Center for Injury Research and Prevention

Swim Safety for Children with Autism

October 12, 2017

I frequently recommend swim lessons for children with autism spectrum disorders (ASD) for a variety of reasons-- motor coordination, sensory differences, and social interaction opportunities. Most of my patients really enjoy swimming, and for many, it can often be a really great joint activity for the entire family.

While previous studies suggest that swimming lessons can be protective for younger children in general, we don't know that much about the effectiveness of swimming lessons in older children as it relates to overall water safety. This is especially so for those with moderate to severe autism spectrum disorders. So it was with great interest when I found this recently published study that sought to examine, among other things, whether swimming skills improved in children with mild to severe ASD after an aquatic-based occupational therapy intervention, and the "minimum dosage" required to achieve water safety in this population. 

This small study examined 7 participants with ASD, aged 3-7 years old, from a clinic in Southern California. Most of the kids had not received any prior swimming lessons. Each participant attended 8, 16, or 24 hours of group intervention (2:1 student:instructor ratio, with no more than four students in a group) led by an occupational therapist experienced in working with and teaching swimming skills to children with ASD. Skills were assessed using a tool based on the American Red Cross Water Safety Instructor Manual, focusing on skills felt to be important for water safety and drowning prevention. Findings from the study include:

ASD and swimming
  • Overall swim skills were significantly improved over time, noted after the initial 8 hours of intervention, and again after 16 and 24 hours.
  • Breath control (blowing bubbles from mouth/nose and submerging face into the water without water intake) was the most consistently advanced skill, and was improved at all three time points.
  • The changing position skill (rotating body from back to front and front to back) was significantly improved at 16 & 24 hours.
  • Propulsion skills (swimming five feet independently) were improved after 24 hours.
  • Navigation (moving along the wall in the pool), exiting the pool (pulling self out of the water using wall, ladder, or stairs), and back float skills did not improve significantly.

This study suggests that swimming lessons with a skilled therapist can be effective in children with mild to severe ASD, with improvements in some of the skills felt to be important for water safety and drowning prevention noted after the first 8 hours of lessons.

Limitations of this study include the small sample size and lack of control group (would these skills have been gained without lessons or via other means?). Future studies examining larger groups of children and potentially with differing formats of swimming instruction are needed to futher evaluate this research question. However, from this study I may be able to suggest to families that swimming lessons may not just be an enjoyable activity but one that is also important for life-saving skills. 

For families with a child with autism, check out more water safety tips on the CAR Autism Roadmap™, a parent resource from the Center for Autism Research at CHOP.

Click here for a tip sheet for instructors who are teaching children with autism to swim.

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