The ADHD - What Now Blog

Reducing stress, growing skills, and building responsive relationships so that your family with neurodiverse kids can thrive.

Occupational Therapy for Kids with ADHD

Jun 26, 2022
 

Is it hard to wrap your head around all the different therapists for children and how they can help?

Parents aren't trained in who does what, yet we are the ones to reach out for services for our kids. That's why I am so excited to start this "Meet the Therapist" series airing on YouTube. This could save hours Googling or the time missing out on help that could alleviate stress for your child and your whole household.  

We're starting with Occupational Therapy.  

Occupational therapists can actually help end:

  • Worrying over why your child seems to be the only one afraid of the slide or swing.
  • Playdate embarrassment because your child didn't pick up on social queues.
  • Guilt over feeling like pushing your child away because they are invading your personal space and leaning on you too hard again!

Of course, it is confusing because it is not as clear-cut as if your child breaks their arm, then they get therapy to regain movement.  

My occupational therapist actually helped fix my backyard that looked like swiss cheese.  Who would have thought that as an outcome of Occupational Therapy?

You see, there were small holes scattered about the yard and a crater large enough to burry an entire double stroller behind the playhouse - all because my son loved to dig, and it seemed impossible to stop him.  

I hated my swiss cheese backyard.  But it was better to me than a whirlwind of running, noise, and headstands on the couch when it is supposed to be school time.  

So when my Occupational Therapist explained why my son loved to dig holes in the backyard, I was relieved to understand. Now that he has been working with her for a while, the grass has grown back, and my yard is safe again - not to mention the headstands have stopped, and attention and following directions improved substantially.     

If you have a child who is having a challenging time doing something they are expected to do, perhaps Occupational Therapy could help them.

It was so confusing to figure out, and so often I see parents asking other parents questions an occupational therapist could (or even should) be answering.  

That is why I am so glad to introduce Occupational Therapist, Dr. Schupak.  

Dr. Schupak is an Occupational Therapist with a specialty in sensory processing and covers:

  • You might want to call an OT if...
  • What OTs can help with
  • What successful treatment looks like
  • OT and insurance

 

 

LINKS

Dr. Schupak's practice


 

FULL TRANSCRIPT

Veronica: Hello and welcome to this episode. We are going through a meet the therapist series. 

So when I was starting off my journey with my child, I had no idea who to call. I didn't understand what exactly was going on with my kids, and I didn't know the difference between occupational therapy, physical therapy or anything else. So this series of episodes is to help parents who are at the beginning of this journey and maybe some who are further along, but still have questions about how can therapy be helpful for my child.

So today we have with us occupational therapist, Ms. Barbara Schupak. Should I call you Dr. Schupak?

Dr. Schupak: Dr. Schupak, yes.

Veronica: So Dr. Schupak, would you please share some of your background to start? And then I'm going to ask you just to share a story of how occupational therapy has been helpful for a child - give us an example of a child that has been helped.

Dr. Schupak: Sure. Well, thank you very much for speaking to me about occupational therapy. It's just about my favorite thing to talk about.

I'm a mother of three, and I have experienced a lot of issues with raising a family. I decided to go back to college later on in life, and I knew I loved science and I knew I loved being creative and wanted to do something in a helping field. And so I actually researched different careers and I kind of honed it down to physical therapy or occupational therapy.

And I decided to go and observe in a school. And I watched both physical and occupational therapy, and I knew occupational therapy was for me because it was a lot more creative. So I received my undergraduate degree at Cain University.

Then I decided I wanted to learn more about the fields of health in general, and I decided to go back to college; I have a master's degree in public health. And as my career progressed and things changed with the kids I was working with, I decided I wanted to specialize specifically in sensory processing disorders. So I went back to school again, this time I went to Seton Hall University and I earned my PhD there in health sciences.

My dissertation focused on measuring sensory processing, not as something that's just observable, but as something that could be measured physiologically. And I was able to prove that what I used was reliable and my article was printed in the American Journal of Occupational Therapy as well.

I have my own clinic. I've been here for a very long time. It's 21 years now. I can hardly believe it myself. And I really love what I do. I have a passion for what I do, and I know that I connect with my clients and families. And I feel that that is my biggest key to success, is a real connection to, you know, how do I help this child? How do I help this family?

Veronica: And I can attest to that as my sign is one of your clients, or our family rather is one of your clients. And I have seen the great way that you interact with him and appreciate it so much. Can you go into a little bit, you said something about how, what you were seeing with the kids and how that inspired you to go towards sensory processing. Can you speak to that a little bit further?

Dr. Schupak: Yes. So I've, I had a personal experience with my own family.

When I first started practicing occupational therapy, I was actually working with the elderly and I did that for about five years. And then I decided I wanted to go out on my own as an independent contractor.

And while I was doing that, a school contacted me and they wanted me to come into the school and work with children. Now I had been trained for that. So, you know, of course I said, yes.

When I started working in the school, I noticed that, you know, a lot of the complaints were, you know, the child can't sit still and the child can't focus. And, you know, I could see that it wasn't always just a purely an attentional issue. And many times these children were just uncomfortable in their skin.

And I became aware that even though I had learned about sensory treatment and processing in school, they don't give you a whole lot. They kind of like expose you to the area, and then if you choose to specialize in that area, you can. And that's what I decided to do.

But what was happening at the same time is my son who was in nursery school at the time he was experiencing problems in school. And when I met with his teachers, I realized that his issues with sensory related as well, and that took me on a whole new journey to kind of be on the other side of the desk, so to speak; the parent, not the therapist. And I had to listen to other therapists, give me suggestions what to do to expose my son to things that would desensitize him to the things that disturbed him.

His primary issue was he was over-sensitive to touch. So he didn't really want me to hug him unless he was ready for it. And then I'd have to give him super tight hugs and that would make him feel better. He couldn't sleep with clothes on, he, you know, slept with nothing on and just a sheet over him. He couldn't take having blankets on him. Tags in his clothing. He couldn't stand textures in his mouth. So he was a very fussy eater.

So there were many, many issues that he had. So being a good parent, I listened to what I was told by the therapists who were giving me suggestions. And I made sure I rigorously gave him what was suggested every single day.

And what I observed over time was a complete change in my child. It was amazing. He started to be able to wear clothing that were different types. It didn't always have to be the same thing. He started to try new foods. He was more comfortable in his skin and he could pay attention and he could do things and he completely changed. And I realized in that situation that I was more his mommy than his therapist, as it should be. Cause it was my child, but it gave me an understanding of A, that sensory therapy works. No doubt about it. And B, how it feels to be on the other side of the desk and how it impacts a family.

And I know that that's what makes me really good at what I do. And that's when I talk about a connection, I can really connect with what families tell me when they'll tell me something that this may sound crazy, but, and they'll tell me, you know, my son will only wear the same pair of shorts every day. He just doesn't want to wear something else. And it's not always related to touch, but I'm just saying the things that I hear, I totally connect with. And I understand.

So whenever I'm, you know, having a struggle, trying to teach about sensory, you know, I think about that. I think about other kids. I think about kids who would never go on a swing or afraid to climb up the ladder to go down a slide. I have a picture in my waiting room of a child who mother said my goal is I want my son to be able to enjoy going to the park.

And after I worked with him for six months, one day, she came to me with a picture that I put up in my waiting room. And it's her son at the top of a tall ladder about to go down a slide with a big smile on his face, something he never could do before he had his sensory treatment. He overcame his fear of movement and being off the ground through sensory treatment.

So it's things like this that, you know, I can always fall back on if I'm having a tough day or having a tough time convincing, you know, a parent or a teacher or a child, why doing certain things are going to make things so much better.

Veronica: That's awesome. I really appreciate your story. It seems to me like some of what you were describing, if I'm thinking of it, I might've heard other parents say, oh, you know, they just do this. You know, like, oh, they just don't like that. Or just kind of that it might be very easy to accept as a parent that this is just the way it is and the they'll grow out of it or something like that. Can you kind of speak into that a little bit? 

Dr. Schupak:  I do hear a lot of, you know, I just thought they would grow out of it. That's something that's a very common refrain. The thing with sensory issues, especially, is that if it's not addressed, what happens is every year a child has more and more responsibilities, more things they're expected to do in school and at home.

And if they foundationally don't feel right in their skin, then they cannot build new skills on top of what they already have, because they're just trying to compensate and adjust to get through their day. They're not really going on this nice linear path where they're just improving and improving. They get to a point, if it's not addressed, where there's a breakdown.

And that's oftentimes when I see the older children with sensory issues come to my office, because now they've gotten to the point where the old things that they used to rely on, the old things that they would compensate with to feel better, it's not working anymore. Now they're overwhelmed. Now, what do I do?

With younger children, typically it's more behavioral things. The parent will say, you know what? I thought they'd grow out of it. Or my husband said he was like that when he was a child, but the teacher's telling me, my son is disruptive in class and I don't know what to do.

So a lot of times, you know, a behavior seen at home, maybe you don't pay as much attention to it, but somebody else, a teacher or a caregiver might say to the parent that, you know, this is interfering with what we need to do. I think, you know, maybe your child needs to get some kind of help. 

Veronica: What are some of the - I'm trying to get to the idea of types of things that you can treat or types of things that you can help with. What are some of the things that parents call in asking you for help with or pointing out or questioning or what, and/or does that cover everything that you do? Or do you get a lot of calls in one area, but you also can help with this?

Dr. Schupak: Well, occupational therapy is very holistic in the sense that we look at the whole child, we're trained to look at everything and you know, oftentimes the name occupational, a lot of people think I do job training.

Well, the truth is they're not that far off; occupational therapists are called that because we view occupations as something that every human being has to do every day. So depending on your age, there are different occupations that you have.

So when you're very, very young, the occupations are things like feeding yourself, playing with toys, getting along with other children, following directions, from adults and so on. So that would be some occupations.

So if a child is having difficulty with following directions from an adult, or they don't want to play with other children, or are they having a lot of feeding difficulties, either, they don't like the things that they put in their mouth, or they physically can't pick up the item to bring it to their mouth, or maybe they can't sit up in order to eat. All those things interfere with the occupation of eating. So that is something an occupational therapist would be appropriate for.

So it's basically what do you do every day?

You feed yourself, you toilet yourself, you bathe yourself.

When you get a little older, you have to know how to read, and you have to know to how to write. You have to know how to solve problems and get along with others. Even playing sports and so on. Being coordinated enough to carry my book bag and make it up and down the stairs without tripping and falling.

All these things fall under the realm of daily occupations. And anything that's a daily occupation is something that occupational therapists can help a person with.

Now, since I work with children, I see a lot of children come here because of certain diagnoses. So it could be an attention diagnoses, one of the biggest categories, along with autism spectrum disorder, there's high functioning and there's low functioning. I mostly see high functioning children on the spectrum. Then there's motor incoordination issues with being able to know what to do with my body parts, you know, how to time and how to sequence and how to coordinate, how to plan what my movements are going to be. The thinking skills to plan those movements.

A lot of parents will come to me and say, you know, my child is clumsy. My child's always falling and tripping and so on. Well, occupational therapists could help a child like that because we call that dyspraxia. That's a motor incoordination where the movements are not planned out right. The sequencing and the timing is off. So they fall and they trip and so on and so forth.

A lot of kids are brought to me because they're having trouble in school. So it could be a focusing problem such as, you know, just paying attention to directions and remembering them, being able to sit, still, being able to sit up and stay attentive.

A lot of kids get fatigued, sitting in a chair and they just slump and slump and slump, and before you know it, they're not paying any attention. So they have inattentiveness, but it's not necessarily because of an attention deficit. It can be a fatigue thing because their postural muscles can keep them up long enough.

A lot of kids are referred to me because of handwriting, difficulty, pencil grasp is important. Now there's many types of pencil grasp, but the main thing is an occupational therapist wants to make sure when a child is holding a pencil, that they're getting a lot of feedback through their muscles. That goes to the brain that tells the brain how those letters are formed. Once the brain can make a map of how a letter is formed, the child no longer needs to think about how do I make an a, it becomes automatic.

But it's that link, that motor input. So that's why the way a pencil is gripped is so important. If it's too loose or too tight, the appropriate information does not get relayed to the brain from the fingertips. So that's a very big area for occupational therapy.

There's also, self-organization; children need to be organized to a certain degree to do a task. So maybe they have to do a cutting and pasting task and they get some simple directions from the teacher. Then they sit there and they're lost. They don't know what to do. That again, falls under the umbrella of occupational therapy.

And there's play behaviors and there's work behaviors. Does a child recognize the social cues? Do they understand when somebody's happy? Somebody's sad? Somebody's scared? Somebody is being silly? Somebody is surprised? Do they recognize those social cues so that they know when is a good time to invite the child to play, or maybe they should be consoling the child or trying to help them. These are very important.

And then work behaviors as well, not only the self-organization piece, but the ability to be able to sit for an age appropriate length of time in order to complete tasks. And what do I do if I can't complete a task? So all these things are daily occupations for children.

I hope I made that clear. Do you have any questions about that? 

Veronica: No, that was wonderful. I really appreciate it. You've covered a very broad range and scope, and actually it was surprising to me how much that you covered. And the part that specifically struck out to me was the understanding other people's reactions or facial expressions and being able to interpret them, that I didn't actually realize fell under the umbrella of occupational therapy as well.

Dr. Schupak: Yes, absolutely. And it's, you know, I work with some kids that have, you know, disorders such as oppositional defiant disorder. And why do I see these children? Because their diagnosis interferes again with their daily occupations.

So a child like that, I would have to help them regulate their emotions, understand how to identify what they're feeling. And then I understand, well, what do I do now that I know I'm feeling this way? What do I do to feel just right? This is all part of occupational therapy. It's very, very broad. It's very broad. When in doubt consultant OT, if it doesn't fall under our umbrella, we'll let you know.

Veronica: It's so very, very true. So then in coming to work with you, what is the typical process that a parent might expect? Like, how does it start? Do we - usually it's the parent calling and initiating perhaps because they have a diagnosis or they just have a question, right?

Dr. Schupak: Right. Well, typically, you know, I will speak to a parent on the phone to get an idea of what's going on with your child and what is your chief concern. Then based on that conversation, I'll recommend that they come in here to the office, either for a screen or an evaluation.

Now I'll recommend a screen if I have doubts on the phone, and if the parent has a lot of doubts about whether or not their child's issue is problematic enough that it would warrant therapy. So if there's a question like that, the child comes in, I work with them for about 30 minutes. And then based on that, I can tell the parent whether or not there's an issue that's significant enough that would warrant a full evaluation.

A full evaluation entails, you know, not only clinical observations, things I have the child do in front of me, but I do a lot of standardized testing. I do interviews with the parent. I get information from the teacher with the parent's permission. And I put all that information together in a very comprehensive report, and I have a parent conference.

The purpose of the parent conferences, I literally go through the entire report with them to make sure they understand everything I have in that document. Because they need to understand the picture I have developed of their child.

Once we get to the point where, you know, the parents understand what I'm seeing and what I'm suggesting we need to do to treat it, then we go forth with treatment. I work with children in my clinic. And part of what I do is I have parents come into the clinic so that I can show them what I'm doing with their child.

And again, this is dependent on age too, for younger kids parents are usually in there for the whole session. For children that are a little bit older and more autonomous, I prefer to work with them first, and then I'll call the parent in for the last 10, maybe 15 minutes. And I'll say, here's what John and I did today. We want to show it to you because I want him to do this at home.

And that's part of the parent training. It's very, very important with children that I show the parents everything I'm showing the child, because carry over is not going to occur at home if the parents don't understand what it is I want the child to do. And more importantly, why do I want the child to do that?

So the communication piece is integral to the success of any treatment program that I put together for a child.

But the typical session is I bring a child in, we do things in the gym, we kind of get the body going. And then whatever area of weakness I need to focus in on, I usually will direct the child to that in some form of an activity that doesn't feel like it's not fun. I try to make therapy fun.

A good occupational therapist, pediatric occupational therapist, just looks like they're playing and having fun. And that's why I always tell parents, you know, if you have any questions about what I was doing, because parents can also view through a window to watch what I'm doing, I want you to ask me, you know, why did I play this game? And why did I - why? I want you to know why, because I'm doing treatment. If it's looking like play, then I'm doing it successfully, because their child's having fun, but I'm actually treating them at the same time.

And that's the creativity piece. And like the magic piece for me, the part that keeps me coming back every day for more is that I do things in a way that are playful and fun so that I can get the most out of the child. And most children can't wait to come back. And that's how I know I'm on the right track.

Veronica: So true, I can attest to that too. Although sometimes I've looked at some of the things and I think, well, gee, this is a game I could do at home. Like, so there's no downside to me incorporating that game at home.

But I guess sometimes I felt a little bit like, well, I felt guilty. So perhaps absolve me of this guilt. I felt guilty like perhaps if I did more of these types of games at home, then my child wouldn't have this issue. Wouldn't need to be here. What would be your response? 

Dr. Schupak: Well, playing the games that I do is what I call carry over. I want you to do that. You know, as much as I may love working with your child, my goal is to graduate them. I don't want them to come here forever. I want them to gain the functional performance skills that they need to be successful in their daily occupations. And then I want to graduate them.

So if you are doing those things at home, that's great. Because guess what? The progress is going to be so much faster and children will tell me, I'll ask them, you know, what did you do since I saw you last time? If they're playing games like that, they'll tell me and I'll know, okay, you're doing that at home. I have at least a thousand other things I can do.

So trust me if you're doing the things that I'm doing here at the clinic, and you're doing them regularly enough that I can see the child is competent, I'll move on to something else. That's how we make progress. 

Veronica: Yeah. And I know that you have the expertise to put it all together in a certain order that the child needs.

Dr. Schupak: Yes. Everything is a developmental progression. As far as the way I design my treatment plan. So whatever the skill is, I know what level I'm going to start at and where I want to get the child to. Yes.

Veronica: Can you comment on insurance and payment? I know that's often a question that parents must have, right. Is OT services covered by insurance?

Dr. Schupak: It's covered by insurance, but again, it depends on what type of insurance you have. Everybody has different insurance plans these days. And the insurance companies have all kinds of rules and regulations.

So insurance companies do pay for occupational therapy, but my best advice to parents, and we tell parents is all the time when they come here, is that they should call their insurance company and specifically let them know what kind of treatment is being proposed here. And do they cover it?

One thing that's important for parents to know with pediatric occupational therapy is that we're referred to as habilitation. That's different from rehabilitation. So the difference is rehabilitation is: I had a skill, I got injured and now I need to regain that skill. Habilitation is I haven't developed the skill yet. So now I need to develop it. That's habilitation.

So it's very important that you're talking about habilitation occupational therapy. When you call your insurance company, that's important to know. But many of my clients do get reimbursed. You know, some full, some 10%. It depends. It runs the gamut. And then there are some insurance companies which may not cover habilitation. They only cover rehabilitation.

So it's really a conversation you have to have with the insurance company. But we do everything we can to help our clients get reimbursement if they're entitled to it.

Veronica: Excellent. Thank you. So if I'm a parent, I'm looking for an occupational therapist, I would want to know too, are there different areas of specialty within occupational therapy or within even pediatric occupational therapy, that I would want to guide whom I call?

Dr. Schupak: Well, occupational therapists do have specialties. You know, my specialty is sensory processing treatment, but I treat everything. So I don't only see children that have sensory processing disorders, but a lot of times those children end up here because of my vast experience, working with sensory processing and my success. Parents ends up here for that issue very often, but I treat everything.

But as far as specialties, yeah, you can have a specialty with pediatrics. There are some therapists that work with cranio type of therapy where children are born and their heads are misshapen. So they make special like helmets for their head, but they fabricate them. So they have expertise in the measurement of the child and how to fabricate it, how long to wear it, how to mold it. So that in time the child's head is no longer misshapen. 

Likewise, there are therapists that make splints for hands, okay? That's a hand therapist, right? And their expertise is amazing. So if somebody, you know, smashed their hand or lost a finger, or, you know, a tendon is torn and they had surgery, they would need a special splint for their hand. And these therapists measure the hand, they go by, you know, what the doctor is ordering and they can fabricate all kinds of splints, movable and non-movable. So that's another area of expertise.

You can be an expert in head trauma occupational therapy. You can be an expert in neurological disorders, such as spinal issues. You know, when people are quadriplegic or paraplegic - spinal cord injury, I should say. So there's many different areas of expertise.

There are some therapists who like to work with a speech therapist and they focus solely on feeding issues. So, you know, I may have a client here that I work with and among some of the issues they have is a feeding issue.

So depending on the severity of it, there's a lot I can do for children. But if it's really severe, I might recommend that they go to an occupational therapist/speech therapist team for feeding therapy. So there are many areas of specialization for occupational therapists, both with children and with adults.

There are some therapists that only work in geriatrics. There's some therapists that just like to do sports therapy. So it really runs the gamut.

And the other area that some therapists specialize in is psychosocial issues. Working with populations that have mental health issues. That's another area.

Another area I just thought of is low vision rehab. That's a specific area as well too, working with either children or adults who have low vision or are almost blind. That's another specialty area.

And what happens is you get trained in school as an occupational therapist generally, and then you can specialize in an area if that's what you choose to do, and also specialize in an age group.

Veronica: Okay. Thank you. That's helpful. And before we wrap up, is there any other thing that you think would be really helpful for parents to know that we haven't yet covered?

Dr. Schupak: Yeah. I would say that you may not know that something is definitely wrong with your child, but sometimes things crop up.

And I know as a mother, myself, you have kind of this intuition where you say something's just not right. Something is just not right. It could be something like, you know, I take my child to the park and no matter what I do, he will not go on the swing. He just won't do it. He's afraid of it. You know? That's a red flag.

Another red flag is a child that gets car sick a lot, okay? That's a red flag because it's very likely there's something going on with their vestibular system. A lot of times the same children that don't want to go on a swing, are the same children that get car sick.

So things like that, you know, they are red flags. Children that are afraid to spin or go on rides. Okay. That's something that you should, you know, that if a parent is like, you know, this is not right. Especially if it's a parent that has more than one child. And like my other child never had this problem. Okay.

Because children can't say, you know, how to articulate what's going on with the way that they're feeling, all they know is they don't want to do it. So they avoid it. Any type of avoidance behavior. Avoidance behavior like once they start school and they don't want to do puzzles and they're having lots of trouble with patterns, they can't figure it out. They have meltdowns. Okay.

Those are things that an occupational therapist would pick up on. Even something like taking a piece of paper. And instead of just looking like this, looking like this, close to it, right? When you know your child's vision is okay, the doctor told you, okay, all these things are indicator that something is wrong.

And many times it's just a visual perceptual deficit. The child, the acuity is okay. The child can't make things out on the paper. His brain is not interpreting as it should be. And they feel okay if I bring this closer, maybe I can figure it out, but it doesn't help.

So behaviors like that. If you're, as a parent, have this like little, you know, voice talking to you and saying, you know, something's just not right about this - that's a good time to consult an occupational therapist.

And someone like me, I'll talk to you on the phone, it won't cost you anything, you know, call me up. Do you think this is something that may be should be looked at? You know, if I think it is, I'll tell you, if I don't think it is, I am not going to waste your time. There's no reason to bring anybody in here if it's not a significant issue. But if it sounds like something, you know, maybe I should screen your child. We can either rule this out, or we're going to discover that there's something that needs to be addressed.

But follow that gut instinct. And I would also say any kind of major over response to any type of sensation should definitely be paid attention to because that's your child's nervous system saying I don't have a good balance between being excited and calm, and this is setting me off. Okay. That's very important to address because that really does interfere with a child's ability to just to relax and have fun.

Veronica: That's a good point. Because as a parent, then sometimes I can interpret these behaviors as resistance or something like that, like more of a defiance of a behavior, as opposed to understanding that it's really their sensory system just isn't able to go there.

Dr. Schupak: Right. Exactly. So, you know, if you see those things and you have an inner voice saying something's not right, you know, do yourself a favor and there's many wonderful occupational therapists like myself that will talk to you on the phone, pick up the phone and ask a few questions.

Veronica: Wonderful. So how can we reach you? Or where do you practice out of?

Dr. Schupak: Well, I'm located in Bergenfield, New Jersey, 10 north Washington avenue. And I also have a website it's barpak.info. It's B A R P A K.info, that's my website. And I guess I can give out my phone number (201) 244-0844.

And really, I am open to answering questions. I get parents calling me all the time with questions and it's part of what I do. And I do love hearing from you and I will help you in any way I can.

And if it's something that it doesn't fall under my umbrella, most times I can at least point you in a direction that will be helpful to you, where to where to go for help next.

Veronica: Excellent. Thank you so much for taking the time to talk with us today. Dr. Schupak. 

Dr. Schupak: It's been my pleasure and I'm so glad that you're interested to know more about occupational therapy.

Veronica: Well, it makes a big difference in kids' lives and it certainly has in my son's. So I appreciate you taking the time to share your expertise. 

Dr. Schupak: You're welcome. Thank you.

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