Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Drowning is a leading cause of accidental death for children with autism. A 10-week therapeutic adaptive swimming pilot study was conducted with individualized swim instruction from an OT or physical therapy student. Parent perspective was investigated to identify the benefits of instruction by a therapist in training. Qualitative themes discovered support swim instruction through an OT lens to increase skills in children with autism.
Primary Author and Speaker: Rebecca Woodson
Additional Authors and Speakers: Erika Kemp
BACKGROUND: Children with Autism Spectrum Disorder (ASD) can experience difficulties with social interactions, communication skills, and sensory processing subsequently effecting their functioning throughout daily activities, including family recreation such as swimming (American Psychiatric Association, 2013). With drowning being a leading cause of accidental death for children with ASD, there is a need for increased safety awareness as well as increased swim skill competence among children with this diagnosis (Autism Speaks, 2017). Children with ASD have specific needs that often cannot be fulfilled through traditional group swim lessons. Aquatic occupational therapy can improve swim skills after 8 hours of instruction however increased improvement continued through 24 hours of instruction (Alaniz, 2017). However, there is a gap in the literature regarding parent perception of the benefits of occupational therapy-led swim instruction which this study seeks to fill.
DESIGN: This was a mixed methods pilot cohort study that used a convenience sample of children ages 3-7 with a self-reported diagnosis of autism and their primary caregivers.
METHODS: Eight children participated in a 10-week individualized therapeutic adaptive swimming program led by an occupational therapist and occupational and physical therapy students. Aquatic sessions were held in a group format for one hour per week, with each child paired to a therapy student in the water. Individualized goals were created by an occupational therapist based upon intake and the Water Orientation Alyn Test 2 (Tirosh et al, 2008) and goal attainment scaling were utilized to track weekly progress. Aquatic instruction was individualized to each child’s level and based upon a mix of traditional swim and Halliwick method instruction, which integrates movement competency through different planes in the water to achieve swim related goals. Activity analysis, critical to occupational therapy practice, was used to design each session as well as individualized visual schedules for both group and individual activities. At week nine, parents were individually interviewed by a member of the research team not involved in the swim instruction to obtain parent perceptions of benefits to their child and family. Recorded interviews were transcribed verbatim. Using content analysis, data was coded by two independent reviewers familiar with the study and comparison was made to reconcile discrepancies, create codes and then collapsed into themes and subthemes.
RESULTS: Themes emerging from the qualitative data included safety, increase in swim, sensory adaptation, and social skills, the benefits of participation and learning to swim, and the benefits of an occupational therapy lens and design over traditional swim lessons. According to WOTA2 data collected, all participants increased total scores from initial to final collection with half of the participants meeting the MCID, mimicking similar studies (Tirosh et al., 2008). All children demonstrated increased scores for four skills and at least 75% of participants increased scores for 12 skills.
CONCLUSION: Parents perceived aquatic occupational therapy as more effective than swim lessons received at local community pools. This study shows that occupational therapy’s unique approach to swim instruction is a valuable tool to increase swim skills in children with ASD, thereby increasing community safety and enabling families to participate in desired occupations.
References
Alaniz, M. L., Rosenberg, S. S., Beard, N. R., & Rosario, E. R. (2017). The Effectiveness of Aquatic Group Therapy for Improving Water Safety and Social Interactions in Children with Autism Spectrum Disorder: A Pilot Program. Journal of Autism and Developmental Disorders, 47(12), 4006–4017. https://doi.org/10.1007/s10803-017-3264-4
Pan, C.-Y. (2011). The efficacy of an aquatic program on physical fitness and aquatic skills in children with and without autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 657–665. https://doi.org/10.1016/j.rasd.2010.08.001
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. https://doi.org/10.25035/ijare.02.03.04
