What Happens When We Refuse TO Give Up: Understanding Executive Function Helps with My Most Challenging Cases

Written By Tera Sumpter

A few months back, I wrote a post that absolutely blew up my Instagram feed. Of all the posts I’ve written, it didn’t surprise me that it was the one that broke the internet. It’s the kind of story that keeps me going every day, that reminds me that a child’s success is directly proportional to our willingness to not give up.

The thing is, that doesn’t just keep me going on a tough day, or when I’m out of ideas for individuals who are challenging cases. If I could trace the trajectory of what I’ve learned about executive function, I think this has always been the engine behind it: kids are more capable than we give them credit for. Sometimes they just need help finding that capability. I have always been and always will be relentless in helping them do that. I scoured the internet and took courses and read books until I found resources that explained that internal capability for self-leadership that I knew had to be there in all of us. Then I tried everything I could think of to help develop what I learned into a therapy methodology for improving executive function.

The story of “James” is an inspiring story. And it results from me continuing to believe in him when no one else did, when he had even lost faith in himself. Not only is faith in our kids’ capabilities a great motivator, it’s also a great teacher. I want to use this story to highlight what I learned from James and others like him, and how I used the all-too-common challenges of his situation to help him find his inner self-leadership. Let me retell the story, and show you how I was guided by the lessons I learned over the years from my faith in kids like James. 

Tera Sumpter working with a teenage client

Most Kids Want to Do Well

Years ago, a family found me and scheduled an evaluation for their son. They said, "You're our last hope. Our son will either end up dead or in jail. Nobody can help him."

James was not the first kid I’ve encountered who parents and teachers thought were hopeless. I’ve seen quite a few at this point. A few that come to mind are a child who came to Seeds of Learning because he was eloping from his classroom and school activities almost every day, sometimes multiple times per day. Another client was being physically restrained in the classroom by an adult aide! 

I don’t really believe in impossible cases, and I don’t believe in bad kids. Honestly, that is part of how I landed on executive function. When I encountered children who were being called “difficult,” I didn’t really believe there was something inherently wrong with them. I don’t blame parents and educators for their frustration–words like unmotivated, lazy and behavior problem are so often used to describe kids.  It's easy to resort to that thinking when we have challenging cases. But I just couldn’t live happily like that. I had faith in these kids–in their motivation, in their capabilities. I didn’t think James wanted to end up dead or in jail any more than his parents wanted him to. I had to help him find his way.

Since I’ve been persistent with so many “tough cases,” I know that executive function deficits are often at the root of behavior problems. I did the evaluation and found that James had very poor executive function in the areas of inhibition, self-monitoring and planning. These deficits were affecting every aspect of his life from self-regulating for friendships, academics and at home. In every setting, he was constantly in trouble.

This is not unusual. Once I saw the patterns, I looked for executive function deficits in all evaluations where there were behavior problems. Think about it. Inhibition is an executive function skill. Inhibition helps us check our behavior before we do it and determine what is situationally appropriate. Inhibition keeps a child from jumping to his feet and yelling during classroom activities, keeps him from speaking his mind when someone else is talking, keeps him from acting on negative emotions by hitting or screaming. Even behavior that is acceptable sometimes is unacceptable in some situations. If a child doesn’t have the awareness to notice that or the ability to inhibit it when appropriate, he’s going to be disruptive, and probably in a lot of different environments or contexts.

I saw this many times. I wasn’t surprised by what I found in his assessment. I knew what to do. So, we started therapy.

Kids Thrive in a Trust Environment

When we take clients with executive function deficits, just creating a productive therapeutic setting can be difficult. The skills that are foundational to executive function—attention, working memory, and engagement—are also fundamental to a productive therapy session. If kids aren’t self-aware, don’t know when or how to pay attention, can’t retain key pieces of information in their minds long enough to work on them… it can be hard to get going in therapy. Add to that the layers of a child’s frustration that have often built up from countless negative interactions before they’ve even arrived in therapy, and it can be quite the challenging experience for everyone involved.

The layers of frustration around James were THICK. He got in trouble so often, and he saw me as just another authority figure who would end up frustrated and punishing him.

Every session started the same way for about the first 6 months: "Go f*ck yourself," he'd tell me.

I made it clear from Day 1 that his colorful language didn't bother me. I'd actually ask for it: "Do you have anything to tell me today?"

"Yeah, go f*ck yourself!"

"Great. Let's get to work."

It was important to me that he felt seen and heard in the sessions. I didn’t let it get out of hand, but I also didn’t give him what he expected by responding punitively. He had emotions, and he was expressing them. This is an important starting point in therapy with so many of our kiddos, particularly those with problems with inhibition. Unexpressed emotions can drive them to distraction. We agree on some guidelines that allow them to express feelings in a non-disruptive way, and then we move on to the next part of therapy. If I trust them and their emotions, it’s easier for them to trust themselves, too. And if I trust them, then they learn to trust me as well.

James revolted in other ways by refusing to engage and cooperate with me. I just reminded him over and over that I wasn't going anywhere. I would tell him we could do this the easy way or the hard way, but we were going to do it, regardless. And he had all the control to decide how it got done.

Tera working with a teenage client

Meet Kids Where They Are

One day, I asked my “challenging” client a really simple question, "What do you want?"

He looked at me, almost surprised, like nobody had ever asked him that before.

"I want everyone to leave me alone," he said.

I responded, "I want that for you too. I want everyone off your back. I want the teachers to stop sending you to the office. I want your parents to stop grounding you. I want the kids at school to stop picking on you. I want everyone to leave you alone, too. And I'm going to help you get that."

After that conversation, it was like a new kid arrived in my therapy room each day. After about 4 more months of therapy, he started telling me how his hours with me were his favorite hours of the day. 

It’s Not a Motivation Problem, It’s a Cueing Problem

So many clients I see with executive function deficits end up in my office because they lack consistency. Their parents and teachers have seen them execute the tasks they need to be able to complete. They can tie the shoes. They can do the math problems. They can spell the words. But when it comes time to perform these actions independently in distractible settings, they often struggle. 

One day, the most magical thing happened with James.

He came into therapy and said, "Miss Tera! I got an A on my math test!!!" 

To which I responded, "That's amazing!! How'd you do that?" 

He said, "I asked my mom to study with me because I knew it would be hard. During the test, this kid kept tapping his pencil, and I wanted to punch him! But I heard your voice in my head.

"I heard the questions that you always ask me: Is that important right now? Where should your thoughts be? What should you be doing right now?”

What he was saying—the words he was repeating—were from hours and hours of reflexive questioning in therapy. Reflexive questioning is a key technique in my therapy methodology that models awareness of self and situation. Instead of telling kids where their attention should be or what they should do, it helps them develop the awareness they need to recognize where their attention should be and what they should be doing. Reflexive questioning provides the child with the opportunity to self-reflect and adjust their performance as needed.  It allows them to practice being the director of themselves.

Why does that matter? Because executive function cues someone to do an action. James was fully capable of taking the test. And, judging by his excitement, he wanted to get an A. It wasn’t a lack of skills or motivation that got in his way. What got in his way was distraction and his emotional response. Before we worked together, his brain didn’t know how to prioritize what was important, so it went with what felt most important–punching the annoying kid who was tapping his pencil.

Go back and take another look at the conversation I had with him to see if you can find another key question I asked him. Did you find it? The question I asked him is, “How’d you do that?” This is another way to use reflexive questioning to help kids with self-awareness. It’s important to help them evaluate the consequences of their actions and envision what they might do differently next time. Or, with success, it’s important for them to recognize what behaviors they want to repeat so they can achieve success again. This time, he asked his mom to study, and he successfully redirected his attention back to his test instead of punching his classmate.

Note: Reflexive questioning is an easy technique for anyone to implement, and I provide a great overview in another blog post and in a YouTube video, Reflexive Questioning for Everyone.

Executive Function-Focused Therapy Enables Self-Awareness and Empowers Self-Leadership

Want to hear the icing on the cake for James’s story? The kid whose own parents feared he would end up dead or in prison? The moment of success for me was not when he passed the test, but when he recognized he did it himself. He heard my voice in his head, but he knew he was the one who redirected his attention. He knew he was the key to his own success. He told me "I heard the questions that you always ask me: Is that important right now? Where should your thoughts be? What should you be doing right now? So I got myself back on track and finished my test and actually got an A!"

The pride I heard in his voice still nearly brings me to tears. It reminds me he wanted to do well all along. It reminds me that the best thing I can do for these kids is believe in them until they can believe in themselves again.

A child's success is directly proportional to our willingness to not give up.

Want to learn more? 

Tera Sumpter
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