Water Competency and Sensory Processing Among Children on the Autism Spectrum

Importance: Globally, drowning is the third leading cause of unintentional injury death, and children on the autism spectrum are at a higher risk of drowning. Several factors affect limited water competency (swim skills and water safety) and engagement in swimming as a meaningful leisure activity. Objective: To identify baseline water competency among children on the autism spectrum, examine caregiver goals for swim skill intervention, and examine factors associated with water competency. Design: Cross-sectional analysis of baseline assessment from a larger randomized controlled trial. Setting: Franklin County Board of Developmental Disabilities Therapy Pool. Participants: Children on the autism spectrum (N 5 37; 28 boys, 9 girls), ages 5 to 9 yr, recruited from the local community. Outcomes and Measures: Water competency was assessed using the Water Orientation Test-Alyn 1 and 2 (WOTA 1 and 2). Caregivers completed the Canadian Occupational Performance Measure (COPM), the Sensory Profile-2 (SP-2), and a prior aquatic exposure questionnaire. Results: Children on the autism spectrum showed limited water competency skills on the WOTA 1 and 2. A majority of caregivers identified safety in and around water as a goal for their child, using the COPM. Higher conduct processing and low registration scores on the SP-2 significantly correlated with lower water competency. Exposure to group lessons significantly correlated with better water competency. Conclusions and Relevance: Children on the autism spectrum demonstrated limited swim and water safety skills, highlighting the need for programs that teach swim and water safety skills in this population. Plain-Language Summary: This study examined water competency, including swim safety skills, among children on the autism spectrum. The results suggest that these children lacked basic water competency and safety skills. Caregivers of children on the autism spectrum identified water safety in and around bodies of water to be a high- priority goal. A child's sensory characteristics and prior exposure to water activities affect their water competency. Our results highlight the need for programs that teach swim and water safety skills for children on the autism spectrum.