The best practical example of the interplay of external and internal stimuli and response is to think of the ADHD child in the school setting. We, along with the teacher (and believe it or not the child himself) would like him to stay in their seat, listen carefully, and not talk loudly to his neighbors or suddenly blurt out the often wrong answers. At school our child lives in a real “outside” world that causes problems for his “inside” world sensitive and reactive personality. The unpredictable day-to-day changes in his environment or in himself cause the seemingly inexplicable variation we see in his performance.
For instance, there are days when all the noisy boys are absent from class, the teacher is in a good mood and is teaching a subject that the child loves (such as dinosaurs or gladiators). Perhaps the lesson involves hands-on activities such as building a volcano or feeding Christians to the lions and rewards right answers with a handful of fake molten lava (just kidding – although you know he would love it!) or more likely plastic golden coins. They have a wonderful day and often outperform his classmates in creativity, enthusiasm and leadership.
The next day, however, all the noisy boys are back, a student or substitute teacher who is unfamiliar with the routines and student personalities is wading for the first time through a difficult math or social studies unit in a monotone lecture (“What is the capital of Djibouti? Anyone? Anyone?....”), They may not have been warned that our child should sit in the front row, rather than the window. As fate would have it the window is open and there is a class at recess playing basketball, tag and kickball. And now his world if filled with swirling images and sounds, random thoughts and new ideas, tangents and intangibles but the lecture is unheard, notes forgotten and homework assignments missed completely. The other children have similar difficulties paying attention because of these distractions, but nowhere near the degree of impairment for our ADHD child.
Although we are only too well aware of this situation, reviewing it now can help us understand why the hallmark of ADHD is variability. It seems strange that at times they can demonstrate laser-like focus on certain topics (like video games) yet drive us crazy at the kitchen table trying to complete a simple fill-in-the-blank worksheet. That is very different from our earlier medical example of strep throat. Although the symptoms of fever and pain may worsen or improve over days, the patient is not totally healthy one minute and deathly ill the next. But this inconsistency is classic for ADHD.
Obviously our best chance to get our child on track will require adjustments to both inside and outside worlds.