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Full Course Details: Public course page
Learn more about our guest: Erika Kemp OTD, OTR/L, BCP, FAOTA
If you have not been paying attention to recent statistics on drowning, you need to be.
After decades of decline, deaths by drowning are on the rise.
Groups already at higher risk have seen the greatest increases in drowning deaths. This includes adults ages 65 years and older of all races and ethnicities, as well as Black people of all ages.
But today, we’ll focus on an especially high-risk group: children (and particularly, children with autism). Drowning is the leading cause of death for children ages 1 to 4, and children with autism spectrum disorder are 160 times more likely to experience nonfatal and fatal drowning than their typically developing peers.
Whatever setting you work in, I hope these sobering numbers convince you to pay close attention to water safety. Here, we’ll look at an aquatic OT swim safety program that you could consider implementing in your community.
Agenda
Intro and breakdown of journal article
- 00:00:00 Intro
- 00:03:00 Swim Safety and Autism Intro
- 00:03:52 The Role of OT in Swim Instruction
- 00:04:27 What was the intent of this paper?
- 00:04:53 What were their methods?
- 00:07:21 What were their results
- 00:08:17 Article discussion and conclusion
Discussion on practical implications for OTs
- 00:09:45Intro to Erika Kemp
- 00:11:49 How Erika became interested in swim safety
- 00:16:35 How the OT swim program came to be
- 00:22:32 Article impressions
- 00:26:07 How can we educate about water safety without fear mongering?
- 00:31:01 How is a good fit for this program?
- 00:34:30 What steps would I need to take to start an OT swim program?
- 00:40:28 How could this fit in the outpatient setting or a non-profit?
- 00:48:05 How to promote swim safety for children under 4?
Supplemental Resources
Swim Safety Materials
- OT Potential Club Handout: Swim Safety for Autistic Children Fact Sheet
- AAP Drowning Prevention and Water Safety
- NAA Big Red Safety Box
- National Drowning Prevention Alliance
- Red Cross Water Safety
- Study: Individuals with Autism at Substantially Heightened Risk for Injury Death Columbia University Mailman School of Public Health, 2017
Additional Research Articles
Article Review
Read Full Text: Addressing Swim Safety in Autistic Children: A Pilot Feasibility Study Using Aquatic Occupational Therapy
Journal: International Journal of Aquatic Research and Education
Year Published: 2023
If you have not been paying attention to recent statistics on drowning, you need to be.
After decades of decline, deaths by drowning are on the rise.
Groups already at higher risk have seen the greatest increases in drowning deaths. This includes adults ages 65 years and older of all races and ethnicities, as well as Black people of all ages.
But today, we’ll focus on an especially high-risk group: children (and particularly, autistic). Drowning is the leading cause of death for children ages 1 to 4, and autistic children are 160 times more likely to experience nonfatal and fatal drowning than their typically developing peers.
Whatever setting you work in, I hope these sobering numbers convince you to pay close attention to water safety. Here, we’ll look at an aquatic OT swim safety program that you could consider implementing in your community.
Two weeks from now on the OT Potential Podcast, we will welcome the article’s lead author, Erika Kemp, for a discussion on the logistics of launching a swim safety program. We’ll also tackle big picture questions—like how to go about mobilizing the entire OT community to prevent drownings in our communities.
Let’s dive in.
Swim Safety and Autism Intro
Formal swim lessons are effective at reducing drowning rates.
Group instruction is the most cost-efficient way to provide swim lessons. However, for autistic children (who are at much greater risk of drowning), parents have reported that group lessons are less successful. This is likely because group lessons do not take into consideration the unique learning needs and differences of autistic children.
In recent years, we have seen more literature focused on developing swim skills in autistic children. These articles have promoted approaches like:
But, there is still not a definitive, agreed-upon approach for specialized instruction.
The Role of OT
Occupational therapy professionals are already trained in developmental skill acquisition, motor learning, sensory processing, and behavioral theory.
This training may pair well with the Halliwick Concept, which considers both the motor and psychosocial aspects of learning to swim by first addressing comfort in the water, and then focusing on gaining control of balance—ultimately leading to independent movement. This approach allows for 1:1 support within a group setting.
What was the intent of this research?
Given the importance of teaching swim skills to autistic children—and the ability of occupational therapy professionals to do so—the authors sought to answer:
- Is group-based aquatic OT a feasible intervention for increasing swim skills in autistic children?
- What are parents’ perceptions of the instructional methods and results?
What were their methods?
This was a mixed methods pilot study. Quantitative data on change in swim skills was collected using standardized assessments. Qualitative data was collected via parent reporting.
Who were the participants?
8 autistic children ages 3–7 participated in this study, along with their caregivers.
What assessments did they use?
The assessments used were:
- Water Orientation Test Alyn 2
- Goal Attainment Scale (GAS)
- Sensory Profile™ 2 (Pre intervention)
- Parent interview (Post intervention)
These assessments were completed with the occupational therapist. 3–4 individualized goals were created for each child based on parent goals, WOTA scores, and clinical observation.
What did the group-based OT entail?
Group-based OT was provided 1x/week over 10 weeks. Sessions occurred in a warm-water pool located at a local school for children with developmental disabilities.
Each individual participant was paired with a swim buddy (a current OT or PT student who had completed their pediatric coursework). The swim buddies individualized intervention under the guidance of two OTs.
Each session lasted 45–60 minutes, and each child had an individualized visual schedule. The flow of sessions looked like this:
- Group song for water acclimation and to signify the start of therapy
- 2–3 minutes of water adjustment
- Group instruction on swim skill of the week
- 30 minutes in stations
- Group song to signify the end of session
- Parent education and discussion of progress toward goals
The general progression of skills was as follows:
Water acclimation —> blowing bubbles (breath control) —> floating on the front and back —> kicking —> locomotion skills
Safety skills taught and consistently reinforced included:
- Not entering the water before the swim buddy gave the safe word.
- Turning around in the water and getting back to the side of the pool.
- Entering/exiting the water.
- Performing a back float to rest if fatigued.
What were the results?
All 8 participants finished at least 8 of 10 sessions. Furthermore, all participants increased their total score on the WOTA, and 4 met the criteria for minimal detectable change.
81% of the individual goals set were met or exceeded.
Three main themes—as well as several sub-themes—were identified in the parent interviews. Here’s the theme map from the article:
Discussion
Given that all 8 children tolerated the intervention with good adherence, the study demonstrated that this particular aquatic OT program is feasible to carry out with autistic kids.
Aquatic occupational therapy services often are NOT covered by insurance, but this study put forth a viable method of delivering these services in a cost-effective manner, with 1 OT overseeing instruction of 8 children.
That said, due to the small participant numbers in this cohort study, the results are not easily generalizable, and more research should be done. An important learning was that the WOTA2 may not be sensitive enough to measure change in children with no prior water experience, so the WOTA1 should be considered.
Conclusion
The need for aquatic interventions for autistic children is evident—and occupational therapy practitioners should be considered as resources to help meet this need.
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