Extended Abstract
1.    Introduction
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by persistent deficits in social communication and interaction, along with restricted, repetitive, and stereotyped behaviors (1). Beyond these core diagnostic features, children and adolescents with ASD commonly experience impairments in both fine and gross motor skills, including balance, coordination, strength, and motor planning (2). Such motor difficulties can hinder daily functioning, limit participation in physical and social activities, and negatively affect overall developmental outcomes. Because motor control challenges often emerge early and persist over time, understanding their underlying mechanisms and implementing targeted interventions from childhood onward is essential (3). A growing body of research supports the effectiveness of movement-based interventions for improving motor and functional abilities in individuals with ASD. Systematic reviews indicate that physical activity programs, aquatic therapy, structured exercise, and equine-assisted approaches can enhance participation, motor function, body structure, and activity levels (4). Exercise-based programs have also been associated with reductions in stereotyped behaviors and improvements in emotional regulation, social interaction, cognitive performance, and attention (5).
Perceptual-motor skills form the foundation for higher-level motor learning and should therefore be emphasized during early stages of development (6). These abilities contribute to cognitive, emotional, and psychomotor growth and are essential for successful movement execution across daily and sport-related tasks (7). However, children with ASD often struggle with perceptual-motor demands required for routine activities (8). Despite their importance, perceptual-motor delays—driven by multisensory and neuromotor processing challenges—have received less attention than social deficits, highlighting the need for comprehensive assessment and intervention (9). Equine-assisted therapy (EAT) is an integrative therapeutic modality that uses the rhythmic, three-dimensional movement of the horse to stimulate postural control, muscle tone regulation, and balance (10). Evidence suggests that EAT produces meaningful improvements in social, behavioral, and motor outcomes in individuals with ASD (11–13). Play therapy, another widely used intervention, promotes cognitive, social, emotional, and motor development (14,15). Studies show that play-based programs can improve gross motor skills, reduce maladaptive behaviors, and enhance coordination and agility in children with ASD (16–18,22). 
Despite substantial evidence for each approach independently, no prior study has directly compared the effects of EAT and structured play therapy on gross perceptual-motor skills and related biomechanical parameters in adolescents with ASD. Given the central role of motor abilities such as balance, bilateral coordination, strength, and agility in functional independence and daily movement (20,21), comparative research is needed to guide evidence-based intervention selection. Therefore, the present study aimed to examine and compare the effects of equine-assisted therapy and play therapy on perceptual-motor performance and associated biomechanical parameters in adolescents with ASD.
2.    Methods
This semi-experimental study employed a pre-test–post-test design with a control group to evaluate intervention effects. A total of 36 adolescents with ASD (25 boys, 11 girls), aged 10 to 14 years, were recruited through convenience sampling from local centers and clinics. Participants were carefully matched based on age, gender, and severity of ASD symptoms, and then randomly assigned to one of three groups: equine-assisted therapy (n = 12), play therapy (n = 12), or control (n = 12). Interventions lasted eight weeks, with five 30-minute sessions per week, and were tailored to accommodate the individual abilities of each participant. The control group continued with their usual activities and center programs. Gross perceptual-motor skills were assessed using the Bruininks–Oseretsky Test of Motor Proficiency (BOTMP), including subtests for running speed and agility, balance, bilateral coordination, and muscle strength, one day before and one day after the intervention period. Data were analyzed using paired-sample t-tests, analysis of covariance (ANCOVA), and Bonferroni post-hoc tests to examine group differences.
3.    Results
The Shapiro–Wilk test indicated that all variables were normally distributed across the three groups (p > 0.05). Paired-sample t-tests showed significant improvements in overall gross motor skills from pretest to posttest in both the equine-assisted therapy (t(11) = -19.549, p < 0.001) and play therapy groups (t(11) = -19.082, p < 0.005), while the control group showed no significant change (t(11) = 1.617, p = 0.137). Subtest analyses revealed significant gains in running speed and agility, balance, bilateral coordination, and strength in both intervention groups, with no improvements in the control group. ANCOVA confirmed significant between-group differences in posttest scores (Table 1), and Bonferroni tests indicated that the control group scored lower than both intervention groups (p ≤ 0.005). 
The equine-assisted therapy group outperformed the play therapy group in overall gross motor skills (p = 0.01), running speed and agility (p = 0.02), balance (p = 0.005), and strength (p = 0.07), but no difference was found in bilateral coordination (p = 0.476). These findings demonstrate that both interventions effectively improve gross motor skills in adolescents with ASD, with equine-assisted therapy providing greater benefits across most subdomains. 

4.    Discussion
The present study examined and compared the effects of equine-assisted therapy (EAT) and structured play therapy on gross perceptual–motor skills and related biomechanical parameters—including running speed and agility, balance, bilateral coordination, and strength—in adolescents with ASD. Both interventions produced significant improvements across all gross motor domains relative to the control group, and the EAT group demonstrated superior gains in most biomechanical parameters, although no significant difference emerged for bilateral coordination. These findings reinforce the potential of EAT as a complementary motor-based intervention for ASD. The rhythmic, multidirectional movement of the horse closely mimics human gait and continuously challenges postural control, thereby promoting improvements in balance, neuromuscular activation, and overall gross motor performance (11). Sensory integration, tonic–postural regulation, and enhanced visual–motor coordination may further contribute to these benefits (27,28). Consistent with previous evidence, EAT has also been associated with reductions in stereotyped behaviors and improvements in self-regulation, arousal, and motor functioning (29,30).
Play therapy likewise led to meaningful gains in gross motor skills. Adolescents with ASD often face reduced opportunities for physical play and structured exercise due to social communication challenges, motor planning difficulties, and environmental barriers (31,32). Play-based interventions provide guided, repetitive, and goal-oriented motor experiences that can improve coordination, balance, and movement organization (33,34). These benefits align with prior research demonstrating improved agility, bilateral coordination, and gross motor performance following structured play programs (18,22). Although both interventions were effective, the relatively greater improvements in the EAT group may be partially explained by the unique behavioral profile of adolescents with ASD. Communication challenges may hinder responsiveness to human-mediated interactions in play therapy, whereas the nonverbal, lower-demand nature of human–horse interaction may facilitate engagement, reduce anxiety, and enhance motivation (35). Social motivation and social–cognitive theories also suggest that observing and responding to an animal’s behavior may strengthen attention, participation, and treatment adherence (13,36). 
Both EAT and play therapy substantially improved perceptual–motor performance and biomechanical parameters in adolescents with ASD, with EAT demonstrating somewhat stronger effects in several domains. However, differences between groups should be interpreted cautiously, given that small changes in BOTMP raw scores may result in notable shifts in scaled scores. Limitations—including sample specificity, lack of long-term follow-up, reliance on BOTMP, and uncontrolled environmental factors—should guide future research toward more comprehensive and generalizable designs.

Ethical Considerations
Compliance with ethical guidelines
The study was approved by the Ethics Committee of the Sports Science Research Institute under the code IR.SSRC.REC.1400.001.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 
Authors' contributions
All authors equally contributed to preparing article.
Conflicts of interest
The authors declared no conflict of interest.