Sue Delport MSc OT Lecturer Cardiff University School of
Healthcare Studies Heath Park Cardiff CF14 4XN Tel: 02920 87790
Email: [email protected] Slide 2 Outline of presentation Rationale
for study Methodology Results Recommendations Slide 3 Rationale for
Study Prevalence of Developmental Coordination Disorder (DCD) is 5
- 8% of childhood population (Polatajko et al., 1995) Long term
effects of DCD on 10 year follow up include both significant motor
difficulties as well as a variety of other psychological problems
(Losse et al., 1991, Smythe and Anderson, 2000) It is the
responsibility of the teacher in the first instance to meet the
childs needs within the schools resources (Special Educational
Needs (SEN) Code of Practice for Wales, Welsh Assembly Government
(WAG), 2004) Slide 4 Pressure on Paediatric OT services Dunford and
Richards (2003) determined that the mean waiting times for a child
with DCD to receive an OT assessment was 46 weeks. WAG (2007) set a
directive to reduce this waiting time to 14 weeks by March 2009.
Paediatric OTs face a difficult dilemma: how to provide prompt,
effective intervention with limited resources Slide 5 Dilemmas
Teachers could be assisted by OTs to give timely and appropriate
help to these children, only referring the more complex cases From
experience, assistance by OTs is not always received and
recommendations not followed through in the classroom. This raises
many questions as to why support is not used. Are teachers just too
busy? Do they not really understand the programmes? Do they think
these issues are not really that important? Are the programmes
presented in a format that are useful to teachers? Are teachers
concerns listened to, and their views respected? Slide 6 Research
Question What needs to be considered from a teachers perspective
before programme material is recommended, selected or adapted for
their use by OTs to assist children with coordination difficulties
in a school setting? Slide 7 Aim of project To explore teachers
perceptions of their role in assisting children with coordination
difficulties in a school setting To identify the type of programme
material that is most appropriate to assist teachers in this role.
Slide 8 Objectives Main objectives are to: Investigate teachers
perceptions of how coordination problems affect children within the
classroom setting. Understand teachers views of their roles with
these children. Explore the barriers and challenges for teachers
assisting these children. Elicit teachers views of a range of
coordination programmes that are currently available for classroom
use in Wales. Elaborate upon teachers perception of the role of the
occupational therapist in addressing coordination problems within
the school context. Slide 9 Methodology Choice of methodology
should be determined by the principal research question (Silverman,
2005). Qualitative methodology selected, because the research
question sought to understand human experience within a particular
context (Patton, 2002; Guba and Lincoln, 2005). The collaborative
relationship between the client and therapist (Sumsion, 2000) may
be compared to the relationship between the participant and the
researcher within the qualitative paradigm. Slide 10 Method
Questionnaires, interview, participant observation and focus groups
considered (Rapport, 2004). Focus groups chosen as method of data
gathering (Krueger and Casey, 2000), as they would offer the most
natural form of data collection in that the teachers would form a
group of shared experience which would contribute to the depth and
richness of the data. Slide 11 Focus Groups A carefully planned
series of discussions designed to obtain perceptions on a defined
area of interest in [a] permissive, non-threatening environment
(Krueger and Casey, 2000:5). The dynamics within the group are a
powerful medium to elicit interaction and ideas (Flick, 1998;
Greenbaum, 2000; Fern, 2001) Advantages: Can reach a wider range of
people in a relatively short space of time, therefore cost
effective. Disadvantages: Group think may dominate over individuals
opinions (Hollis et al, 2002). Transcribing the discussions and
analysing the data may be complex and cumbersome. Slide 12 Focus
Groups - recommendations Recommended size is between 5 10
participants (Krueger and Casey, 2000) Familiar environment (Bloor,
et al, 2001) Free from interruptions (Kitzinger and Barbour, 1999)
Three t0 five groups, to achieve data saturation and to clarify
ambiguities (Morgan, 1998). Use of an observer to make note of
non-verbal communication and to give feedback to the moderator
(Sim, 1998; Carter, et al., 1999). Verbatim transcription of
audio-taped groups (Braun and Clarke, 2006). Slide 13 Focus Groups
These were held over a period of 4 months with 7 teachers from
mainstream education who volunteered to be involved following my
appeal at a SENCo meeting. First group: Explored teachers
perceptions of the difficulties children with DCD faced and their
views on their role Second group: Explored themes that arose from
first Third group: Discussed views of programmes issued Fourth
group: Reviewed issues discussed Slide 14 Ethical consideration
Guidelines by Christians (2005) were used: Informed consent
permission sought from Local Education Authority and from head
teachers of the schools with participating teachers. Information
leaflets outlining the purpose of the study were given to each
potential participant. Non-deception Aims explained prior to
volunteering, and information re possible publication given Right
to privacy and confidentiality use of pseudonyms Protection from
harm Slide 15 Data analysis Focus groups were transcribed and the
data analysed using NVivo (2007) computer package to manage the
data (Dey, 1993, Miles and Huberman, 1994; Bazeley, 2007). Codes
were generated, and analysed into broader themes that linked them
(Coffey and Atkinson, 1996; Braun and Clarke, 2006) Slide 16
problem then because it is interpreted by other people throughout
the school as misbehaving, and I think its very much outside of
their control, and they cannot help that. Sally: It does take quite
a while, but I think you are having to get to know your child first
of all... and then. Mandy: Yes, yes. Alison: Were talking about the
change group as well, because with juniors it tends to be more
linked to handwriting than anything else. Mandy: Yes, yes. Sally:
But I think when you put all the things together, its difficult to
see with the handwriting with some of the younger children, because
obviously they havent started writing, but it is quite evident some
of the drawings, the drawings are very disjointed with perhaps just
the head, arms not attached to anything at all, very tall, long
elongated figures, with head at the top of the page because they
have very poor spatial awareness these children. Mandy: They are,
cant judge the space. Clumsiness interpreted as misbehaviour
Intuitive feeling that something is wrong Difficulty over
diagnosing and identifying DCD Getting to know the child Observable
signs of coordination problems Handwriting an essential skill
Observable signs of coordination problems Analysis of what is
faulty Observable signs of coordination problems TranscriptCode
Extract of Coded Transcript using NVivo Slide 17 Sample of Free
Nodes (initial categories) using NVivo (2007) computer package
Slide 18 Results Five main themes emerged: The complexity of
recognising and understanding coordination difficulties Personal
and organisational influences on teachers perception of their role
in responding to children with coordination difficulties Obstacles
to teachers fulfilling their perceived role in helping children
with coordination difficulties Teachers perceptions and experience
of programmes and materials Attitudes to occupational therapist
Slide 19 First Theme: The complexity of recognising and
understanding coordination difficulties Difficulty identifying
coordination difficulties Age and stage of child affects teachers
ability to recognise coordination difficulties Coordination
difficulties not taken seriously I think what might possibly happen
is that youve got a child who is keeping at maintenance level
within the mainstream school and they have coordination
difficulties they might be overlooked because they are not in
school terms a problem. Slide 20 Theme two: Personal and
organisational influences on teachers perception of their role in
responding to children with coordination difficulties Personal
factors: Lack of confidence and attitudes Its quite an easy problem
to hide. I think the frustration comes when you dont know what to
do next. Traditionally I think in mainstream, weve thought of it as
somebody elses problem theyve referred so its out of their hands
and somebody elses responsibility.. Slide 21 Organisational
Factors: Such as the role of the SENCo, level of support from LSAs,
head teachers leadership style Fulltime class is a fulltime class.
If you have a fulltime class you dont in theory and in practice
have time for anything else. It depends what value the head teacher
puts on special needs in the school and how the special needs
budget is spent. Slide 22 Theme Three: Obstacles to teachers
fulfilling their perceived role in helping children with
coordination difficulties Lack of Training Practical obstacles e.g.
not having sufficient time, a lack of access to resources and
materials when they needed them, and difficulty finding a suitable
venue for intervention activities. Pressures on teaching staff to
fulfil multiple roles Red-tape and paperwork Do you really want to
go down the road of recognizing this problem because it means that
youve got to write a programme for it Slide 23 Theme Four: Teachers
perception and experience of programmes and materials Layout and
packaging of programme material - simplicity, attractiveness
Content practical, manageable, and purposeful, for the whole class,
needed to fit into the curriculum I mean would you just want to put
dry peas into a bottle and screwing on the lid without doing it for
a purpose? Slide 24 Theme Five: Attitudes to OT Factors affecting
referral to OT organisational issues, and attitudes to impact of
coordination difficulties Factors impacting collaborative work
between teachers and OTs: Respect, and relationship building Even
if the OT were to spend half an hour, with the class teacher, that
would give them so much more information and help...[the face to
face time] will cut your [the OT] list and help teachers to feel
confident to deal with the child in the school as well. Slide 25
Recommendations OTs need to concentrate on relationship building
with teachers to ensure successful collaborative work OTs need to
be more aware of the format and the content of the programmes they
recommend, determining the teachers preferred learning style
(diagrammes or more detailed explanations) Further training of head
teachers, SENCos, teachers and LSAs is needed for both
identification and management of children with DCD. Further
research could investigate the way that OTs, teachers and parents
could work together to effectively manage children with DCD. Slide
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