Measuring Water Orientation And
Beginner Swim Skills of Autistic Individuals
Kenneth J. Killian
Bronx Developmental Services
Rosemary A. Joyce-Petrovich and Lucille Menna
Bronx Autistic Unit, New York City Public Schools
Susan A. Arena
St. Joseph School for the Deaf, Bronx NY
There is little objective evidence to support the belief that swimming is an enjoyable
and valuable activity for autistic individuals. In this study, a checklist was used to
record the responses of 37 autistic children and youth to water orientation and beginner swim activities. The data indicated that the autistic subjects responded in a predictable and apparently normal manner to a hierarchy of water skills. Also, the subjects
displayed a low objection rate to water activities. Strong relationships (r = .95,p <
.01) were shown between age and water orientation and also between prior experience
and water orientation (r = .88, p < .01). The findings support the literature in that
the majority of subjects responded well to, or at least tolerated, water activities. Swimming pool activities may offer potential learning opportunities for many autistic individuals and should be investigated further as an avenue for improving a variety of
physical, academic, or social skills.
In his initial study of autistic children, Kanner (1943) reported that one of his
subjects had learned to swim during summer camp. Subsequently, autistic children have
been observed to play in water or mud for hours (Wing, 1972, 1976a), enjoy bath time
(Delacato, 1974), and engage in a variety of activities in the water (Bettelheim, 1967).
The autistic child's apparent interest in water activities has led to the suggestion
that swimming be used as an enjoyable and motorically valuable addition to education
programs (Mosher, 1975; Oppenheim, 1977; Wing, 1976b). In one of the two research
studies reviewed, swimming and water activities were identified as popular recreational
activities among autistic individuals (Dewey, 1973). Describing questionnaire responses
of 200 parents and professionals, Dewey reported swimming to be the favorite sport of
autistic children and highly recommended the use of water toys and a splash pool; however,
she did not include statistical findings.
We wish to acknowledge the guidance of Robert Spitalnik throughout this study and to
thank Roseann DeGennaro for her help in preparing the manuscript. We also wish to thank the staff
of the Respite Service, Bronx Developmental Center, for their cooperation during this study.
Request reprints from Kenneth J. Killian, Bronx Developmental Center, 1200 Waters Place,
Bronx, NY 10461.
ADAPTED PHYSICAL ACTIVITY QUARTERLY, 1984, 1, 287-295
287
288
Killian, Joyce-Petrovich, Menna, and Arena
The therapeutic use of water activities or swimming with autistic children is believed to facilitate language and self-concept (Hamilton, 1972), improve adaptive behavior
(Kawamura & Ishii, 1975), and provide an appropriate setting for early educational intervention (Bachrach, Mosley, Swindle, & Wood, 1978). Best and Jones (1974) used swimming as a major component of their movement therapy research on three autistic children.
The subjects participated in an individualized swim program which utilized manipulation,
imitation, commands, and self-motivation in an unspecified way to measure progress. It
was reported that over a period of 15 weeks the subjects improved in confidence and body
awareness, as well as in the skills of front float, back float, and kicking. But these conclusions are open to criticism due to a lack of specification throughout the report and the
lack of controls noted in the report.
While the literature indicates that many autistic children respond well to swimming activities, the reports are few in number and are based on subjective observations
or questionable research. The purpose of this study was to observe the responses of a sample
of autistic subjects as they orientated themselves to the pool and to beginner swimming
skills. The subjects were expected to respond willingly to such tasks. Unlike prior research,
operationally defined terms were used in this study to systematically collect data. This
methodology encouraged objectivity and allowed the replication of findings. The aim was
to describe the autistic individual's response to swimming pool activities more precisely
and objectively, and subsequently to indicate the potential value of swimming pool activities in the education or treatment of autistic persons.
Method
Subjects
Subjects (N = 37) were selected from a diverse population of 50 developmentally disabled children and youth who attended a state developmental center's community recreation program. The subjects, 32 males and 5 females who ranged in age from 6 to 20,
were identified as autistic based on the evaluation and placement criteria of the local school
district's Committee on the Handicapped. Of those subjects, 22 exhibited atypical language
(i.e., pronominal reversal, echolalia, lack of intonation) while the remaining 15 were nonverbal. The subjects displayed a variety of behavioral characteristics such as self-stimulation,
perseveration, rituals, tantrums, self-abuse, inappropriate affect, and social isolation. Sixteen subjects could perform simple self-help skills (e.g., toileting, dressing) independently, while the remaining 21 demonstrated only limited ability at such skills.
Regarding prior swim experience, no subject had used the developmental center
pool in the previous year due to a mechanical shutdown of the facility. However, 33 subjects had participated in weekly pool instruction for at least 2 years prior to the pool's
closing; the other 4 had not used the developmental center pool prior to this study. Although
pool experience outside the developmental center was unknown, this research was conducted in late summer and many subjects were likely to have experienced pool activities
in a summer-camp setting.
Instrument
The Aquatic Orientation Checklist (see Table 1) was devised as an observational tool to
MEASURING WATER ORIENTATION
289
1977; Murray, 1981) was observed in the initial four items: (a) walking toward pool, (b)
touching the water, (c) water entry, and (d) sitting or attaining a horizontal position in
the water. Items 5 and 6 related to the beginner swim skills of breath control and face
submersion (American Red Cross, 1981). Each Aquatic Orientation Checklist (A.O.C.)
item was rated using a behavioral scale adapted from Best and Jones (1974) and other
leisure assessment literature (Crawford, Griflin, & Mendel, 1978; Kraus, 1978). The following definitions were used in the behavioral scale:
Spontaneous: A behavior that is observed prior to the instructor's verbal directions;
Voluntary: A behavior showing the subject's compliance with the instructor's
verbal directions;
Demonstration: Instructor uses verbal and visual cues to describe a specific task;
Manipulation: Instructor puts subject's body through a movement which corresponds to a desired task, and manipulation is accompanied by verbal and visual
cues;
Objection: Avoidance of task by absolute noncompliance, tantrum, or active
resistance (i.e., pulling away crying, shouting).
Reliability was examined using inter-observer agreement, defined as the percentage of agreement between the data of the two observers. As indicated in Table 2, the
percentage of overall agreement was 86 %, with a range from 78 % (blowing bubbles) to
94% (entering pool). Also presented in Table 2 are Pearson product moment correlations
between the data of the two observers. For each A.O.C. item, the correlation of data was
positive and significant.
Procedure
Two observers were used in the study, both graduate students who had extensive experience
working with autistic children. The observers read, reviewed, and clarified the A.O.C.
prior to its use. During observation sessions, the observers sat 10 feet apart from each
other and approximately 5 feet from the pool edge. The observations took place at a
developmental center therapy pool measuring 58 by 23 feet, with a depth ranging from
2 to 4.5 feet. The temperatures were kept between 85-88 degrees for water and 80-84
degrees for air.
Observations coincided with the subjects' weekly recreation program. Subjects
were observed individually during one of six sessions over a 3-week period. A single subject was accompanied into a locker room and changed into a bathing suit. The observation
session was supervised by a swim instructor who was well acquainted with each subject,
and began as the instructor escorted the subject into the pool area. The instructor held
the subject by the left hand upon entering the pool area and positioned the subject close
to the pool edge. As the instructor and subject walked slowly toward a predetermined
location at the pool's shallow end, the instructor permitted any spontaneous behavior
which did not violate standard water safety practices. The instructor said something like
"Jane, let's go to the pool" if the subject did not spontaneously walk toward the pool.
If the subject failed to respond to repeated verbal cues, the instructor either lead the subject by holding both hands, or slowly guided the subject's torso toward the pool. If the
subject objected by actively pulling away or engaging in a tantrum, the observation session ended and the subject was removed from the pool area.
Killian, Joyce-Petrovich, Menna, and Arena
Table 1
Aquatic Orientation Checklist
Observer checks one behavior for each numbered item:
1. lnstructor and subject begin to walk toward pool.
A. Subject spontaneously leads by pulling instructor's arm
B. Subject voluntarily walks
C. lnstructor manipulates subject toward pool
D. Subject objects to task
Note unusual behavior:
2. At edge of pool, subject touches water with hand or foot:
A. Spontaneously
B. Voluntarily with demonstration
C. Subject requires manipulation to touch water
D. Subject objects to task
Note unusual behavior:
3. Subject enters the pool (both feet in shallow water):
A. Spontaneously
B. Voluntarily with demonstration
C. lnstructor manipulates subject into pool
D. Subject objects to task
Note unusual behavior:
4. Subject attains a sitting, squatting, or horizontal position in the water:
A. Spontaneously
B. Voluntarily
C. After manipulation by instructor
D. Subject objects to task
Note unusual behavior:
5. Subject blows bubbles (mouth contacts water and exhalation produces bubbles):
A. Voluntarily
B. Voluntarily after demonstration
C. After manipulation
D. Subject objects to task
Note unusual behavior:
6. Subject submerges entire face (forehead, eyes, nose, mouth, chin) in water:
A. Spontaneously
B. Voluntarily after demonstration
C. After manipulation
D. Subject objects to task
Note unusual behavior:
This sequence was generally followed for all A.O.C. items. If necessary, the
instructor said a few words to elicit a response to a particular A.O.C. task. For example,
if the subject spontaneously avoided contact with the water, the instructor might say "Jane,
let's go touch the water." Similar cues were used if needed to elicit a response to other
MEASURING WATER ORIENTATION
Table 2
Reliability for Aquatic Orientation Checklist (A.O.C.)
A.O.C. Item
Inter-observer agreement (%)
Pearson1
81
91
.45
94
6. Face submersion
83
78
91
.88
.90
.90
.97
Overall
86
-
1. Walks to pool
2. Touches water
3. Enters pool
4. Sits, etc., in pool
5. Blows bubbles
.93
Table 3
Subjects' Responses to Aquatic Orientation Checklist (A.O.C.) Tasks
A.O.C. Category
Spontaneous
Voluntary
Responses (%)
Voluntary
w/ demo
Manipulation
Objection
1. Walks to pool
2. Touches water
3. Enters pool
4. Sits, etc., in pool
5. Blows bubbles
6. Face submersion
A.O.C. tasks. All verbal cues were expressed as a request, not a command. The instructor was permitted to use no more than three brief verbal reinforcers (e.g., "good boy,
John") during the observation. An observer cued the instructor after the third reinforcer
had been used. A subject could object to sitting in the water (item 4) or blowing bubbles
(item 5) and yet continue to be observed for the remaining items of A.O.C. Once the observation was concluded, the subject was removed from the pool area and the instructor escorted
the next subject into the pool area. Individual observations generally lasted between 5 and
10 minutes. Between 5 and 13 subjects were observed in this manner at each session.
Killian, Joyce-Petrovich, Menna, and Arena
5
"
"
X-.....X
Spontaneous
*-+
Voluntary
&--A
Manipulation
MO b ~ e c t t o n
1
2
3
4
5
6
A .O.C. C a t e g o r y
Figure 1- Responses to Aquatic Orientation Checklist hierarchy. Note: A spontaneous
response was not possible for item 5. Voluntary comprises "voluntary" and "voluntary with demonstration" behaviors.
Results
The subjects' responses to the A.O.C. tasks are presented in Table 3 using percentage
form. A low objection rate (1.4%-6.7%)was seen for items 1 through 4. In all A.O.C.
items only a few (2.7%-13.6%) of the subjects required manipulation in order to participate. Further analysis of the data revealed that a hierarchy of tasks existed within the
A.O.C. This hierarchy generally reflected a widely used instructional progression (American
Red Cross, 1981) and followed the numerical order of the A.O.C. The least difficult task
was walking toward the pool (item 1) while the most difficult task was submerging the
face (item 6). Figure 1 displays the data as it related to the hierarchy. The figure shows
that spontaneity decreased as the A.O.C. tasks became more difficult. Conversely, the
objection responses increased as the degree of difficulty increased.
Responses were also examined concerning observers' comments that approximately
20% of the subjects either awaited verbal direction or beckoned for permission to touch
the water (item 2). Both behaviors may have reflected their prior participation in a structured pool program which stresses compliance with verbal directives. This prior learning
experience apparently suppressed spontaneous responses in item 2, and such prior learning may have influenced the responses to other items. Figure 2 examines the possible influence of prior learning on spontaneity by comparing the spontaneous response pattern
MEASURING WATER ORIENTATION
X"""x
Spontaneous
t-*Spontaneous
and
Voluntary combined
MManipulation and
oblection.combined
o
l
-
i
i
l
d
i
k
A .O.C. Category
Figure 2-
Combined responses to Aquatic Orientation Checklist hierarchy.
between the two patterns indicates the degree to which prior learning (i.e., compliance
with verbal directives) could suppress spontaneity in many A.O.C. categories.
Figure 2 also presents the A.O.C. hierarchy with regard to general responses that
indicate the subjects' compliance versus noncompliance. The combined "spontaneous"
and "voluntary" responses produced a general compliance pattern that decreased as tasks
grew more difficult. The subjects' noncompliance pattern (i.e., combination of objection
and manipulation responses) reflected a near linear increase as difficulty increased.
Pearson correlations examined the relationship between the A.O.C. score and factors such as age or experience. An A.O.C. score was obtained for each subject by summing the ordinal numbers assigned to behavioral scale responses. Chronological age was
determined in months, while experience was defined as the number of months which a
subject had the opportunity to use the pool at the developmental center. The correlation
between age and A.O.C. score was .95 @ < .01). The correlation between experience
and A.O.C. score was .88 (p < .01).
Discussion
The subjects' objection and manipulation responses indicated that only a small percentage
294
Killian, Joyce-Petrovich, Menna, and Arena
failed to comply with verbal requests to perform water orientation and beginner swim skills.
This noncompliance increased only after the introduction of tasks which could be considered artificial (i.e., blowing bubbles, face submersion). The subjects' apparent tolerance
for pool activities was reflected in the spontaneous and voluntary responses. These patterns are noteworthy, given the autistic child's negativism and noncompliance (Wing, 1972).
The emergence of an A.O.C. hierarchy indicated two trends in the subjects' responses: As seen in Figure 1, spontaneity decreased as A.O.C. tasks grew more difficult,
and objection responses increased as the degree of difficulty increased. Both patterns suggest that the subjects responded in a predictable and apparently normal manner when
presented with a hierarchy of water tasks. This finding is also noteworthy considering
the unstable behavior often associated with autistic children (Rirnland, 1964). The subjects' predictable behavior patterns, combined with the aforementioned tolerance of swimming activities, offers a possible explanation for the literature's reports of autistic children
who enjoy or respond well to water activities (Bettelheim, 1967; Delacato, 1974; Dewey,
1973; Park, 1972). In discussing the subjects' response patterns, it should be noted that
few if any of these subjects responded to water orientation and beginner swim activities
in a manner appropriate to their age.
Pearson correlations suggest that learning, or the ability to adapt to the swimming
setting, did take place. A strong correlation showed that the subjects demonstrated greater
compliance with water orientation tasks as they grew older. Similarly, a strong correlation showed a positive relationship between water orientation and pool experience. It should
be noted that the study's statistical data are nonparametric, thus all levels of significance
may be interpreted at a less powerful level than indicated (Darlington, 1975).
Based on observers' comments and the subjects' behavior patterns, it seems likely
that prior structured learning did affect the spontaneity of some subjects. The influence
of prior learning on spontaneity would be of particular interest to future research since
spontaneity is thought to indicate playfulness (Lieberman, 1977). Future research could
also focus on the behavioral and learning patterns of autistic subjects with varying swimming pool experience, comparing them to behavioral patterns of mentally retarded, learning disabled, or normal populations..
The findings of this study go beyond the case studies and subjective reports that
dominate the literature on swimming pool activities with autistic individuals. Data were
collected in a systematic and objective manner and involved one of the largest samples
of autistic subjects in the literature. Preliminary findings support the current literature:
the data indicated that the subjects responded in a predictable and apparent normal way
to a hierarchy of water tasks. Also, a majority of the subjects responded well to, or at
least tolerated, water activities. Given the learning and behavioral characteristics of the
autistic individual, the findings suggest that swimming pool activities may offer potential
learning opportunities for many autistic individuals and should be investigated further as
an avenue for improving a variety of physical, academic, and social skills.
References
American Red Cross. (1977). Adapted aquatics. New York: Doubleday.
American Red Cross. (1981). Swimming and aquatics safety. Washington, DC: Author.
Bachrach, A. W., Mosley, A.R., Swindle, F.L., & Wood, M. W. (1978). Developmental therapy
for young children with autistic characteristics. Baltimore: University Park Press.
Best, J.F., &Jones, J.G. (1974). Movement therapy in the treatment of autistic children. Australian
Occupational lherapy Journal, 21 (2), 72-86.
MEASURING WATER ORIENTATION
295
Bettelheim, B. (1967). The empty fortress. New York: The Free Press.
Crawford, M.E., Griffin, N.S., & Mendel, R. (1978). The assessment process in recreation with
severely and profoundly retard populations. Practical Pointers: American Alliance for Health,
Physical Education and Recreation. 2(1), 1-6.
Darlington, R.B. (1975). Radicals and squares, Ithaca, NY: Logan Hill.
Delacato, C.H. (1974). The ultimate stranger. New York: Doubleday.
Dewey, M. (1973). Recreation for autistic and emotionally disturbed children. Rockville,
MD: National Institute of Mental Health (ERIC Document Reproduction Sewice No. ED 094
0495).
Hamilton, A. (1972). Learning to talk while developing motor skills. Journal of Health, Physical
Education, and Recreation, 43(4), 80-81.
Kanner, L. (1943). Autistic Disturbances of Affective Contact. Nervous Child 2, 217-250.
Kawamura, T., & Ishii, T. (1975). Play therapy for autistic children in the central hospital
of Aichi perfectual colonly. Japanese Journal of Child Psychiatry, 16(5), 307-315 (from
Psychological Abstracts, 1980, 63, Abstract No. 3914).
Kraus, R. (1978). Zherapeutic recreation service: Principles andpractices (2nd ed.). Philadelphia:
Saunders.
Lieberman, J.N. (1977). Playfulness: Its relationship to imagination and creativity. New York:
Academic Press.
Mosher, R. (1975). Perceptual-motor training and the autistic child. Journal of kisurability, 2,
29-35.
Murray, J.L. (1981). Infaquan'cs-teaching kids to swim. New York: Leisure Press.
Oppenheim, R.C. (1977). Effective teaching methodsfor autistic children. Springfield, 11: Thomas.
Park, C.C. (1972). The siege. Boston: Little, Brown & Co.
Rirnland, B. (1964). Infantile autism. New York: Appleton-Century-Crofts.
Wing, L. (1972). Autistic children: A guide for parents and professionals. Secausus, NJ: Citadel
Press.
Wing, L. (1976a). Diagnosis, clinical description and prognosis. In L. Wing (Ed.), Early childhood
autism (2nd ed., pp. 3-51): New York: Pergamon Press.
Wing, L. (1976b). The principles of remedial education for autistic children. In L. Wing (Ed.),
Early childhood autism (2nd ed., pp. 198-215). New York: Pergamon Press.