Water Works An SLP takes a dip into pool group treatment sessions for clients with autism and other disabilities. In the Limelight
In the Limelight  |   December 01, 2015
Water Works
Author Notes
  • Haley Blum is an ASHA Leader writer/editor. hblum@asha.org
    Haley Blum is an ASHA Leader writer/editor. hblum@asha.org×
Article Information
Special Populations / Autism Spectrum / In the Limelight
In the Limelight   |   December 01, 2015
Water Works
The ASHA Leader, December 2015, Vol. 20, 26-27. doi:10.1044/leader.LML.20122015.26
The ASHA Leader, December 2015, Vol. 20, 26-27. doi:10.1044/leader.LML.20122015.26
Name: Nanette Cote, MA, CCC-SLP
Title: Owner/clinician, Naperville Therapediatrics; blogger,www.speech2me.blogspot.com
Hometown: Naperville, Illinois
Nanette Cote is not a particularly good swimmer. An ironic fact, she says, considering she chose to spend her summer in a pool.
But when the pediatric speech-language pathologist stumbled on the idea for a pool-based treatment program more than 10 years ago in Rhode Island, she was inspired to jump into the (metaphorical) deep end. “I felt like, ‘That’s it—that’s what I can do,’” she says.
And it’s all worth it in the water. “When the [children] are in that very emotionally charged, happy kind of atmosphere, you can do so much more with them than you can sitting on the floor in my office or in their home,” she says. “I’ve never seen kids develop so much communication in such a short period of time.”
Cote, whose career focus has been on early intervention and some work in public schools, is now in her second iteration of pool-based group treatment for children with autism spectrum disorder and other disabilities, such as cerebral palsy, apraxia and Down syndrome. After running a group with success through the early intervention program at Hasbro Children’s Hospital in Providence, Rhode Island, Cote moved with her family to the Midwest, where she found her footing working in several public schools through a contract agency and eventually with her full-time private practice. But the pool group sessions lingered in her mind, so she set out to create a new one in her community.
Once billing and liability were squared away, and after securing pool space at the Rush Copley Healthplex in Aurora, Illinois, she began a six-week session this past summer with a handful of children ages 3–6.
Splish, splash
Cote mostly uses singing activities to target speech and movement goals. (Cote credits physical therapist Kate Sparrow, with whom she worked in Rhode Island, for teaching her about the motor aspects of water play.) Starting off with a “hello” song, the group passes a beach ball as the children and their individual caregivers introduce themselves one by one. A “body wakeup” exercise follows, to the tune of “Wheels on the Bus,” emphasizing movement in the water.
The group included children who had had difficulty imitating in the past. Some of them, when they were “in the water, and singing ‘Wheels on the Bus,’ all of a sudden I’ve got [them] doing the old familiar gestures, and I was making up new ones, and they were copying those, too.”
Plastic toy motorboats and frogs, as well as ABC-corresponding rubber duckies and fish, often come into play in the remaining musical activities (usually an average of five per session, says Cote) to practice following familiar and novel directions. Bubbles create opportunities for oral motor work—also serving as a good icebreaker if any of the kids are antsy—and occasionally Cote brings out noodles and kickboards. A “goodbye” song closes each session.
When the kids are in the water, they have a better sense of their body in space and they’re in a better position to vocalize, Cote says. She sometimes even sees her clients carrying over songs they learned from the pool group into office sessions.
Winning in the water
Although working in a pool environment holds clear benefits, Cote says some parents hesitate because they worry how their kids may react. But with a few exceptions, she says her clients have taken well to the novel environment.
“[Originally some] parents were really concerned that their kids wouldn’t come out of the water—that they would give them a fight—and we never had one fight,” Cote says.

Some parents hesitate because they worry how their kids may react. But with a few exceptions, clients have taken well to the novel environment.

The SLP saw some significant progress in her clients by the end of this summer’s pool group. One child was initially so overwhelmed he couldn’t imitate anything and would loudly protest if his mom left his side. He ended the session imitating and helping Cote pass out objects to his peers on his own.
Cote is careful to note that the pool group probably isn’t the only—or even the main—reason he made strides during the six weeks. But she’s hopeful the group helped him along and gave him an environment where he could generalize concepts.
With more demand and referrals, Cote eventually would like to run a session every season, although spring and summer are currently more practical because of available resources and time during the school year. She’d also like to bring on occupational and physical therapists.
But for now, Cote is fueled by the glee she sees in her clients.
“It really takes a lot to get [some kids] to crack a smile,” she says. “And we’d be in the water, and these same kids did not stop smiling from beginning to end. That interest and that bond and relationship with them in the water—it changed everything.”
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December 2015
Volume 20, Issue 12