Parent Question
My son is 11. He’s autistic and very bright. I’m wondering if you have any advice on helping him with rejection sensitivity. While he doesn’t have a lot of the sensory issues often associated with autism, he is extremely self-conscious, gets very upset by perceived criticism, can’t take correction, and finds it hard if he can’t do something immediately or if something doesn’t work out as planned. He gets upset at school very easily and tends to hold on to the upset for a long time. If something goes wrong with a game or with a friend, he’ll avoid it.

We used to have a journal that he filled in at night, which was all about growth mindset and we work with him on reframing/understanding that he is in control of how his day goes, but we haven’t made much progress. Is cognitive behavioural therapy (CBT) something that might help him? I feel life will be very hard for him if he internalises every setback and perceived slight. He’s working with an OT (occupational therapist) and this has helped him in lots of ways, but I’d like to figure out what else he might need to support him as he moves towards the teenage years.

ANSWER:
Rejection sensitivity and perfectionism are common challenges for autistic and ADHD children. Like your son, many children can find criticism extremely painful (even when criticism is not intended), can hold on to upset for long periods and can avoid important activities for fear of rejection. When this sensitivity is extreme and debilitating, some clinicians describe it as rejection sensitivity dysphoria (RSD). Rejection sensitivity is a life-long personality profile that can be managed but not usually “fixed”.
Below are some ideas on how you can help your son:

Compassionately accept your son
When your son experiences rejection sensitivity, it is most important to be compassionate and understanding. Be careful about expressing frustration or expecting him to “snap out” of what he is feeling. You don’t want to reject him for his rejection sensitivity, which will make things worse. Remember, in his own mind he is likely to be already likely to be self-critical and giving himself a hard time about what he is feeling. Instead, it is important to be compassionate and to listen carefully to help him articulate his thoughts and feelings, however unreasonable they might appear.

Helping your son cope with his feelings
In helping a child cope with rejection sensitivity, there is rarely a one-size-fits-all approach. As a result, it is important to be flexible to see what works for your son.

Some children benefit from expressing their feelings and thoughts in detail to a good listener (perhaps having a good cry). It might help to set aside daily listening times to let your son vent and express his feelings and worries. For example, you might have a daily walk with your son to listen to whatever is on his mind.

Adopt a stance of encouraging and affirming him as you listen, pointing out his strengths – “the reason that you feel so hurt is that you care so much”. Or “you are such a sensitive child, very attuned to other people’s feelings”.

Co-problem solve with your son
Involve your son in problem solving about what might help with rejection sensitivity. You might ask, “what do you think of RSD in your life?”, “How is it affecting you and what might help?” Inviting curiosity and naming RSD as something separate can help him to be less caught up in the negative emotions. Invite him also to be curious about the strategies that might help him.

You have already tried the growth mindset journal at night, and even though this has not been fully successful, it is great that you got his co-operation to give this a go. Try to positively learn from the experience by asking him “what worked even a little bit about it?” or “what changes would make it work better?”

Remember it can be a case of trial and error to find what works best when he feels rejected. For example it might work for him to:

• Distract himself with his passions or special interests (such as listening to music, drawing or playing video games). You can help by providing extra access at difficult times.
• Repeat a self-compassion mantra such as “this is a difficult moment, and that is okay”, or “I feel hurt, but that is because I care”, or “I can get through this”.
• Engage in physical activity or practise a deep-breathing, mindfulness or sensory-grounding exercise.

Getting the right support
You ask whether to take your son to therapy and, though this could help, you would have to be careful to set it up well for him so it does not reinforce a sense of failure if it does not work out. Rather than picking the right therapy model (such as CBT), the important thing is to pick the right therapist. You would want a therapist or coach who is compassionate and neuro-affirming and who understands RSD.

Equally, it is important to involve your son in choosing what supports might work for him. He might not want to go to a “therapist”, especially if he feels this is pathologising or identifying him as the problem, and he may prefer more practical or coaching help. It is a good sign that he is doing well with his OT and you could explore with them what additional support might help.

Whether your son engages in psychological help or not, you can of course seek help as parents and learn different ways to support him. There is a growing number of excellent resources about RSD online. I particularly recommend neurodivergentinsights.com which illustrates the subtle distinctions between RSD, OCD, perfectionism and autism as well as many practical strategies and resources for managing and coping.

John Sharry is founder of the Parents Plus Charity and an adjunct professor at the School of Psychology, University College Dublin. This parenting Q&A was originally published in the Irish Times in June 2024. John writes in the Irish Times Newspaper on Tuesdays. His website is www.solutiontalk.ie.