Drowning is the leading cause of injury-related death among autistic children, occurring at rates dramatically higher than neurotypical peers — yet structured, autism-specific water safety programs have remained scarce. A manualized 10-week occupational therapy intervention now shows unusually strong effect sizes in improving both swim skills and water safety awareness in this high-risk population, offering a replicable clinical model.
The AquOTic program enrolled 37 autistic children aged 5 to 9 years in a county developmental disabilities therapy pool setting. Using a pre-post cohort design drawn from a broader randomized controlled trial, therapists and caregivers independently set individualized goals assessed via the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS). Post-intervention, children demonstrated significantly improved GAS T-scores alongside COPM performance and satisfaction scores, with Cohen's d effect sizes ranging from 2.1 to 2.3 — an exceptionally large magnitude by behavioral intervention standards. Motor skills represented the most frequently targeted goal domain, followed by aquatic safety awareness and sensory regulation.
Effect sizes in this range are rarely observed in pediatric behavioral or motor interventions, which warrants both excitement and caution. The dyadic interventionist-child format, embedded within a group setting, may explain part of the efficacy by providing individualized sensory accommodations alongside social modeling — a combination known to support skill generalization in autism. However, several limitations temper conclusions: the sample of 37 is modest, the pre-post design within a larger RCT introduces potential selection and expectation biases, and long-term skill retention was not assessed. The absence of a concurrent control group in this specific analysis means causal attribution is incomplete. Still, given the documented drowning mortality disparity, even incremental evidence supporting a structured, occupational therapy-led aquatic model carries meaningful public health weight. This study is best read as a compelling signal warranting a fully powered, independently replicated RCT rather than a definitive clinical mandate.