WEST PALM BEACH, Fla. (AP) — In an airy indoor pool with fish cutouts on the walls, a group of small children bobbed, floated and tentatively flutter-kicked.

It was what it looked like, a starter swimming class. But here, instructors worked one-on-one or even two to a child. Some held cards to help kids communicate with teachers by pointing instead of speaking. No one blew whistles.

All the students in the class at the Small Fish Big Fish swim school had autism, a developmental disorder linked to a higher-than-average danger of drowning.

It has long worried autism experts and parents, but recent data make the stakes starkly clear. In Florida, a state where water abounds from beaches to backyards, over 100 children who had autism or were being evaluated for it have drowned since the start of 2021, according to the Children’s Services Council of Palm Beach County.

The numbers highlight an oft-overlooked dilemma: Autism makes swimming instruction all the more necessary but, often, all the more difficult to get.

“It’s life-changing for kids with autism,” said Lovely Chrisostome, who was terrified this winter when her 6-year-old son slipped out of the family’s home and wandered through their lake-dotted neighborhood. She’d once tried enrolling him in swim classes at a public pool, but he had refused to go in.

But her son was in the pool at the autism-specific class at Small Fish Big Fish. An instructor helped him float on his back. When he started showing discomfort – he doesn’t like to get his head wet – she eased him onto his side, where he seemed content.

Autism affects an estimated 1 in 31 U.S. children. Their water safety has gotten occasional public attention after tragedies such as the death of Avonte Oquendo, an autistic teen who was found in a New York river in 2014 after disappearing from his school.

While academic research on the issue is limited, a pair of 2017 studies documented a substantially heightened risk of drowning among people with autism spectrum disorder. The risk stems in large part from their propensity to wander off and to underappreciate perils, according to co-author Dr. Guohua Li and other experts.

One Florida 5-year-old apparently wriggled out a doggy door and got into his grandmother’s pool. Another died in a canal after slipping through a fence hole at a playground specifically intended for autistic kids. A 6-year-old drowned in a lake after she evidently climbed a bookshelf positioned to block an apartment door, according to the Children’s Services Council of Palm Beach County. It’s now building a national database.

“Swimming lessons should be a first-line treatment for autism,” said Li, a Columbia University epidemiology professor who isn’t involved in the council’s research. Li himself has a son with the condition.

Lessons a potential lifesaver

Some autistic people excel at swimming, such as the New Jersey teens featured in the 2017 documentary “Swim Team.” Many others are adept in water. Even some profoundly autistic children can master survival basics with as little as eight hours of aquatic occupational therapy, said Michele Alaniz, a practitioner who published research based on her work at Casa Colina Hospital and Centers for Healthcare in Pomona, California.

But some families don’t sign up for classes, fearing they’ll overwhelm children who might have symptoms ranging from not speaking to repeatedly banging their heads to becoming distressed by noise. Other youngsters get kicked out of programs that can’t handle them. Private sessions can be helpful, but pricey.

“Having somebody that understands a child on the spectrum — what the special needs are, how to communicate with a child, how to also mitigate a meltdown, particularly in a pool — is so vital,” says Lindsey Corey. She said her 5-year-old son didn’t absorb much from a general swim class or from private lessons at home in Lake Worth, Florida, but made progress in a program with instructors trained by the Autism Society.

As drowning risks have come into focus, advocates are trying to make swimming lessons more accessible. An Australian charity called Autism Swim says 1,400 swim teachers, physical therapists and others worldwide have taken its online training since 2016.

Trepidation and joy in the water

In Florida, the Children’s Services Council’s of Palm Beach County provided $17,000 last year for the Autism Society of America to train dozens of instructors, said Jon Burstein, who did the council’s research on autism and drowning. The organization paid another $13,500 for the classes at Small Fish Big Fish.

The dozen students, ranging from about 4 to 8, attend a nearby autism-specific charter school. They initially were reluctant to get in the bus, let alone in the water, organizers said. But on an early April afternoon, they readily headed for the shallow pool.

One girl floated on a foam board with her face in the water, an exercise in breath control. Another girl grinned as she propelled herself on a foam noodle.

“She’s fearless to the point it’s scary because she’ll just jump into a pool, whether she can swim or not,” her mother, Jana D’Agostino, said later. “So this is really important. It’s saving their lives.”

Across the pool, a boy reluctantly eased himself from the steps into the water, where Small Fish founder Melissa Taylor waited for him. “My turn!” she said, and dunked her head in the water.

He did likewise, then retreated to the steps. Taylor continued working with him, but he soon backed out of the pool and began making hand movements. Realizing he’d had enough, instructors let him towel off.

“It’s taking a lot to get him to trust us,” explained Taylor. But she also recognizes when repetitive splashing and movement signal excitement, not alarm.

The session continued for the other children, including Chrisostome’s son, who emerged with a smile.

He has learned a lot in the lessons, but what struck her most?

“The happiness that he has.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.