13yo Daughter

[Maranatha]

Hello,

I am new and wanted to introduce myself and my experience. I am married and a mom to a 13yo girl (will be 14 next month) and 9yo boy. Our son is on the autism spectrum and has ADHD, or "AuDHD," and our daughter has been affected by poor mental health since her preteen years.

It has been an emotionally draining, full-time job advocating for both of them, especially our daughter. I know it has been hard for her too, but we really do try to do what is best for her. She is currently inpatient at the adolescent behavioral health unit for the second time this year, by way of involuntary detention due to SI with intent. Her attending psychiatrist at the hospital is referring her to an extended inpatient setting that has a 4 to 6-week waiting list, with interim in-home therapy.

School starts Monday but we will NOT be sending her back; she will do online school until she is admitted into the program. We learned over the summer that her inability to self-advocate, regulate feelings and need to people-please has led to many unsafe choices, including vaping and drinking with a friend in the bathroom at school. The friend provided the substances but I feel like it's only a matter of time before she starts acquiring them herself if there is no intervention. 

She was an excessively fussy baby, impulsive toddler and strong-willed younger child. Since 2nd grade, she has been in and out of therapy and we have tried her on various meds for what appeared to be severe social anxiety and depression mixed with behavioral problems, e.g. getting in trouble at school for being disruptive. We suspected ADHD or autism (like her younger brother), but her testing was negative.

She cycles through friends quickly and usually finds herself entangled in some type of drama that ends up implicating her, whether or not she is an active participant in it. I've had to attend more meetings and write more emails than I can count to address one peer situation or another at school.
She has been both the target of bullying and the bully. This past year, she did a tour in ISS after threatening to fight a girl in the bathroom. When this was reported, she denied it; however, the surveillance footage from outside the bathroom picked up the audio. This is normal for her. She denies fault whenever she is questioned about anything that may potentially end up requiring discipline.

She is exploring her sexual orientation and is identifying as bisexual. A teammate on her soccer team flirted with her last fall and they secretly struck up a relationship. I had no idea about it until the girl's mom contacted me one night, saying that my daughter had been on the phone with her daughter, talking about k_lling herself.

After she was admitted to the ER, I had to become a Sherlock Holmes level investigator to figure out that she was DATING the girl, and her mom did not approve of the relationship and forbade her daughter from calling her. So, the girls had devised to meet up on the night of her crisis at a mutual friend's house. The plan fell through and prompted my daughter's suicidal state. However, on the hospital intake, she attributed her SI to her "homophobe" parents hating her if they found out about her same-sex relationship. Neither one of us had given any indication of "hating" her if she were to engage in a same-sex relationship (or for anything she may do), but we certainly had some questions and words to express knowing that the two girls had done multiple sleepovers! Call me old fashioned, but 12 and 13 is way too young for a sexual relationship, regardless of orientation.     

Our parenting style with her has to be a combination of loving and validating but militant. She is skilled at twisting situations to her advantage. We've tried all the things - we spanked a few times earlier on but that made things worse. We've defined and posted realistic expectations and rules. We've tried rewards on a schedule of reinforcement for meeting these expectations. We've taken away privileges and preferred activities. We've ignored attention-seeking behavior and praised behavior that gains attention in a healthy manner (you know, like communicating effectively). Nothing has stuck.

Natural consequences are somewhat motivating to change her behavior, but it depends. If the behavior is doing her laundry or wearing dirty clothes, she'll wear the dirty clothes. But if the behavior is following my directions to conduct herself appropriately while at church camp or be embarrassed, she won't mind the embarrassment as long as she gets what she wants (a boy's attention).

On that note, I believe this was the precipitating factor of her current crisis. She engaged in a short-lived but intense relationship with a boy from church who turned out to be very avoidant. He broke up with her due to fear of her hurting him later down the line, but he didn't want their separation to be permanent, thus he kept her hanging. My daughter downplayed the effect this had on her and engaged with his noncommittal behavior by placating him and responding to his few and far between texts.

I could tell it had taken a toll on her. I reminded her that she deserves better than that and emphasized that this is a perfect time for a boundary - tell him you support him but at the same time, you have needs too, so if he isn't willing to compromise on how both his and your needs can be honored here, then he needs to just let you loose! She didn't do that though. Instead, she immersed herself in spending every waking moment she was allowed with her current best friend, chatting up former crushes, and video chatting with strangers on Snapchat. She lost her phone and that accelerated her spiral. She does not know what to do with herself without her phone. She was back in the hospital within days - and naturally, it was my fault! CPS visited our house the day after to question me on allegation of abuse she had made.

Our continual work on our parenting, our relationship with her, talk therapy, meds and not even the 12-week intensive outpatient program she completed after her first hospital stay have been enough for sustainable results. As much as I don't want to have to do this, I feel like the prolonged inpatient program is the best option at this point. If we simply let her come home, it will only be a matter of time before the next dysregulating thing happens and we are back on square one. It is very frustrating that BPD isn't recognized as a viable diagnosis at this age because it's clear to me that my daughter has it. Thankfully her psych team acknowledges that she is exhibiting the traits and characteristics; even so, they will not diagnose her.

Thanks for listening.
     

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[In4thewin]

I'm so sorry you are going through this. It's terrible to feel so hopeless when all we want to do is help your kids. My daughter didn't have signs of problems as a young as yours did, but I can relate to the 13ish age when things really go haywire. Based on what you've shared, I'd suggest that you and your daughter find an adherent DBT program and do it together, even if you need to pay out of pocket. I would not delay because she doesn't officially have a BPD diagnosis. I think it could really be helpful to her in general, and in keeping interpersonal clashes to a minimum. Have any of her psych providers mentioned DBT to you?

[Maranatha]

I'm so sorry you are going through this. It's terrible to feel so hopeless when all we want to do is help your kids. My daughter didn't have signs of problems as a young as yours did, but I can relate to the 13ish age when things really go haywire. Based on what you've shared, I'd suggest that you and your daughter find an adherent DBT program and do it together, even if you need to pay out of pocket. I would not delay because she doesn't officially have a BPD diagnosis. I think it could really be helpful to her in general, and in keeping interpersonal clashes to a minimum. Have any of her psych providers mentioned DBT to you?

[Maranatha]

Thank you for your empathy. Yes, when she was hospitalized the first time earlier this year and her doctor assessed her for BPD, he strongly recommended DBT as it is the "gold standard" for BPD. DBT was the main focal point in the virtual IOP she completed, but she clearly did not internalize it enough to put it in practice. This time around, he is still endorsing DBT - but in residential care so it can be continuous and monitored and hold her accountable.

I'm not sure the virtual platform and the therapy in a group setting was effective enough for her after her first crisis. I agree that she needs to be more closely monitored and held accountable while participating in therapy, so my hope is that residential care will provide that. If we continue to have major problems (and God I pray we don't), we will look into DBT in another setting.  Ultimately though, I realize that her engagement with the process and motivation to get better are the main driving forces.