Terryl Rosenberg

Tue, Jan 10, 2023 2:58PM 1:02:55 SUMMARY KEYWORDS child, parent, problems, dcd, cluster, diagnosis, ot, pt, support, school, developmental, executive function, motor, ball, vmi, important, difficulty, learning, coordination, impact

00:02 All right. Welcome, Terryl. Thank you for joining us. And I appreciateyou coming on today to talk about this very important topic that a lot of people don't knowabout Developmental Coordination Disorder. And I'm excited to dive in. But first and foremost, thank you for joining us. Thank you. Can you just tell folks a little bit about you and what you doand how you are that strategist for our special education folks or our students that need support. 01:30

I am a pediatric physical therapist. With 45 years experience, I started my career inrehabilitation working on multidisciplinary teams, and I have been a part of a multidisciplinaryteam during my entire career. I started my career in Canada. And then I moved to Texas where I was the senior physical therapist on the neurology service at Baylor hospital where eventuallywe were working with infants and children. When I went back to school 2000 ish, and I was studying for my clinical doctorate in physical therapy. One of the things that my advisor wasdiscussing a lot was Developmental Coordination Disorder, and where he had gotten a lot of hisinformation from was from McMaster University in Toronto, Ontario, Canada, which is Hamilton,Ontario, Canada, sir. And then the work of CanChild, which is an organization in Canadadedicated to children that have special needs. And through my advisor, I started looking atDevelopmental Coordination Disorder and in my mind, it looked an awful lot like what my otcolleagues are calling developmental dyspraxia. Yet at that time, I believe, way back then that was probably a DSM three. They were they were probably coded differently. One was lack of coordination and the other one I don't remember what the what what what it was called, but in any event, they weren't considered to be synonymous in any way whatsoever. And dyspraxiaseemed to be the term that many of the clients when I had a private practice was they know tthey came in with a diagnosis of developmental, dyspraxia. And over the years, things have changed in that. Now in the United States, they are recognizing Developmental CoordinationDisorder as as a as a distinct disorder that is very similar to developmental, dyspraxi a up untilnow, children are present, much like someone I might have seen yesterday here that is got adiagnosis of DCD. Perhaps in the past that may not have been the diagnosis that they mighthave been given, they might have been given a diagnosis of dyspraxia some time ago, theUnited States and the powers that be have decided to adopt Developmental CoordinationDisorder, even though it has been studied thoroughly in any Scandinavian countries and inCanada, and has been used and there are treatments designed for it for for for many years.This is just something that is, to me peculiar, but it's it's actually very new here. And the reason that I think it is so important for all of us to come together as a community with this diagnosisis because generally, it could be a physical therapist that sees this person first. Because of a motor coordination problem. It could be an occupational therapist because of scale self careproblems or emotional All regulation problems, it could be a psychologist again, because ofemotional problems as she's the parents may be having at home with a child or could be aspeech therapist because there are some issues with language. You know, that may be that may be a part of all of this. And the thing about this diagnosis is, I really don't believe that justone of us can do this, I think we need to function as a team. And that's why I think it's reallyimportant to move this diagnosis away from something that is dyspraxia, which really justinfers that there are certain things going on and it's actually a lot more complex than theoriginal diagnosis, dyspraxia the description is more complex.

05:50 So let's kind of go back a step back before we move forward to talk about a deeper dive and,and that Developmental Coordination Disorder. Can you help some of our listeners distinguishbetween you had mentioned OT and PT, so what are some reasons a child may need ot? Andwhat are some reasons that a child may need PT? Just like a quick little? Okay. 06:18 Okay, I would say that, first of all, it depends where you live. Because there it's a very regional thing that depends on where you live, there are certain areas like NICUs a great example there,

gp y, gp, places where the neonatal intensive care unit and care of infants that have motor difficulties issolely under the umbrella of occupational therapy, and there are hospital centers, all over theworld where it's solely under physical therapy. So I think that especially in children, there's a tremendous amount of overlap. And I think that there's actually more similarities than there are differences. You know, we both work with clients across lifespan, we both die with clients tounderstand their strengths. And our job is to educate and train families, caregivers, and so thatthey can improve client safety and client skills. So I would say that when it comes toDevelopmental Coordination Disorder, the physical therapists would be more involved in thelarger muscle group movements. And the occupational therapist may be involved in that finermovement movements, given that the foundations of physical therapy are in physicalrehabilitation, and a lot of muscles. And the foundations of occupational therapy are also inphysical rehabilitation, but also mental health. And they have with children an integral part of their educational experience. 07:49 So thinking of a school and an IEP team, can schools kind of a twofold question? What does thatassessment look like, for determining the Developmental Coordination Disorder? And then thesecond part is can schools help play a role in that assessment? Um, okay. 08:18 So the actual diagnosis of Developmental Coordination Disorder, a clip, a person with thedoctor to integrate, can actually call somebody and if he can call the child's F 82. Okay.However, I would strongly suggest that that diagnosis came from someone that had done waseither in neurologists or had done the neuro that had done a neuro psych, neuro psychevaluation. So I would think that those things would have to be done. And I don't think that at the level of the school, I think is going to notice the child is having problems. How the therapistcan have is, if there is a therapist involved is to communicate with the school and try and geteverybody to find out, you know, what, what is going on? Are they talking? Is the child havingproblems with fine motor performance? And is your fine motor performance impaired? Are theyriding slowly? Are they having trouble with use of scissors? Are they having trouble dressing?Well, that's going to fall you know, into more of the realm of an OT. For the PT are they havingtrouble, trouble problems on the playground with walking, carrying their lunch tray posturessitting in their chair? And, and I just don't think it's as clear cut as it would be an adult rehabwhere the physical therapist teaches the person to stand and the occupational therapistteaches them to brush their teeth while they're standing. I don't see it as such a Division I reallysee it as much more as a collaborative, multi layered and integrated efforts. From all this Applying to to help these children? What are some 10:05 common signs or symptoms? You've kind of mentioned a few, just in this initial part of ourconversation today, but what can some common signs or symptoms of DCD for either parentsto look out for or educators or professional supporting a student?

10:25 Um, well, generally, the the DSM five has has have criteria that you have to meet in order toget the diagnosis. And the first one is a motor performance deficits, having problems doingthings that most kids can do every day. Difficulty with participation and other activities of daily living. Generally, the onset is is is very early, and there are no other exclusionary conditionsthat could explain what you're what you're seeing. So those things those things have to be metin order for the child to meet the criteria for the, for the DSM five, diagnosis. And the risk factors are generally a child that may have been born less than 1500 grams, which have beenless than three pounds, a child that would be born prematurely less than 37 weeks, and maybemaybe possibly maternal drug or alcohol use. And that's still out there. Oh, one more. If there's someone else in the family that possibly presents as such, we still haven't made the connectionthat you can, in fact, say that that's why it in however, that is something to be 11:46 considered in the discussion 11:50 DCD D, co occur with other developmental disabilities? And if so, what would that look like? 12:01 Well, 12:02 it's most likely going to co occur with difficulties with executive function, and probably mostcommonly with ADHD. 12:12 So a lot of the gross motor problems can be actually attributed to attention problems 12:20 in some 12:24 individuals with DCD, and recently and November 2022, a new art journal article came out fromthe Netherlands on and they actually had divided the CD now into four subtypes for clusters.And in the clusters you're able to see some of these kids have more problems with fine motor And in the clusters, you re able to see, some of these kids have more problems with fine motor control. Some of these kids have more problems with visual perception, like drawingconclusions from information that they see. Some children have more problems with visualspatial like where objects in space where their body parts in relation to other body parts wherethey relation to other children. And if you have difficulty processing that visual, spatial sensoryinformation, it can definitely impact you academically and also your social relationships.

13:20 What are the four subtypes? 13:24 Well, the four subtypes are two, but I just read the article within the last week, because I justgot the fort they're there. They're divided into four clusters, cluster, 123, and four. And there were just differences in the clusters like that Cluster One had, the children had an average IQ,visual perception and VMI Wirthlin within normal limits. But their motor skills were at risk as demonstrated by their fine motor control on the theory and their gross motor on themovement, ABC cluster to average IQ, manual dexterity and VMI were normal. Ball and balance skills were very much involved and scores in this in cluster two. Were higher on all metricsexcept ball skills and balanced cluster three, your IQ and your very VMI are within normallimits. ball skills are the lowest of all the clusters and I've seen kids they can learn anythingrelative to the thermal cluster three had neuro below the grand mean for normal performanceIQ, manual dexterity and visual perception. And cluster four. They have very well developed and scales and I'm seeing a child pick this right now. That is all that he is great at and he is great at that. But you asked him to go up the stairs and he has so much difficulty separating hisbody And plasting that, but the children in cluster four have, again, the besides the welldeveloped ball skills, they have average verbal IQ, average very visual perception. And relative to the sample, what they found out in cluster four is their ball and balance skills were so muchmore above average. And, however, the performance IQ and cluster for was below mean of the whole sample. So I just think it's fascinating because when we work with neuro diversity, itdoesn't matter how many children you see, and even if they're identical twins, and they havethis same diagnosis, I've never seen two children that are the same ever. And as I've gone through all this DCD, because I'm very interested in this condition. And as I've gone throughthat, and I looked at all the clusters, I was like, that's why they that's another reason why theywere all different. It wasn't their own individual differences. It's also the description of the of the of the presentation, and it wasn't my imagination. You know, like, why can this child catch aball? And that's the best skill, the OG and why does this child over here? Everything else, he'she's learning to do all sorts of things, fine motors moving along, you know, but I can't get himto catch a ball to save lives. So, you know, it's, it's really, it's really interesting. And it's, I guess it heterogeneity. I mean, it's, and now even more so that you know, that this article came outwith actually giving them clusters. 16:42 Can you help us understand the emotional part that comes into play, you had mentioned thatthat could be an impact for a child that's identified with DCD? What would that look like? Andhow do we better support that child?

16:57 Um, well, I mean, I think that I think that's sort of multifaceted. One is parents, if you know,your child has DCD, and you're educated about that, you know, that there's a possibility thatthis is something they're going to have for life. So we, I think that teaching your child you know,stuff, advocacy, and you know, all those things are extremely, extremely important. Because Emotionally, I think what this can look alike is a child that really struggling, struggling to getdressed, struggling to keep up struggling to write as fast as their peers struggling to getdressed, to make it outside in playground on time struggling in the playground, because theycan't do some of that fancy stuff on the playground that some of their peers can do. And I think that it can impact their self esteem very, very much. So very, very, very much like what theoriginal description the developmental dyspraxia was, I mean, they were in 1939, in 1990 30,something years ago, they were way on to the fat that even though I don't think they had thewhole picture, but they were very, very much on to the fact that this could, you know, impact,you know, ah, a child's sense of self. And also the other things that would go along with thatthe, you know, your anxiety and things like that, because you, you can't you can't keep up andthe frustration. Or those are the kinds of words you're looking for. 18:32 Yeah, so how could let me step back? What does the PT What do you focus on as a PT when itcomes to DCD? 18:50 Like how would I evaluate them? 18:51 Or I mean, I would focus I would go, I would focus on whatever we determine the goals are.Okay. And so whatever the goals are, those are the things we're going to focus on. And as we've described, with four different clusters of this situation, I'm going to nap I'm going to lookmore carefully for clusters. And what I you know, what I want, what I want to be able to do is isto be able to meet the child's goals, and to meet and to meet them to meet the parents goals. I mean, generally these children almost whatever cluster they're in, they're going to havetrouble with balance, you know, on on surfaces and part of my job I think would be you know,an assessment of their body and their, you know, are their feet in good alignment, their hipsand good alignment, you know, are they did they need inserts in their shoes in order to be ableto navigate surfaces you know, better what is their walking look like? What is their running looklike? What is their strength like is it is their strength the way that it is because it's somethingthat's inherently kind of the muscles are not firing maybe the way that you want them. Do youwant them to be or is it more that their strength is okay, but they don't really know what to dowith the strength that they did with the strength that they have. As a PT, I would do move analysis. Mature movement is characterized by you know, head moving on this part stayingstable, you know, upper body moving on the bottom part of the body stay stable, and making sure that when that person is moving place to place, you're using a variety of moving patternsto get from place to place, because we use multiple patterns to move from place to place. So my assessment is also going to be a lot of observation now on how does a child actually dothat? How do they? How did they get up? And how do they manage, you know, going overgetting involved setting the game up for us, whatever, you know, whatever, whatever the casemay be, I would look at posture, posture is really important. Posture impacts output ofhandwriting, and that could be a whole other podcast, if you want to do that. So I think that I would look at all those things. And the other thing that I do with all patients is this a good timeto mention this, the OPM the Canadian occupational performance measure, I have, for manyyears, used the Canadian occupational performance measure, with with my clients, it is a it is aclient reported list of things that are important to to the family. And these things are gonna,you know, fall in the in the areas of self care, leisure, leisure and, and, and participation. And one of the things that I think is critically important is that my goals, match the child's goalsmatch the parents goals, and oftentimes what happens is something maybe a portance of afive to a parent, but to the child, it's an it's an eight. And sometimes you could have one parentthat thinks ball catch and throw isn't zero, and they don't care, but the other parent thinks thatthe 10. So I think that it's very important to have the discussion about goals, and setting goalswith with the family, so that everybody is going to be working on this together. And so not onlydo I think that all the team members need to be on the same page, I highly recommend that ifat all possible, however, you have to manage it, try and get the parents and the family and thechild o n the same page, you get the, you know, like I do things like well let the mom you know,give the mom to and you take to you know, like, just didn't negotiate like if this is important toher. But this isn't important it and generally this conversation would be a child, maybe eight orup that I would be having with but there's kids that are five or six that can tell you what theycan't do. And it may not be something that you saw, you know, they may tell you, I can't hangup my coat at school on the rack, I can't snap the top button on my pants, you know, thingsthat you don't that you don't even did you wouldn't even think about are you sick the parent,here you are as a PT, what's the biggest problem my child does not wash their hair in a month.But you know what, that's really important. That's there's a lot about, but you know, usuallykids that have spatial problems, washing hair is very difficult for them and tending to stop hereis difficult for them. But then I think that leads me to start to look at, you know, let's try to getthat problem solved. And, you know, let me get an OT here helping me. You know, like, I just think we have to listen to what they're telling us. And then we know who the next person is to ask. You know, if you're telling me that school saying you're struggling, then we then the childneeds a neuro psych evaluation and we need to find somebody that's going to be able to dothat, you know, for them to be able to help them and unfortunately, now that's a little difficultbecause of everybody's backlog. But you the the thing is, is to be able to pivot and direct,direct the family so that they get all the information that they need to address that the themotor and the executive function concerns because they are coexisting, and they areimpacting one another.

24:32 Let's talk about the executive function component. So what executive function skills can DCD impact? Well, 24:45 I would say it's going to is going to impact it's going to impact attention and paying attention.

It's going to perhaps impact inhibitory control, like you? It, it sort of that, that that thatfeedback like knowing knowing that you knowing that you made a mistake, error correctiondetection. I think that that would be impacted because these children have a tremendous,tremendous difficulty learning, learning, learning new skills, and oftentimes they have difficultyprocessing information. So the way that and so if you have difficulty processing information,and you have lapses in attention, one could understand why they're going to have problems,perhaps on a playground that may or may not be related to muscles. Or it may be and I thinkthat our job is to determine what you know, what's contributing? And how do we get this childto a place where they can function with their peers, and, and, and participate for lifetime healthand wellness? 26:16 So part of an IEP team, what are some common school accommodations that you have seen tokind of help support all of this that ECD specifically, though, the processing information, theattention that executive function component, have you seen accommodations that have reallybeen a value for students identified with DCD? Oh, 26:49 I don't have a whole lot of experience working with older kids, that would be in a more publicschool setting. And that's also more difficult to get accommodations. In that setting. I certainlyhave had experience with younger children, you know, when they're four or five, so it's notreally a formal, a formal IEP. But you certainly getting supports in place, you know, to try andhelp the child meet their meet, meet their milestones, for the older children, in myunderstanding is that if you have a diagnosis of dcga, and you're not able to participate in PE, Imean, you could get adaptive PE, there's something you could do. You could also have peerinteractions, you know, there, there are peers that can help add their kids do stuff, like if a childcan throw a ball, but another child can run, if you've got a good inclusion thing going at yourschool, you can make someone the thrower or someone the runner, and then they're both inthe game. You know, I know people don't think these things through the way. But it's very, verypossible to include everybody, if we were to think of it and sort of, and frame it that way. And so for you know, and in school, I mean, if they're not safe on stairs, I mean, certainly, that, youknow, a PT can go in and work with the child. But I mean, those would have to be very involvedchildren, for physical therapists to get into a school, an elementary school. And certainly amiddle school, it would certainly be easier, you know, to maybe get ot for pullout. But once again, 28:42 I don't think those 28:45 things happen until the child's older. It's not until they're eight or nine. And finally, becausethey can't find anything that's wrong, right? That the MRI is normal, this is normal, that'snormal, there's no other obvious thing the child is struggling, you know, and then finally, they normal, there s no other obvious thing the child is struggling, you know, and then finally, theygo and they send the child for neuropsych denial, and then they realize that there there areissues, you know, in their, in their profile, that that could be contributing to their difficulties withgross motor skills, or vice versa. And a lot of it, you know, has to do with, they're not they'renot making a memory of when they have when they make when they make a mistake, youknow, like when they when they perform something for the for the first time. They that's not a reference for them for future actions. It doesn't they don't have the stored experience, andthey can't use that, you know, to generate intended movement. So I mean, I think that, youknow, our job is to try and is to try and help them do that and you can you can help the schoolwith strategies if

29:53 they're willing 29:56 to work with you. But again, as a peach If a child can get into classroom and sit in a chair,they're not going to get PT services at school, they could get OT, but they wouldn't get PT. 30:10 So as an outside professional, and I really like how you kind of define that making a memory tohelp support future action. So from your lens and your expertise, what is an example of howyou would help a child create that memory so that they could repeat the success? 30:29 Well, I'm glad you asked that. Because the there the 30:36 the know, one of the main 30:38 outcome measures, it's used for DCD in the literature is the Canadian occupationalperformance measure that I mentioned, and also the performance quality rating scale, I believeis is. Is is used also, there is an approach to working with these children. And it's called the cognitive or orientation approach to daily occupational performance. It was originally developedfor occupational therapists also, and has now been generalized for use across all disciplines.And the principles of co op or, or cognitive orientations, daily performance, and this could beapplicable to anybody that's working with the child and their work principles. And this is to getthat internal representation that we're speaking of, you ask that the child has to have average intelligence, the child has to be able to understand you. These children are not children that have below average intelligence, because otherwise they don't have this diagnosis. Okay. So to use to use Co Op, though the child has to be able to answer these questions. Now, there are some kids that are five or six that are incredible with this strategy. And sometimes that happens in a brighter kid. And sometimes that happens, and a kid that is just more interestedor more motivated, you know, in what you're doing than the next child, and therefore,principals or Co Op, or what is your goal? And the child says, I'm going to throw the ball to the tower. Okay, and then, and then I say, Okay, what is your plan, my plan is to push the ball, thisis what I want forward, because I don't want it to go to either side of the target, my plan is topush the ball forward, and I'm going to try and hit the yellow box. Okay, do it. And then I'm quiet, you cannot speak when children are performing. They do it. And then you say, the check is what happened. So the child will stay, I missed the yellow boss by this message. Or I keep on throwing the ball over that way. Or I threw the ball too high,

33:05 I threw the ball too low. And then you say, Okay, what would we do next time. 33:15 They tell you how to refine it. And then you try again. And then if the child says to you, I am going to throw the ball to the blue box. Honestly, by about the third time that ball hits the box almost every single time. Okay, now you have to sometimes figuring out how far away youneed to be to get success. And it may not be the distance that's age appropriate, but it makes the kid feel they can do it. And then you move back. But it's it's just a matter. It's a matter of also getting the child to recognize error detection. Because if you leave them to practice deafon their own, like many of these kids have been doing since they're nine and we find out theyhave DCD all they're doing is reinforcing their errors. They're not correcting errors, which iswhy we have this huge push to recognize children earlier. And it's hard. It's hard to do, because there's no explanation and when children are their motor coordination is not developing well, atthe age of one or two. The there's still a lot of wait and see because there is a lot of variety andin trajectory of motor development, and especially now even more so now than ever before. So, you know, I think that that the that the COP is a very, very valuable evidence based tool thatwould is very, very useful for all disciplines working with kids with DCD and it's also applicableto I have two children that are high functioning autism, and they're both bright and they'reunder eight and they both responded very well to this, it keeps them in the minute it keepsthose children in the moment. Because in that moment, we're not thinking about anything elseaccepting that, hitting that yellow box. That's all we're doing bots, bots, it's not watch the ball. I don't think that's particularly helpful command, you know, 35:21 keep your eye on the ball. 35:23 That's not a particularly helpful command for these children either. Watch the ball come into

That s not a particularly helpful command for these children either. Watch the ball come into your hand. That is, because then you're giving them the two things that they need to attend to,you know, and you can also say, the beginning of it before where my hands and just orientthem to where we both are in space. And then go through your goal plan, do check. And I one little girl I saw yesterday, she's nine. She's older. She's another person that was developed later, was diagnosed later. However, she's really getting great at saying, you know, I didn'tthink about it before I did it. 36:02 And I was like, Yay, that's so great. 36:07 You know, I mean, too bad. You didn't start doing this many years ago. But it's okay, because now you are. And she's really, she's really made some nice progress. Now do I think she's going to still have some difficulties over time, maybe. But her abilities now to self monitor are much better. And she's performing better at soccer. And she was performing better at lacrosse before they finished her season. So there's really something to bringing it back to the child in terms ofif you can find out what's important to them, and and get some buy in from them. And then the child has got to learn to monitor and manage their own performance so they can learn newstrategies. And that may that may include ot strategies, because these kids do have someunderlying sensory issues. And and some of these children respond very well to having sensorystrategies address, some of these kids don't respond very well to that at all, which is differentthan the original 37:27 definition of 37:29 dyspraxia, which spoke about impaired tactile proprioception and vestibular dysfunction, andlaughed at the wide open for it really to be wider, you know, and it was really described as aproblem of doing and it really is a problem and problem of doing and again back in 1990, youknow, to credit uh, you know, Fisher, Murray and Bundy the road that sensory integrationtheory and practice, you know, they said, they left it wide open, that this developmentaldyspraxia is a multifaceted thing that impacts daily life. And learning new tasks can be very difficult. And it's the same description, the only thing that's different is they give the reason forit as being sensory in nature. And I think that there are definitely and every child has differentsensory contributions and sensory things that can help. However, I think we need to be lookingmore initially at motorcrew coordination and executive function. And then with a good ot onboard, they've got sensory strategies in their back pocket that they're going to pull out and,and help and help you as you know, so it's not it's, it's the develop the DevelopmentalCoordination Disorder has moved us to understand this a little bit beyond sensory issues, eventhough there are certainly sensory impairments or contributors, or sensory issues that developover time

39:12 because of lack of experience or such frustration. 39:21 Well, the cognitive oriented approach, I can see how it would be incredibly valuable and a lot ofdifferent areas right? So if we're thinking about goal plan, do and check. I'm thinking from aparent's standpoint, whether that is something you know, and still pulling in this executivefunction processing memory attention and you know, then our spatial awareness and such butsay, you know, brushing the teeth, what does that look like? What is our goal, what is the plan,and then being quiet why they do that which can be hard as a parent right? You want to To kindof interject to help, help help, but if we're just sit back and then have the child verbalize, youknow, how did that go? What did that look like, and that really coming into more of the not themanagement role, but just that kind of consultant role as a parent to that child. And then in a classroom setting the same thing, and you could see where goal plan do and check could workfor academics, it could work for social situations, it could work for a lot of different things. And easily the IEP team could translate a AP goal that would have a student work on these skills,goal plan, do and check. Again, you know, in all facets of the school day, and we could easilycollect data on that, and what does that look like and, and add that to the present level? In anIEP, so I think it's really interesting that that is the focus, but incredibly valuable, you know,beyond a PT realm, that it could really be likable to all different things. Oh, absolutely, 41:10 absolutely. I mean, it's it Co Op is, is a is a client centered approach, right? I mean, it's, it's aproblem solving approach, and you're leaving the problem solving to your, to your to the child,and you want them to get skill acquisition through using their, their strategies. And, and through this process of discovery or Guided Discovery, I mean, that's what we want the child todo. And that's why the externals don't work, you can't sit there and say, you have to stand likethis, you have to do, you have to have the child do it. And they have to create that internalmodel so that they improve with their planning, sequencing, organizational, I mean, there'smore executive function stuff. I mean, so they said that they, you know, they improve, and inall those things, but they can only do that, if they're the problem solver, because the issue isthey're not getting, they're not getting the message, they're not learning it the first timearound. And because it takes a long often for them to be identified. they've practiced the wrong things for a very, very, very long time. 42:31 You know? 42:32 Absolutely, absolutely. And I'm just shaking my head just as a, as a mom, as a parent, as a

Absolutely, absolutely. And I m just shaking my head just as a, as a mom, as a parent, as a special educator professional. Having that problem solving aspects, really then translatesthroughout school, or secondary in the workforce as an adult, and then really, truly helps withthose self advocacy skills, right? Because you're reflecting on what went well, what didn't go,Well, how can I do this, and then reducing that frustration for that individual. 43:04 Right. And it kind of getting back to, to your, your point about school. I mean, it used to be granted, like, when I was getting all of this, we had, we had a lot more papers than we do now.But I mean, the things they used to talk about for school modifications, or to decreasing theamount of paper, the child took off, decreasing the number of books that they took home,decreasing the number of folders that they took home, or, you know, or pencils, or whatever,when anything that they need to complete a project. You know, they they need a little bit ofassistance with and, and the school can definitely that school can definitely help help help withthat. And I think that we also have to be mindful of the family. And here, especially the areathat we live in, you know, the family and the cultural expectations, and, and assists familiesand matching interests, skills and expectations with ours, and with their children. So, you know,I think that that's another area too, that we have to sort out, we don't just jump in and say weneed to do this so that I can meet my goals. I think what we need to do is we need to sit there and we need to, you know, we need to assess the risk management you have, we have aclumsy child. And the most important thing I want to hear is what are the goals of the parents?And what are the goals of the child because that is where I'm going to meet them. That's where we're starting. And I'm going to actually build in everything they think's important withinreason, but I'm gonna I'm gonna I'm gonna do that so that I can meet them where they are andalso try to help them understand that you know, there's a there is a possibility like you said thatthis isn't that this is a lifelong thing. And when you're when you when you look ahead to to yourkids in middle school and in driving, and, and risk taking, and all those other things, it becomes,you know, a whole bunch of other things I don't have personal experience with because I don't,you know, I don't work with children that are that are older, you know, although I will say that,in my experience, I have worked with kids, that as they got older, they're really doingeverything in their lives that they need, they're living full lives. And so, you know, I'm alwayshopeful that, you know, that there are ways to, to, to, to help these children. And I think some of them, it may be easier to help than others. And that depends on their presentation. And that depends on their environment. You know, it's genetics and environment, like everything else. I think, 45:58 absolutely. And I love that we're matching interest and expectations. And I would also, youknow, prioritizing, you know, what is important for the family as a system. And then you know,to help that family then communicate their priorities with the school so that we can start tobridge that gap, not only between home and school, but from the medical model, where you'recoming from, to the educational model, to really ensure that we're supporting this child, thisstudent in a way that is going to help them grow and learn the best they can. So how can we help teach students that you internally check what they are doing? How do you help them dothat? Is that practice? Or what does that look like? Well, I

46:50 think intensive, I think intensive practice matters. But what you can't intensively practices errors. So you know, that's where we get stuck. You know, I was fortunate to participate inresearch at Columbia University on intensive practice in, in, in therapy. And I do believe that intensive practice works. But I also believe that there are other things that, that, that, that playinto that I think there are some times intensive practice can be carried on by other individualsbesides beside me. And it depends on it. Again, it depends on the environment and sort ofwho's willing who's or who's willing to, to pick up the ball, I, I do think that the older children,one of the things that can, you don't want to scare a younger child, however, I think it's reallyimportant if if a child has not been that active, and they have decreased aerobic power, andthey have decreased strength, it's not a bad idea to have a discussion, I'd like discussion aboutthe fact about lifetime health and wellness, you know, I mean, you cannot get out of breath,getting dressed and tying up your shoes, and you're done for the day, because that's nothealthy living. So I think you have to try to get everybody, you know, on the same page, as far as that goes. And there's, there's some restrictions and affordances for that. Also, dependingon the environment, you know, in which they live in, and you really want to prevent any kind ofsecondary issues from this, you don't want to have them have muscle tightness, you don't wantto have them, you know, be unable to, to walk up a flight of stairs and and get up, you know,and get get get out of bra. So, you know, and and I think that the, your question is really good,because we need to know is the intervention working. And one of the ways that we can knowthe intervention working is it with Co Op, you can ask parents to do it, right? Like you try togive them a couple of like you on their goal list, tr y a goal plan, do check on that, and then seewhat happens. And then they maybe start to talk to their child in a different sort of way. And not that they're going into any of this by harming them. This is how we're educating them, totry to help them help their child by letting your child solve their own problems. But we have to be able to guide them in the direction that they'll be able to do that. And sometimes, that sometimes we need to sometimes we need tons of sensory strategies from an OT, in order toget them in the right place to be able to carry out what we're, you know what we're talkingabout, and sometimes that's, that's not necessary. How, however, again, at the end of the day,I would still say that there needs to be with these children. If there's a lag Which issue thereneeds to be speech therapist there almost always should be an OT and PT and not one at theexclusion of the other because I can't do their job and they can't do my, I know about balance,they know about handwriting. And we both need to be working on that. And they need to spendall their time on the visual perception and the visual motor, and then and the, you know, in thein that fine motor control stuff, and then I my job is the larger muscle groups, the running thejumping the plane, the playing in the playground, and then perhaps they need help with socialskills. And maybe there's, you know, another individual that we need to bring in from themedical community to be able to assist the family. And I think as a therapist, we need to knowwhen it's time for me to stop and somebody else to come in. So we don't overload the family.However, from the get go, I just think it's super, super important, you know, that we arecommunicating, you know, and coordinating with other personnel, because this isn't somethingthat I don't think any one of us can do, by ourselves.

51:10 Not at all. And that's why even you know, taking it back to kind of that school lens, having thatIEP team approach and having the professionals and including the parent, communicate andcollaborate, to better ensure support is taking place at school, and then having outsideprofessionals communicate and collaborate and even encouraging that with the school team to see what kind of accommodation support schools are needed to better support this childthroughout the day. As we kind of wind down here. What should I have asked that I didn't know enough to ask.

51:50 Are you pretty good when? I didn't know. Your question. This was like, Whoa, that she asked me and yeah, I think I think the only thing I might want to add is the tool that we might use? Yes, yes. So for definitely for occupational therapy, because, because of my education, I know howto do VMI, but I'm not going to do a VMI because my ot counterparts, my trusted on the OTside, just, I want them to do it. And I want them to explain to me, you know, the differencebetween the motor, you know, the motor control, and the visual perception, the visual, spatialand, and all those kinds of things. So they definitely they need, they need a VMI, I would saythat if you've had an OT on board, and they were to do a sensory processing measure, I thinkthe biggest bang that we would get out of that is that there you go there, you would get theschool involved. And if you were doing the sensory processing doesn't matter, the OT couldmaybe help the family with strategies. And from the sensory processing measure, you also get participation. And if the school says they're not participating, but the parents are not aware ofthe fact that they're not participating, then you right away have, you know, stumbled uponsomething that that needs to be addressed. Okay. And then as far as motor tests are concerned, the the test that's used mostly in the literature, even though the bricks has beenused, but the one that has been used the most for Developmental Coordination Disorder ismovement, ABC two, that's a movement, the movement assessment battery for children. And it, it identifies mild to moderate movement disabilities in, in, in children, and it can help withclinical explanations and, and intervention planning. The nice thing about movement ABC,especially the PT is that they each age band has a has a behavioral checklist. So you can sayyou know, you know, not persistent, all sorts of words that sort of leads you down andexecutive function past, you know, where you get to state, you know, frustrates easilyoverestimates abilities, underestimates abilities, like those kinds of things. So I can put thosecomfortably into your report without feeling like I'm going into anyone else's lane. Okay, so allI'm doing is reporting the behaviors from the movement ABC checklist, which is a tool that issupposed to be used by OTs and PTs. So, and the nm ABC checklists can also be taken to the school. And again, similar to the sensory processing measure. We can see where there's a difference in what the school season mean, what the parents see. And sometimes if it's the same, I mean, then you're off to the races because you have a discussion and you haveeverybody, you know, on a similar page and you know, any one of these parent group quartz issomething, you know, I had this happen recently where, you know, something comes out and ifthere is no way is that that is really what's happening. And all you have to do is you have to sitdown and you have to, you have to probe and you have to talk to the families, and you have totry and find out, you know, what is it that's really going on? And how do you get how do you tryto, you know, move their perception enough that you can be able that you can help them andand oftentimes, you know, people maybe don't report things, because they're afraid, you knowthat something's wrong. And I understand that. And I think that we just need to help them. And when we see that there's a parent centered or a parent report that's been filled out. And youknow that, it really you've never seen it occur that way, then just ask the parent, when did thathappen. And actually, you could learn something from them, they'll tell you what, when we dothat, we actually do this first. So seeing if they've already got a strategy. And that's why that came out. Okay. So you know, there's, you've got to talk, you've just got to talk you cannotwalk in to I don't think you do any patient, group or diagnosis. But especially this, because it encompasses so many areas. And so many areas where you just you want to stay in your lane,but you don't want to, you don't want to you don't want to miss anything, and you want toguide families appropriately.

56:42 So real quick, let 56:42 me just help kind of, clarify for parents that are listening that may be concerned, that DCD maybe part of what their child is, they would start with a neuro Psych. 57:00 Or if they're if they noticed that their child is having motor difficulties as compared to theirpeers, you could certainly start with a PT with a motor assessment, if the child was havingproblems, you know, with their pencil to paper tasks, you could certainly, you know, start withwith an OT, but you got to know that you got to keep on going you know that whoever isassessing that person, is is is is 57:29 not going to 57:32 is going to be consideration is can take into consideration all the things that they're 57:37 observing. 57:40 What would it be? And why if we could have or if you could have a billboard with one tip for parents. That's my final question. 57:49 One tip for parents. Well, don't listen to your neighbors. You know, like, I

57:59 think that's true, 58:00 I mean, because don't listen to anybody else that says, I have a child and my child has a andthis is what we're doing. And it worked. Because we all know the, we've never seen two children that are the same. So consider your child, an individual. And never and never forget that. Never forget that your child brings to the table strength that many other children do nothave. So my greatest message to parents ever is that your child comes to this world with thingsthat other children don't. And that's going to determine how I proceed, you know, with with myintervention, and I really want parents to understand you know, that there often is, you know, acognitive linguistic component to this and that we want to try and prevent participationrestrictions so that your child lives a satisfying life with good quality. 59:10 Beautiful, beautiful, 59:12 how can people find you Terrell? 59:14 I can be reached by email, or I can be reached by by phone or my My website is www dot yourkid networks.com. 59:29 And we will put all of your contact information in the show notes. I appreciate your time and thank you for shedding some light on DCD for us today. Thank you. 59:39 Thank you so much. 59:42 There you go.

59:43 That wasn't bad at all. 59:45 Are we finished? 59:46 We're finished. 59:47 Thank you. Okay, 59:48 you did amazing. I'm gonna don't listen to your neighbor. You will want to not miss this episode of the special ed stuff. added just podcast and you want to wait to the end. Let's try all that again. Don't listen to your neighbor. That is our advice for our billboard from our guests today.Stick around to the end to hear why we don't want to listen to our neighbor. Today I'm talkingwith Terrell, we're talking about Developmental Coordination Disorder and how to take aproblem solving approach for self care, leisure and participation. Welcome to the special ed strategist podcast where we strategize all things special ed. If you're a new parent to special education or a seasoned parent sitting at the table. Come join us for our conversation, get alittle broader scope and see how you can better support your students. I'm your host WendyTaylor, my mom and special educator I have sat on both sides of the IEP table as a parent anda professional. Over the last 25 plus years I have made it my passion and mission to helpparents and professionals bridge learning gaps, access special education services and buildkick butt IPs. If you want more tips show us some love on social at learning essentials. If you are new to our podcast, give us a like and a follow. Let's get ready to strategize. 1:01:19 Thank you again for listening. It is my hope that you are going to take away some wonderfulnuggets and thinking about a cognitive oriented approach when working with either yourstudent or students within your classroom and thinking about goal plan, do and check. Thank you again for strategizing and spending your precious time listening. If you love what you've heard, give us a like and a follow at learning essentials. You know your kid best and you know ifthey're struggling or thriving, if they have happy if they are happy or losing hope, if theyunderstand or are completely lost. The question is what now? If you're unsure what steps totake to help your child succeed and need a starting point, take my free quiz. After answering some questions about your child, it will guide you towards the first step and helping your childbe the best they can be. You can find that quiz learning essentials edu.com. If you need morespecial education support visit learning essentials where we provide an individualized andsystematic approach to supporting students with various learning needs and differencesthrough academic coaching and educational therapy brain camp as our executive functionsupport model. If you're a parent, we got you covered as well through IEP coaching