Jennifer Knott, CTRS, discusses aquatic therapy programming for autistic individuals. She highlights the potential of such programs for removing barriers to involvement and expanding individual recreation repertoire to build memories and experiences together in a community-based setting. The speaker emphasizes the lifelong nature of aquatic therapy and presents various examples of individualized treatment techniques and goals. The speaker highlights the absolute need for teaching autistic people water safety skills and details how water’s essential qualities assist therapy techniques and individual skill-building. Knott asserts that we can promote lifelong health, wellness, and leisure development for autistic individuals by harnessing the power of the water and designing inclusive accessible programs. 

Take the knowledge quiz for this presentation HERE
Handouts are online at: Aquatic Therapy for Individuals with Autism

In this webinar: 

1:30 – About Jenn Knott
4:08 – Recreation therapy
6:15 – Aquatic therapy
8:25 – Properties of water
10:30 – Water safety skills
13:30 – Need for physical activity across the lifespan
15:55 – Barriers to community aquatic programming
18:40 – Aquatic therapy approach
20:20 – Aquatic therapy assessments
22:00 – Skills addressed in aquatic therapy
28:30 – Sensory stimulation in the water
33:20 – Case study: Donovan
38:00 – Swim skills are transferable
40:30 – Teaching swim safety skills
43:02 – Alleviating fear and anxiety
47:45 – Q & A

Introduction

Jennifer Knott introduces herself and explains how her intense passion for aquatic therapy was born. Her journey in aquatic therapy began while she was in college and volunteered at Hattie Laram, a group home for individuals with severe to profound disabilities. There she witnessed the transformative power of water on individuals’ physical functioning, behavior, and mood (1:30). Knott notes that this experience solidified her decision to dedicate her life’s work to eliminating barriers and providing meaningful recreation programs for individuals with special needs. She started Rec2Connect to provide communities with more accessibility to these life-changing therapies across an individual’s life (3:00). 

Recreation and aquatic therapy

Recreation therapy, although not widely known, is a lifelong therapy that uses recreational approaches to address the specific needs of individuals with chronic disabilities, syndromes, or diseases (4:08). Knott explains that treatment methods are highly individualized and can include any recreation (not just aquatic). Methods retain similar goals to physical, occupational, and speech therapy techniques. Skills taught in these programs aim to be transferable across opportunities and daily life. 

The speaker defines aquatic therapy as a form of recreation therapy that uses “water and specifically designed activity by qualified personnel to aid in the restoration, extension, maintenance, and quality of function for persons with acute, transient, or chronic disabilities, syndromes, or diseases” (6:40). Aquatic therapy includes goals that address skills which can be transferred to land and can be administered by a variety of professionals (7:35). Knott details properties of water like buoyancy, resistance, and hydrostatic pressure, which provide sensory-rich environments and help with focus and centering (8:30). For example, the hydrostatic pressure of water evenly distributed across the body offers a comforting “hug” and balanced sensory inputs. 

Aquatic therapy and autism

The speaker notes that many autistic individuals are often drawn to the water but lack the necessary safety awareness and skill sets. She discusses research suggesting a need for teaching swimming skills at a young age, highlighting that autistic children are 160 times more likely to die from drowning compared to the general pediatric population (10:30). Knott therefore asserts that swimming should be taught as an imperative survival skill before any behavioral, speech, or occupational therapies. She provides examples of safety measures such as specialized bracelets and watches and locks on doors and pools to ensure the well-being of autistic individuals in the water (12:35). Knott emphasizes the need for physical activity across the lifetime as a driver for mental and physical health (13:30). The presenter notes significant barriers to community aquatic programming and their effectiveness in skill-building for individuals with autism and other disabilities (15:50). 

Many autistic individuals exhibit hyperactivity, sensory-seeking behaviors, aversion to water, motor deficits, hypertonia, and balance issues. The speaker explains that participating in aquatic therapy can address these challenges and provide opportunities for lifelong leisure and skill development (19:00). She summarizes the aquatic therapy approach as individualized (based on patient assessments), goal-driven, and focused on lifelong skills, like motor movement. Personalized sessions are based on an individual’s interests and are often conducted weekly to track progress and guide future therapy sessions (21:15).

Skills addressed in aquatic therapy

Knott reiterates that skills addressed in aquatic therapy sessions extend beyond swimming and aim to be transferable. These can include gait, core strength, following directions, balance, gross motor skills, sensory regulation, and much more (22:00). She presents different examples of activities that address core strengthening, like pushing objects underwater or using fins for kicking (25:00). Motor skills and strength can be addressed with weighted medicine balls, squeezing sponges, and pool games that incorporate physical actions and hand-eye coordination. The speaker describes techniques used to build capacity for using one’s arms and legs simultaneously in water compared to on land (27:00). Knott reiterates the importance of incorporating sensory activities into therapy techniques, as well as allowing sensory breaks (32:34). She outlines a case study where therapeutic goals addressed sensory needs, core-strength, and coordination, as well as swim safety skills such as grasping the pool wall, swimming to the pool wall, and holding breath underwater (33:20). The presenter notes that many individuals experience water aversion and discusses techniques for building trust and alleviating fear and anxiety surrounding water (43:00). 

Knott reiterates the impact of aquatic therapy on lifelong health and wellness such as increased physical activity, decreased likelihood of drowning, increased strength, and opportunities for social activities (44:40). She provides thanks and references before the Q & A session where she covers accessibility to aquatic therapy programs, potentially toxic chemicals in pools, autism-friendly swimming environments, and more (47:45). 

 “If you are an exhausted or overwhelmed caregiver, this presentation is for you.”

Amanda Tami, LPC, BCBA, discusses the importance of self-care for adult caregivers supporting people with special needs, including autism. She provides context for mental health in the US and highlights the importance of self-care in the modern world. The speaker outlines factors that affect mental health, discusses burnout compared to depression, and describes issues with the way society views and idealizes self-care. Tami reframes self-care using five key aspects to create more accessible and realistic expectations for adult caregivers. She emphasizes short personalized self-care routines that can be done alongside other responsibilities and notes the trial and error of discovering what works. Throughout the presentation, Tami highlights community support and socialization. She provides references and resources before the Q & A.

Learn more about our speaker HERE

Take the knowledge quiz for this presentation HERE

In this webinar: 

0:40 – Introduction and agenda
2:58 – Factors that may impact mental health
4:20 – Risks for parents of children with autism
5:50 – Relationship challenges
7:26 – Family needs
8:16 – What is burnout
9:52 – Burnout vs depression
12:20 – Improvement as a major difference
13:11 – COVID-19 Pandemic impact on mental health
14:20 – Societal issues with self-care
15:56 – Expectations vs reality
18:00-  Self-care for a bad day
19:25 – You don’t need to earn that nap
20:26 – Reframing self-care
21:19 – Setting priorities
23:15 – Setting boundaries
26:50 – Recognizing the non-negotiables
28:50 – Self-care via Maslow’s Hierarchy of Needs
31:54 – Find a purpose
33:10 – Filling your cup
35:29 – Key to filling your cup
36:10 – Possible self-care activities
40:12 – Daily cup flowchart
42:09 – Community care vs self-care
45:45 – Three important questions
48:08 – References and resources for parents
48:30 – Q & A

Tami introduces the presentation agenda (0:40) and summarizes the current face of mental health in the US (1:30). Since the pandemic, she explains, the number of people seeking assistance for mental health has significantly increased. However, up to 66% of those individuals never attain care (2:33). She emphasizes the importance of self-care in light of such data and lists factors that can impact mental health (especially for caregivers and parents of individuals with disabilities): stressors related to diagnosis and treatment, relationships difficulties, family needs, work, and burnout (2:58). Tami highlights that parents of children with autism are at a higher risk for acute and chronic stress than parents of children with other disabilities and neurotypical children (4:20). 

The speaker gives real-world examples and descriptions of relationship challenges faced by caregivers and parents of autistic individuals (5:50). She underscores how overwhelming family, household, and employment needs are (7:26) and that they often lead to burnout, especially for parents of kids with disabilities (8:16). Burnout, Tami explains, is an exhaustion syndrome caused by a gap between resources and demands and can apply to parenting, caretaking, and any other form of work (8:41). The presenter compares burnout to depression (9:52), noting differences in terminology and qualifications and similarities in physical and physiological symptoms (11:30). Tami discusses the impact of the COVID-19 pandemic on mental health, citing a study that found 43% of caregivers reported an increase in pre-existing mental health conditions post-pandemic (13:11). 

Even with the enormous responsibility and long to-do lists of caregivers, many single parents or solo caregivers must navigate independently (14:20). The speaker describes misconceptions in our expectations of what self-care looks like (15:56) and explains how idealized self-care strategies (i.e., long walks in nature, vacation, cleaning the whole house) are often not realistic (15:56). Tami emphasizes benefits of doing less (18:40) and asks viewers to consider when/why they learned that their self-care needs are lesser than everyone else’s (20:20). 

The presenter reframes self-care (20:26) to include five key aspects: 

1. Set priorities (21:19)

From a young age, we learn (especially women) that making yourself a priority is selfish and wrong. Tami asserts that we must question this narrative and “add ourselves to the list of priorities.” 

Tip: You can start by telling yourself that practicing self-care is helping others because you will be able to care for them better if you are healthy. 

2. Set boundaries (23:15)

A boundary is a “limit to what you will do and what you are willing to take on as your responsibility.” It’s best to discuss boundaries before they need to be enforced, Tami states, as it allows for more realistic expectations and more meaningful interactions. 

Tip: When someone asks you to do something, finish what you were doing first. 

3. Recognize the non-negotiables (26:50)

Maslow’s Hierarchy of Needs places physiological (biological) needs at the base of the pyramid, followed by safety needs, love and belonging, esteem, and self-actualization. If one’s biological (baseline) needs are not fulfilled, one can meet no higher need. Tami encourages viewers to reframe their self-care in this view, starting from the bottom up (28:50). 

Ask yourself: How much water am I drinking? Am I eating and sleeping enough? How much news and social media do I take in? How may that be affecting me? Do I need to reach out to someone? (30:30). 

4. Find a purpose (31:54)

Take time to rediscover and relearn what you like, or pick up a new hobby. The speaker suggests anything from leisure activity to advocacy but warns that over-investing in macro causes can lead to burnout.

Ask yourself: I am a parent/caretaker… and? What do I want to be to the world? 

5. Fill your cup (33:10)

Tami rethinks the “fill-your-cup metaphor” (34:03), asserting that the goal is to keep the cup from running empty. Using practical, simple, and repeatable self-care activities (35:29) throughout the day helps to consistently “refill” one’s cup a bit at a time (40:12). She lists potential activities, including an extra long shower, alone time in the car, small movements, intentionally enjoying what you buy for yourself, using your senses, or anything that changes your focus or energy. The speaker underscores that it’s okay to do what you need to do to get time for yourself – this includes allowing kids screen time when you need to unplug (36:10). 

Ask yourself: What energizes me? What depletes my energy?

Tip: Make lists of needs versus wants

The presenter touches on community care as a hopeful paradigm for the future, as it is clear that caregiving, like life, is not meant to be done alone (42:09). She underscores the power behind the principle of universality and urges viewers to attend events where people in similar situations will be (43:00). Tami leaves viewers with three critical questions to ask themselves: What brings me joy? What is the unmet need? What prevents me from getting that need met (45:45)? She provides references and resources for parents before the Q & A addressing questions about finding communities, delegating roles/responsibilities, how to set boundaries amid blowback, and much more (48:30).