# Exercise as it relates to Disease/Effects of a swim program for children with ASD

The following is a critique on the scientific study Effects of a swim program for children with autsm spectrum disorder on skills, interest, and participation in swimming, published in the American Journal of Recreational Therapy, 2014.

## What is the background to this research?

ASD is a neurological and developmental disorder that affects how an individual thinks, feels and interacts with others. Behavioural Symptoms of ASD generally appear early on in a child’s development, with many children displaying symptoms between 12-18 months. Early signs of ASD include:
* Delayed speech and communication skills
* Difficulty maintaining eye contact
* Repetitive and restricted behaviour patterns
In 2018 approximately 1 in 44 children under the age of 8-years-old were diagnosed with ASD in the US. The characteristics and behavioural nature of ASD creates barriers that can deter a child’s participation in physical and recreational activities which can lead to chronic health issues and encourage sedentary behaviour. Children with ASD are up to 40% more prone to becoming obese compared to children without ASD. Swimming is a popular physical activity for children with ASD as the water provides buoyancy and postural support by reducing the effects of gravity. This study aimed to analyse the effectiveness of a sensory-supported swim program for children with ASD focusing on skill development, interest rate, and increase in physical activity.

## Where is the research from?

This study was published in 2014 as part of a project conducted by Kansas University (KU) for Sensory Enhanced Aquatics (formerly sensory-supported swimming). The authors of this study are a part of the KU Medical Centre. The lead author Lisa Lawson has a PhD in Occupational Therapy Education, has been a part of 50 publications, and has expertise in developmental disabilities and recreational therapy. The project Log for the KU Sensory Enhanced Aquatics was updated regularly throughout 2017-2018, ensuring up-to-date information and studies were conducted.
This study was approved by the Institutional Review Board (IRB). The IRB review and monitor biomedical research studies that involve human subjects

## What kind of research was this?

This study used a quasi-experimental design in the form of a pre-post and survey design to analyse the effectiveness of the intervention of a swim program on the skill, interest, and physical activity levels of children with ASD. This study design is advantageous in determining whether there is a difference between pre and post-intervention data and capturing comparable measurements between pre and post-intervention which eliminates the possibility of bias when interpreting results.
A limitation of the pre-post design during this study is that the activities conducted outside of the experimental environment (swimming pool) are unable to be monitored. Especially when using a survey design to measure parent satisfaction, the responses may become invalid due to differences in opinions and perceptions regarding the child’s behaviour.

## What did the research involve?

Participants were recruited through program notices that were distributed throughout community centers in Kansas, US. Participants needed to meet three criteria to be chosen for the study: ASD diagnosis, age (4-18 years of age), and order of enrolment. Forty-two children with ASD participated in the study (39 male and 3 female) and ages ranged from 4-15 years-of-age.
For this study, the adolescent/adult sensory profile, American Red Cross learn-to-swim levels and parent satisfaction questionnaire were used to compare pre-post data. During the first swimming lesson, the parents of participants were asked to fill out a sensory profile. If the participant was over the age of 11-years-old and competent enough, they were to complete their own sensory profile. Instructors holding current or previous Red Cross water safety instructor training recorded the participants beginning swim levels. Each participant completed eight 30-minute sensory-supported swimming lessons and the swimming level was retested. Parents then completed a Parent Satisfaction Questionnaire after their child’s last swimming lesson.
The methodology of this study was conducted well as the measures for pre-post intervention were kept the same and descriptions of each measure were provided. Important information such as diagnosis, previous formal and informal participation in recreational activities and services commonly utilized by the participants such as occupational therapy and speech therapy were recorded.
The diagnosis of each participant was categorised into either having Autsm, Asperger’s, other or missing. 4 participants recorded a missing diagnosis and 3 recorded other. This missing information may affect the validity of the data collected as the purpose of the study was focused on children with ASD. This study also did not specify the ratio of teachers to students in the class

## What were the basic results?

Main Findings:
* 11 participants improved skills within the level they started in, 25 participants advanced one swimming level and 4 participants advanced two swimming levels.
* 75% of participants advanced at least one level after the eight-lesson sensory-supported swimming program.
* 85% of parents either “agreed” or “strongly agreed” their child’s physical activity levels increased
* 91% of parents reported their child’s interest in swimming had increased
The results of the study were interpreted through the responses in pre-post tests conducted at the start and end of the swimming program. The use of surveys for improvements in physical activity and interest in swimming may be over-emphasised due to the personal opinions of the parents whereas improvements in skill progression can be effectively tracked as curriculum testing was conducted.

## What conclusions can we take from this research?

The study has effectively demonstrated the positive effects a swimming program can have on children with ASD. Overall, there was an increase in the swimming skills, interest from the children, and physical activity. Sensory-supported swimming also had a positive effect on parent satisfaction.
The findings of this study align with previous research studies conducted to analyse the effects of swimming on children with ASD. One other study conducted compared the effects of technical vs. game-based aquatic training. Both training interventions were found to have improvements in locomotors and control skills. The technical vs. game-based study also analysed emotional regulation but little to no improvements were found. Another study reported that an aquatic therapy program showed positive effects on social interactions and one-on-one teaching was most effective.

## Practical advice

* Physical exercise such as swimming improves motor skills, physical activity, social interactions, and communication. skills of children with ASD.
* One-on-one lesson formats were found to be more effective in improving motor skills faster.
* Technical and game-based swimming training can be used to increase physical activity
* Safe pool environments should be used when conducting a swim program, and with qualified swimming instructors.

## Further information/resources

For Further information on this topic:
Autism Swim
Autism Awareness Australia
The Key Benefits of Swimming for Children on the Autism Spectrum

## References

Add in the references using this code
* 1 2 3 4 5 6 7 8 9 Lawson L. et al. Effects of a swim program for children with autism spectrum disorder on skills, interest, and participation in swimming. American Journal of Recreation Therapy. 2014 [cited 6 September 2022];13(2):17. Available from: https://www.researchgate.net/publication/272148783_Effects_of_a_swim_program_for_children_with_autism_spectrum_disorder_on_skills_interest_and_participation_in_swimming
* ↑ Lord C. et al. Autism spectrum disorder. The Lancet. 2018 [cited 8 September 2022];392(10146):508-520. Available from: https://www.sciencedirect.com/science/article/pii/S0140673618311292
* 1 2 When do children usually show symptoms of autism?. https://www.nichd.nih.gov/. 2017 [cited 8 September 2022]. Available from: https://www.nichd.nih.gov/health/topics/autism/conditioninfo/symptoms-appear#
* ↑ Autism Spectrum Disorder (ASD). National Institute of Mental Health (NIMH). 2022 [cited 8 September 2022]. Available from: https://www.nimh.nih.gov/health/statistics/autism-spectrum-disorder-asd#:~:text=Across%20the%20CDC%20surveillance%20sites,all%20racial%20and%20ethnic%20groups.
* ↑ Curtin C. et al. The prevalence of obesity in children with autism: a secondary data analysis using nationally representative data from the National Survey of Children's Health. BMC Pediatrics. 2010 [cited 8 September 2022];10(1). Available from: https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-10-11
* ↑ Hulls D. et al. Clinicians' Perceptions of the Benefits of Aquatic Therapy for Young Children with Autism. Physical &amp; Occupational Therapy In Pediatrics. 2006 [cited 8 September 2022];26(1):13-22. Available from: https://pubmed.ncbi.nlm.nih.gov/16938823/
* ↑ https://www.researchgate.net/project/KU-Sensory-Enhanced-Aquatics-formerly-Sensory-Supported-Swimmimg
* ↑ https://www.researchgate.net/profile/Lisa-Mische-Lawson-2
* ↑ What is the Institutional Review Board (IRB)?. Research Office. 2022 [cited 9 September 2022]. Available from: https://research.oregonstate.edu/irb/frequently-asked-questions/what-institutional-review-board-irb.
* ↑ Gouldthorpe J. et al. Capturing Change: Comparing Pretest-Posttest and Retrospective Evaluation Methods. EDIS. 2013 [cited 8 September 2022];2013(1). Available from: https://edis.ifas.ufl.edu/publication/WC135
* ↑ Marsden E. et al. Single group, pre- and post-test research designs: Some methodological concerns. Oxford Review of Education. 2012 [cited 9 September 2022];38(5):583-616. Available from: https://www.tandfonline.com/doi/full/10.1080/03054985.2012.731208
* ↑ Kang H. The prevention and handling of the missing data. Korean Journal of Anesthesiology. 2013 [cited 11 September 2022];64(5):402. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668100/#:~:text=Missing%20data%20(or%20missing%20values,from%20the%20data%20%5B1%5D.
* 1 2 3 4 Marzouki H. et al. Effects of Aquatic Training in Children with Autism Spectrum Disorder. Biology. 2022 [cited 11 September 2022];11(5):657. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9138228/
* 1 2 Güeita-Rodríguez J. et al. Effects of Aquatic Therapy for Children with Autism Spectrum Disorder on Social Competence and Quality of Life: A Mixed Methods Study. International Journal of Environmental Research and Public Health. 2021 [cited 12 September 2022];18(6):3126. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002945/
* 1 2 3 Munn E. et al. Improvements in Swim Skills in Children with Autism Spectrum Disorder Following a 5-Day Adapted Learn-To-Swim Program (iCan Swim). Journal of Clinical Medicine. 2021 [cited 13 September 2022];10(23):5557. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658159/#B22-jcm-10-05557
* ↑ Rogers L. et al. Using a Constant Time Delay Procedure to Teach Foundational Swimming Skills to Children With Autism. Topics in Early Childhood Special Education. 2010 [cited 12 September 2022];30(2):102-111. Available from: https://journals.sagepub.com/doi/abs/10.1177/0271121410369708
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