Mohamad Nizam Nazarudin, Wan Ahmad Munsif Wan Pa, Mohd Syazwan Zainal, Ardo Okilanda
Aquatic interventions have increasingly been recognized as effective therapeutic approaches for children with autism spectrum disorder (ASD); however, the specific intervention components that optimize motor, social, and behavioral outcomes remain insufficiently established. This systematic review aims to examine the influence of key intervention characteristics, frequency, duration, instructional approach, and therapist involvement, on these outcome domains. A systematic search was conducted across multiple electronic databases, including Scopus, Web of Science, PubMed, ScienceDirect, and Google Scholar, following PRISMA guidelines. Studies published between 2006 and 2023 were screened against predefined inclusion and exclusion criteria, yielding 18 eligible studies for qualitative synthesis. The findings indicate that higher intervention frequency (2–3 sessions per week) and longer program duration (8–12 weeks) are consistently associated with significant improvements in motor skills, particularly balance, coordination, and aquatic competence. Structured instructional approaches incorporating visual supports, task sequencing, and guided interaction demonstrate stronger effects on social outcomes, including increased social engagement, communication, and cooperative behaviors. Behavioral improvements, such as reductions in stereotypical behaviors and emotional dysregulation, are most evident in interventions with active therapist involvement and predictable activity structures. Despite these positive trends, substantial heterogeneity in study design, intervention protocols, and outcome measures limits the comparability and generalizability of findings. The review highlights critical gaps, including the lack of standardized intervention frameworks and limited longitudinal evidence on sustained outcomes. These findings provide evidence-informed guidance for clinicians and educators while emphasizing the need for more rigorous, theory-driven research to establish standardized and scalable aquatic intervention models for children with ASD. © 2026 Authors.
Faculty of Education, Universiti Kebangsaan Malaysia, Malaysia; Fakultas Ilmu Keolahragaan, Universitas Negeri Padang, Indonesia
