Date Presented 03/28/20
Drowning is the number one cause of death in children with autism. OTs are uniquely positioned to develop effective water-safety interventions, but their voices has been largely absent from the literature. The purpose of this study was to evaluate the effectiveness of OT in the aquatic setting for improving water safety and social skills in children with autism.
Primary Author and Speaker: Michele Alaniz
Contributing Authors: Sheila Rosenberg, Nicole Beard, Emily Rosario
PURPOSE: Children with autism are often drawn to water exploration and are at a high risk for drowning. Few evidenced-based interventions have examined the effectiveness of water safety intervention for children with autism and even fewer have included lower functioning children in their studies. The purpose of this study is to examine the effectiveness of a group aquatic occupational therapy program on water safety and social skills in children with autism of varying severity. The research questions asked were as follows: (1) Do swim skills and social skills improve in children with mild to severe autism after aquatic based occupational therapy intervention? (2) What is the minimum dosing required to achieve water safety skills in this population?
DESIGN: Experimental, single group, pre-test post-test design. Study population included children with mild to severe autism, between the ages of 3 to 7 years old, recruited from an outpatient pediatric clinic. Children who had unpredictable bowel movements were excluded from the study.
METHOD: Children who were eligible for the study engaged in a 1 hour, individual testing session with an occupational therapist prior to beginning session 1 and again after session 8, session 16 and session 24. Swim skills were assessed using the Aquatic Skills Checklist (ASC), a tool developed by the researchers and based on the American Red Cross Water Safety Instructor Manual. Testing was videotaped and the ASC was completed by video review. Social skills were calculated using the Social Skills Improvement System (SSIS), a standardized questionnaire completed by the caregiver. In addition, caregivers participated in a semi-structured interview and individualized goals for goal attainment scaling (GAS) were identified for each participant based on the results of the testing and family feedback. Paired T tests were used to compare differences between pre and post intervention variables.
RESULTS: Our findings demonstrate preliminary evidence that children with mild to severe autism can achieve water safety skills, which are important for drowning prevention. Overall swim skills improved at a significant level after just 8 hours of intervention (Paired T-Test: p-value=0.0079). The skills most amendable to intervention included breath control, propulsion and changing positions while swimming. GAS was also utilized to assess swim skills on a more individualized basis and we observed achievement of over half (64%) of treatment goals with significant improvement in the following goal areas: breath control (p=0.0069), propulsion (p=0.0069), and back float (p= 0.0239). We did not however observe significant changes in social skills as a result of this group aquatic occupational therapy intervention (p=0.6409).
CONCLUSION: We provide preliminary evidence that children with mild to severe autism can achieve water safety skills that are important for drowning prevention. Furthermore, we establish response to treatment with as little as 8 hours of group intervention, with peak performance observed after 16 hours of intervention. Implementation strategies were adapted from the American Red Cross program and modified to address occupations, preparatory activities/methods and training. Aquatic based occupational therapy addresses several childhood occupations and is a promising and possibly lifesaving intervention for children with mild to severe autism.
References
1. Little, L. M., Sideris, J., Ausderau, K., & Baranek, G. T. (2014). Activity participation among children with autism spectrum disorder. American Journal of Occupational Therapy, 68(2), 177-185. doi: 10.5014/ajot.2014.009894
2. Mortimer, R., Privopoulos, M., & Kumar, S. (2014). The effectiveness of hydrotherapy in the Treatment of social and behavioral aspects of children with autism spectrum disorders: a systematic review. Journal of Multidisciplinary Healthcare,7, 93-104. Doi 10.2147/JMDH.S55345
3. Pan, C.Y. (2010). Effects of water swimming exercise program on aquatic skills and social behaviors in children with autism spectrum disorders. Autism, 14(1), 9-28. doi: 10.1177/1362361309339496
