Caputo, G., Ippolito, G., Mazzotta, M., Sentenza, L., Muzio, M.R., Salzano, S., & Conson, M. (2018). Effectiveness of a multisystem aquatic therapy for children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 48(6), 1945–1956. http://dx.doi.org/10.1007/s10803-017-3456-y.
Previous research has shown that improving motor skills in children with ASD is associated with improvements in a variety of nonmotor domains including imitation, social attention, and speech and communication (Srinivasan et al., 2015 & 2016) but less is known about the impacts on adaptive/daily living skills and overall ASD symptoms.
In this study, the authors aimed to test the effectiveness of a multisystem aquatic therapy on the behavioral, emotional, social, and swimming skills of children with ASD.
26 participants were included in the study—13 in the CI-MAT (Multisystem Aquatic Therapy; Caputo and Ippolito 2016) group and 13 in a control group. CI-MAT is a formalized treatment program based on a multisystem approach that uses cognitive-behavioral strategies and principles of attachment theory to enhance functions, emotions and social aspects of children with ASD as well as to teach swimming skills.
The protocol includes three phases:
- Emotional adaptation that is focused on building a functional attachment relationship between the expert and the child
- Swimming adaptation that aims to teach swimming skills by means of aquatic exercises specifically adapted for individuals with disabilities
- Social integration where the child participates in classical group swimming activities and games
Participants in both groups received the standard-of-care treatment (a widely used combination in Italy) that consisted of a combination of conventional language therapy and psychomotricity (a psychomotor training for the enhancement of goal-directed actions and motor coordination). Participants were assessed preintervention and again 10 months later at postintervention. Autism symptomology was measured using the Childhood Autism Rating Scale (CARS), adaptive behavior using the Vineland Adaptive Behavior Scales (VABS), and aquatic skills using the Humphries’ Assessment of Aquatic Readiness (HAAR).
Results demonstrated significant improvements of the CI-MAT group when compared to the control group on CARS emotional response, adaptation to change, and activity level. Within-group comparisons in the CI-MAT group showed significant improvement on almost all CARS items, whereas the control group displayed no significant advancement. The CI-MAT group also showed significant improvement on daily living skills and general growth of the adaptive behaviors measures by VABS. The HAAR checklist revealed learning of swimming skills as well.
Multisystem aquatic therapies can be effectively combined with the standard-of-care treatment for promoting positive changes in relevant aspects of ASD, including enhancing several functional behaviors, as well as swimming skills of children with ASD.
This study provides further support of previous research suggesting that movement-based interventions within social context can effectively activate dysfunctional brain networks in children with ASD (Srinivasan et al., 2015 & 2016). Additionally, it has been suggested that children with movement difficulties experience more success in an aquatic environment because of the buoyancy of the water, and of the decreased effects of gravity which may allow an individual to exercise motor skills with fewer body constraints (Pan, 2011).
Families may find that pools, especially those in community settings, offer chances for participation and social interaction for children with ASD. Psychologists may want to encourage community settings to offer programs to families with children with ASD or incorporate ASD-friendly accommodations to be more welcoming of these children and families.