Background: Hippotherapy (HT) or horseback riding is a therapeutic modality that is suggested to improve function in children with cerebral palsy (CP), autism spectrum disorder (ASD) and Intellectual and Developmental Disability (IDD) Aim: The aim of this review was to evaluate HT in children with ASD and to assess the feasibility to conclude on this effect, considering the cognitive level of participants. Method: Articles describing HT intervention with individuals with ASD were methodically collected and evaluated. Strength of evidence was graded according to the American Academy for Cerebral Palsy and Developmental Medicine. Results: Most of the 17 articles found supported evidence of positive outcome across a broad range of ASD challenges. Only 5 studies reported participants' IQ level so that the effect of cognitive ability on outcome could not be fully ascertained. Only one study was rated at evidence level I (highest level), two studies were rated at evidence level II, and the remainder were rated at evidence levels III-V. Conclusion: The findings suggest that HT benefits children with ASD. Nevertheless, the evidence supporting HT for individuals with ASD and IDD is limited due to methodological limitations of past research, highlighting the need for further study.