AquOTic water competency intervention improves outcomes in children with autism

IMPORTANCE: There is a critical need for therapeutic water competency (water safety and swim skills) interventions tailored to meet the needs of children on the autism spectrum, a group that is at high risk for drowning. OBJECTIVE: To examine the effect of AquOTic on caregiver- and therapist-based water competency goals for children on the autism spectrum. DESIGN: Pre-post cohort design based on a larger randomized controlled trial. SETTING: County Board of Developmental Disabilities therapy pool. PARTICIPANTS: Children on the autism spectrum (N = 37; 28 boys) ages 5 to 9 yr were recruited from the local community. INTERVENTION: AquOTic is a manualized 10-wk occupational therapy-based water competency intervention for children on the autism spectrum. AquOTic incorporates evidence-based therapeutic techniques and embeds individualized therapy (interventionist-child dyads) in a group environment. OUTCOMES AND MEASURES: Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were completed at baseline and post intervention. RESULTS: Children showed significantly higher GAS T scores and COPM Performance and Satisfaction scores post-AquOTic compared with baseline (effect size d = 2.1-2.3). All goals mapped onto the Occupational Therapy Practice Framework (4th ed.), with motor skills emerging as the most common category for both caregiver- and therapist-derived goals, followed by safety awareness in the aquatic environment and sensory functions. CONCLUSIONS AND RELEVANCE: Children on the autism spectrum demonstrated improved caregiver- and therapist-based water competency goals following the AquOTic intervention. Plain-Language Summary: This study examined the effect of AquOTic, an occupational therapy-based intervention, on parent/caregiver- and therapist-based goals related to water safety and swim skills among children on the autism spectrum. Caregivers identified goals for their children, and therapists developed goals that guided the intervention. After completing the 10-wk intervention, children showed improvements in both caregiver perceptions of their performance and satisfaction with goals set as well as therapist-rated goals. Our results highlight the value and effectiveness of an occupational therapy-based water competency intervention to improve water competency among children on the autism spectrum.