• Suzanne Axelsson

Autism: waterplay

“I would like to rephrase Dr. Stephen Shore’s statement “If you’ve met one person with autism, you’ve met one person with autism,” to become “if you’ve met one person with a label, you’ve simply seen the label and not the person.” We are all unique individuals with many labels.” 

Kurt Muzikar


If you were to do an online search using the words “waterplay” and “autism”, an overwhelming number of results will be about autistic children’s love of water, the risks that are involved and how to keep them safe. While these are, indeed, important considerations it does not tell the whole story of children with autism, or their interactions with water, or how they play.

This article strives to provide a more complex narrative of children on the autism spectrum interacting with water and engaging in water play, and how teachers and parents can facilitate and encourage their children’s participation in play, from a sensory and social point of view.

The label autism, or ASD (Autism Spectrum Disorder) is both helpful and limiting. As a mother of three children placed under this label, and being “actually autistic”  I have seen how it impacts the individual and how others see and interact with them. The label should be like being told you are shortsighted, nothing to be ashamed of, and you are given the tools you need to best take part in society as an equal… glasses. Your eyesight gets regularly evaluated to ensure that the tools are still effective or whether they need to be adapted, a new lense, for example. This I see with autism, each person will need different tools to be able to participate in society as an equal, and that these tools will need continuous adjustments throughout life. Just as the same strength lenses will not make life easier for all with eye-sight impairments, as educators and parents  we cannot offer the same solutions to every child with autism. We need to take the time to learn about each individual’s capabilities, their struggles and their triggers. While the online search might imply that children with autism love water, I have also encountered many that do not, or only in specific ways.

In this article water play is defined as a time and place to engage freely with water, without stress. There are times when children can engage with water as part of a lesson or a therapy session. While these may be playful, I am not defining these as play in this article. Play with autistic children often needs to be guided, as some definitions of  play implies no adult involvement, I want to make it clear that in this article play still exists when there is an adult guide or interpreter.


The play environment in this article is a water play area, this can be a water table, a splash pool, or water park - an area specifically designed for water and play. Water play can also happen in natural areas too, puddles, beaches, streams etc. 


Water will take the shape of the container it is in. I find that we humans are like this too; there is a tendency to take on the shape of the society that we find ourselves in, conforming to the norms. People with autism tend to be their own form, and this can create problems for them and also for the others around them, it causes friction rather than flow.

As educators we need to create play environments that are flexible enough to allow all children to feel included. My experience with autistic children has lead me to be extremely flexible, especially with my own expectations of what play looks like, and my own participation to allow a more inclusive play. Usually, as a parent and as an educator, I want to have a hands off approach to play, to allow children to have the space they need to explore and mess about with the play environment…


To create inclusive water play environments for children with autism we need to pay careful attention to the children’s individual strengths, struggles and triggers - so that the play maximises on the strengths, helps them overcome struggles and avoids the triggers. For example, I have worked with children that enjoyed playing with water at the water table but would have a meltdown if their feet got wet. Usually water play involves splashing and spilling, so there is a high chance of wet feet, so for this child I would always ensure that the water table had a low number of children actively engaged, I had small mats on the floor to absorb spills, extra towels to soak up excess water, and an extra pair of socks on standby just in case, (which I always informed the child of prior to the water play so that they knew that we could quickly remedy the problem and reduce stress). It takes several meltdowns before managing to find a good routine that works. We need to be unafraid of the meltdown, it is simply a way of communicating, and we need to learn from the communication. Other autisitc children have been fully immersive in the water experience and it ends up being the other children getting frustrated with becoming wet due to excessive splashing. Again having a few children at a time, rather than a full water play group, has allowed for more splash space, and also being careful in the choice of group constellations, avoiding the children who are sensitive to being splashed.

Control has been another area that has triggered negative outcomes at the water table and other water play environments. I have observed how children with autism have planned to use a certain water tool but find that someone else picks it up just before they can themselves, the other child being completely unaware of the autistic child’s intention. Flexibility is seldom a mastered skill of an autistic child, and this change of plan suddenly feels like a major disaster and the child reacts accordingly. For children working on their flexibility, their collaboration skills and their social skills, the water table can be a great space to meet others, and at first the play is more guided and supported. For it to be free play there is a possibility that the child needs to play alone at the water table for a while to feel a sense of satisfaction, and then be introduced to a play friend to collaborate with. I have always opted for a child who is predictable and easy to read, as this will make it much easier for the autistic child to interpret the play code.


So, how to set up a water play opportunity for children with autism? This will depend on the child, their fascinations and sensory reactions, and also what they need support with. For some children it will be the visual stimulation of the water, the ripples, the patterns made when water drips or pours, or when water runs through other materials. For other children it will be a huge sensory need, to feel the pressure of the water around a hand deeply submerged, the weight of the water, the temperature of the water and how the water moves on their skin. Equally there will be those who struggle with many of these sensory inputs, the water feels painful when poured onto their skin, showers are experienced as painful. As educators we observe and dialogue with parents  to find out interests, behaviour patterns and triggers so that play and learning activities can be provided that optimises positive participation with the water and also with peers.

Children requiring visual stimulation from the water can be given simple things like syringes, shampoo bottles etc that can be easily filled with water and then squirted out, not just over the water to create streams that hit the water surfaces causing ripples, but also squeezed out under the surface of the water to create currents. Water can be coloured, extra interest created if a water table is coloured with some blue drops on one side and yellow drops on the other… over time and through the movement of play the colours will begin to mix. Bubbles and whisks work well to create different patterns, as well as jugs and other items that allow for pouring from great heights that also create a different kind of bubble. Adding lights in, under or over the water can also change the visual experience.


The water table can be filled with dry cornstarch, some children will prefer this dry material, while others will struggle with the texture of flour. I have learned this from my three children, they all have completely different reactions to flour, from fascination to avoidance at all costs. If there are bottles of water at the side of the cornstarch filled table they can be poured in slowly, changing the consistency of the dry powder slowly, adding challenge and sensory input - to meet the needs of those who like to get messy and feel the goop and those who hate to get messy. The children can participate for as long as they want, with tools, or their hands, I have always supplied spoons for those children who love to observe the movement of goop but have been loathe to participate because of the mess. What I have observed is that some of these spoon children have, over time, started to dare to touch the goop on their own terms. It can be very important to have a sink for cleaning close by to ensure the child is able to clean up and dry off before reaching the stage of being overwhelmed.

For those children seeking sensory stimulation I have changed the temperature of the water. Ice and cold water have often had a great fascination, especially huge blocks of ice in a deep water table that float and offer a new and exciting surface to balance things on. I have also found that ice tends to be where many children, not just autistic children, love the sensory feel of cold in their mouths. If I see this happening I usually give children the opportunity to have this need met by giving them their own ice piece to sit at a table with and explore and lick as they choose. I have found this a much more hygienic way, and children then know they do not need to sneak licks when they think the teacher is not looking. We can develop trust. Creating trust and a feeling of safety is crucial for all children, but especially for children with autism who tend to have a heightened state of anxiety (White et al, 2009). Water play can be used to help autistic children feel calm, but also to appropriately challenge them, so that they always feel safe but at the same time broaden their experiential repertoire.


Aquatic therapy or Aquatic Physical Therapy (APT) is an alternative or complementary treatment for people with autism. This is a treatment that requires a pool and specific training in the water where the water, warmth and pressure, allows the children to feel calm, improves emotional response and flexibility (Caputo et al 2018). While this kind of immersive play is not always suitable for early years settings or homes it is worthwhile remembering that water can have a therapeutic effect.


It is about twice as more likely for people with autism to drown than the general population (Martin and Dillenburger, 2019), this is an important reason for autistic children to develop a healthy relationship with water. From an early age all children, but especially autistic children, need to learn about water safety, develop an understanding of the dangers of water and how to keep themselves safe. Children whose parents and teachers have observed in the home and learning environment have a big interest and fascination for water are children that are at greater risk. It is worth being extra vigilant when around bodies of water, even small ones, especially if the child is prone to wandering off. Not all children with autism are going to have this fascination for water. 

My own children have all had a huge fascination for water and water play has featured heavily in our home. At the age of two my son jumped into a pool without warning on our summer vacation, and he sank like a rock. Fortunately we were all present and within seconds he was pulled back up to the surface coughing up the water from his lungs. After this it took many years for him to feel safe with any water near his face. Bath time continued to be one of  his favourite times of day, but it was not until he was seven that he dared to ut his face under water again or cope with splashing and required a great deal of support through play to help him get there, the sensation of heavy wet cloths being a part of that process.


In conclusion, providing water play opportunities for autistic children, and groups of children that include autistic children, is an excellent way to meet multiple needs - sensory, social, emotional and cognitive, as well as stimulate them. Water is a fabulous, natural medium that I have found unites children regardless of whether they are on the autism spectrum or not. It is also a medium that allows the educator/parent to provide a broad range of activities with a variety of possible outcomes, from a place that can support language acquisition while feeling calm and joyful playing and experiencing the water, to negotiating interactions with other children, to managing sensory experiences and unpredictability. Water play can be small, from a simple tray with small jugs and cups to pour into each other, to big water tables, to complex systems of pipes, channels, pumps and pools, to swim-halls and water parks.


The image above is from Dorothy Snot Preschool in Athens, Greece taken in the outdoor playspace for 1-3 year olds. I love the length of this water area - allowing space for children to play together or alone at the same time

to lean over and play, even climb in and be more immersive. This is rainwater that had collected. Different toys and resources were introduced and used.



The above image is from one of the AnjiPlay preschools in Anji County,China. I was totally in love with the areas designed for water play. They were on a massive scale and there was a variety of ways to interact with water - in waterways, with pumps, in massive sand areas with taps and hose pipes, buckets, spades and other tools - and also together with paint and colour, or with bamboo and berries and whisks...

The fact that the children discuss their play with each other, guided by the teacher and films and photos taken of the play brings another element of support for children with autism. This could be a technique used in small groups for children with autism to learn about play, decode it, think about planning future play, learn about unpredictability and also strategies to make things work as well as social strategies.

i have written a post about Sand and Water Play in Anji with lots of inspiring images... if you have the time it is worth checking it out - Sand and Water Play

Above is a tray with water and small coloured jars floating on the surface. Torches were used to create light reflections on the wall, the moving water creating patterns.

this is a great calm activity for those who love visual stimulation - light and patterns, colours and movement

Above I placed a large clear plastic box on top of a light box. in the box are large pieces of ice (frozen balloons - but I can use all sorts of forms)

the children explored with their hands, with salt, coloured water and pipettes and created patterns.

i have also placed ice in a large water table and used outdoor lighting (that is safe in water) which creates yet another visual experience of light above, next to and under. Images can also be projected onto the water and/or ice.



References

Caputo, G., Ippolito, G., Mazzotta, M. et al. Effectiveness of a Multisystem Aquatic Therapy for Children with Autism Spectrum Disorders. J Autism Dev Disord 48, 1945–1956 (2018) doi:10.1007/s10803-017-3456-y 


Kurt Muzikar https://the-art-of-autism.com/looking-for-neologisms-for-neurology/)


Martin, C., Dillenburger, K. Behavioural Water Safety and Autism: a Systematic Review of Interventions. Rev J Autism Dev Disord 6,356–366 (2019) doi:10.1007/s40489-019-00166-x

White, S.W., Oswalds, D., Ollendick, T., Scahill, L. Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, Volume 29, Issue 3, April 2009, Pages 216-229. doi.org/10.1016/j.cpr.2009.01.003

Interaction Imagination

© 2017 Suzanne Axelsson. Interaction Imagination. Stockholm, Sweden.
suzanne@interactionimagination.com 

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