Adolescent with BPD and autism

[Pepper76]

Reading this forum has been so helpful and has helped me to not feel as alone. Like many of you, I have felt like a complete failure and that trying to help My child has been all consuming and at the same time completely unfruitful. My child is 15 born female and identifies as male. So my pronouns sometimes flip flop all over the place.  Symptoms of BPD started in the fifth grade. No history of trauma and very seemingly happy childhood. They always wanted me close and I slept with her until she fell asleep most nights until she was close to 10 years old because they were afraid at night and my husband traveled frequently. Occasionally I would tell them I was going downstairs to spend time with my husband. My child never cried or told me they were afraid and I always said that if they were that they could come get me. But now 5 years later he says that was what traumatized him. I’m not sure if that is some rewriting of history because I am always to blame or that he truly felt that way.  He felt abandoned. I now realize that seemingly normal things that most parents do, like having their 10 year old sleep on their own is extremely emotionally charged for someone with bpd. But at the time I had no idea, he never even said he needed me to stay. I was not a perfect parent but they have never been in an atmosphere of violence or have ever even been yelled at. I have corrected my children but have never belittled or yelled at them.  Like many of you I wonder how we got to this place. My older child is valedictorian and just graduated from high school with a full tuition ride and has been admitted to an Ivy League public school in our state. Not to compare these children, but just to show that we did provide a stable, supportive home for our children, with two parents, and all the opportunities that they wanted. My younger child was a very sweet, easy-going child up until puberty, and fifth grade. At that point they began to feel like they were isolated at school even though they were not isolated and they had good friends.  they became very anxious  And had some issues with the teachers saying negative things towards my child. I addressed this quickly and my child was moved out of this school within a month. This also happened to many other children and many of those children were also pulled out of the school. I decided to homeschool for a few months and then we found a lovely private school that was very supportive and a much smaller environment. Of course my child did well there for a couple of months and then the same issues started. Crying every day extremely anxious unable to get through the school day. So I ultimately started to homeschool in the seventh and eighth grade. This went very well for the first year and a half, but by the end of eighth grade, my child was becoming more resistant to doing any work for me. Also over this period of time my child was figuring out their gender and sexuality and felt like they were a transgender male. I was not completely affirming at first but I also was not rejecting my child at all.  I did question their gender preference when they discussed it with me only because at that point, I knew that this child was mentally unhealthy  And was seeing borderline traits and what I now realize was also autism traits.  I was concerned that their gender identity and extreme push for a quick transition was associated with BPD traits. They continue to want to medicalize and go on hormones and have chest surgery. I am now completely accepting of their transgender identity but I really want them to wait until they are 18. We are constantly at odds about this and it has caused so much strife on top of just dealing with school.  We did have them tested and they see a psychiatrist for medications and have had an extensive evaluation for autism. They are extremely intelligent but have autistic traits.  For high school, my child did one semester at a very open and accepting high school that I thought would be a perfect fit for them, however, I was getting weekly calls from the therapist, that my child was extremely overwhelmed, unable to do the work, and that they were having suicidal thoughts .  They have a typical bpd depression where they are crying and extremely upset one minute but sometimes 20 minutes later laughing with their friends.  They would eventually do the work, but they would come home from school, drained and unhappy and they were missing a tremendous amount of days of school because they just were so overwhelmed, crying and I was not sure what to do. So again I pulled them out and we are homeschooling again. I wish that fixed everything but of course it does not. They are not self harming or suicidal but they are in a complete bubble at home and not being asked to do anything right now.  At this point, I am completely supportive of his transGender identity, however, he is definitely not mentally stable and has frequent outburst of anger at any irritation or frustration with schoolwork.  He is mostly at home and does not seem to have motivation to do any schoolwork. I try all kinds of positive reinforcement, negative reinforcement as far as taking away electronics nothing works or really sticks. And of course I get the constant “Everything is your fault” if you would have just listen to me or understood me, I would be fine. It is a constant victim mode and blaming me for all problems, blaming me that they cannot do the work, and blaming the autism and ADD for not being able to do any work  at all,  Although this child is extremely bright, and actually gifted academically. We are taking a break from school for the summer however, I’m not sure how I am going to proceed in August when I have told him we would start school back. I have given him very very minimal work to try to get him to finish high school level math and some basic writing  And he even with that small amount of work says that he cannot do it. He does have a therapist that he meets with once a week, but I almost feel like that therapist enables some of this behavior and the avoidance of schoolwork because they are just completely affirming and do not question the wrong thinking that he has many times. However, he likes his therapist and I do think that she wants the best for him and that she has a good heart.  so where I am at is I am really struggling with how to enforce any boundaries or to motivate a teenager that has no motivation. I initially told him that if he wanted to see someone at the gender clinic that I would support that but that I wanted to see some progress with school and considering doing drivers Education. I needed to see that he was moving towards being a little more independent. We have made no progress with either of these things however, he still expects that we should give in to, any demands that he gives. We are still going to see the gender clinic and my hope is that if we give him support in this area that possibly he would get more motivation and would feel better about himself being the gender that he prefers or moving towards that.  However, deep down, I am actually very afraid that the BPD is actually the cause of his gender dysphoria as the unstable image is such a big part of BPD.  and his gender struggles, started at the same time as the BPD symptoms, he did not have any inclination towards gender dysphoria as a child.   
We have tried DBT and he will do it but is not very engaged in a group setting. He is doing weekly therapy and therapist is supposed to be doing DBT skills with him.
He seems to be completely happy just living in his online bubble daily as long as I ask nothing of him and he does not have to do schoolwork. But how long can we carry on like this? At minimum he needs to finish high school. Again I have tried so many things to motivate this child. Nothing works and he has absolutely no tolerance for frustration. He is on medication as well but I think this is more bpd than anything else.
I also would love to hear if anyone’s child is transgender and if transitioning helped? He has completely socially transitioned and I hoped that would help but if anything he is worse than ever. And I’m afraid that will be the trajectory even when he medically transitions.
Thank you for any help or suggestions. Things are so hard.

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

[Sancho]

Hi Pepper76
Can I ask how old your son is now? You sure are dealing with a complex child - and you have done so well responding in all the different ways that you have over the years. Although the issues seem to have appeared around the same time, I wonder if it is better to view them separately, although they do and will affect the symptoms of each of the other conditions.

As a teacher I noticed that around grade 5/6 was often a time when students would start to talk about transitioning. It is understandable as the hormones are starting to kick in, there is a lot of talk going on among their peers about sexuality etc and it tends to become urgent.

The urgency of one grade 5 girl that I taught was that she would start developing as a girl and desperately wanted to have her inner self known to others ie that she identified as a boy. Her mum was very supportive but wanted her to wait because she felt her daughter was too young to be making this decision.

For the daughter this was agony. To cut a long story short, the girl transitioned in grade 6, choosing a boy's name and with lots of process undertaken by school staff (supporting friends, teachers, family etc).

I don't know how things went as far as medical transitioning went as the school finished at grade 6. Last time I saw him he was pretty happy.

I can identify with the situation you are in ie when a child is negatively responding to everything you try to keep them on track and in some way connected to the usual social and developmental process. I have experienced huge anxiety around this sort of situation - at my wits end to know how to make it work for them.

In the end if they refuse to engage no matter what, there is very little you can do. You say your child is extremely intelligent yet finds it hard to cope with school work etc. Perhaps there is just too much going on in their mind to focus on learning? Computer games etc become a way of escaping from the pressure they feel in their mind.

I am not sure how things are where you live, but here there is a possibility of adult uni entrance even if someone hasn't completed year 12 of education. It sounds as though he is gifted enough to be able to pick up later on in an area of academic learning - do you think this is the case?

It is quite hard for a young person to be consistent in practising DBT skills - and I am not sure what support you can access in relation to ASD.

Do you have a counsellor that you work with to help you deal with this difficult situation? You have worked hard to put things in place. It will take quite a while though to see the benefit of your work. In the meantime it is so hard to know what to do!

I have certainly been in this situation and found it impossibly frustrating to try to get a child to anything when they flatly refuse. In the end I think I just chose one or two things to focus on and try to help them achieve that.

It's a bit like an Individual Learning Plan. It could focus on an aspect of ASD that needs addressing and will be beneficial in the long term. Thinking long term might be the way to go. Sorry I am not very helpful!

[Pepper76]

Thank you for responding sancho. Your reply was helpful for sure. It helps to know I am not the only one that feels like they have tried everything to allow a child to develop and thrive in some way and none of it works. I agree I have had to really just set up my own very flexible learning plan for him.
Lately he has been very emotional and scared that someone will hurt him because he is trans identified. He has never even been bullied over his identity but there is so much on the internet about this and how upset and scared he is of this is pretty close to delusional. I do know that trans people can be attacked and marginalized and I empathize with him.yet how upset he is extreme and he then goes into the argument that there’s nothing He can do and he’s afraid to even be in public. And he has had no persecution personally at all. And he has trans friends that are doing well in school and in the workplace. But yet he doesn’t think that he can. I do think this is the bpd delusional thinking. It Is so hard to work with. Really everything is hard right now.  Thank you again though. I feel for everyone on this board with someone they love suffering in this way. It really is suffering for the family member and the pwBPD.

[Pepper76]

I also like that you made the point to separate the bpd and the gender dysphoria. I do think that they meld into each other but I think that I need to treat them separately. I know many trans identified people that have transitioned and are doing phenomenal in their careers and personal life. I would love that for him. Sadly I don’t think that transitioning will fix anything besides his gender dysphoria. The bpd will still be there.

[Pepper76]

To answer some of the questions he is 15. I have a therapist and I talk to his therapist regularly. But really there’s no answers per se from either of them.
He is completely socially transitioned. But not happy or productive in any way. . Which makes we wonder if medically transitioning will make much of a difference. I would literally do back flips if it would help but I just don’t think it will be that simple.

[livednlearned]

I suspect my stepdaughter (26) has autism and BPD. She went through a trans phase that lasted from 16 to 22 or so. I say she because those are her pronouns now, after identifying as male during those years. I wouldn't spend too much time trying to figure out what you did wrong. Autism is a completely different way of being wired and there is a chronic "double empathy" challenge where neurotypical people don't understand the communication patterns of people with autism and vice versa. It has to be so invalidating to be autistic, which is why you sometimes hear "wrong planet syndrome." It's also a spectrum of sensory differences so your daughter (at age 10) maybe struggled to cope with intense sensory issues, including the physiology of experiencing her own emotions. It doesn't help that most neurotypical people are grossly ignorant about autism, including people who have good intentions. It's taken me years to feel like I have an understanding.

Not to complicate things, but I also have a son on the spectrum (no BPD), and something you refer to sort of reminds me of my son more than my BPD stepdaughter, SD26.

In the UK it's referred to as pathologic demand avoidance (PDA), which is different than oppositional defiance disorder. PDA is considered by some people to be a type of autism but don't let the categorizing distract you if the behaviors seem to fit what you're seeing. In the US it isn't really a thing but autism is not as well understood here versus other countries.

For me, the PDA insight is what helped me with interventions. My son is 21, and it took me years to build the kind of trust we need in order for him to take small steps. He will volunteer at a food bank with me, and did some volunteering during covid. He did some classes online and I am focusing on the fact he finished that class versus taking over a year to do what he could've completed in a month. He's exceptionally bright which honestly I think makes it harder. Lately, he has gone on short overnight trips with me which is pretty incredible. He has applied for jobs and for different reasons couldn't do them. The fact he applies, experiences rejection (sometimes him rejecting himself before they can reject him), but then applies again if it's months later -- I see those as wins.

Once our relationship felt like it sat on a bedrock of trust, I started what I think of as slow parenting. When it's something big I give him two choices, both of which are acceptable to me. Right now, he either gets a job by his birthday or we mobilize a plan where he attends college 2 hours from here and lives independently. He only has to take one class. This gets him to focus on the emotions of working in a social setting versus the emotions of living independently. Which one unnerves him more we will see.

What PDA taught me is to change the way I phrase things, similar to validation but more like extreme validation.

Autism + BPD + transitioning + teen ager is obviously a very tough nut to crack and adding PDA to will probably change your parenting, and maybe even you.

With the transitioning stuff being the most urgent, I feel for you. That's a tough one. In Europe kids have to undergo a psychiatric evaluation before they can transition whereas in the US it's more about transition to cure the psychiatric issues.

If I were to think about how slow parenting might work given what you're dealing with... I think I would look for allies who could share the burden and help guide the process. Not to stop it but to make sure it was the most informed decision-making process on the planet. When I give S21 responsibility for his choices, he obstructs himself, even if it wants something. He has better language to describe what's happening and I'm trying to model how to maneuver through these moments. It's not that the behaviors are so bizarre they aren't human -- they are very human, it's just a matter of degree. I suspect it happens when a person experiencing "wrong planet syndrome" feels their very basic existence has to be masked or switched off or hidden. Kids with autism are expected to do all kinds of things that are hard, like sit in rooms with flickering lights or have loud sounds or uncomfortable clothing or eat foods that are weird. We want them to have friends at the expense of them knowing what it's like to feel like themselves. And no one is to blame, it's just how it is. If I knew my kid was on the spectrum, I'm still not sure how things would've turned out.

Another thing that I took to heart, for better or worse. I'm the only person who has his back. I used to try and change him and get him to fit in and do things he didn't want to do. That's why I had to rebuild trust. We did a road trip across the country and had a lot of time to talk and when it was over, I kind of decided to walk in his shoes and figure out what life looked like from his perspective. I voice my doubts, I talk out loud about how I'm thinking about a situation. I pay attention to the more benign versions in me that pertain to the extreme manifestations in him and try to problem solve my way forward.

I don't talk down to him anymore. He's so far beyond the kind of parenting I used to do. It didn't ever really work and probably led to this massive burnout that coincided with covid. I might be the only person on the planet who was kind of relieved covid happened because it slowed everything down and lowered expectations.

You have a very complex child and your parenting is going to look different and there will be no right answers a lot. You'll be blamed for doing the wrong thing when you do the right thing all. the. time. Set small goals that are manageable and model ways to handle anxiety since that's a big element.

And let yourself go through a grieving process. I think I did that many times over until I accepted the fact this smart, creative, hilarious empathetic kid is probably not going to have the life I dreamt for him. We're going to have something different and here's hoping there is a silver lining in whatever he chooses to do.

[Pepper76]

Thank you for this response. So many good suggestions and your son seems very similar to my child. And yes I do at times become concerned that the trans identity is part of the autism and bpd and he will regret wanting to transition. Although I think some people transition and then desist but say it was something they needed to go through.
As far as the pathological demand avoidance that does seem to be what is most likely going on with my child. His therapist mentioned this as well. It’s difficult though because as you alluded to as parents we have to dig deep with empathy and take small wins when they happen. I have a hard time setting boundaries and how much to push any sort of expectation. I like how you gave him the choice between two things. Like you said I’ve been in a grieving process the last few years. I anticipate that he may never be able to be completely self sufficient. I do hope he can eventually find something he can do in the world though.