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IntroductionThere is a critical need for evidence-based and manualized interventions targeting water competency including swim and water safety skills tailored to meet the needs of children on the autism spectrum, a group that is at a high risk of drowning. This study examined the efficacy of AquOTic—a 10-week occupational therapy-based aquatic intervention to improve water competency among children on the autism spectrum.MethodsA total of 37 children on the autism spectrum (ages 5–9 years) were randomized to a waitlist control group (n = 24) or AquOTic intervention group (n = 37; 28 males). Blinded assessors administered the standardized Water Orientation Test-Alyn (WOTA) 1 and 2 and a Swim Skills Checklist to all participants pre- and post-AquOTic/control. Repeated measures mixed effects models were used to examine intervention effects.ResultsAverage WOTA 1 scores increased significantly after participants received AquOTic (Δ = 5.7; 95% CI: 3.7–7.8; p