Treatment Fidelity of AquOTic: An Occupational Therapy-Based Aquatic Intervention for Children on the Autism Spectrum

Importance Children on the autism spectrum face significantly higher risks for unintentional drowning, yet aquatic interventions often lack the standardized specification necessary for evidence-based replication. Objective To examine the treatment fidelity of AquOTic. Design Descriptive design based on a larger randomized controlled trial. Setting County Board of Developmental Disabilities therapy pool. Participants Children on the autism spectrum (N = 37) ages 5 to 9 year and graduate-level therapy students (swim buddies, N = 18). Intervention AquOTic is a manualized 10-week occupational therapy-based water competency intervention for children on the autism spectrum. Outcomes and Measures Adherence was measured via a 13-item fidelity self-checklist and video-coding analysis. Results High overall fidelity was achieved, with mean swim buddy adherence at 95.93%. Component-level fidelity averaged 97.36%, with core ingredients such as play-based strategies, modeling, and water property integration consistently appearing in 100% of analyzed sessions. Conclusions and Relevance The AquOTic intervention demonstrates high treatment fidelity, confirming that theorized active ingredients are consistently implemented. Use of fidelity practices and intervention specification supports the reproducibility and clinical translation of occupational therapy-led aquatic interventions to improve water safety for autistic children.