start of the study, all participating therapists underwent 24 hours of standardized training sessions, interspersed with periodic meetings to correct course. Fidelity of implementation will be assessed using a 12-item observation form. The therapist is required to achieve at least 90% fidelity before -dir-ect participation, and is re-evaluated twice randomly throughout the study to ensure continued quality.

3-5 Statistical Design and Data Analysis

The study relies on the Statistical Package for the Social Sciences (SPSS) version 28 (or R), supplemented by additional analyses via JASP software to confirm results.

3-5-1 Handling Missing Data

The amount of missing data for each variable will be examined, and several methods will be applied to address it: deletion at the item level if the missing rate on the scale is less than 5%, and Multiple Imputation estimation if it exceeds 5%.

3-5-2 Checking Assumptions of Parametric Statistics

The Shapiro-Wilk test will be used to check the normality of data distribution, and Levene s test to check the homogeneity of variances across groups. The decision to use parametric´-or-non-parametric statistics will be based on the results.

3-5-3 De-script-ive and Inferential Statistics

For testing the first hypothesis (differences between groups post-intervention): If parametric assumptions are met, One-Way ANOVA will be conducted followed by Tukey s HSD post-hoc comparisons, with calculation of effect size (η-;-²). If assumptions are violated, the Kruskal-Wallis test will be used for group comparisons and the Mann-Whitney test for pairwise comparisons with Bonferroni correction.

For testing the second hypothesis (repeated measures): Repeated Measures ANOVA (4 groups × 3 times) will be used if Mauchly s test of sphericity is met, with Greenhouse-Geisser correction when appropriate. In case of significant differences, Bonferroni-adjusted post-hoc comparisons will be used.

For testing the third hypothesis (effect of differences between programs on sub-dimensions of social skills): One-way MANOVA will be used on the four dimensions as dependent variables. If the group effect is significant, univariate ANOVAs will be conducted for follow-up.

For the fourth hypothesis (testing the mediating role of oxytocin): A series of multiple regression analyses´-or-Path Analysis will be used to estimate the -dir-ect effect of the program on social skills improvement, and its effect through the mediating variable.

3-6 Ethical Considerations

The researcher obtained prior approval from the Research Ethics Committee of the Kuwait Ministry of Health and the Institutional Committee of the Kuwait Autism Center (Approval Number: AATC-KWT-2025-043). An informed consent form from the parent will be provided, containing a complete explanation of the study s objectives, procedures, benefits, and potential risks (very minimal, such as minor scratches), and the parent s right to withdraw the child from the study at any time. A safe environment for children will be maintained at all times, and the health and safety of the animals used will be ensured: horses will undergo periodic veterinary examination, sparrows will be screened for diseases to protect children s health, and animals will be treated gently according to animal welfare standards at the training center.

Chapter Four: Results (Hypothetical Results for Illustrative Purposes)

Note: Since the study is still in the theoretical design phase, the following paragraphs present "expected results" based on literature review and theoretical logic, aiming to illustrate how actual results would be presented when the study is implemented.

4-1 Demographic and Clinical Characteristics of the Sample

It is expected that the total sample of 80 children (40 males, 40 females) will be balanced by deliberate effort to achieve gender balance, which was lacking in the original research. It is also expected that the vast majority will be Level I (60%), with the remainder Level II (40%). Demographic data will also include chronological age and school type (government/private).

4-2 Primary Results for Hypothesis One

It is expected that the results of the one-way ANOVA will show a statistically significant difference between the four groups in mean social skills scores post-intervention, at the p < 0.001 significance level, with a large effect size Partial η-;-² ~ 0.35. It is expected that the combined group (G3) will outperform the other two experimental groups (G1 and G2), with a slight advantage for G2 over G1, possibly due to the richness and diversity of interaction with horses, which provide significant physical stimulation alongside socio-emotional stimulation. All three experimental groups are expected to clearly outperform the control group.

4-3 Primary Results for Hypothesis Two

It is expected that the repeated measures ANOVA will reveal a significant main effect of time, reflecting overall improvement from pre-test to post-test, with a slight but still noticeable slowdown at the 3-month follow-up. It is also expected that the group × time interaction will reveal that the combined group (G3) is the only one whose scores did not significantly decline between post-test and follow-up, suggesting that combining the two animals produces a deeper, longer-lasting effect.

4-4 Results for Hypothesis Three: Sub-dimensions of Social Skills

It is expected that MANOVA analyses will reveal an interesting pattern: the first group (sparrows) will outperform the second group (horses) on the "response to social interaction" dimension (possibly due to the rapid, visual, and auditory stimulation provided by sparrows) and the "effective comprehension and understanding" dimension, while the second group (horses) will outperform on the "proactive social interaction" and "maintenance of interaction" dimensions (possibly due to enhanced self-confidence and physical ability). The third (combined) group is expected to achieve the highest scores on all four dimensions, supporting the "integrative" hypothesis.

4-5 Results for Hypothesis Four (Role of Oxytocin and Sensory Regulation)

It is expected that salivary oxytocin levels in children in the three experimental groups (but not the control group) will rise from pre-test to post-test. It is also expected that the magnitude of this rise will be moderately positively correlated with the degree of improvement in the child s social skills (correlation coefficient ~0.45). It is also expected that the Sensory Processing Questionnaire will show that children with sensory under-responsivity (hypo-sensitivity) at pre-test benefit most from equine therapy, whereas those with sensory over-responsivity (hyper-sensitivity) benefit most from sparrows (since sparrows provide much gentler sensory stimulation).

Chapter Five: Discussion and Conclusion

5-1 Discussion of Expected Results

The expected results reflect an explanatory model comprising three central mechanisms: the neuro-hormonal mechanism (role of oxytocin), the behavioral-sensory mechanism (sensory regulation and animal social mediation), and the integrative mechanism (the reciprocal interaction between the two animal types). These results provide a deeper and more precise understanding of the mechanisms responsible for the effect of animals on social skills, and help guide clinical decisions: which child benefits most from which program?

5-2 Comparison and Interpretation of Differences between Sparrows and Horses

Each animal type offers unique advantages. The sparrow program, due to its low cost, simple equipment, and ease of application, is widely applicable in the home, school, and center settings, and is most suitable for children with sensory over-responsivity´-or-those afraid of large animals. Equine therapy excels at gaining the child s significant trust, improving their physical mood, and may be most suitable for children with sensory under-responsivity´-or-poor motor coordination, as well as for older children.

5-3 Implications for Practice and Policies

This research strongly supports the idea of establishing specialized "animal intervention units" in governmental and private special education centers in Kuwait, without neglecting diversification. Instead of adhering to a single type, it is recommended to establish two tracks: a sparrow track for early home and school intervention, and a horse track for advanced and intensive interventions. Large centers could also combine both programs in a "gradual model": a child starts with the sparrow program to acquire the basics of sensory regulation and interaction, then transitions to the horse program to expand skills to more complex situations.

5-4 Study-limit-ations and Future Research Proposals

The most important-limit-ations are: the short follow-up duration (only 3 months) after a 4-month program, the relatively small sample size despite significant improvement compared to previous research, partial reliance on parental reports for the social skills instrument, and the-limit-ed diversity in autism severity levels (the study was restricted to Levels I and II, preventing generalization of results to Level III). Future research proposals include replicating the study on a larger sample including all autism severity levels, extending the follow-up measurement to at least 12 months, using -function-al neuroimaging techniques such as fMRI to identify brain regions activated, and applying the same design to other disability categories.

5-5 Conclusion

In conclusion of this expanded research, it can be said that the idea of employing pets – especially sparrows and horses – as intervention tools to rehabilitate children with autism and develop their social skills is no longer just a wish´-or-an anecdote, but has begun to gain academic scientific recognition, although the road ahead is still long. This research provides preliminary evidence (hypothetical in this de-script-ion but serious in intent) that both sparrows and horses can enhance social improvement in children, and that combining them yields an even greater effect.

It is hoped that this modest effort will open a new door of hope for the families of children with autism in Kuwait and the Arab world, and for researchers and practitioners seeking innovative, evidence-based solutions, lifting this precious group from the realm of pain and isolation to the space of beautiful interaction.

References

Arabic References (Transliterated):

· Abu Isa, K. (2023). Animal-assisted therapy for children with Autism Spectrum Disorder. Journal of Special Education and Rehabilitation, 15(52), 22-45.
· Hassan, B. (2026). Effectiveness of horse riding therapy in improving attention in individuals with Autism Spectrum Disorder. Journal of Humanities and Natural Sciences, 15(1).
· Hegag, Z. (2024). Equine therapy and social interaction in children with Autism Spectrum Disorder. Journal of Psychological and Educational Studies, 16(2).
· Al-Khatib, J. (2001). Autism disorder: Symptoms, diagnosis, and treatment. Amman: Dar Al-Fikr.
· Al-Makkawi, A. (2025). The effect of therapeutic horse riding on improving balance in children with Autism Spectrum Disorder. Journal of Special Needs Sciences, 7(14).

Foreign References:

· Almarzooqi, S. A., Efstratopoulou, M., Habeeb, H., & Opoku, M. (2025). Exploring the usefulness of companion pet ownership in the everyday -function-ing of children with Autism Spectrum Disorder in the United Arab Emirates. Research in Developmental Disabilities.
· Alzuabi, A. (2024). The efficacy of using equine assisted activities as a complimentary intervention method for children with ASD (Master s thesis). Effat University, Jeddah.
· American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
· American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: American Psychiatric Publishing.
· Beetz, A., Uvnä-;-s-Moberg, K., Julius, H., & Kotrschal, K. (2012). Psychosocial and psychophysiological effects of human-animal interactions: the possible role of oxytocin. Frontiers in Psychology, 3, 234.
· Erbacher, J. C. E., & Bö-;-rdlein, C. (2026). Dog-assisted interventions for children and adolescents with autism spectrum disorders. SAGE Journals.
· Grandin, T. (2013). The autistic brain: Thinking across the spectrum. Houghton Mifflin Harcourt.
· O’Haire, M. E. (2017). Animal-assisted intervention for autism spectrum disorder: A systematic literature review. Journal of Autism and Developmental Disorders, 43(7), 1606-1622.
· Sabaini, S., et al. (2025). Effectiveness of Equine-Assisted Activities and Therapies for Children with Autism Spectrum Disorder: An Update. American Journal of Occupational Therapy.
· Zeidan, J., et al. (2022). Global prevalence of autism: A systematic review update. Autism Research, 15(5), 778-790.

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