December 2017: Autism Spectrum Disorders

Spotlight on Aquatics & Autism Spectrum Disorders 


Content courtesy of the National Swimming Pool Foundation

Recent PUBLICATIONS WHICH show how WATERWORKS for autism

Therapists and caregivers have a powerful weapon in their fight against autism: water. The bathtub, shower, or public pool can offer countless opportunities to tame transitional stresses, promote social encounters, correct out-of-kilter motor systems, and promote sensory integration. In water, children have the power to harness buoyancy, viscosity, turbulence, surface tension, refraction, and thermal shifts. Aquatic therapy offers so much promise for this population that entire therapy pools have been designed with these children in mind. 

As always in the field of physical medicine, research lags behind anecdotal evidence. Intuitively, many pediatric clinicians believe in the power of the pool. In the literature, clinicians have reported a substantial increase in swim skills, attention, muscle strength, balance, tolerating touch, initiating/maintaining eye contact, and water safety during their sessions with young children with autism. Providers who require assistance creating aquatic treatment ideas and skill-specific challenges can benefit from reading their findings.

To date, there are few gold-standard clinical trials which support aquatic therapy for the treatment of autism. This is interpreted—in all probability, prematurely—by some as a reason to deny aquatic therapy for this diagnosis. This represents a fundamental misunderstanding of what aquatic therapy is. Insurers who deny aquatic therapy, yet readily approve of their land-based counterparts, do not understand that the pool is just another tool. Much like a therapeutic ball, a bolster, a mat or a swing, the pool is a means to an end, not a treatment in and of itself.

Truly, there is no such procedure as aquatic therapy. Instead, there is neuromuscular re-education, trained in the water. Or therapeutic exercise performed in a space dominated by buoyancy. Or sensory training practiced in a room overloaded with warm, viscous molecules. Insurers who would never consider denying therapists the right to use a splash-table or bucket in the clinic have little leg to stand on when denying those same clinicians the right to a “really big” pail. 

Many clinicians believe that children with autism have difficulty with change because they are unable to distinguish relevant from irrelevant information, resulting in huge difficulties with decision-making. Such kids often cannot “make up their minds” or make a simple A-versus-B choice. These kids have a need for sameness and have a strong need for rituals and routine. Free time is very difficult for them to manage. Additionally, children with autism have organizational and sequencing problems. These children don’t know where to start, what comes next, or when a task is finished. The child’s life can become one long series of tragic interruptions. 

Enter the pool. In addition to the normal therapy pursuits of strengthening, balance training, and range of motion (ROM), the pool is an excellent location to work on:

  • Transitional stress
  • Social interactions
  • Body awareness and kinesthesia
  • Tactile processing
  • Vestibular processing, and
  • Visual processing

Water activities can provide autistic children with the opportunity to embrace change. Even the act of entering the pool from the deck is a massive leap into uncertainty, and parents looking for ways to promote acceptance of change can use the pool for this end …and beyond. 


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. Retrieved from

Benedita, M., Pardo, L., & Israel, V. L. (2014). Hydrotherapy: Application of an Aquatic Functional Assessment Scale ( AFAS ) in Aquatic Motor Skills Learning. American International Journal of Contemporary Research, 4(2), 42–52. Retrieved from

Bukowski, E. (2017). Aquatic Exercise. In C. Kisner, L. A. Colby, & J. Borstad (Eds.), Therapeutic Exercise: Foundations and Techniques (pp. 295–316). Retrieved from

Busst, C. (2015). Exercise as an intervention for children with Autism Spectrum Disorder: Perspectives of education professionals. Birmingham City University. Retrieved from

Case-Smith, J., Weaver, L. L., & Fristad, M. a. (2014). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism: The International Journal of Research and Practice, 19(January), 133–48.

Eversole, M., Collins, D. M., Karmarkar, A., Colton, L., Quinn, J. P., Karsbaek, R., … Hilton, C. L. (2016). Leisure Activity Enjoyment of Children with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 46(1), 10–20.

Fabrizi, S. (2015). Splashing Our Way to Playfulness! An Aquatic Playgroup for Young Children With Autism, A Repeated Measures Design. Journal of Occupational Therapy, Schools, & Early Intervention, 8(4), 292–306. Retrieved from

Forrand, K. (2017). Special Education Teachers Perception Regarding the Benefits of a Specialized Aquatics Program for Students with Autism as it Relates to the Areas of Social. Endicott College. Retrieved from

Fragala-Pinkham, MA, Haley, S.M., O'Neil, M.E. (2011). Group swimming and aquatic exercise programme for children with autism spectrum disorders: a pilot study. Developmental Neurorehabilitation, 14(4), 230–241.

Franzen, K., & Tryniszewski, P. (2013). Effectiveness of Aquatic Therapy for Children with Neurodevelopmental Disorders: Systematic Review of Current Literature. The Sage Colleges. Retrieved from

Gaskell, J., Janssen, M. A., & RTC, C. (2017). Benefits of a structured swim program for children diagnosed within the autism spectrum disorder. American Journal of Recreation Therapy, 13(1), 9–16. Retrieved from

Grosse, S. (2014). Aquatic safety for individuals with autism spectrum disorders. International Journal of Aquatic Research and Education, 8(3), 295–301. Retrieved from

Guan, J., & Li, G. (2017). Characteristics of unintentional drowning deaths in children with autism spectrum disorder. Injury Epidemiology, 4(1), 32.

Güeita-Rodríguez, J., García-Muro, F., Rodríguez-Fernández, Á. L., Lambeck, J., Fernández-de-las-Peñas, C., & Palacios-Ceña, D. (2017). What areas of functioning are influenced by aquatic physiotherapy? Experiences of parents of children with cerebral palsy. Developmental Neurorehabilitation, 1–9.

Güeita-Rodríguez, J., García-Muro, F., Cano-Díez, B., Rodríguez-Fernández, Á. L., Lambeck, J., & Palacios-Ceña, D. (2017). Identification of intervention categories for aquatic physical therapy in pediatrics using the international classification of functioning, disability and health-children and Youth: a global expert survey. Brazilian Journal of Physical Therapy. Retrieved from

Jackson, J., Cosbey, J., & Meyer, W. (2015). Influence of Adaptive Water Sports Programs on Quality of Life Perceptions for People with Disabilities: A Feasibility Study. University of New Mexico. Retrieved from

Jull, S., & Mirenda, P. (2015). Effects of a Staff Training Program on Community Instructors’ Ability to Teach Swimming Skills to Children With Autism. Journal of Positive Behavior Interventions, 18(1), 29–40.

Kafkas, A. Ş. A., Gökmen, Ö., & Özen, G. (2015). Teaching of Swimming Technique to Children with Autism: A Pilot Study. Journal of Rehabilitation and Health on Disability, 1(1), 12–20. Retrieved from

Ketcheson, L., Hauck, J., Autism, D. U.-, & 2017, U. (2017). The effects of an early motor skill intervention on motor skills, levels of physical activity, and socialization in young children with autism spectrum disorder: A pilot study. Autism, 21(4), 481–492. Retrieved from

Klein, N., & Kemper, K. (2016). Integrative approaches to caring for children with autism. Current Problems in Pediatric and Adolescent Health Care, 46(6), 195–201. Retrieved from

Lawson, L. M., Foster, L., Harrington, M. C., Oxley, C. A., (2017). Effects of a swim program for children with autism spectrum disorder on skills, interest, and participation in swimming. American Journal of Recreation Therapy, 13(2), 17–27. Retrieved from

Lawson, L., & Little, L. (2017). Feasibility of a swimming intervention to improve sleep behaviors of children with autism spectrum disorder. Therapeutic Recreation Journal, 51(2). Retrieved from

Lawson, L. M., Mazurowski, M., & Petersen, S. (2017). Sensory processing patterns and swim skill acquisition of children with autism spectrum disorder. American Journal of Recreation Therapy, 16(2), 29–40. Retrieved from

Levy, K. M., Ainsleigh, S. A., & Hunsinger-Harris, M. L. (2017). Let’s Go Under! Teaching Water Safety Skills Using a Behavioral Treatment Package. Education and Training in Autism and Developmental Disabilities, 52(2), 186. Retrieved from

Menear, K., & Neumeier, W. (2015). Promoting Physical Activity for Students with Autism Spectrum Disorder: Barriers, Benefits, and Strategies for Success. Journal of Physical Education, Recreation & Dance, 86(3), 43–48. Retrieved from

Mohamed, S.-E. (2017). Effect of aquatic exercises approach (halliwick-therapy) on motor skills for children with autism spectrum disorders. Ovidius University Annals, Series Physical Education and Sport / SCIENCE, MOVEMENT AND HEALTH Romania Science, Movement and Health, 2(172), 490–496. Retrieved from

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, 93–103.

Oriel, K., & Kanupka, J. (2014). The Impact of Aquatic Exercise on Sleep Behaviors in Children With Autism Spectrum Disorder A Pilot Study. Focus on Autism and Other Developmental Disabilities …, 31(4), 254–261. Retrieved from

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.

Pan, C.-Y. C., Chu, C.-H., Tsai, C.-L. C., Sung, M. M.-C., Less, S., Huang, W.-Y. M., … Ma, W.-Y. (2017). The impacts of physical activity intervention on physical and cognitive outcomes in children with autism spectrum disorder. Autism, 21(2), 190–202.

Rajko, V. U. T. E. (2017). Halliwick Swimming Method in the Swimming Method in the Wellness Reflexions as Swimming for Everyone. Acta Salus Vitae, 5(1), 56–63. Retrieved from

Rogers, L., Hemmeter, M. L., & Wolery, M. (2010). Using a Constant Time Delay Procedure to Teach Foundational Swimming Skills to Children With Autism. Topics in Early Childhood Special Education, 30(2), 102–111.

Shams-Elden, M. (2017). Effect of Aquatic Exercises Approach (Halliwick-Therapy) on Motor Skills for Children with Autism Spectrum Disorders. Ovidius University Annals, Series Physical Education & Sport/Science, Movement & Health, 17(3). Retrieved from

Tanner, K., Hand, B., O’Toole, G., & Lane, A. (2015). Effectiveness of interventions to improve social participation, play, leisure, and restricted and repetitive behaviors in people with autism spectrum disorder: A. The American Journal of Occupational Therapy, 69(5), 12. Retrieved from

Scharoun, S. M., Wright, K. T., Robertson-Wilson, J. E., Fletcher, P. C., & Bryden, P. J. (2017). Physical Activity in Individuals with Autism Spectrum Disorders (ASD): A Review. In M. Fitzgerald & J. Yip (Eds.). Autism - Paradigms, Recent Research and Clinical Applications. Retrieved from

Yanardag, M., Erkan, M., & Yılmaz, İ. (2015). Teaching advance movement exploration skills in water to children with autism spectrum disorders. Research in Autism Spectrum Disorders, 9(1), 121–129. Retrieved from