’Oh,Right You Surf! That's Really Cool’: A Realist Evaluation of Surfing as a Strength-Based Activity for Autistic Children

C1.1 Cultural Norms

Children, parents and coaches identified cultural norms relating to surfing and the beach as aligned with their traditions, values and practices. Surfing was described as ‘a big thing in Australia’ (Parent 10) and ‘a massive culture’ (Parent 13). Children identified with surfing culture, thinking of themselves as surfers, ‘I’m like a fish. I love being in the water.’ (Child 12). Some parents also regarded surfing as part of their identity which motivated them to support their children in engaging with the Ocean Heroes’ Surf Experience programme, ‘I’ve been a surfer all my life’ (Parent 9). Even parents who ‘didn't surf’ supported their children's preferences ‘[my son] always loved the water’ (Parent 8), while others identified with their surroundings, ‘[…] we have always been beach people’ (Parent 10). Surfing and spending time in the water transcended simply being a hobby or work, with coaches describing themselves as ‘an ocean lover’ (Coach 1) and ‘the biggest water baby’ (Coach 5).

C1.2 Familiarity

The subtheme of familiarity captures how most children and parents were used to going to the beach, spending time in the water or being familiar with the idea of surfing. Those who identified with their surroundings tended to be familiar with going to the beach, swimming (in pools or the ocean), surfing and other water-based activities, ‘The beach is everybody's happy place’ (Parent 10). Familiarity with impacted motivation for continued engagement, with participants choosing to continue engaging in an activity they knew at a location where they had previous experience.

Familiarity was also impacted by distance. The parents who had their child surfing at the beaches in Perth reported a mean drive of 26.1 min (SD = 16.2) to get to one of the beaches, reflecting how most of those involved in the study lived relatively near the ocean and had geographical opportunity to access the sessions.

C2.1 Weather

The weather was the primary factor in determining whether surfing sessions were possible and what activities were planned. An onshore wind, no waves, rain, cold, extreme heat and strong currents were described as less favourable conditions for surfing. The weather affected the water and air temperature, impacting participants’ experience and enjoyment, see Table 3. The weather also affected which boards were used, the type of surfing, how long the participants spent in the water and their feelings afterwards. If the conditions were deemed as too challenging, session plans were altered, for example, when the water was flat, ‘they do a lot of beach games’ (Parent 4) or ‘they'll get the boogie boards out and they'll get other stuff out.’ (Parent 13).

C2.2 Location

Changing the location made it possible to provide surfing sessions throughout the year and seasons. The changing of beaches occurred every couple of months. In Perth, surfing sessions occurred at three different beaches, depending on the conditions. Perth beaches were public, sand beaches with low to high energy waves. Before each session, coaches identified the most suitable area for surfing, looking at aspects such as seaweed, sandbanks, currents, other beachgoers and waves. Suitability varied from week to week or even from one hour to the next.

C2.3 Sensory Aspects

There was a pre-existing belief among the parents and coaches that there were beneficial sensory aspects associated with surfing, ‘I like the feeling of saltiness, sea water.’ (Child 1). Water offered ‘that constant nice pressure’ (Coach 6), although the sensation of seaweed was generally disliked. Children enjoyed digging their hands and feet into the wet sand (see Table 3), with parents noting the impact of sensory aspects on their children's ability to regulate both inside and outside of surfing sessions.

C3.1 Parents Seeking Support

While some parents denied having any goals for their children, all parents reported wanting their children to achieve something, whether to ‘do some fun stuff’ (Parent 14), ‘be part of the community’ (Parent 5) or ‘[to] give him confidence’ (Parent 11). Some wanted their child to increase their surfing skills, while others hoped for increased independence, instruction following, and staying safe in the water. Some parents also explicitly sought instructional support from the coaches, having tried to teach their children how to swim or surf, but ultimately concluding ‘there are some things that it's better if the parent is not the teacher’ (Parent 9).

C3.2 Children's Characteristics

Some children experienced difficulties understanding social cues and others struggled with verbal communication and direct instructions. Coaches were informed of preferred forms of communication, stimuli and interaction, either from parents, support workers, the children or by experience. Both coaches and parents noted the social hardships some of the children experienced with friends, at school and at home and how they enjoyed coming to the programme, see Table 3.

Children, parents and coaches shared stories of initial hesitation and refusal among the children due to a lack of familiarity with the activity, an inability to accommodate their preferences, or fear (e.g., of water, sharks, waves), ‘I didn't want to go in [the first time] because it was so busy and you know, huge waves.’ (Child 10a). By contrast, some parents shared that their child had ‘no sense of danger’ (Parent 8) or ‘doesn't have the awareness of his surroundings’ (Parent 13), enjoying the unpredictable ocean and dumping waves, ‘My favourite thing is when a lot of water splashes, like chaos.’ (Child 13b). Overall, children demonstrated determination in the water and were interested in becoming proficient surfers, ‘my goal [is to] enjoy surfing, like get on the big waves’ (Child 1) and ‘One day I would like to surf on a fiberglass board by myself.’ (Child 13a)

C3.3 Coaches’ Experiences

All coaches had surfing experience prior to their involvement in the Surf Experience programme. Some had experience of disability and most started with limited experience supporting autistic individuals.

Lack of experience was not described as an obstacle, with one coach sharing that it is the inherent empathy of the coaches that matters most. Parents expressed appreciation towards the coaches and their knowledge, ‘I mean they all surf. They're just a different type of people, like these guys that come out and take our kids out, I don't know what it is. they're just amazing.’ (Parent 8)

C4.1 Booking App

The surfing programme used a mobile application (app) for the booking of sessions. Parents could choose the time depending on school and other obligations, taking into consideration the goals of the session and children's preferences, ‘We choose to come at quiet times so that we don't have to deal with all of that.’ (Parent 5). It was also possible to request a specific coach, which some parents saw as a benefit, ‘You can request a coach and that does make a big difference because it all comes down to relationship and who they connect with.’ (Parent 10)

C4.2 Time

Each surfing session in the Surf Experience programme was scheduled for one hour, which was enough time for most participants, ‘Yeah, I think an hour is pretty much perfect, I think any less, it almost wouldn't be worth it.’ (Coach 1). If there was a need or want to surf for a longer time, children and parents could book more time using the app, ‘I mean, you can go for an hour, but you can also book for two hours, and I reckon that's enough’ (Child 14).

C4.3 Equipment

Ocean Heroes provided varying surfboards, bodyboards, wetsuits, life vests and sunscreen. The equipment was utilised to maximise comfort and safety, matching the skill and confidence levels of the children, ‘even if it's cold, they make sure like they put on the second wet suit’ (Parent 3). Other equipment such as buckets for making sandcastles provided the opportunity to do something else if the weather did not allow for surfing, or if a break was needed.

C4.4 Supporting Coaches

Coaches described being supported by the organisation. They were slowly introduced to coaching and were continuously educated in safety, autism awareness and ‘making sure that we're skilled in using the equipment that we're using’ (Coach 3). This support made the coaches feel comfortable and led to continued involvement.

OPEN IN VIEWER

Table 4.

Overview of Mechanism Themes and Subthemes.

Theme	Subtheme
M1. Coaches’ approaches	M1.1 Adaptability
	M1.2 Ensuring safety
M2. Social	M2.1 Interaction
	M2.2 Communication
M3. Perseverance	M3.1 Dealing with setbacks
	M3.2 Continuity
M4. Fun	M4.1 Playful participation
	M4.2 Atmosphere

M1.1 Adaptability

Coaches continuously adapted the sessions and their approaches, understanding that the ‘Surfing Experience’ part of the programme could be many things. Delivering an individualised, person-centred and strengths-based approach, ‘they're able to adapt the session to meet the child where they're at, so in that way, they're noticing what their strengths are.’ (Parent 2). One parent shared, ‘it doesn't have to just be surfing’ (Parent 11), agreeing that a session without using the surfboard could be a perfectly good session.

M1.2 Ensuring Safety

Coaches continuously worked to ensure comfort and safety with the help of equipment, communication, and knowledge of environmental and personal preferences. Knowing when and what equipment to use, using verbal and physical cues when communicating, and listening to the participants and their parents ensured safety.

M2.1 Interaction

Participants were encouraged to play and interact socially, either with other participants or with the coaches. Playing was described as an important reason for enjoying surfing, ‘What is my favourite thing about surfing? Playing with people.’ (Child 13b). Not all play required verbal communication, suiting participants who preferred to communicate non-verbally, see Table 5. On some occasions, coaches introduced children to each other, coordinating activities to ‘get [the children] doing the same kind of things’ (Parent 8). Party waves (multiple surfers catching the same wave) offered a fun way of incorporating surfing skills with social play, facilitating interaction between children. Even children who played or surfed independently were not completely isolated, ‘even though they're separate, he's fully aware of [the other participant] and the other kids that are around him.’ One-on-one coaching also facilitated interactions between coaches and participants. For the participants who did not prefer verbal communication, coaches maintained a relationship through actions, such as splashing water, high-fiving and applauding.

M2.2 Communication

Verbal communication played a significant role in social interactions between coaches, parents, and children. Coaches and children engaged in conversation during the sessions, including general instructions for surfing and more casual conversations about interests and daily life. Children received ‘comments and feedback on how my last wave was and what I can do to improve’ (Child 14), with verbal cues assisting them in learning to surf, ‘lie down on your tummy’ (Child 13b) and ‘one, two, three, stand up now’ (Child 7).

It was important for the participants to be able to chat with the coaches and make ‘offbeat’ comments, ‘with no pressure and no judgement’ (Parent 9). Children were invited to participate in conversations, with coaches setting examples of different types of communication, ‘The coaches interact with themselves and that models to the children that this is the sort of interaction that the children can have as well’ (Parent 2b). Parents shared that they had noticed children imitating or continuing the coaches’ way of making conversation, by ‘being goofy [and] mucking around’ (Parent 2b). Some participants also spoke with other children, usually with those who had previously been surfing together or with siblings.

M3.1 Dealing with Setbacks

Occasionally, children would have a ‘wipe-out’, where they were thrown off their boards, see Table 5. Other types of setbacks included children getting water up their noses and being scared by aquatic animals. These experiences were often initially described as stressful, upsetting and ‘discouraging’ (Coach 3), and for some resulted in a child temporarily refusing to enter the water. Coaches played a key role in encouraging children to return to the water through ‘gentle coaxing’ (Parent 14) and ‘encouragement’ (Coach 3), and by maintaining awareness of their own reactions to setbacks, see Table 5. Coaches also ‘remain[ed] calm in all situations’ (Parent 7) and made sure ‘[my child] is OK’ (Parent 11).

M3.2 Continuity

Time and continuity were other components of dealing with setbacks and overcoming the initial fear experienced by some children, see Table 5. Continuity was also necessary in progressing surfing skills and developing closer relationships. Both parents and coaches acknowledged the benefits of maintaining the same coach across multiple sessions, as it allowed the participants and coaches to get to know each other. By contrast, alternating coaches was also described as beneficial as it allowed participants to find the coach with ‘that personality that [their child] really enjoys’ (Parent 2b).

M4.1 Playful Participation

Incorporating fun into every aspect was essential. Even dealing with setbacks required a light-heartedness for the children to stay engaged. Children enjoyed surfing because ‘it's fun’ (Child 12) and described the coaches as ‘really fun to be around’ (Child 12).

M4.2 Atmosphere

The surfing programme's ‘inclusive camaraderie’ (Parent 9) was described by parents and coaches as necessary for the children's learning and development. Maintaining a ‘good atmosphere’ (Coach 2) and ‘a good balance of fun and learning’ (Coach 2) involved creating opportunities for everyone to participate in the fun activities and interactions. For the children, Ocean Heroes differed from other programmes, mainly because of its sense of inclusivity, ‘[Child 15] said to me afterwards, she said, ‘do you know what, mum, the difference between the school surfing and this is?’ And I'm like, ‘what's that?’ And she goes ‘Ocean Heroes is the community’.’ (Parent 15).

O1.1 Ocean Skills

Fundamentally, the Surf Experience programme helped participants ‘[get] better at surfing’ (Child 10b). Children described learning the skills required to independently surf; ‘that you have to bend your knees when you’re on the surfboard’ (Child 5), ‘how to stand up’ (Child 13b), and how ‘to turn on the surfboard’ (Child 1). Children were proud of the progress they made across sessions: ‘[I can paddle] on my own now, which I couldn't do at the start’ (Child 10a) and ‘I've learned the push up’ (Child 2). The children also gained water safety skills, improved swimming abilities, and learnt surfing etiquette, ‘he will carry his own board down now’ (Parent 4) and ‘I can now feel comfortable to let him go in [the water] by himself.’ (Parent 11). In addition to becoming surfers, some children also became better surfers, finding confidence in their acquired skills.

O1.2 Life Skills

Surfing and spending time in the ocean lead to increased independence in daily life. Children were described as ‘more willing to have a go at things’ (Parent 11), ‘more responsible’ (Parent 3) and having ‘learned about boundaries and waiting’ (Parent 2a). Some of the children were more comfortable staying home alone and were no longer ‘scared of baths and showers’ (Coach 6). Some children ‘felt very confident’ (Child 1) during sessions, with this sentiment stretching into parts of everyday life.

O2.1 Emotional

Children, parents and coaches identified the participants as ‘happier’ after surfing, a feeling which persisted throughout the day. Some children were better able to ‘self-regulate’ (Parent 2a) after the session, being more in tune with their body, emotions and needs, ‘especially with hunger and thirst’ (Parent 2b). Parents sometimes described having a tough morning, a tough day or even a tough week, ‘but once they've had that one session, it's almost like they're cleansed of all that, their worries and all the things that are consuming them and they'll come out and they're happier.’ (Parent 10).

O2.2 Mental

Participating in the Surf Experience programme led to improved mental health for some of the coaches and children. Coaches attributed this improvement to sharing something they love with the community and feeling like they are doing a ‘good thing’ (Coach 6). For children who sometimes experienced anxiety and had difficulty sharing or expressing their worries, ‘after surfing, he would then be able to talk about what [he's] worried about’ (Parent 2b).

O2.3 Physical

Surfing with Ocean Heroes led to physical benefits for the children, including improved fitness, balance, strength, stamina, endurance and coordination. Feeling tired after a session was a welcomed outcome, leading to a calmer and more regulated child and a ‘peaceful’ rest of the day (Parent 10).

O2.4 Parental Benefits

Parents often enjoyed staying for the duration of sessions, see Table 7. Some parents enjoyed watching their children participate, while others took the opportunity to go for a swim or walk or sit down on the beach. This hour was described by some as the only time when someone else was taking care of their child and could be ‘a nice little break’ (Parent 13) where they got ‘an hour to [themselves]’ (Parent 8).

O2.5 Coach Benefits

The coaches shared their enjoyment in working for Ocean Heroes, expressing that they ‘look forward to coming for work’ (Coach 1) and calling it ‘the best place I could possibly work’ (Coach 2). It was seeing ‘where [the participants] came from and where they are now’ (Coach 5) and having an ‘amazing team’ (Coach 1) that made it enjoyable. Coaches also gained knowledge on autism, feeling more ‘educated’ (Coach 2) on autism and ‘the huge spectrum that there is’ (Coach 3). Understanding ‘what [the children have] had to overcome at school, in their personal lives’ (Coach 5), was humbling for some, reminding them of ‘what's important in life’ (Coach 5).

O3.1 Relationships

Parents shared that one of the most impactful outcomes of joining the Surf Experience programme was their children feeling a sense of belonging. They felt ‘part of a group’ (Parent 6), ‘part of a team’ (Parent 2a) and ‘part of a family’ (Parent 2a). Relationships with the coaches and other participants had helped them find confidence in their social abilities, some feeling like ‘I can talk to anyone’ (Child 1). Some of the parents felt they ‘found their people’ (Parent 13) and others like ‘we’ve joined a community’ (Parent 12).

O3.2 Surfing is Cool

Parents explained that surfing was something ‘cool’ (Parent 11) that the children could talk about in school and share with their friends, ‘I tell all my friends about it and they want to join.’ (Child 10a). It was an activity that others were interested in, which sometimes differed from ‘these sort of autistic special interest topics nobody else is interested in’ (Parent 11). It was something that gave the participants ‘a bit of street cred’ (Parent 13) and the identity of being ‘a surfer’, ‘potentially [making] that connection with other people that surf or go to the beach’ (Parent 6).

O4.1 Looking Forward to Surfing

After surfing, the children were ‘keen to come back again’ (Parent 11). Children looked forward to the sessions and there was little need to coerce them into participating, see Table 7. This was described as unique, as it was common for the children to resist leaving the house for an activity.

O4.2 Teaching Others

The potential of becoming a surfing coach was motivating to both parents and children, who were excited by the prospect of volunteering or coaching in the future, ‘[Child 13a]'s next goal with Ocean Heroes is to become a coach.’ (Parent 13). Parents encouraged children to speak with programme coordinators about their goals, working with them to progressively increase their responsibilities and independence. Volunteering at events was seen as a good starting point, dealing with tasks such as washing wetsuits and helping inexperienced participants.