Aquatic Interventions in Autism: A Dual-Lens Review of Clinical Efficacy and Community Implementation

Accidental drowning is a leading cause of death among children with Autism Spectrum Disorder (ASD), making aquatic interventions a public health priority. Although clinical benefits are well documented, the literature remains fragmented, often separating child-centered physiological and behavioral outcomes from the socioecological barriers faced by caregivers and instructors. To address this gap, this narrative review synthesizes 21 peer-reviewed empirical studies published between 2017 and 2025. Using a dual-lens framework, the review examines both clinical efficacy and community-based implementation. Quantitative evidence shows that structured aquatic programs improve water competence, gross motor skills, and executive functioning. Preliminary findings suggest that these gains may be linked to physiological mechanisms, including increased vagal tone and modulation of inflammatory cytokines IL-6 and IL-10, which are associated with better sleep regulation and fewer stereotypic behaviors. In contrast, qualitative evidence reveals a serious implementation gap. Although families value aquatic participation as a meaningful activity that reduces parental stress, equitable access remains limited by sensorychallenging pool environments, high costs, and a shortage of autism-informed instructors. Bridging this efficacyimplementation divide requires scalable policy reforms, including task-sharing models in which therapists support mainstream instructors. Larger randomized controlled trials are also needed to strengthen the evidence base and help establish aquatic therapy as an equitably accessible standard of care.