Aquatic interventions in autism: efficacy and access (2026)

In short: This 2026 narrative review of 21 studies looks at aquatic programs for children with autism spectrum disorder from two angles: clinical effects and practical access. Structured programs improved water competence, gross motor skills and executive functioning, while families faced barriers such as sensory-challenging pools, costs and a shortage of trained instructors.

About this study

Catama and Villanueva synthesized 21 peer-reviewed empirical studies published between 2017 and 2025. They start from the observation that accidental drowning is a leading cause of death among children with autism spectrum disorder. The review combines quantitative studies on outcomes with qualitative studies on the experiences of caregivers and instructors.

Main findings

Structured aquatic programs improved water competence, gross motor skills and executive functioning.
Preliminary findings link these gains to physiological changes such as increased vagal tone and changes in inflammatory markers, associated with better sleep and fewer stereotypic behaviors.
Families valued aquatic participation and reported less parental stress.
Access was limited by sensory-challenging pool environments, high costs and a shortage of autism-informed instructors.

The authors conclude

The authors conclude that the gap between proven effects and access should be bridged, for example with models in which therapists support mainstream swimming instructors, and that larger randomized trials are needed.

Limitations

This is a narrative review; the physiological findings are preliminary.

Source

Catama BV, Villanueva MC. Aquatic Interventions in Autism: A Dual-Lens Review of Clinical Efficacy and Community Implementation. Journal of Anthropology of Sport and Physical Education. 2026;10(2):27-33. doi: 10.26773/jaspe.260404. Published under a Creative Commons Attribution (CC BY) licence.