604 Transcript

Dr. Jeremy Sharp (01:19)
Hey everyone, welcome back to the podcast. Got another clinical episode for you today on a hot topic in our field that is pathological demand avoidance or pervasive drive for autonomy. Either way, it’s called PDA. And my guest today has done a lot of thinking and practicing in this realm. Dr. Monica Carrado is a clinical psychologist who specializes in assessment, particularly psychoed assessment.

She has experience working with anxious test takers and specializes in PDA students who might be hesitant or resistant to testing. She makes it her her top priority to give families testing results that accurately reflect their child and not the test or the testing environment. And she feels strongly that the assessment process, report, and feedback sessions are just the start of a relationship rather than the end product. And she feels passionately about working with families to implement the best recommendations possible.

For them. So as I said today, we are talking all about PDA and specifically how PDA shows up in the testing process. So we do a little bit of background, you know, talk about, you know, what is PDA, how do we identify it in clinical practice, the historical

background, things like that. We talk about how to conceptualize PDA and social attunement and you know, re-evaluating what we might be tempted to call manipulative behavior.

We talk about distinct clinical features that differentiate PDA from classical autistic profiles. We talk about, gosh, looking at the process of testing versus the scores and why Monica prefers using a tool like the DOS instead of the WISC in these evaluations. We talk about power dynamics and non-standard administration. We talk about differential diagnosis in terms of PDA versus OCD, ODD.

Parent and teacher rating scales and how those get woven in. And then, of course, we talk about actionable recommendations and school environment modifications and community support networks and things like that. So, as always, lots to take away from this conversation. Monica’s done a lot of deep thinking, I think, on this topic. And there is plenty to apply in your practice. So please enjoy this conversation with Dr. Monica Carrado.

Dr. Jeremy Sharp (03:44)
Monica, hey, welcome to the podcast.

Monica Corrado (03:46)
Thanks, Jeremy. Happy to be here.

Dr. Jeremy Sharp (03:49)
Thanks for being here. Yeah. Fellow Coloradoan. It’s always nice to have somebody sort of local. You know, we’re not technically in the same town, but it’s close enough compared to a lot of my guests.

Monica Corrado (03:57)
Exactly.

Hour fifteen away. That’s nice and

Dr. Jeremy Sharp (04:01)
Yeah, yeah. It’s not bad. Not bad.

thanks for being here. Yeah, we’re talking about pathological demand avoidance or pervasive drive for autonomy. Either way, it’s PDA and this is a hot topic in our field right now, and there’s a lot of discussion around it. So really excited to to dig into this. But I’ll start with the question that I always start with, which is, you know, of all the things you could care about or talk about on a podcast, I suppose in our field, why

This in particular.

Monica Corrado (04:30)
Yeah. So this is important to me for so many reasons. I think the number one reason is, and you can probably empath empathize with this, is when I’m testing a kid, the worst feeling in the world for me is feeling like I’m torturing them, feeling like they are not enjoying what

Dr. Jeremy Sharp (04:47)
Mm.

Monica Corrado (04:48)
we’re doing, feeling like I’m putting them in any sort of emotional or even like physiological pain.

And it often feels that way when we’re working with our PDA kiddos, that what we’re asking them to do is incredibly painful. And I feel passionately about how to minimize that pain for them.

Dr. Jeremy Sharp (05:08)
Yeah, yeah. It can be s it can be really bad. It can be really bad in the room. I think a lot of us have been there, especially if you work with with kids and you get all kinds of behaviors

Monica Corrado (05:17)
Yeah.

Dr. Jeremy Sharp (05:18)
and avoidance and feelings.

Monica Corrado (05:20)
Right. Whether that be meltdowns, you know, running out of the room, going to check in with mom or dad, or just a complete like shutdown in the chair. it’s painful for me to see with children. And I feel passionately that I don’t want this to be a painful experience and I want numbers that stick with them to represent them. and that’s not always possible, but I want to get that as close to re representative as possible.

Which is why I have some techniques.

Dr. Jeremy Sharp (05:50)
Yeah, which we will talk about, which I’m looking forward to. Yes. But I wanna set a little a little background first, I suppose. So

Monica Corrado (05:58)
Yeah.

Dr. Jeremy Sharp (05:59)
you said that, you know, you have a little bit of a a personal connection, I suppose, or you know, you kind of resonate with the PDA profile in in some sense. Can you talk about that with me a little bit?

Monica Corrado (06:11)
Yes. I work for myself, which has been a lifelong dream, because I

Dr. Jeremy Sharp (06:16)
Mm-hmm, mm-hmm.

Monica Corrado (06:18)
agree with the PDAers that I I find it sometimes painful to be kind of under thumb someone’s thumb and give up a some autonomy. and I think

Dr. Jeremy Sharp (06:30)
Mm-hmm.

Monica Corrado (06:30)
I’m definitely one of those kids who, you know, couldn’t wait to be 30 years old.

And couldn’t wait to kind of have control and live my own life. And so their desire to have control and the distress it causes them when they don’t have that control really resonates with me. I completely understand where they’re coming from and remember feeling that way as a child myself. If even though I don’t

Dr. Jeremy Sharp (06:53)
Mm-hmm.

Monica Corrado (06:54)
necessarily identify with the PDA profile in other ways, I feel like that it also

brings out that high anxiety and I can resonate with that.

Dr. Jeremy Sharp (07:06)
Mm-hmm. Mm-hmm. Yeah, I I can appreciate that. it’s always it’s fascinating to me that not everyone feels that way. I have to remind myself of that sometimes, you know, that not everyone wants to be completely independent and like make all the decisions all the time. But that is a trait that’s common, I think, among practice owners.

Monica Corrado (07:23)
Totally, totally. Like I opened my practice the day after I graduated. So I didn’t

Dr. Jeremy Sharp (07:28)
Mm-hmm.

Monica Corrado (07:28)
do a postdoc. I just went right in working for myself. I was so ready to and as soon as

Dr. Jeremy Sharp (07:31)
You’re ready. You’re ready.

Monica Corrado (07:34)
I started grad school, I was like, that’s what I want to do. so

Dr. Jeremy Sharp (07:37)
Uh-huh. Yeah. I always

joke like coming out of my postdoc that the reason I started my practice was because I didn’t want to attend another meeting that I was not running. And that seems to fit here as well, you know.

Monica Corrado (07:50)
Absolutely.

Absolutely. That resonates with me.

Dr. Jeremy Sharp (07:53)
Mm-hmm.

Monica Corrado (07:54)
I I love feeling that little bit of control. So any way that I can help

Dr. Jeremy Sharp (07:58)
Mm.

Monica Corrado (07:59)
kids get that because I I’ve similarly felt whether being a student or a coworker or a child, I was just so ready to have a little bit more of independence and agency.

Dr. Jeremy Sharp (08:11)
Mm-hmm. Mm-hmm. So I would imagine, I mean, that gives you a certain amount of empathy for these kids who are who are struggling during our testing and otherwise.

Monica Corrado (08:20)
Absolutely. I feel so drawn to people with ASD in general and this profile in particular.

Dr. Jeremy Sharp (08:25)
Hm.

Mm-hmm. Yeah. So tell me give me a little more background on just the professional exposure. like how did you, you know, come into contact with the concept of PDA? yeah, how did that strike you at the time?

Monica Corrado (08:39)
Yeah. I was testing a kiddo several years ago who I just could not understand. it it he didn’t fit what I would typically associate with autism in terms of great eye contact, highly expressive, emotionally, highly express facially gesturing well.

All all those things and highly imaginative and creative. So all those things that we look for when we’re doing an ADOS, you know, we even rate their creativity and imaginativity. He hadn’t speeds.

Dr. Jeremy Sharp (09:15)
Right.

Monica Corrado (09:15)
And so I was thinking, man, this kid would score very low on an ADOS. What could possibly be going on? I came across work by Neil Christensen who works in the therapeutic and wilderness space.

and he introduced me to this PDA profile. And it just it seemed, and this is apparently a common experience. As when I was hearing him describe PDA, I I thought, this is this child. Like I can’t believe you’re describing him so succinctly. which research has proven about PDA is that it does hang together nicely, and that parents say, this is my kid when you read them the PDA

Dr. Jeremy Sharp (09:53)
Mm-hmm.

Monica Corrado (09:54)
profile, something that they feel like is so unique, actually.

is very generalizable.

Dr. Jeremy Sharp (10:00)
Mm. Yeah, yeah. Can you think I mean I know you sent me an article that details a lot of this. you know, this info from yeah, f is it written by Christensen or was it a tag team or someone else? Yeah.

Monica Corrado (10:14)
He cited it. Yes, he cited it and

it’s by E. Newsen, I think it’s Elizabeth. and it’s coming out of the UK and I think they’re really at the forefront with the PDA profile and research around it.

Dr. Jeremy Sharp (10:28)
Right, right, right. Yeah, yeah. So I know, you know, we’ve I did an episode, I don’t know, a couple years ago now, probably with Donna Henderson on PDA and we did some definitions and so forth. But I would love to hear from you, like how you are conceptualizing and like just reflecting the research as you understand it as far as what PDA is.

Monica Corrado (10:47)
Yeah,

absolutely. and I approached you about doing this podcast as sh sh Donna gave so much incredible information and really laid the foundation. so really appreciated that podcast and her work. So

Dr. Jeremy Sharp (10:59)
Sure. Yeah.

Monica Corrado (11:01)
how I understand it is

Kiddos with PDA are what you would this is a word that sounds really pathologizing and that I don’t like, but it’s unavoidable when we talk about PDA and that it feels like there’s some social manipulation. and why that feels really different from ASD is because a lot of times with ASD, they don’t know what they want what the person’s looking for them to say.

or looking for them to do. Does that make sense? They’re not reading that. whereas with PDA, they’re really in tune, which requires a certain level of emotional attunement to what the person is looking for them to say or do and how

to manipulate the situation so they don’t have to do it. so really different there. And again, I don’t like that word manipulative. And yet in the research it feels kind of unavoidable.

And manipulative

Dr. Jeremy Sharp (11:57)
Mm-hmm.

Monica Corrado (11:57)
has this connotation of of meanness and and underlying intentionality, which I

Dr. Jeremy Sharp (12:03)
Mm-hmm.

Monica Corrado (12:04)
don’t think it’s self preservation, right? and so it

Dr. Jeremy Sharp (12:06)
Mm-hmm, mm-hmm.

Monica Corrado (12:07)
doesn’t have it’s that’s the intention rather than any sort of cruelty.

Dr. Jeremy Sharp (12:13)
Yeah,

yeah, go ahead.

Monica Corrado (12:15)
I I also think a lot of times people will say it’s like he’s like a little professor or she’s like a young adult, is these kids who you think that get along really well with adults, and who are more oftentimes more drawn to adults than kids their own age. I think that’s another quality that I think of, especially with PDA, is is this kind of like miniature professor quality that I think a lot of them have.

Dr. Jeremy Sharp (12:42)
Mm-hmm. What is it that I I cause in that description there’s a certain amount of maturity I think that I assign to that to that description. and at the same time, kids with PDA can be challenging to interact with at times. And

Monica Corrado (12:58)
Mm-hmm.

Dr. Jeremy Sharp (12:59)
you know, it almost seems like counterintuitive too. Like they’re they’re they’re presenting as kind of immature.

some ways. And so yeah, how do you sort of like make sense of that or reconcile that?

Monica Corrado (13:09)
Totally. I think you’re spot on there that I think like I said, I’ve always been drawn to the ASD community. I appreciate when people are very passionate. So whenever I’m assessing, I find myself getting sucked into fixed interests unintentionally because I find it really interesting, no matter what the fixed interest is. It can be a ceiling finger

Dr. Jeremy Sharp (13:27)
Fascinating, yeah. Right.

Monica Corrado (13:30)
or an elevator. And I I really w actually want to learn more, which is why I’m in the

Dr. Jeremy Sharp (13:34)
Uh-huh, uh-huh.

Monica Corrado (13:34)
right field, right? Being curious about anything.

but so I think that this kind of like surface social social ability or maturity can really come up around fixed interests and then kind of

Dr. Jeremy Sharp (13:46)
Mm-hmm.

Monica Corrado (13:46)
disintegrate into this more emotional dysregulation and what we would consider like immaturity when we’re away from the fixed interest or passion areas.

Dr. Jeremy Sharp (13:55)
Mm. Mm. Mm-hmm. That’s a good way to put it. Yeah, it’s funny to hear you say that. I feel like I get into the same dynamic with wanting to know more about people’s interests, you know, and totally get off track. I’m like, Why has this ADOS taken two hours? You know, it’s because I’ve asked fifty seven questions about medieval sword making, you know, or whatever, you know. ‘Cause I’m just so interested. Yeah. Yeah.

Monica Corrado (14:14)
Right. Exactly. That’s why

sometimes I have a hard time discerning because I’m like, well, they talked a lot about this specific fandom

and that was interesting to me. So how much did I play into it? but then this

Dr. Jeremy Sharp (14:27)
Yeah. Yeah. Yeah. Exactly.

Monica Corrado (14:31)
I do see when we’re not on that topic, the wheels falling off a little bit emotionally

Dr. Jeremy Sharp (14:36)
Mm-hmm.

Monica Corrado (14:37)
and cognitively. yeah.

Dr. Jeremy Sharp (14:39)
Yeah. Yeah.

So let me ask you, I mean, ask everybody this question when we get onto this topic, but are you where do how do you stand where do you stand on the, you know, PDA is a variant of autism question, or you know, PDA is a version, or PDA is specific to autism, or you know, it’s more of a transdiagnostic kind of you know, set of traits. How do you think about that?

Monica Corrado (15:03)
I have to say I loved Donna’s answer here and and really agreed

Dr. Jeremy Sharp (15:06)
Mm.

Monica Corrado (15:06)
with her that I do find it to be part of autism. I don’t think it is outside of an A S D diagnosis or neurodivergent diagnosis, but especially A S D I I I think

If people are are tempted to give a PDA diagnosis and maybe they see ADHD and they have features of PDA, my guess is that it’s an ASD profile.

Dr. Jeremy Sharp (15:33)
Mm, mm-hmm.

Monica Corrado (15:34)
I really do think that it is r tied inextricably to ASD. The thing that’s interesting though is that I they’re they’re different profiles, and if you treated them the same,

you would be very much doing someone a disservice, right? if you were to send a PDA kiddo maybe into an ABA center, it depends on the kid completely, or a very a very structured predictable environment, that isn’t going to work for them. Although you would think for an ASD kiddo, that’s exactly where they would feel best.

so I think there’s a really important distinction between these two and it’s really important for us to identify PDA so that we can accurately know what we’re working with and therefore treat it.

Dr. Jeremy Sharp (16:18)
Yes.

Yes. Yeah, that’s a great segue. So yeah, how would you differentiate differentiate them? Yeah.

Monica Corrado (16:26)
When testing or in general about how different they are?

Dr. Jeremy Sharp (16:29)
Let’s start in general. Yeah, like how do you see the PDA profile as as distinct from classic quote unquote autism? even though spectrum, continuum, all those things. But

Monica Corrado (16:40)
Right.

Dr. Jeremy Sharp (16:40)
genera we’re making generalizations here, of course, but what are kind of big picture things that you’d say differentiate PDA kids from autistic kids?

Monica Corrado (16:49)
I definitely think the surface social ability where you can

have, again, if we’re looking at an ADOS, the quality of rapport, if they’re talking about something that interests them, can be fairly high. and and if they’re talking to adults even higher, right? Than they would with peers. So I think this

Dr. Jeremy Sharp (17:05)
Mm. Mm-hmm.

Monica Corrado (17:07)
social ability where it’s actually it an ADOS has good flow to it, you know, and our conversations have good flow that may be different from what we would see with ASD.

And then I also think the comfortability and role play and pretending would be much, much higher with our PDA kiddos, whereas you would, you know, and and we’re forgiving an ADOS or you know, an ADIR, we’re asking parents, what is it like? Do how are they with imaginative play? Oftentimes our PDA parents are saying they adore imaginative play. It’s hard to get them away from imaginative play. They’re highly creative, they love the worlds that they’re living in, right? And they could be there

Dr. Jeremy Sharp (17:44)
Mm.

Monica Corrado (17:44)
all day.

and are highly imaginative. That feels different from an ASD what we would like typically think of as ASD. So I think those are

Dr. Jeremy Sharp (17:53)
Mm-hmm.

Monica Corrado (17:54)
differences that

very much resonate with me.

Dr. Jeremy Sharp (18:00)
Yeah, yeah, yeah, I hear you. And that may be a nice bridge into the actual testing process and what shows up differently kind of in the room, you know, as we’re as we’re working with these kids. So

Monica Corrado (18:13)
Yeah.

Dr. Jeremy Sharp (18:13)
yeah. So one thing I mean, you you talked about this in our, you know, as we were sharing information, you know, before the interview, but I mean it sounds like there you pay a lot of attention to

sort of the process of testing versus the outcome, I guess, like the how versus the what, or you know, the process versus the score, you know, depending how you want to frame this.

Monica Corrado (18:37)
Absolutely.

Dr. Jeremy Sharp (18:38)
Yeah. Tell me about that a little bit. Like what’s what’s happening in the room that we’re paying attention to?

Monica Corrado (18:43)
Yeah, it’s so interesting. And I I wonder if other psychologists are like this. Of course, they are. And I was taught by other psychologists, but to me the number means one thing and how we got there means everything. And unfortunately,

Dr. Jeremy Sharp (18:54)
Yeah.

Monica Corrado (18:54)
we do have a heavy emphasis on those numbers. And yet the most interesting, the most telling information is everything to me is a projective measure, essentially.

Even and I’m one of those people who loves a TAT and aurorshock, but to me, even a waste, a whisk, a whipsy is a projective measure. And I’m seeing how you’re doing and gathering information about you and your processes. It’s the number is just such a small part of it. and so I think and I think that sometimes us psychologists are not great at looking at the bigger picture because we really want to stick to standardized testing. And and I get that and I’m with you and I agree that there should be certain standards and

I don’t want to lose the larger picture about what we’re looking for. Does it really matter if I’m trying to think? This isn’t necessarily a well thought out example, but if a kid says, Okay, I could define a glove, it’s something, something that protects your hands.

It’s a place, the kitchen where you go and cook food. If they can generally know what it is, why wouldn’t we give them the point, right? Just basically my my point being sometimes I feel like we lose the plot a little bit about what we’re asking kids to do.

And so I think that with a PDA profile kiddo, we are going to have to do things pretty differently if we don’t want this to be torturous for them. and so we have to have flexibility while remembering the larger picture.

Dr. Jeremy Sharp (20:17)
Mm. Yeah.

Monica Corrado (20:18)
So I think how I start and I told you about this is that I’ve had a lot of trouble with love the Wesler measure measures, and I’ve had a lot of trouble with our Wesler measures and PDA kiddos. A core 10 feels awful to my PDA kiddos. Jumping into blocks feels awful.

Awful to my PDA kiddos. Transitioning from blocks to similarities that have nothing to do with each other feels awful. Right.

Dr. Jeremy Sharp (20:50)
Right, right. Why do

Monica Corrado (20:52)
And

Dr. Jeremy Sharp (20:52)
you think that’s accentuated with PDA kids compared to other kids?

Monica Corrado (20:58)
I think that the whisk has gotten and all these standardized measures has gotten to a place where they’re administered fairly quickly. So they’ve kind of just I I’ll say that a lot of my ASD kids have trouble with Weshlers too, but especially PDA folks. They’ve just started to feel a little in control and that they’ve got their bearings and then we’re it’s ripped away and we’re on to the next. Just when

Dr. Jeremy Sharp (21:20)
Mm.

Monica Corrado (21:20)
they’ve kind of mastered it, right?

Dr. Jeremy Sharp (21:23)
Mm-hmm.

Monica Corrado (21:24)
which makes me

and I see a lot of distress that oftentimes by the time we get to matrix reasoning, we’re having a a a breakdown. Like that’s usually where it occurs. where you’re asking me to do three completely different things that asks for a completely different part of my brain. How can I get my bearings? This is yeah, torturous and and

Dr. Jeremy Sharp (21:45)
Mm-hmm.

Monica Corrado (21:47)
vulnerable feeling.

Dr. Jeremy Sharp (21:49)
Yeah, that makes sense. If you zoom out and think about it just in terms of well, control and being able to, you know, have autonomy in your environment. There’s it’s really kind of impossible to predict what testing is gonna be like and then if you’re switching tasks every five to ten minutes, it’s pretty disconcerting.

Monica Corrado (22:07)
Right, exactly. And so I found a lot of success in the DOS. I was definitely taught that and I’m I’m sure everyone is you should know more than one intelligence measure just because you know you never know when there’s gonna be an invalid test.

And so for me that w the one I chose, I know a lot of people like Stanford Vanet, I really like the DOS. and I have found that it

especially resonates with my PDA folks in a way that

Dr. Jeremy Sharp (22:33)
Mm-hmm.

Monica Corrado (22:33)
I don’t think I could ever, ever go back because I’ve ha seen such more accurate reflections of their cognition.

Dr. Jeremy Sharp (22:42)
Gotcha. What

is it about the DOS that you like specifically for PDA kits? I’m not

Monica Corrado (22:46)
Yes.

Dr. Jeremy Sharp (22:47)
I’ve never administered the DOS, full disclosure, so I am not I don’t have like a great working knowledge of it. So you can explain as much as you want to.

Monica Corrado (22:55)
Totally well, luckily it is very similar to the WISC with some key differences. So you’ll be very you’ll be oriented quickly. I’m sure you could truly pick up and give one because there there is enough similarities. I think the

Dr. Jeremy Sharp (23:08)
Thanks.

Monica Corrado (23:08)
thing that I like about it is that okay, this is definitely my favorite part is that processing speed and working memory, those two composites are considered diagnostic in the DOS.

Dr. Jeremy Sharp (23:20)
Mm-hmm.

Monica Corrado (23:20)
so they are not considered a part of our conceptual ability, which we have on the Weshler, right? The CPI and the GAI are different, but then they’re average into the FSAQ. And to me, processing speed and working memory are so different with what is traditionally associated with IQ, with what kind of our clients have in mind when they come for IQ testing, right? and so

To me, I I really prefer that them to be this diagnostic subtest rather than averaged into a global composite. So I really like that if you were to if you’re thinking about diagnosing anything with executive functioning, that’s when you would add working memory and processing speed in the DOS.

Dr. Jeremy Sharp (24:03)
Gotcha. So

Monica Corrado (24:05)
And

Dr. Jeremy Sharp (24:05)
you that gives you the choice whether you administer those subtests or not. So it’s shorter. Mm-hmm.

Monica Corrado (24:09)
Exactly. It’s shorter.

It is six subtest. I I would say it

Dr. Jeremy Sharp (24:13)
Mm-hmm.

Monica Corrado (24:13)
for me it still takes an hour. It’s six subtest. And it’s very similar to that there’s equivalents to verbal comprehension, fluid reasoning, and visual spatial. So there’s those three equivalents. and then average into the conceptual score. And then so it but it still takes about an hour. Maybe I’m doing that a little slower.

But it feels to me that there’s many more opportunities to learn and build. Whereas on the Weshlers, teaching opportunities I often feel like are sparse and not necessarily kind of scattered throughout a test. So we get we we get through the sample items, we get through the teaching opportunities, and then they better understand it or else, right? Whereas with the DOS, then

we move on to additional teaching opportunities. And instead of two teaching opportunities, there’s six. And so there’s this ability,

to kind of correct. And I think that my PDA kiddos really appreciate the learning opportunities before they’re kind of set off to build confidence and control. Feelings of autonomy. Yeah. Feelings of

Dr. Jeremy Sharp (25:17)
Mm-hmm. Mm-hmm. That fits.

Monica Corrado (25:21)
yeah, mastery, I think, which is really what

They’re soft I’m looking for.

Dr. Jeremy Sharp (25:26)
Right, right. Yeah, that’s another variation of control, I suppose. Like f yeah, mastery, of course. Of course. Like

Monica Corrado (25:32)
Exactly.

Dr. Jeremy Sharp (25:33)
feeling confident, knowing what to expect. I can do this. Yeah.

Monica Corrado (25:36)
Exactly, exactly. So the DOS I think does that so much better. It it just feels more tailored to that population in terms of and and of course plenty of kids don’t need that that sense of mastery, but a lot of our kids do are more anxious test tailers.

Dr. Jeremy Sharp (25:52)
Yeah, yeah, certainly. Certainly. Let me let me go back to that first question that that I raised as we transition into the clinical side of things. As far as like looking at the process versus the outcome, you know, are there other things in the room that you are looking for, noticing, you know, when you when you talk about even using an IQ test as a projective, you know, like what what are you looking for?

And noticing specifically with these kids.

Monica Corrado (26:23)
Yeah, great question. I think I am noticing how they do on transitions. I think I’m noticing

Dr. Jeremy Sharp (26:30)
Mm-hmm.

Monica Corrado (26:31)
how they’re doing on feelings novelty versus mastery, right? How are they doing on something that’s brand new versus something they feel they’re very good at?

Dr. Jeremy Sharp (26:40)
Mm-hmm.

Monica Corrado (26:41)
How are they doing in terms of resilience? If they get something wrong, are they able to get back?

How are they doing if I am to offer a teaching opportunity and elicit what may be considered as a correction. Wow, that could be a huge threat to to control or autonomy, right? If I’m offering a correction. I don’t know if you have this a lot, but I hear my my PDA kids or ASD kids to correct my pronunciation oftentimes. Like I will have sou thought it was pronounced a certain this word was pronounced a certain way.

What it was a word on the why in the comprehension. I thought it was pronounced this way the whole time and then I’ll get corrected. and i I do think it is because of the sense of control to say, okay, I I can I know what that word is better than the examiner, you know. And so I I think those

Dr. Jeremy Sharp (27:31)
Mm-hmm.

Monica Corrado (27:31)
are things that I’m looking for in terms of how they respond to that or or if they are correcting me.

Dr. Jeremy Sharp (27:38)
Mm. Mm-hmm. Yeah, that reminds me of something that Donna said during our interview, you know, where she talked about how these kids will sort of like subtly try to assert control in the room with us, right? And

Monica Corrado (27:51)
Right.

Dr. Jeremy Sharp (27:52)
that’s like a great example of that. like I’ll tell the examiner how to pronounce this the right way. Sure. Yeah.

Monica Corrado (27:57)
Right, right.

And my argument is why not give them that control? Why are we sticking so much to the standardized protocol when we’re gonna get a more emotionally regulated kid? And as we know, emotionally regulated kids do their best performing if

Dr. Jeremy Sharp (28:15)
Mm-hmm.

Monica Corrado (28:15)
we make these changes, right?

Dr. Jeremy Sharp (28:18)
Totally.

Monica Corrado (28:19)
Such as I I had a kiddo again on the Wyatt, who really did not like handwriting. We know this is common for ASD kiddos to have maybe some fine motor troubles or a little bit more difficulty with ex right expressive language and writing in general. I let him use my computer. Am I supposed to? N no. D are we losing sight if, you know, I wasn’t able to? Yes, he wasn’t going to participate. Would I rather have an invalid

Dr. Jeremy Sharp (28:47)
Mm.

Monica Corrado (28:48)
You know?

achievement measure or or make some concessions and keep keep him feeling like he has the power. And of course I’m more than happy to succeed to secede power. I know that no matter what power I give them, I still have it, right? They’re in my testing room.

Dr. Jeremy Sharp (29:04)
Mm-hmm. You know, that’s a really simple statement, but I think worth highlighting that no matter what happens, we do have control over the process as clinicians. You know, like we have a lot of leeway to cede some power to the kiddos.

Monica Corrado (29:19)
Exactly. Exactly. Exactly.

So to see them some power. I with my PDA kids, I do think that another thing that kind of differentiates although PDA from ASD, although under both profiles for sure, is this kind of inappropriate questions and statements, right? We associate that with ASD and and I think I see it a little bit more in the PDA profile, this kind of overtness with inappropriate questions or statements.

I’ve had one student who asked me, you know, are I don’t think adults are supposed to get acne. Why do you have acne? Which is

Dr. Jeremy Sharp (29:52)
Ha ha.

Monica Corrado (29:53)
also I think a great way to gain control and kind of put me in my place. But also I it didn’t offend me, right? it’s these things that I think maybe would feel offensive are more so a way for them to gain some control. And I’m happy to give it to them. the kid who used my

laptop would sit was said, well, your laptop’s really dirty. You know, he wanted to talk about, wow, you’re really not a a clean person. And I’m

Dr. Jeremy Sharp (30:17)
goodness.

Monica Corrado (30:18)
right, but I’m happy for him to to make fun of me if it makes him feel more in control. What what is it to me, right? I can you know what my laptop probably could be a little bit cleaner. I’m in guilty of writing reports and having my lunch. So happy to admit that. Yes.

Dr. Jeremy Sharp (30:33)
Aren’t we all? Yes. Now I’m looking

at my laptop.

Monica Corrado (30:37)
Exactly. So we have so many of those

Dr. Jeremy Sharp (30:37)
dirty as my laptop here. Yeah. Yeah.

Monica Corrado (30:41)
instances where whether it being just letting them tease me a little bit or go ahead and ask that inappropriate question that gives them a a little bit more of that feeling of I have some autonomy here. Yeah.

Dr. Jeremy Sharp (30:55)
Mm-hmm. Yeah.

While we’re talking about this whole concept of being looser and maybe you know, non standard administration, that kind of thing, do you ever get pushback from parents or other professionals in terms of the results? Like if they’re kind of like really dialed into the concrete, like the numbers and you’re kind of talking about the process, does that ever create friction?

Monica Corrado (33:43)
That’s a good question. And I’m wondering if I’ll get pushback or comments from this podcast. just because I I don’t know how much I talk about this with other professionals. although definitely the people who who have supervised me. in terms of from parents, i it depends. I think sometimes parents can be really tied to the numbers.

And so I don’t know if I get pushback or just have to add some additional context about — I think that, especially with kids, especially with neurodivergent kids, what’s so misunderstood is that there are so many factors that go into cognitive testing. I try to isolate all the variables outside of testing. I mean we’re in a windowless room. We’re we we have no distractions.

Dr. Jeremy Sharp (34:28)
Mm.

Monica Corrado (34:29)
It’s just you and I.

And yet there are

Dr. Jeremy Sharp (34:31)
Yes.

Monica Corrado (34:31)
so many external variables. How could I possibly isolate one? How you know? How could I possibly say this this is representative of your kid when they could have, you know, had a runny nose. There’s just too many, you know?

Dr. Jeremy Sharp (34:46)
It’s a great point. Yeah. I think we like

Monica Corrado (34:47)
Okay.

Dr. Jeremy Sharp (34:48)
to think the numbers are a lot more predictive and concrete, but there’s

Monica Corrado (34:54)
Wait.

Dr. Jeremy Sharp (34:54)
so many factors that influence performance.

Monica Corrado (34:56)
Right. So I think I definitely make a big deal about that with families who feel a little bit more tied to what does this number mean for and I get it, like especially in a lot of time times

I’m talking about working with independent schools, but it’s especially especially when there’s cutoff scores, right? and cutoff scores are a reality. You you have to get a certain score in order to get to get Medicaid, right? You just do.

and you have to get an assert score in order to meet GT standards for Colorado. You just do. so I can understand

Dr. Jeremy Sharp (35:25)
Yes.

Monica Corrado (35:25)
why people are tied to that.

Dr. Jeremy Sharp (35:28)
Yeah, yeah, there’s a place for both, of course. Yes.

Monica Corrado (35:30)
Yeah. Absolutely. So

yes, I don’t think I’ve had a ton of pushback, but I’m curious to hear from other professionals who especially from the ADOS community where, you know, we we go to these

Dr. Jeremy Sharp (35:40)
Mm-hmm.

Monica Corrado (35:41)
like the gains modules put out by

Dr. Jeremy Sharp (35:43)
Mm-hmm.

Monica Corrado (35:44)
Cornell who who are really focused on standard scoring and standard administration and and I don’t know how much that has I I think there I’m having a little

I w I want us to push back on that a little bit for our PDA folks.

Dr. Jeremy Sharp (35:56)
Yeah. Yeah. It’s really tricky. I don’t I don’t have the answer necessarily, but I can join you, I think, in being okay with a non standard administration more often than not, probably. In some form or fashion. I mean, there’s there’s degrees, of course, but yeah. I mean, we d I was telling you before we started to record, I just came out of an ADOS with one of our interns and certainly did not

ad you know, go like all the way down the line reading every question or doing every activity exactly like they describe it. So there’s I th I feel like we gotta have room to to flex a little bit. But it is a slippery slope too. So I’m kind of saying both things at the same time.

Monica Corrado (36:34)
Totally, I completely

agree. It’s but with my PDA kids, with all my autism kids, have you ever gotten teased or bullied? Man, does that one hurt you every time? Because it hurts me. is there anything you

Dr. Jeremy Sharp (36:44)
Yeah. Yeah.

Monica Corrado (36:45)
could do differently to change that? God, that’s a painful one. And our

Dr. Jeremy Sharp (36:49)
Mm-hmm.

Monica Corrado (36:50)
PDA kiddos are gonna have a hard time there and the likelihood that they have had social troubles because of their avoidance of demands, whether that be social or

academic, you know, is really high. And that’s that that’s a hard one for me.

Dr. Jeremy Sharp (37:06)
Yeah, yeah.

Monica Corrado (37:08)
and when we look at the scoring on an ADOS, a PDA kid isn’t going to have high scores. We’re gonna rate the conversations as solid. Reporting of events, it’s gonna be perfect nine times out of ten, right?

you know, there’s not necessarily a unusual eye contact. So how how are we supposed to get a valid number when it doesn’t necessarily apply to this population in the same way?

Dr. Jeremy Sharp (37:37)
Yeah, I mean add us to the to the list of requested improvements for the ADOS or you know, differences.

Monica Corrado (37:43)
Right. Exactly.

Dr. Jeremy Sharp (37:45)
I know.

I know. Yeah, yeah, and it just it’s another reminder of how we have to stay on our toes clinically and be aware of these differences that may exist in people’s performance, kids’ performance. Yeah.

Monica Corrado (37:57)
Right. Ex and

the ADOS is, you know, projective and and the idea of we does it matter, you know, my my kid ha has a special interest in cars. Does it matter if I’m asking him to show me how to brush his teeth or if I’m asking him to drive a car? Is he gonna brush his teeth? No. Can he mime driving a car and gesture to that? Yes. Is that maybe standard administration? Not necessarily, but let’s not lose sight of what we’re looking for, which is the gesture.

You know? And so

Dr. Jeremy Sharp (38:26)
Right, right.

Monica Corrado (38:27)
how can we move that into a fixed interest and get a better sense of that?

Dr. Jeremy Sharp (38:32)
Right, right. Yes. I like that point. Do you have a sense I don’t know if you have a a rubric of sorts or even a just a way of thinking about balancing standardization with the need to grant these kids a little more autonomy? I mean, like, how far are you willing to go, I suppose, in sort of preserving the kids good

good vibes, you know, if it comes at the the expense of standardization.

Monica Corrado (38:59)
you know what? That’s a great question. and I don’t know if I have firmly defined that boundary, but I do as I mentioned, the refusal, the crying, the meltdowns, the eloping, to mean it’s not worth

Dr. Jeremy Sharp (39:14)
Yeah.

Monica Corrado (39:15)
it, you know. Like I I I it’s hard for me to think that anything’s worth it. so as long as I feel like I have enough information.

great, you know, and we can be creative about

Dr. Jeremy Sharp (39:24)
Mm-hmm.

Monica Corrado (39:25)
the ways that we use to get that information.

Dr. Jeremy Sharp (39:28)
Mm-hmm, mm-hmm. Sure, sure.

Monica Corrado (39:29)
Especially on something like

the Eatos, which is much more qualitative.

Dr. Jeremy Sharp (39:33)
Certainly.

Monica Corrado (39:34)
and and sometimes I mean it’s true that I’m having scores that don’t represent kiddos on on, you know, they they hate writing, they don’t wanna do the writing. I I can coerce you know, and incentivize a little bit and sometimes sometimes it’s not worth an elopement and that’s okay.

Dr. Jeremy Sharp (39:52)
Yeah, yeah, absolutely. I isn’t that the worst the elopement is the worst. gosh, we had a kid, I mean, a month ago, maybe no, two months ago, run out of our office. Our our office is on the second floor of a mid size office building, right? And this kid runs out of our office and somehow gets to the street, like to an intersection, you know, and his mom is like running after him. anyway. I digress.

Monica Corrado (40:15)
Right. Right.

God forbid, I I have spent plenty of time in ABA centers and and special ASD centers that’s designated by DPS and very afraid of safety’s paramount to me and and emotional safety is paramount to me too. And I think so let’s let’s prioritize that in terms of assessments and that can mean a different administration than you were taught.

Dr. Jeremy Sharp (40:40)
Absolutely. Do you have other I don’t know if you call tips necessarily, but other strategies, other things that you might do in the room to accommodate these kids a little bit and help them feel more comfortable?

Monica Corrado (40:53)
Yeah. Any way that you can secede control, whether that be an and these are tips recommended to me by other professionals, whether that be okay, you wanna sit in this seat or you want the room to look s slightly different. You would like to be on the floor, you would like to have a fidget toy or a weighted blanket. Any of these environmental changes where they can choose what the environment looks like to them and what’s gonna make them most comfortable again is gonna give

Dr. Jeremy Sharp (41:17)
Mm-hmm.

Monica Corrado (41:18)
them these pieces of control back.

I will say the other tip is it I don’t love starting with an IQ test. I’d much rather start with an ADOS and have us play together. I’d rather we play and and talk and mainly play. and

Dr. Jeremy Sharp (41:33)
Mm-hmm.

Monica Corrado (41:33)
then when you

know me and you’ve you’re familiar with my office and you’ve you’ve familiar with me, then we can do an IQ test. Or we can do testing in your

speech therapist office or I have a hard time doing testing in schools just because it does sometimes feel dysregulating to kiddos, but in terms of other professional offices they’re familiar with, I think that really helps them feel more in control.

Dr. Jeremy Sharp (41:58)
Yes.

Sure.

Monica Corrado (42:01)
inter I’m I’m I think we all do this, but especially with my PDA like have our incentive what are we working towards, you know, this whole are we working towards a video game at the end of this? How are we measuring that, you know, and saying encouraging about what they’re earning again is giving them control over this process.

Dr. Jeremy Sharp (42:19)
Yeah, yeah, absolutely. Yeah. Sometimes I will also, you know, pretty classic idea, like just give kids a choice of what we do, you know, like do you wanna do reading or math now? Do you wanna do you know, a thing on the computer answer questions about yourself? Or do you wanna, you know, give me some word

Monica Corrado (42:37)
Exactly, exactly.

Dr. Jeremy Sharp (42:38)
definition, whatever.

Monica Corrado (42:40)
The choice is paramount. And I also agree that what was I gonna say? Yeah, that choice choice is so, so important to these kiddos, and everything we do, so I think that’s a really good tip.

Dr. Jeremy Sharp (42:57)
Yeah. Yeah. Yeah. I appreciate these examples. It’s always nice to have some concrete ideas, you know, for how to work with these kiddos in the room.

Monica Corrado (43:05)
Yeah.

Dr. Jeremy Sharp (43:05)
I want to go back to the diagnostic part, maybe. And

Monica Corrado (43:10)
Yeah.

Dr. Jeremy Sharp (43:11)
you know, you talked about PDA being being a variant of autism, right? And I don’t know, that might be a place where we we diverge a bit. I don’t know that I’m convinced that it’s

solely, you know, a variant of autism. But that’s not what I’m I want to discuss necessarily. I’m more curious about, you know, the it gets mixed up, I think, a lot with like ODD and sometimes conduct disorder, you know, depending how significant these these

behaviors are. And I would love to hear how you sort of separate those or you know, think about PDA in the context of like an ODD consideration.

Monica Corrado (43:48)
Mm-hmm. Absolutely. I think as many people agree, I don’t believe in ODD or C D. I believe those are symptoms rather than the root cause. I’m looking for the root cause. and

Dr. Jeremy Sharp (43:59)
Mm.

Monica Corrado (43:59)
so I am looking for the the roots, those are the leaves of the trees. and so it’s it’s I believe in them as symptoms, I don’t believe in them as diagnoses. I that being said, I so not only am I looking to

to change kind of the standardized testing in the battery when I’m working with a PDA kiddo, the self-report and informant reports forms look very different from a PDA kiddo, right? Versus what we would typically associate with ASD. And going to what you said with conduct disorder and oppositional defiant disorder, when we’re looking at something like the Connors, which looks for oppositional defiant disorder and conduct disorder, oftentimes it’s gonna be

really, really high for our PDA kids. And that’s a really good indicator that something maybe in a that this could be autism, right? when we see that those are, you know, there’s maybe anxiety and some executive dysfunction and these really high CD and ODD scales. I think that’s a really good indicator that there could be something with PDA.

going off with that, same with the vinyland, right? I always include a maladaptive behaviors domain. if there’s gonna if they’re high in maladaptive behaviors, but maybe the vinyl, I and I can go on a tangent on this or not, looks completely different for a PDA kid versus a a kid who we would more traditionally think of as on the spectrum, which unfortunately is a big disservice because vinyls are what

a lot of, you know, Medicaid and and disability determinants are based

Dr. Jeremy Sharp (45:28)
Mm.

Yeah. What differences do you see? That is intriguing.

Monica Corrado (45:32)
I think that oftentimes communication is really strong for my PDA kids, right? I had a PDA who was working on his second novel, right? And we’re looking at written domains. They’re they’re excelling in those domains. So communication being really high. Oftentimes daily living skills are sign are high as well because of that hyperindependence aspect of yes, they have no trouble dressing themselves and

hygiene or paying for things. They want that independence, right?

Dr. Jeremy Sharp (46:04)
Yes.

Monica Corrado (46:05)
And then when we look at social skills, the the third domain on a violent, making friends oftentimes with our PDAers, that’s okay. Again, this social, the surface level sociability, making friends, we’re not having trouble with. When we look at maintenance, that’s a harder time.

But especially for some of these younger kiddos, what we’re looking at you know, they they’re making new friends every year. And so their parents are writing, no, they are, you know, sociable. They are approaching kids on the playground. They’re responding well to approaches from others. that goes into the ADIR, the autism diagnostic interview as well.

Dr. Jeremy Sharp (46:41)
Right, right. While we’re on this ass on the topic of assessment, what

are are there other questionnaires, first of all, that that you tend to rely on or maybe see differences in compared to quote unquote classically autistic kids that we could talk about?

Monica Corrado (46:58)
Yeah, absolutely.

Yeah. Absolutely. I mean, the ADIR I love. I think it’s a great, great assessment. And these things that we’re looking at in terms of early childhood social ability and early childhood

like imagination imaginative play are not going to be very high and that’s gonna be a huge part of the ADIR right that it comes up

Dr. Jeremy Sharp (47:25)
Mm-hmm.

Monica Corrado (47:26)
in both communication and social reciprocation one thing that so that I think is a big one that you we need to modify. and that’s not a rulout as we would suggest would when we think about ASD versus PDA. The other one

That I think is different. I mean, I would say I I always will use a basque, right? Just general social emotional functioning. I consider that my MMPI for little people, and so I appreciate that. And

Dr. Jeremy Sharp (47:52)
Uhhuh. That’s yeah, same.

Monica Corrado (47:54)
right. Just kind of general functioning. and then our we’ll always do executive functioning as well, right?

I would say, like I said on the Connors, that looks different. same even on a brief or something, what I would see more is this high dysregulation. And and sometimes what I associate with ASD, right? We think of as a spectrum for from hypo to hyper, and we would think I oftentimes I feel like my PDA kids are more on the hyper end, right? So they’re hyper expressive, right?

so maybe sometimes what we would think of in ASD as kind of low expressionality, there’s gonna be higher expressionality with a PDA kid that’s gonna show up more on something like the Connor Subrief, the Basque, in terms of emotional dysregulation. and again, they’re gonna they probably won’t have what we see on the Basque in terms of adaptive skills. Yes, they’re gonna have trouble adapting to routines.

They may not have trouble with leadership. Leadership might be their biggest strength, whereas that’s what we’re seeing with our more traditional ASD kids. We’re looking at a basque and thinking, okay, low leadership, that’s an indicator. and then I think there’s

Dr. Jeremy Sharp (48:58)
Good point.

Monica Corrado (48:59)
a big difference between parent and teacher basque. And I think that’s well documented that a lot of times with our ASD folks, they’re actually it’s not gonna necessarily present through a teacher report. I I find that’s different with PDA.

I think there’s good research on I went to the autism symposium through Pearsons and the creator of the Mask Four was saying, you know, oftentimes with autism, we’re not gonna see a teacher report that endorses that. I think that’s different at PDA when the demands are really high at school, the teachers are recognizing that and reporting on it.

Dr. Jeremy Sharp (49:32)
Yep. Yeah. I hear that. what about interviewing?

terms of questions we might be asking parents or even asking the kid. Do you have a sense of yeah, how you how you tackle that over PDA kids?

Monica Corrado (49:46)
Yeah, especially for parents. So one of the tenants about PDA is the passive milestones. I think

Dr. Jeremy Sharp (49:54)
Cool.

Monica Corrado (49:55)
that’s really interesting and different in terms of dial milestones might not be fully delayed in what we would you know, I don’t I typically ask how our milestones met, but I think we have to with our PDA folks get a little bit more into the nitty-gritty, right?

that okay, milestones were met, but how were they met? Is it, you know, that they’re more passively that they, you know, that you know they went they didn’t they went from scooting, never crawled to standing, maybe not necessarily, or they were more kind of observing. it wasn’t as active of a role in terms of these motor or verbal milestones, right? That it it seems to

Sometimes with PDA kids you kind of think it it doesn’t hit these kind of stepping stones and comes kind of all at once. And I think that kind of fits the is is under that passivity umbrella too, if that makes sense. so that’s kind of one of the questions that I would think of really differently from a a traditional ASD kiddo where we’re looking at, okay, w you know, a a good indicator with

PDA is or with ASD is delayed milestones. It’s not gonna be the case necessarily here. There’s more nuance.

Dr. Jeremy Sharp (51:09)
Yeah. Great.

Monica Corrado (51:11)
I can I feel like I can think of a few others. I mean, I will say with my PDA kiddos, a lot of times what’s really different is when I do the collateral interviews, especially with maybe prescribers, psychiatrists or primary care providers, they’ll say they don’t quite make sense to me. You know, they have this feeling of that this kid doesn’t

quite make sense to me. I feel like that’s a common refrain that

Dr. Jeremy Sharp (51:35)
Mm.

Monica Corrado (51:36)
I hear in the collateral interviews. And another piece with the I hear a lot that no medication has ever worked for them before.

And so that makes me think, okay, this this could have

ha be an indicator that there’s PDA. I mean, that’s also an indicator for ASD, right? but just kind of a slight difference of a lot of times ASD responds really well to a stimulant. So I haven’t seen that

Dr. Jeremy Sharp (52:08)
Mm.

Monica Corrado (52:08)
as much with my PDA folks. But I I am not

Dr. Jeremy Sharp (52:12)
Mm-hmm.

Monica Corrado (52:12)
a medication prescriber.

Dr. Jeremy Sharp (52:15)
Sure, sure. Yeah. Yeah. Have you found any any valuable conversations or questions for the kids themselves that can elicit some helpful info?

Monica Corrado (52:28)
Gosh, that’s a really good question that can elicit.

Dr. Jeremy Sharp (52:33)
Yeah.

Yeah, I don’t necessarily have any in mind myself. I’m just I’m just curious, you know, off the top of my head, like what

Monica Corrado (52:40)
Yeah.

Dr. Jeremy Sharp (52:41)
kids might share with us that

Monica Corrado (52:44)
I I think that one thing that stands out to me is most of my PDARs are spending a lot of time in the cozy corner. and

Dr. Jeremy Sharp (52:51)
Mm.

Monica Corrado (52:52)
a lot of time in the space where typically they’ll go if they’re dysregulated or if they want to avoid a demand. so I think talking to kiddos about, you know, what do you do in these instances? How much time are you spending needing to

disengage, you know, how much time? What is the cozy corner like? How much time are you spending there? and a another piece of PDA is, you know, oftentimes associated with this this bright cognition, but these really stagnant achievement scores because of the demands placed on them for learning, right? So we look at

Dr. Jeremy Sharp (53:25)
Mm-hmm.

Monica Corrado (53:25)
a great indicator is are we seeing test scores continue to either plateau or decline? you know, kind of when when they can no longer

Learner learning can’t be done through osmosis. That’s where we see it, you know.

Dr. Jeremy Sharp (53:38)
Mm. Mm-hmm. That’s fair.

Monica Corrado (53:40)
That’s a question I

ask parents and teachers, so less so kiddos, but

Dr. Jeremy Sharp (53:45)
right, right. Yeah. No, that’s fair. That’s fair. Yeah. And then how about like communicating communicating about this either with parents? I suppose we could talk about with kids themselves, but I’m more interested with parents. Like how do you describe it, you know, in feedback sessions, how do you write about it in reports, that kind of thing?

Monica Corrado (54:03)
Yeah, absolutely. I think as you know, boot PDA, pathological demand of win ends, having pathology in the name, man, that’s such a self-first failure. I don’t love that. so do very much use both terms in report writing and explaining to parents. I’m

Dr. Jeremy Sharp (54:19)
Yeah, yeah.

Monica Corrado (54:20)
sure you do too. I

think I I I have only had really positive responses from parents when receiving this information. Again, like how do you know this is my kid exactly? This is exactly what I’ve been dealing with. so even though I am not a particular fan of pathology meaning the name, it really resonates with families and and makes them, I think, yeah

Families so often with these kiddos feel completely out of control. So then it makes them with this label feel like they have a little bit more control and then can have those tailored recommendations

Dr. Jeremy Sharp (54:57)
Mm-hmm, mm-hmm.

Monica Corrado (54:59)
based on on this profile. yeah. So I don’t I I guess I don’t have a I haven’t had any negative experiences other describing what I went through in the room and then instances, you know, that they’ve reported to me.

and a lot of times they saw what the testing was like, they saw the breaks that had to be made, they they’re they know what’s going on, you know, so it feels like finally an answer rather than something that has to be dug deeper into.

Dr. Jeremy Sharp (55:24)
Yeah, yeah, that’s fair. That’s fair. Gosh. we’ve covered a lot of ground. what have we missed here? Anything

that feels feels important to talk about, either, you know, in terms of things we see in the room, ways to interact with these kids, yeah, strategies that can be helpful.

Monica Corrado (55:41)
Yeah, I I’d love to talk about recommendations, that kind of final step.

Dr. Jeremy Sharp (55:45)
Yeah. Let’s do that. Yeah, that kind of closes

the loop with the evaluation process.

Monica Corrado (55:50)
Yeah. Although I am a big believer that the feedback session is just the beginning of the next part of our relationship, which is then how we implement these accommodations, right? which I try

Dr. Jeremy Sharp (56:01)
Yeah.

Monica Corrado (56:02)
so much as to walk my families through because that I know and I’m sure you do too, the idea of my gosh, you gave me twenty recommendations. where do I start? Can be so daunting.

Dr. Jeremy Sharp (56:14)
yes, yes.

Monica Corrado (56:16)
I think that where I start in terms of recommendations, and probably Donna said something similar is parenting support, right? There’s we really, really need to have parents understand how they can modify the environment at home to best meet their kids’ needs and to best give them a sense of predictability and control and novelty, right? Because PDA is that fun one that also wants novelty.

not just ability. so I would say parent coaching, and there are so many wonderful people who specialize now in working with this. I don’t know if you’re familiar with Thrive Autism Coaching. they do parent coaching and they do kiddo co like coaching as well, but for 13 and up. We have a lovely resource here in Colorado. It’s called Hive Parents

Dr. Jeremy Sharp (57:01)
huh.

Monica Corrado (57:01)
and it’s

all for parents. It’s for parents of PDAers specifically. and it’s located in Colorado

Dr. Jeremy Sharp (57:07)
Huh. That’s great.

Monica Corrado (57:09)
Springs, but they have parent groups, parent coaching, videos to watch, forums to join. I think that parents can feel overwhelmed and lonely in this space. And so connecting them with resources and and

like minded folks is paramount. so I like to definitely start with the parent coaching. yeah,

Dr. Jeremy Sharp (57:30)
Sure. Love that.

Monica Corrado (57:32)
I think the other thing that I heard in the autism Pearsons summit is we e we either change our expectation we change the environment or we change the expectations, right? and so I’m a strong believer in let’s the

environment at school as well? How do we give control at school and set

Dr. Jeremy Sharp (57:52)
Mm-hmm.

Monica Corrado (57:54)
minimize demands and stick to typical age expectations, right? Like that’s we should never I never want it to be that, okay, that means that you’re meeting, you know, our expectations for that of a five-year-old for a seven year old. No, it’s still all age appropriate, but how do we lessen it?

Dr. Jeremy Sharp (58:14)
I think that’s the thing. Yeah, like people get really up in arms when we talk about adjusting expectations and you know, are we letting them coast or are we making you know, having lower expectations?

Monica Corrado (58:27)
Right.

Dr. Jeremy Sharp (58:27)
I like that you make this point.

Monica Corrado (58:29)
Right. They can always be age appropriate and just different, right? and so I think I I use there’s a free resource who and I would have to look at my desktop to see where, but it’s for schools about how to change environments for ASD kiddos, the school and community toolkit. I think it’s fantastic. I will include that to any

teacher who’s eager to learn more about ASD and PD profiles and how to

change the school environment. I mean, especially as we see not only in PDA kiddos, but especially in PDA kiddos the the rise of school refusal, right?

Dr. Jeremy Sharp (59:08)
yeah.

Monica Corrado (59:09)
yeah. And and then for my PDA errors, because there is so much of this high masking, right? Again, this manipulative that is more so masking, right? I think that the autistic burnout can sometimes be even more intense because it’s flown under the radar.

Dr. Jeremy Sharp (59:26)
Mm-hmm, mm-hmm, mm-hmm.

Monica Corrado (59:26)
leading to

this school refusal other refusals that, you know, contribute to the PDA a little bit.

Dr. Jeremy Sharp (59:33)
Yeah, yeah, yeah. I think you’re right. Gosh, I’m thinking of as we talk, I’m thinking about this specific kiddo that worked with, you know, a couple of years ago where this was super prominent, you know, and we really had a hard time figuring out strategies for school. There was a lot of school refusal, you know, and that was

Monica Corrado (59:49)
Yeah.

Dr. Jeremy Sharp (59:50)
kind of stuck in that pattern. So just revisiting that that kiddo. But yeah.

Monica Corrado (59:54)
Yeah. Yeah. And I’ve had

success with kids, you know, taking a break. And I I’m very familiar with all the one on one programs in my area. and doing one on one for a year, taking a break if we need to. all the statistics show that it is gonna take longer for someone who’s an neurodivergent to graduate college. Why don’t we set those standards earlier that we’re gonna need breaks earlier in life too? so maybe we need a a

Dr. Jeremy Sharp (1:00:15)
Sure.

Monica Corrado (1:00:15)
one on one break. Maybe we need an ABA therapist in school.

with us depending. to help us get maybe we need and I had a PDA or who needed an ABA therapist only to help with school getting there and leaving that transition piece. and so there are so many, so many alternatives rather than

Buck up, which we know as the psychologist.

Dr. Jeremy Sharp (1:00:40)
Right. It’s not always the best idea. Yeah. Yes.

Monica Corrado (1:00:41)
Yeah. Yeah. Yeah. Absolutely. When it comes

to especially disorders of a nerve system. so I think really identifying autistic vernaut and thinking of school alternatives is gonna be excellent for these for these families, traditional school al alternatives. I almost always include that in my recommendations.

Dr. Jeremy Sharp (1:01:00)
Mm-hmm.

Monica Corrado (1:01:01)
what else do I always include?

I I think that there are several books about PDA that are fantastic. PDA by PDAers is one of them. The family experience of PDA is another. and then I we have these lovely podcasts, including the one that you run that I think I also frequently provide to parents again to help them feel less alone in this process as well as these

things that are in these groups that are in Colorado, but are probably everywhere, such as Autism Color Colorado, and Gunny Bright Minds, right?

Dr. Jeremy Sharp (1:01:39)
Mm.

Monica Corrado (1:01:39)
so these communities and are really important. And one of the things that I don’t think we learned in grad school, that’s paramount. If you have a developmental disability of any kind, you’re entitled to state services. And how can I help the family walk through that? that’s another

big one of my jobs. So whether that be helping them or connecting them with an advocate, whether that be educational advocate or just in general, right? Advo everyone in the in Colorado is also entitled to an advocate. and so hooking them up there to help them walk through those resources that our lovely state provides.

Dr. Jeremy Sharp (1:02:13)
Yes, yes.

Monica Corrado (1:02:15)
Yeah.

Dr. Jeremy Sharp (1:02:15)
Yeah, speaking of our lovely state, you’re also involved with the Colorado Assessment Society, right?

Monica Corrado (1:02:22)
Yes, I am. And I would love to plug our events if that’s okay.

Dr. Jeremy Sharp (1:02:27)
Yeah, yeah. I mean I would love to hear. I mean, one, like if people wanna talk with you more, like get in touch with you, how can they do that? But yeah, also any resources that might be available through through the society.

Monica Corrado (1:02:39)
Yeah. so right now through Colorado Assessment Society, my we have some great events coming up, but my personal plug is we recommend interventions and we don’t often know what they look like in the room. We say you need to go to Orton Gillingham. Do

Dr. Jeremy Sharp (1:02:53)
Yes.

Monica Corrado (1:02:53)
we know what Orton Gillingham looks like? That’s not something we’re necessarily taught. So let’s know what it looks like so we know how to better tailor our recommendations.

Dr. Jeremy Sharp (1:03:02)
Yeah.

Monica Corrado (1:03:03)
so I am

on a big push right now for executive functioning coaching. Do we know what that looks like in the room and who we would we would recommend that to? Maybe not necessarily. So we’re having a panel of executive functioning coaches come September 11th and they’ll walk walk us through all of what they would want us what they want to see in reports in terms of recommendations. and then what

Dr. Jeremy Sharp (1:03:25)
Mm.

Monica Corrado (1:03:26)
they do, their ideal clients, you know, and and to tie back to PDAers, I think there are plenty of PADAs who would

benefit from an executive function coach or education therapists. And so would it it’s just on us psychologists to know what that looks like in the room. And anyone

Dr. Jeremy Sharp (1:03:43)
Sure. And

Monica Corrado (1:03:45)
to those events are open to psychologists or lay people. And oftentimes we we try to do try to make them as digestible as possible.

Dr. Jeremy Sharp (1:03:53)
Okay, fantastic. Yeah, I was gonna ask if folks outside Colorado could attend.

Monica Corrado (1:03:57)
Yes, it’s gonna be virtual. And then we have Steve Finn coming, who you know, is kind of prolific in the therapeutic assessment space. And he’s coming for a weekend training on memory reconsolidation in October. and Jeremy, we’d love to have you join, but we’d love to have anyone join and he’s a a pretty incredible person and presenter. If you haven’t seen him present.

Dr. Jeremy Sharp (1:04:20)
Sure, sure. Yeah. Yeah. Lots of cool things. Yeah.

Monica Corrado (1:04:23)
Yeah.

Dr. Jeremy Sharp (1:04:24)
Nice. So we’ve covered a lot of ground. Yeah, I really appreciate it. this is great. I think, I mean, with a lot of topics, it’s kind of a tip of the iceberg situation, but I just appreciate that you, you know, the way that you’re thinking about this and the fact that we were able to talk about some pretty specific strategies, things to look for, concrete, you know, ideas that we can actually use in our practice.

Monica Corrado (1:04:48)
And people can always reach out to me if they have more questions about that or a particularly challenging case or or a kiddo who, you know, is is refusing and and I can continue to share more ideas and strategize with them.

Dr. Jeremy Sharp (1:05:03)
Awesome. Awesome.

Monica Corrado (1:05:03)
Yeah.

Dr. Jeremy Sharp (1:05:04)
Well, thank you so much for your time, Monica. Yeah, it was great to chat with you.

Monica Corrado (1:05:07)
Great to talk with you. Thanks, Jeremy.

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