Date Presented 04/03/2025
This presentation discusses the impact of child engagement and therapeutic relationship on water competency outcomes after the AquOTic intervention for children on the autism spectrum.
Primary Author and Speaker: Maddie Massie
Additional Authors and Speakers: Erika Kemp
Contributing Authors: Jewel Elias Crasta, Haleigh Rowe
PURPOSE: Facilitating child engagement and establishing a strong therapeutic relationship to enhance engagement are essential components of occupational therapy intervention for children on the autism spectrum. Active child engagement is a critical factor influencing the effectiveness of therapeutic interventions. This study examined the impact of child engagement levels during an evidence-based aquatic occupational therapy intervention – AquOTic on water competency outcomes.
DESIGN: A randomized control trial of the AquOTic 10-week intervention with 20 children on the autism spectrum ages 5-9 years (Kemp et al., 2024).
METHODS: The Pediatric Rehabilitation Intervention Measure of Engagement-Observation (PRIME-O; King et al., 2017) was used to measure child engagement during AquOTic intervention sessions via video-analysis by an independent rater. Water competency, the primary outcome, was measured using the Water Orientation Test-Alyn (WOTA 1).
RESULTS: Among the 20 children who completed the 10-week AquOTic intervention, engagement levels were consistently high across child engagement, provider engagement, and child-provider interaction. Higher PRIME-O child engagement levels were significantly associated with higher water competency following AquOTic as measured by post-WOTA1 scores (r=.49, p=.03). Similarly, higher PRIME-O child-provider interaction scores demonstrated a strong positive correlation with water competency outcomes (post-WOTA1 scores: r=.68, p <.001).
CONCLUSION: Child engagement levels and therapist-child interaction during intervention significantly influences water competency outcomes in an occupational therapy-based aquatic intervention for children on the autism spectrum.
IMPACT: The results emphasize the importance of promoting children’s active engagement during interventions as well as developing a therapeutic relationship with children on the autism spectrum, as these factors positively impact on therapeutic outcomes.
References
Kemp, E., Nikahd, M., Howard, M., Darragh, A., & Crasta, J. E. (2024). Improving water competency among children on the autism spectrum: the AquOTic randomized controlled trial. Frontiers in Pediatrics, 12, 1473328. https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2024.1473328/full
King, G., Chiarello, L. A., Thompson, L., McLarnon, M. J. W., Smart, E., Ziviani, J., & Pinto, M. (2017). Development of an observational measure of therapy engagement for pediatric rehabilitation. Disability and Rehabilitation. https://doi.org/10.1080/09638288.2017.1375031
Tirosh, Ruthy; Katz-Leurer, Michal; and Getz, Miriam D. (2008) ‘Halliwick-Based Aquatic Assessments: Reliability and Validity,’ International Journal of Aquatic Research and Education: Vol. 2: No. 3, Article 4. http://scholarworks.bgsu.edu/ijare/vol2/iss3/4
Albaum, C. S., Sellitto, T., Vashi, N., Bohr, Y., & Weiss, J. A. (2023). Treatment Engagement as a Predictor of Therapy Outcome Following Cognitive Behaviour Therapy for Autistic Children. Journal of Autism and Developmental Disorders, 1–12. https://doi.org/10.1007/s10803-023-06083-7
