This paper describes the use of hippotherapy with children who have autism spectrum disorders (ASD). It details the rationale, frames of references and a review of the literature. Furthermore, descriptions of a capstone project are provided on the investigation of hippotherapy outcome measures being used by current occupational therapists. Five hippotherapy sites were visited and at least one full day of sessions was observed at each. Occupational therapists were also interviewed about current practices. Findings support the use of non-standardized testing for measuring outcomes of children with ASD. Also noted are the various methods for delivering hippotherapy services.