Joanna Fortune: My teenage son hardly speaks to anyone  

Symptoms of ASD will manifest and present differently in different people.

Joanna Fortune

CHILD PSYCHOTHERAPIST

I have a 13-year-old son who has a diagnosis of ASD. I am not wholly convinced the diagnosis is correct - I have always felt it's more social anxiety. My son chooses to hardly speak to anyone, and I am worried about how this will impact his life moving forward. Is there something I should do to help him become more confident and less anxious?

The first thing that registers with me reading your letter is your doubt about your son's diagnosis. This uncertainty can be very difficult and I suggest you connect with the service that provided his assessment and diagnosis and ask that they talk you through their conclusion. 

Symptoms of ASD will manifest and present differently in different people. Sometimes we have to start by questioning our preconceived understanding of how a person with ASD behaves and deepen our understanding of how the neurodivergent condition can look, feel and sound differently in different people. It is also possible for someone with ASD to have social anxiety.

You might find the work of American speech and language therapist Michelle Garcia-Winner helpful in supporting your son's social engagement and connection with his peer group. She has many publications and resources to explain social thinking to children. 

You could also connect with your local CAMHS service or TUSLA family service to ask about the SPACE programme, which is available to parents of children with anxiety. You can learn more about SPACE by searching YouTube ( www.spacetreatment.net) for its developer, child and adolescent psychologist Dr Eli Lebowitz.

Aside from seeking professional support, make time and space for play. Playfully connect and communicate with your son every day. Being interested in what interests him teaches him that he is interesting and will help support and boost his self-esteem and confidence.

Try this playful communication activity at home. Pick a deeply emotional experience you've had (very happy, very angry, very sad). It should be a short story as you will need to repeat it three times. The first time, ask your son to observe your body and note what it expresses as you talk (arms folded, leaning forward/back, tapping foot). 

The second time you tell the story, ask him to observe your face and note what your facial expression is saying (furrowed brow, wide eyes, tight jaw, biting lip, smiling). 

And the third time, ask him to listen to your words and how you are saying them, noting your tone, pace, type of language etc. 

Then ask: 'How am I feeling about what happened?'. He has to say how he thinks you are feeling but draw on body language, facial expression and vocalisation to explain his interpretation.

This game supports emotional fluency and recognition of what others might think, feel, and say beyond words typed on a messaging platform may not. 

Your son might benefit from 'doing' communication rather than just speaking it, especially if verbalising his thoughts and feelings is difficult. 

Select a movie or book you know he really likes. Ask him to imagine deleting a scene and replacing it with a new one. 

Using coloured pencils and paper, draw the new scene and a new ending for the book/movie based on this change. Also, you could create a new character to insert into the story and playfully consider how this character will influence the story.

Remember you are supporting his emotional development within this playful connection. You are his greatest resource. 

• If you have a question for child psychotherapist Joanna Fortune, please send it to [e-mail]