© 2016 John Wiley & Sons, Ltd. The objectives of this study were to examine the effects of the Thai Elephant-Assisted Therapy Programme for children with Down syndrome (DS) (TETP-D) on balance, postural control and visual motor integration (VMI). A quasi-experimental design with blind control was used. Sixteen children with DS from grades 1 to 6, in a Thailand, public school were recruited for this study. The participants were divided voluntarily into two groups: control and experimental. These both groups received regular school activities, but the experimental group had added treatment, which consisted of TETP-D twice a week for 2months. The balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency 2, the postural control record form and Beery VMI were applied as outcome measure 1week before and after the TETP-D. The results showed no significant difference in balance or postural control. However, a significant difference of VMI was shown between the two groups (z=13.5, p=.04). Children with DS benefited from the TETP-D as it improved their VMI. The TETP-D could improve balance and postural control if provided within a suitable frequency and duration. Further research is needed to test this hypothesis. The limitations of this study are the significant differences in some aspects of the groups at pre-test such as gender and supine flexion of postural control. Copyright