Aquatic Interventions for Children and Adolescents With Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Motor, Sleep, Executive Function, and Adaptive Measures.

Authors

Hussein M Ziab, Rami Mazbouh, Abdullah Alshami, Kalpana Singh, Abdulqadir J Nashwan

Published in

Cureus. Volume 18. Issue 9. Pages e116809. Epub Sep 23, 2026.

Abstract

Children and adolescents with autism spectrum disorder (ASD) frequently face challenges in motor coordination, balance, sensory processing, sleep, physical activity engagement, and social and adaptive functioning. Aquatic interventions can offer a supportive therapeutic setting by combining physical activity, sensory input, motor practice, and opportunities for functional participation. This systematic review and meta-analysis examined the effects of structured aquatic interventions in children and adolescents with ASD on aquatic skills and water safety, sleep, social and adaptive outcomes, motor and balance performance, executive function, biomarkers, quality of life, and participation-related outcomes. A search was conducted in PubMed, CINAHL, Web of Science, Cochrane CENTRAL, and PEDro for studies involving participants aged 0 to 18 years with ASD who underwent structured hydrotherapy, aquatic therapy, swimming-based therapy, or other water-based interventions. A narrative synthesis was carried out for all eligible studies, while random-effects meta-analyses were conducted for controlled studies reporting comparable outcomes. Nineteen studies, reporting ASD samples totaling 342 participants, were included, and seven of these contributed to the quantitative synthesis. Aquatic skills and water safety produced the most consistently favorable findings. Pooled estimates favored aquatic intervention for sleep (Hedges' g = 1.76, 95% confidence interval (CI): 1.16 to 2.37), motor and balance outcomes (g = 1.49, 95% CI: 0.91 to 2.07), and executive function (g = 0.92, 95% CI: 0.35 to 1.46). Social and adaptive outcomes similarly favored aquatic intervention, though the pooled effect did not reach statistical significance (g = 0.38, 95% CI: -0.17 to 0.94). Since most domain-specific meta-analyses included only two studies, the pooled estimates should be viewed with caution. Overall, aquatic interventions appear to support water safety, motor and balance performance, sleep, and possibly executive function in pediatric ASD, while effects on social and adaptive functioning remain uncertain.

PMID:
42927206
Bibliographic data and abstract were imported from PubMed on 25 Oct 2026.

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