Aquatic Interventions for Children and Adolescents With Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Motor, Sleep, Executive Function, and Adaptive Measures.
5 affiliations
- 1Al-Maha Pediatric Specialized Care Center, Al-Wakra Hospital, Hamad Medical Corporation, Doha, QAT.
- 2Physiotherapy, Islamic University of Lebanon, Baalback, LBN.
- 3Research and Development/Physiotherapy, Health Rehabilitation Integration Research Center, Beirut, LBN.
- 4Medical Research, Hamad Medical Corporation, Doha, QAT.
- 5Nursing and Midwifery Research, Certified Global Nurse Consultant, Doha, QAT.
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.
Related
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BibTeX
@article{ziab2026aquatic,
title = {{Aquatic Interventions for Children and Adolescents With Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Motor, Sleep, Executive Function, and Adaptive Measures.}},
author = {Hussein M Ziab and Rami Mazbouh and Abdullah Alshami and Kalpana Singh and Abdulqadir J Nashwan},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116809},
url = {https://europepmc.org/article/MED/42927206},
note = {CC BY},
}
RIS
TY - JOUR
TI - Aquatic Interventions for Children and Adolescents With Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Motor, Sleep, Executive Function, and Adaptive Measures.
AU - Hussein M Ziab
AU - Rami Mazbouh
AU - Abdullah Alshami
AU - Kalpana Singh
AU - Abdulqadir J Nashwan
PY - 2026
DA - 2026/09/23
JO - Cureus
DO - 10.7759/cureus.116809
UR - https://europepmc.org/article/MED/42927206
AB - 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.
SN - 2168-8184
ER -