article april-11 jodie

Title

Seeing a child with autism swimming is sometimes like seeing a completely different

child. The aquatic environment can help in achieving many personal, social, motor skill, and

fitness objectives. Early intervention, physical education, and therapeutic recreation programs

often utilize an aquatic setting (Benjamin, Harvey, & Prupas 2006; Gayle, Lepore, & Stevens,

2007; Jake, 2003). The aquatic environment is chosen for these programs because the water

provides the proprioceptive and tactile input that calms and soothes children with autism,

allowing the student more freedom from their disability and more ability to focus on the tasks

presented to them.

Autism is defined in the Individuals with Disabilities Education Amendment Act of 2004

as “a developmental disability significantly affecting verbal and nonverbal communication and

social interaction, generally evident before age three, that adversely affects a child's educational

performance.” 300 A 300.8 c 1. Individuals with autism have a combination of characteristics at

various degrees of severity which may include: (1) Difficulty with speech, language, and

communication; (2) Difficulty relating to people, objects, and events; (3) Abnormal response to

sensory stimuli; (4) Developmental discrepancies; (5) Difficulty processing information; (6)

Engaging in repetitive activities and stereotyped movements; (7) and resisting environmental

change or change in daily routines (IDEA, 2004; Janzen, 1996). Each student is affected

differently by autism and will have their own personality, a unique combination of characteristics

and unique needs. For example, difficulties with language and communication might include that

the student is non-verbal, meaning they do not talk at all, uses echolalic speech, meaning they

tend to only repeat what they hear instead of responding appropriately, or has difficulty making

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2Aquatics programming for individuals with autism

eye contact (Winnick, 2005). Sometimes this will cause others to assume they are not

acknowledging the speaker when they really are listening.

A child with autism will follow normal motor developmental patterns but may have poor

motor skill performance, low fitness, and low muscle tone (Birkan, 2004; Jake, 2003). Land

based exercise programs can pose the risk of injury to any person who is untrained or unfit due to

muscle weakness and subsequent poor joint alignment. Considering the buoyant support of

water, an aquatics program would be an excellent choice for a fitness program (Gayle, Lepore, &

Stevens 2007). In the water students can experience more success in activities that require

balance and timing, which provides encouragement to continue the activity For example

dynamic balance activities like hopping on one foot and leaping can be done much slower

allowing time to react between parts of the skill. The support also makes the threat of falling

much less apparent. Benjamin, Harvey, & Prupas (2006) noted that “many children with autism

have more success in attaining movement skills in an aquatic environment than in a gymnasium

setting” (p. 47).

Swimming is an effective way to achieve fitness and is an excellent choice for recreation

because it is a socially appropriate outlet for lifetime involvement. Researchers have documented

many physical benefits of aquatic programs for people with autism, including balance, speed,

agility, power, hand grip, muscular strength, flexibility, cardiorespiratory endurance (Birkan,

2004). Psychomotor improvements in swim skill performance and water safety have also been

shown (Powell, Vonder- Hulls, & Walker 2006).

In addition to the motor skill and fitness benefits; aquatic sessions are a great time to

focus on social and cognitive objectives is while children are calm in the pool. Because of the

difficulties with language and communication, students with autism lack social skills and if not

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nurtured, may lack social interaction. Playing pool games is an excellent way to promote verbal

and nonverbal vocabulary, communication skills, and social interaction. One of the greatest

benefits that have been shown in research is a reduction in stereotypical autistic movements after

physical activity (Levinson & Reid, 1993; Richmond, 2000).

cite that research here). Occupational therapists find that paying attention, tolerating touch, eye

contact, and self stimulating behaviors can all be improved in the aquatic environment (Powell,

Vonder- Hulls, & Walker 2006). Need additional info regarding social skills here and how they

can be nurtured.

Students with autism can be included in many different aquatics programs based on the

most developmentally appropriate setting, the child’s individual needs, and the goals of the

aquatics program. Examples of settings that could include aquatics: physical education, adapted

physical education, inclusive physical education, therapeutic recreation, behavior management,

physical therapy, IEP goals, recreation, learn to swim, water safety instruction, and competitive

swimming.

If given the opportunity to implement an aquatics program for a student with autism,

professionals should be eager to take advantage of it. This article will provide some strategies for

planning and implementing a program for those who will be taking initiative to teach a student with

autism in the water.

ABC Model introduction

Short paragraph

Step One: Pre-Planning for Safe Participation

These things should be considered before deciding if a child will participate.

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Original source is Levinson and Reid (1993) Richmond (2000)Jodie april.


Health Conditions

Before starting an aquatics program you will need to determine if the student can

participate safely. It is important to gather information on the student including any medical

conditions the student may experience. Seizures are a common secondary condition for children

with autism so it is important to find out if the child has ever had a seizure and train the staff on

how to care for the student in that situation. The student should get a doctor’s approval in regards

to any health conditions prior to beginning any aquatics program.

Lastly, make sure to get parental consent for the student to participate. Due to the

inherent risks of aquatic activities, if medical conditions cannot be managed, swimming may not

be the best type of program.

Sanitation

Some children with autism engage in self-injurious behavior like picking or scratching

the skin that could cause open skin wounds (Exkorn, 2005). State bathing codes prohibit

swimming with an open wound due to the risk of serious viral or bacterial infections that can

lurk in swimming pools (new jersey bathing code page 15 ; Griffiths, 2003).

Some students with autism may be delayed in toilet training (Boswell & Gray, year?).

Ask caregivers if the student is toilet trained. If not, students should be required to wear a water

proof swim diaper and state bathing codes require plastic water proof briefs with snug fitting

elastic at the legs and waist (NJ pg 15). Reminding all students to use the toilet before

swimming is also recommended (Page 15 new jersey bathing code)

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Direct linkhttp://teacch.com/educational-approaches/applying-structured-teaching-principles-to-toilet-training-susan-boswell-and-debbie-graysite date accessed! Check where else it was published!I

jodie, 04/09/12,

Format- I can’t get this to move to the left edge! Grr


Safety

Children with autism may lack safety awareness and an understanding of the importance

of pool rules. All staff should have disability awareness training on how to interact with an

individual with autism and to understand the safety issues they need to watch for, such as a

student running and jumping into deep water without regard for safety of ability level.

Supervision & Personnel

Instructors should communicate with the facility’s management to consider lifeguard

supervision. Some things to consider for staffing would be: assigning particular lifeguard staff to

exclusively watch the student(s) and informing lifeguards about medical issues so that they can

be prepared to respond to an emergency.

If a student has any known conditions that require frequent assistance from an aid or

nurse, make arrangements for those trained staff to attend the sessions.

While a one to one teacher student ratio may be needed to supervise some students, small

or large group instruction may be appropriate for others. Within a program that accommodates a

larger group of people, one-on-one assistants, peer tutors, or other supervision will likely be

necessary.

Choosing a Facility

The potential for a successful aquatic program starts with choosing a facility. Some

things concerning the facility may be out of the instructor’s control and therefore should be

considered before choosing the location.

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For some students, warm water will be more relaxing and comfortable. Pools that are

shared with competitive swimming programs or used for other vigorous exercise will likely need

to have a water temperature between 79 and 82 degrees F. This temperature may be appropriate

for some students with autism while others would focus better in temperatures closer to 85

degrees. Raising the water temperature is usually not a reasonable request in large public or

private facilities.

Environment- Limiting distractions and noises in the pool setting is greatly beneficial due to

hypersensitivity and distractibility. Consider scheduling the lessons for a time of day when the

pool is not heavily used by other programs and patrons. You could also plan your lesson so that

the student is facing away from distractions. Noises such as fans, motors, and music at a low

volume might be considered background noise by most of us but, can be very distracting for

some students with autism. Fans for ventilation and motors like those used for filtration are often

required for operation and are not adjustable.

Some individuals with autism are sensitive to lighting, especially bright florescent lights.

It might be permissible to dim or turn out a portion of the lights but ask the facility managers in

advance. If the ideal conditions are not available, it is not a dead end. Over time and through trial

and error teachers and students may learn how to deal with the environment to be able to enjoy

the water.

Step Two: Assess

(knowing where students are at the end of instruction/ make modifications)

Getting to know a student with autism in the water is an experience that cannot be substituted with any amount of reading nor will it be the same as getting to know them on dry-land. In order to determine student’s needs and identify which objectives will be addressed in

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the aquatic program you will need to learn how the student is affected by autism and what abilities he/she has in the water.

Consult with school teachers, caregivers, parents, other professionals who know the student and are trained in strategies to manage his/ her behavior, and possibly the student to help decide what goals will steer the program. If the student has an Individualized Education Plan (IEP) or other equivalent type of plan for school, ask the parents if you can read a copy of the plan to gather useful information. The IEP will show you what goals the student has at school that you may be able to contribute to during the program. Some goal areas may be more heavily weighted than others due to the individuals needs but, try to balance affective, cognitive, psychomotor, and fitness goals.

If you find that the student’s goals at school or home are related to behavior management or modification, you should become familiar with any existing behavior management strategies that the student already uses in that setting. Learn how to use the strategies and plan to use them consistently throughout the program. For example if the student is being taught at school to control outbursts like screaming when happy and excited; the swimming instructor should also discourage this and/or replace it with a more appropriate response during the lessons. Some basic examples of behavior management are redirecting and replacing.

A wide variety of goals can be incorporated in the aquatics program. Some examples of program goals or objectives are: health related fitness, therapeutic play-based functional movement, improving range of motion, helping to facilitate neurodevelopmental growth, improved body awareness, increased balance, sensory integration, mobility skills, social skills, communication skills, and most importantly, having fun.

Based on what you know now, choose an aquatic assessment that will allow you to discover what the student can do in the water. See [table x phil conatser, book, red cross, ]The assessment could range from observations of the student’s behavior during free play in the water to a swimming skills test. It is important to observe the student in the water because the water may prompt certain impulsive behaviors. Working through some of these behaviors might become a short term or secondary program goal. If the child has a great fear of the water, overcoming this fear will be the first goal.

Continue to assess in each session. Through teacher observations or formal data gathering with rubrics, make a record of your student’s progress that can be used to make adjustments to the program.

Step Three: Planning Instruction (old title prescribe)

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Perhaps give some examples of appropriate aquatic assessments


Lesson Structure: To aid the student with autism that depends on routine, the general

structure of the lesson components should remain consistent. The duration of a lesson will

depend on the students’ tolerance. Lessons should be ended before the student loses focus. The

parents and other teachers can advise on how long the student will usually focus on instruction.

Consider planning the session a few minutes shorter than the predicted time limit. After learning

more about the student’s behavior, the teacher can adjust the duration of the lessons to maximize

learning. Try to schedule the lessons at the same time on the same day(s) of the week.

When a change is coming, try to let the student know in advance. For students who are

very dependent on their routine schedule, consider inviting them to come to the pool for out of

water activities if there is a problem preventing them from getting in the water such as an open

wound, ear infection, or problems with the pool chemistry.

To help with the transition from daily activities to the pool, caretakers can give the

student something to hold while they walk into the building that relates to the swimming

program. It could be a picture of the instructor or of the pool or an object like goggles or a kick

board (Langendorfer & Bruya, 1995). The transition object could even be a social story or

activity schedule for the lesson.

Setting up stations can help students with autism that have short attention spans and is an

excellent way to map out the various parts of the lesson so that there can be an easy flow

throughout. Stations should have routine transitions in between. Each station should have a goal

or time limit to be sure the duration does not go over a few minutes. Use of timers or a

countdown to the number of repetitions toward a goal can be used to signal the approaching end

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of a station. The actual time and space between stations should be short and clearly mapped out.

Teachers should explain and demonstrate the task at each new station.

When planning a lesson, focus on the student’s strengths. For example use a task the

student is already successful with for the focal point of a game and design the game with ideal

conditions that the student is known to function well within. This is in contrast to first choosing a

typical game and then trying to manage your student’s behavior within that game.

Design games that are cooperative instead of competitive to encourage social skills.

When the goal of the game can only be reached by incorporating others, the students will be

learning social interaction. Plan interactions that allow students to make eye contact and speak to

each other.

Step Three: Teaching

Successes and challenges both motivate students. Tasks that are too easy or too difficult

often do not encourage a student to participate at full potential. When a task seems too easy

students may be bored or easily distracted. When a task is too difficult, students may be

frustrated or discouraged. Finding a balance between challenge and success is an important

teaching skill that will help to motivate and control behaviors (find a reference, look in

Winnick). To ensure success, plan some things in each lesson that you know will be successful.

To ensure that each task is an appropriate challenge, teachers need to plan adaptations that can

make each task easier or more difficult.

When introducing new skills, do so gradually. For example, you could demonstrate a skill

near the end of a session and tell the student that he/she will try it at the next session. Develop

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small components of skills at a time to increase success before attempting the whole skill. Then,

review learned skills frequently.

When reviewing, be consistent in using the same strategies and cues that were used when

a skill was first taught. Over time the cues can become less frequent or can be replaced with just

a prompt. For example- when first teaching the breast stroke kick, you might constantly repeat

the cues with each repetitive motion, “heels up, toes out, and around”. As the student learns the

skill the repeating cues could be shortened to “up, out, and around”. When reviewing the breast

stroke kick later on the teacher might say, “show me your breast stroke kick, remember up, out,

and around”. Over time you may only need to say, “show me your breast stroke kick”.

Learning Environment- The potential for success with each pool session starts before

the student arrives. There are many things you can do that may help the student to accept the

swim lessons into their routines and therefore be more calm and ready to focus. All of these

could be considered environmental cues. The environmental cues that work best will be unique

for every student.

Choosing to use plenty of fun bright colored equipment can attract the student’s attention

and help to motivate them. In addition to bright colors, different textures may appeal to some

students. Scarves or other cloth like objects that move in a flowing manner underwater may

interest some students. Using buoyant swimming aids that can be held, positioned under, or

attached to the body when learning new skills, can increase the level of success and confidence

thereby increasing participation.

The pool environment and lesson schedule should be used as consistently as possible. For

each lesson, use the same part of the pool, enter through the same doors and walk to the

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designated area via the same path. Set up equipment in the same arrangement and at the same

time i.e. before or after the student arrives. Setting up the equipment so that the student can see

what will be used during the lesson is an environmental cue to let them know what is coming up.

Posting a daily visual schedule that outlines the lesson plan is an environmental cue that may

help the student to be ready to accept the various lesson activities. Always use the same type of

opening and closing. One example for a routine would be to sing a hello song at the opening and

a goodbye song at the closing (Langendorfer & Bruya, 1995). Another example is to do a certain

type of greeting at the beginning and a cheer at the end or give students a small token like an ink

stamp or sticker at the end.

Beginning the Lesson- When you finally will meet the student in the water there are

some things you can do to make them more comfortable and more able to focus. Entering the

water can be made more inviting by using different approaches other than a traditional ladder. A

disorder in visual depth perception may cause hesitation and anxiety when entering the pool.

Using a larger stair case style ladder or a pool with a zero entry slope may be more inviting than

a regular ladder. Some students with autism interpret a light touch as offensive and prefer or

even crave firm pressure. Entering the water step by step is similar to a light touch while a more

instantaneous entry will give a rush of firm pressure (Martinez, 2006). Using a sliding board or

jumping in may be more inviting due to depth perception and water pressure. The same sensation

could be incorporated throughout the session by allowing students to jump off a large floating

mat in the center of the pool. If the student uses a reward or token economy behavior strategy,

jumping or sliding in it could be the tangible reward used throughout the lesson. If your pool

doesn’t have a sliding board, you can create a similar object by hanging a large thick mat over

the side of the pool. An assistant instructor should kneel on the mat behind the student to hold it

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in place and spot the student’s head, while another assistant should be in the water to receive the

child if needed.

Communication

Students will usually respond better to simple, one part or two part instructions. When

students are not responding to instruction, the teacher can progressively make the verbal

directions shorter and add more visual and physical prompts until the student starts to respond.

The teacher can encourage any response that resembles the desired response with praise and

positive reinforcement and then continue to shape the response toward the desired response.

(Peterson, 2004)

Example Script:

Teacher - “Bobby, raise your right arm up towards the ceiling and put your left arm down

by your side.” Student- No response. The teacher adds a demonstration while repeating

the instruction, “Bobby, raise your right arm up towards the ceiling and put your left arm

down by your side.” Student- No response. Teacher shortens the instruction repeated with

demonstration, “right arm up, left arm down”. The student puts the left arm up. Teacher -

“Good job, arm up. Thank you. Now let’s put the other arm up”. The teacher adds a

physical prompt to continue with shaping the behavior- The teacher touches the right arm

and says “down”

For students who do not communicate verbally, teachers must learn how to communicate

with very little talking. Visual cues, environmental cues, physical prompts, and demonstrations

are all excellent ways to communicate. Teachers can demonstrate a skill and then give the

student a visual cue to repeat it like pointing at them. A physical prompt, like touching the

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students hand could signal that they should do something with that hand. Teachers can also use

“hand-over-hand” strategy by holding the students hand, foot, arm, or other appropriate body

part to manipulate it through a motion. Arranging equipment in order that it will be used would

be an example of an environmental cue.

Many students with autism use pictures to communicate. Aquatic instructors can create

pictures for the pool by simply laminating papers and/or placing them inside air tight plastic

sandwich bags. Follow the same design for any picture communications that the student already

uses. Consider photo copying pictures or photographs and label them with a short phrase or

sentence. Strategically arrange the pictures in a sequence that follows the lesson plan, known as a

picture schedule. Pictures can be organized into a photo album, binder or, along on a linear

object like a ruler.

For students who like music, teachers can repeat cues in a simple rhythm that will help

the students remember them. For example the three chosen cues for elementary backstroke could

be repeated to the tune of three blind mice.

When choosing what cues to use, consider what the student may already be familiar with, what

their interests are, and what would be age-appropriate.

If echolalia is one of the student’s characteristics, respond by acknowledging and

repeating the phrase again. For example the student repeats what you have said, “Bobby, we are

going to swim”, respond with, “that’s right, we are going to swim”. After a few rounds of

repeating, the student will eventually stop repeating the phrase and will move on towards

completing the task (Martinez, 2006).

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Use clear language without jokes, sarcasm, similes, or metaphors. For example, instead

of telling a student to, “be a rocket”, tell them to put their arms over head in the streamline

position.

Behavior Management Strategies

Always try to identify what came before and after each success and failure. Give students

attention and praise when they are behaving appropriately. Try not to give attention to

inappropriate behavior unless it is unsafe or very disruptive. Some behaviors like hitting oneself

may be done to attract attention. Students may eventually stop doing behaviors that don’t get

attention. For example, if the student is splashing excessively, the teacher can quietly stand back

and wait for them to stop before continuing instruction instead of shielding the face while asking

and wildly motioning for them to stop.

Replacing or redirecting strategies are appropriate for behaviors that need to be

interrupted because they are unsafe or inappropriate (Siegel, 2003). For example, if the student

is doing something inappropriate like touching others, the teacher can redirect the behavior by

giving them something to hold, which will keep the hands busy. In this way, the behaviors are

avoided without having a confrontation or challenge between the teacher and student.

Rewards, as with a token economy system, are often used for motivation and behavior

management. With a token economy, each correct response will earn the student a token, i.e.

sticker on a card. Once the student has earned the predetermined goal number of tokens, they can

be exchanged for a reward that is tangible like a toy, fun activity, or in some situations food. A

practical way to do this in the pool is to use a reward bucket. Simply place a bucket at the edge

of the pool and add things to it that the student can play with at the end of the lesson or add

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tokens to the bucket the student can trade in for a reward at the end of the lesson. Remember that

this system is only a positive reinforcement so; do not take things out of the bucket as

punishment. When the student is not achieving the desired outcomes, nothing is added to the

bucket (site Martinez?).

Directing Personnel- Incorporate peer tutors, para-professionals, or other assistants to

help manage groups of students. The lead teacher should give assistants specific instructions and

demonstrate teaching strategies for the assistants. Peer tutors, or same age students without

disabilities can participate alongside students with autism to help promote social interaction and

model the desired behaviors.

Safety & Sanitation While Teaching – While teaching a lesson there a few things to be aware

of to ensure safety and sanitation. Swallowing pool water is a common behavior for students

with autism that needs to be avoided. To control this, use strategies from the student’s behavior

management plans or replacement redirect strategies.

Staying submerged under the water may be common for students who enjoy the quietness

and water pressure here. Closely monitor the amount of time the student is under water and be

prepared to prompt them to come up after a few moments. Never encourage any student to stay

under water or hold their breath for any amount of time. Breath holding is not only dangerous,

but it can trigger a seizure for those prone to epilepsy (Gayle, Lepore, & Stevens 2007). For

students who have frequent seizures, wearing a US Coast Guard approved lifejacket should be

required. Students with epilepsy require close supervision at all times (red cross wsi).

If students will be allowed to swim in water deeper than the shoulders, the instructor

should wear a lifejacket or a lifeguarding rescue tube, if properly trained, in order to be prepared

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in a situation where a student could do something unexpected or become fearful or panicked. The

panic or distress associated with drowning will cause a person to “climb” anything or anyone in

reach, pushing others underwater. The student should not be allowed into the deeper water if the

swimming assessment did not show the ability to swim proficiently.

Step 5 Evaluate

Trial and error will be part of the process. Evaluation is needed in regards to the details of

each session but also to the program as a whole.

When lessons don’t go as planned we learn more about our students and we get useful

information on how to improve. Reflecting on each session will help to identify the reasons why

some things worked and others did not.

When evaluating the program as a whole, focus on the goals established prior to the start.

If goals were not met was satisfactory progress made towards reaching the goals? Do the goals

need to be adjusted? Are major changes needed like; moving to a different facility or changing

the main schedule?

Some things that may likely need to be adjusted are Talk about adjusting the duration of

each session..?. Evaluate also is an evaluation of the program effectivenss as a whole. Was the

program effective, should it continue, does it need to be changed, did it work?

…

Adjustments can be made to any aspect that the teacher can control. Some things

are not controllable. Learn how to work around these problems instead of focusing on

them. (end of section)

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Summary

This article provided suggestions on designing and implementing an aquatic program for

students with autism. Not all the information in this article will apply to every student. The

suggestions here are meant to provide instructors with the confidence to take the first steps

toward success with their students. not.

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Administrator, 04/03/12,

This needs to be greatly expanded. At least 3 paragraphs. Review the steps the ABC model. Remember, articles and presentations should:Tell them what you are going to tell themTell themTell them what you told themThis is the “tell them what you told them” section.


References

Benjamin, J., Harvey, W., Prupas, A. (2006). Early intervention aquatics: A program for children with autism and their families. The Journal of Physical Education, Recreation & Dance, 77 (2), 46-51.

Birkan, B., Bumin, G., Yandarda, M., Yilmaz, I (2004). Effects of swimming training on physical fitness and water orientation in autism. Pediatrics International, 46, 624–626.

Birkan, B., Camursoy, I., Erkan, M., Konukman, D., Yilmaz, I (2003). Using constant time delay procedure to teach aquatic play skills for children with autism. Research Quarterly for Exercise & Sport, 74 (1).

Boswell, S., Gray, D. (no date). Applying structured teaching principles to toilet training. Retrieved from teacch.com/educational-approaches.

Exkorn, K. (2005). The autism sourcebook: Everything you need to know about diagnosis. New York, NY: Harper Collins Publishers Inc.

Fragala-Pinkham, M., Haley, S., O'Neil, M. (2008). Group aquatic aerobic exercise for children with disabilities. Developmental Medicine & Child Neurology, 50 (11), 822-827.

Griffiths, T. (2003). The complete swimming pool reference (2nd ed.). Champaigne, IL: Sagamore Publishing Company:

Gayle, W., Lepore, M., Stevens, S. (2007). Adapted aquatics programming: A professional guide (2nd ed.) Champaigne, IL: Human Kinetics

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ABC MODEL KELLY AND WESSEL

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Richmond (2000)

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spectrum disorder. Teaching Elementary Physical Education. 17(2), 30-34.

Abstract

Autism is a developmental disorder affecting the lives of thousands of children. According to the Centers for Disease Control and Prevention (CDC), approximately 34 in 10,000 children ages 3 to 10 years of age have autism (CDC, 2004). The Autism Society of America (ASA) reports that 1 in 166 babies born today will develop autism spectrum disorder (ASD). Several researchers have developed programs that use physical activity to benefit children with autism. Richmond (2000) found a decrease in stereotype after children with autism participated in jogging sessions and ball throwing. Similarly, Levinson and Reid (1993) discovered that vigorous activity reduces stereotyped behavior in children with autism. Further, O'Conner and colleagues (2000) have developed effective methods of exercise that allow children with autism to remain engaged in the developmental process. The purpose of this paper is to examine appropriate physical activity for children with autism and its effectiveness in addressing deficits associated with ASD. Specifically, this article discusses (a) organized play, (b) the importance of physical activity, (c) a sensorimotor approach, and (d) programming based on five physical education objectives.

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article april-11 jodie

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