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The Effects of a Physical Therapy-directed Aquatics Program on Children with Autism Spectrum disorders
... All studies except two (Mills et al., 2020;Oriel et al., 2020) reported on motor outcomes. Nine studies reported an outcome on both motor and social skills (Alaniz et al., 2017;Caputo et al., 2018;Chu & Pan, 2012;Ennis, 2011;Güeita-Rodríguez et al., 2021;Marzouki et al., 2022;Pan, 2010;Yilmaz et al., 2004;Zanobini & Solari, 2019). Outcomes on motor skills only were found in nine studies (Ansari et al., 2021;Fragala-Pinkham et al., 2011;Lawson et al., 2014;Munn et al., 2021;Pan, 2011;Yanardag et al., 2013;Yılmaz et al., 2005;Yilmaz et al., 2010). ...
... In two studies (Chu & Pan, 2012;Pan, 2011), children without ASD participated besides children with ASD. The average percentage of boys was 90% overall within the ASD participants, with one study that did not report the sexes of the participants (Ennis, 2011). The age in all the studies ranged from 3 to 17 years old. ...
... One study required 3 months of aquatic therapy experience for eligibility (Güeita-Rodríguez et al., 2021). In one study, all participants had experienced previous water interventions but it is unclear if that was a requirement for inclusion (Ennis, 2011). ...
Children with autism spectrum disorder (ASD) often have motor impairments. A promising strategy to improve motor and social functioning in children with ASD may be an aquatic intervention because of the properties of water. This systematic review investigated the characteristics and effects of aquatic interventions on motor and social skills in children with ASD. Searches in six databases on studies conducted between 2000 and 2023 resulted in 19 intervention studies involving 429 children aged 3 to 17 years with ASD. Best evidence syntheses and meta-analyses were used to evaluate the effects. Aquatic interventions guided by a combination of professionals in influencing behavior and in aquatic skills improved motor and social skills and significantly decreased autistic behavior in children with ASD.
... Out of 13 analyzed articles 5 were group study design (Pan, 2010;Fragala -Pinkham, Haley, & O'Neil, 2011;Pan, 2011;Chu & Pan, 2012;Lawson, Foster, Harrington, & Oxley, 2014), and another 8 were single subject design (Huettig & Darden-Melton, 2004;Yilmaz, anardag, irkan, & umin, 200 ;ilmaz, irkan, onukman, & Erkan, 200 ; lmaz, onukman, irkan, zen, anardag, & C amursoy, 2010a; lmaz, onukman, Birkan, & Yanardag, 2010b, Rogers, Hemmeter, & Wolery, 2010Ennis, 2011;Yanardag, Akmanoglu, & Yilmaz, 2013). The total number of participants in all studies was 167, where Yilmaz et al. (2004) had the lowest number of participants, at 1, while Chu et al. (2012) and Lawson et al. (2014) had the highest number of participants, at 42. ...
... Huettig et al. (2004) tested the swimming abilities of children following 4 years of application of the program, but with no explanation of the weekly training frequency or session duration. The ten-week program was the most frequently applied form of exercise, in Yilmaz et al. (2004Yilmaz et al. ( , 2005Yilmaz et al. ( , 2010a and 2010b) and Ennis (2011). Weekly frequency was 2 and 3 times per week in 8 studies. ...
... Weekly frequency was 2 and 3 times per week in 8 studies. It was only in the study by Ennis (2011) that the frequency was once weekly, and in Lawson et al. (2014) it was once or twice per week, depending on the participants. Individual training session duration ranged from a minimum of 30 minutes in Lawson et al. (2014) to a maximum of 90 minutes in Pan (2010). ...
Autism spectrum disorder is a complex brain development disorder characterized by restrictive and repetitive behaviors and a significant impairment of one's ability to interact with other people and engage in verbal or nonverbal communication, as well as in play. One form of physical activity which can be used with success in people with autism is aquatic activity. The objective of this systematic review study is to collect and analyze studies of the effects of aquatic activity on improving physical fitness and aquatic skills in children with autism. Based on an analysis of electronic databases and the inclusion criteria set, 13 studies were included in the analysis. The following conclusions are proposed based on their analysis: In terms of influence on aquatic skills, aquatic programs at least 10 weeks in duration can effect improvement in aquatic skills in children with autism, by means of learning methods well-used with autistic children, such as the Constant time delay procedure, Most to least prompting procedure, and assistance from siblings and peers. Regarding physical fitness improvements following aquatic activity, it is difficult to draw conclusions based on the results obtained in only three studies. Recommendations for future research include the application of aquatic programs with a higher weekly frequency, as well as the use of heart rate monitors during aerobic exercise in order to control heart rate training zones.
... In two articles the researchers defined their intervention as "aquatic physical therapy" (APT) [8,27]. The use of well-known AT approaches was mainly based on the Halliwick approach (20 studies) in various ways, i.e., swimming, treatment, playing individually or in a group [9,10,14,40,41,[43][44][45][46]49,50,52,60,62,63,71,73,[75][76][77]79,83], with one study testing the effects of the Watsu technique along with conventional AT [96]. Twelve studies based their research on swimming or on the promotion of swimming abilities, including various swimming learning programs and the adapted swimming exercises, in groups or individuals [7,50,59,64,65,79,81,89,90,93,98,99]. ...
... Within the various diagnostic groups studied, a prominent trend could be observed that there is a relationship between the examined health condition and the studied ICF-CY components. The studies that examined the effect of AA on children with ASD [7,10,[58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] focused more than the others on the A&P component; out of 125 categories that were linked to the positive results, 76 were related to this component. That is, 60.8% of the positive results referred to areas from the A&P component, compared to studies on children with CP (48.5%) [27,, or compared to the studies on children with DD (46.7%) [6,8,14,[78][79][80][81]. ...
... Cerebral palsy (CP)[27,;(2) Autistic spectrum syndrome (ASD)[7,10,[58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77];(3) Different developmental delays (DDs)-the DD group included all the studies that examined several disorders together in the same study-CP, dystrophy diseases (Mus. D)-DMD-Duchenne muscular dystrophy and CMD-congenital muscular dystrophy [82-87]; (5) General health conditions (GHCs)-a group that included Asthma, Hemophilia, Juvenile Dermatomyositis, and Obesity [88-92]; (6) Juvenile Idiopathic Arthritis (JIA) [93-95]; (7) Attention Deficit Hyperactivity Disorder (ADHD) [96,97]; (8) Development Coordination Disorder (DCD) [9]; (9) Down Syndrome [98]; ...
(1) Background: In recent years, reviewing studies of aquatic activities for children with developmental delays has been a complex task due to the multitude of indices and professional languages. (2) Aim: To determine if the ICF-CY framework can be used as the unifying language in AA studies of children with DD. (3) Methods: Part One—A systematic review of selected studies focusing on goals that were found to be positive. These goals were linked to the ICF-CY categories. Part Two—Review of all studies using the ICF-CY’s functioning components. (4) Results: Most of the positive goals were properly linked to ICF-CY and made it possible to review the 71 articles in a uniform language. (5) Conclusions: It is feasible to use the ICF framework as a universal structure and language.
... In this study, the mean post-AquOTic total WOTA2 score was 36.8 points, which clearly shows that children have the potential to continue learning water competency skills and highlights the need for higher doses of AquOTic. Current studies of swim interventions in autism show that children demonstrate the highest gains in water competency with 24-28 h of intervention (23,30,32,33). Exposure to positive aquatic experiences and prior swim lessons has been associated with greater swim skills among children on the autism spectrum (34,35). ...
... The advanced training among the study interventionists potentially contributed to the high intervention fidelity. Prior studies also note that skilled clinical therapists providing the intervention result in children on the autism spectrum gaining greater skills (30,33). Future research should investigate optimal implementation strategies such as involving individuals with high-school or undergraduate-level training and developing water competency/safety instruction training for nonprofessional individuals to ensure scalability in the community. ...
Introduction
There is a critical need for evidence-based and manualized interventions targeting water competency including swim and water safety skills tailored to meet the needs of children on the autism spectrum, a group that is at a high risk of drowning. This study examined the efficacy of AquOTic—a 10-week occupational therapy-based aquatic intervention to improve water competency among children on the autism spectrum.
Methods
A total of 37 children on the autism spectrum (ages 5–9 years) were randomized to a waitlist control group (n = 24) or AquOTic intervention group (n = 37; 28 males). Blinded assessors administered the standardized Water Orientation Test-Alyn (WOTA) 1 and 2 and a Swim Skills Checklist to all participants pre- and post-AquOTic/control. Repeated measures mixed effects models were used to examine intervention effects.
Results
Average WOTA 1 scores increased significantly after participants received AquOTic (Δ = 5.7; 95% CI: 3.7–7.8; p < 0.001), and average WOTA 2 scores increased significantly after participants received AquOTic (Δ = 9.0; 95% CI: 5.7–12.3; p < 0.001). Average swim skills increased significantly after participants received AquOTic (Δ = 7.6; 95% CI: 5.3, 10.0; p < 0.001).
Conclusion
Our results highlight the efficacy of AquOTic to improve water competency among children on the autism spectrum. Further research is needed to examine long-term effects, dosage requirements to achieve water competency, and the impact of aquatic therapy on other health outcomes.
Clinical Trials Registration
clinicaltrials.gov, NCT05524753.
... Numerous studies have identified that skilled water intervention provided by health care professionals (e.g., occupational therapists, psychologists, recreational therapists, physical therapists) is effective for teaching swim skills such as breath control, floating, and locomotion to children on the autism spectrum (Alaniz et al., 2017;Caputo et al., 2018;Ennis, 2011;Mische Lawson & Little, 2017); however, each used a different method of instruction and small sample sizes. Research describing water competency in children on the autism spectrum, factors that affect water competency, and caregiver goals for water safety is limited and may lead to interventions tailored to each child's specific profile. ...
Importance: Globally, drowning is the third leading cause of unintentional injury death, and children on the autism spectrum are at a higher risk of drowning. Several factors affect limited water competency (swim skills and water safety) and engagement in swimming as a meaningful leisure activity.
Objective: To identify baseline water competency among children on the autism spectrum, examine caregiver goals for swim skill intervention, and examine factors associated with water competency.
Design: Cross-sectional analysis of baseline assessment from a larger randomized controlled trial.
Setting: Franklin County Board of Developmental Disabilities Therapy Pool.
Participants: Children on the autism spectrum (N = 37; 28 boys, 9 girls), ages 5 to 9 yr, recruited from the local community.
Outcomes and Measures: Water competency was assessed using the Water Orientation Test–Alyn 1 and 2 (WOTA 1 and 2). Caregivers completed the Canadian Occupational Performance Measure (COPM), the Sensory Profile–2 (SP–2), and a prior aquatic exposure questionnaire.
Results: Children on the autism spectrum showed limited water competency skills on the WOTA 1 and 2. A majority of caregivers identified safety in and around water as a goal for their child, using the COPM. Higher conduct processing and low registration scores on the SP–2 significantly correlated with lower water competency. Exposure to group lessons significantly correlated with better water competency.
Conclusions and Relevance: Children on the autism spectrum demonstrated limited swim and water safety skills, highlighting the need for programs that teach swim and water safety skills in this population.
Plain-Language Summary: This study examined water competency, including swim safety skills, among children on the autism spectrum. The results suggest that these children lacked basic water competency and safety skills. Caregivers of children on the autism spectrum identified water safety in and around bodies of water to be a high-priority goal. A child’s sensory characteristics and prior exposure to water activities affect their water competency. Our results highlight the need for programs that teach swim and water safety skills for children on the autism spectrum.
... Al., (2006) discussed similar ndings in their research, suggesting that a decrease in children with ASDs asking teachers for help could be interpreted positively as a sign that the child is gaining con dence and independence, rather than as diminishing interactions. The study by Ennis (2011) implemented a 10-week water program on children with ASD, with results showing improvements in social skills and interaction with peers and smaller changes in emotional and school functioning after aquatic therapy intervention(Ennis, 2011). The effect of the aquatic program on behavioral and social skills in the study by Pan, 2010 evidenced in decreased antisocial behavior ...
Purpose: Children and adolescents with autism spectrum disorder (ASD) have delays in developing motor skills and social behaviors compared to typically developed children. Various exercise program can improve social and motor behaviors of individuals with autism spectrum disorder. There is no consensus among researchers about how aquatic exercise effects of individuals with ASD. The purpose of this study is the comprehensively reviews the impacts of aquatic exercise on motor skills and social behaviors among children and adolescents with ASD.
Methods: This systematic review is based on the PRISMA guidelines. The following criteria was used to determine acceptance into this review: the participants were children and adolescents with ASD, the experimental program was involved aquatic exercise program, and all studies were peer-reviewed English publications from 2002 to 2022.
Results: After applying exclusion criteria, a total of 9 studies were identified. Analysis indicated that various aquatic programs including hydrotherapy and traditioanl swimming activities can improve motor skill levels and social behaviors in children and adolescents with ASD. Optimal duration of aquatic programs appears to be at least 8 weeks for a minimum of two times per week for 30 minutes per session.
Conclusion: Results of this analysis suggest that physical therapists and physical educators should recommend this intervention when appropriate, and consider developing community-based aquatic exercise programs.
... Każde dziecko podczas wykonywania ćwiczeń było pod nadzorem wykwalifi kowanych specjalistów, ale i chętnych wolontariuszy oraz rodziców, którzy w zależności od możliwości dziecka byli bezpośrednio zaangażowani w trakcie trwania zajęć bądź tylko je obserwowali (Ennis, 2011, s. 6). Ćwiczenia w wodzie obejmowały skakanie, odpychanie się od ściany, podrzuca nie i łapanie piłki, swobodne unoszenie się na wodzie, dmuchanie baniek, manipulowanie zabawkami, a także wyjmowanie ich z dna basenu w zależności od indywidualnych umiejętności (Ennis, 2011). Wykorzystano również relaksację poprzez głębokie oddychanie. ...
Nowadays, the use of the hydrotherapy method in children and adolescents with autism spectrum disorder (ASD) is a little-known phenomenon. The aim of this article is an attempt to discuss hydrotherapy as an example of a supporting method that can be used in children and adolescents with ASD. This paper presents the most important issues related to the method of hydrotherapy. Research shows that children and adolescents with ASD are less likely to engage in physical activity than their healthy peers. As a result, it can lead to health problems. Regular exercise and physical activity contribute to a better mental and physical well-being of the individual. The use of hydrotherapy brings many positive effects, so it is worth getting to know it better.
PURPOSE: To our knowledge, there is no systematic review of swimming and aquatic exercise intervention studies for Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (AD/HD). Therefore, we conducted a scoping review of swimming and aquatic exercise intervention studies for ASD and AD/HD with the aim of identifying outcomes and issues in previous studies.
METHODS: This study was conducted in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR), and articles were collected and selected. We used PubMed, Science Direct, J-stage and CiNii Research as databases. Searches were conducted using terms such as "swimming", "Autism" and "AD/HD". The collected literature was selected according to eligibility criteria, and the quality of the studies was evaluated using the PEDro scale.
RESULTS: Finally, 40 articles were selected and analyzed for (1) study areas and publication date, (2) sample size and participant profile, (3) study design and quality, and (4) intervention and measurement methods. The results showed that, despite challenges in the field, size, and quality of the study, ASD and AD/HD symptoms improved and multifaceted effects on physical, cognitive, and socio-emotional development were observed.
CONCLUSION: The scoping review clarified the achievements and issues of previous studies and indicated the therapeutic significance of swimming and aquatic exercise for ASD and AD/HD.
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