Before considering medication, you may want to know that children with AD(H)D symptoms are 3x more likely to have a common vision problem called convergence insufficiency that can interfere with a child’s ability to attend to reading and/or writing tasks.

Convergence Insufficiency (CI) is a vision coordination problem that affects about 10% of children. When the eyes look near, such as when reading and writing, they have to make precise eye movements together in order to keep things clear and single. CI is not related to eyesight, or the need for glasses or 20/20 vision. In some children, the coordinated eye movements needed to precisely converge the eyes do not develop properly. Concussions or other types of mild head injuries can also cause convergence problems. While some children (and adults) will try to work through their symptoms and get headaches or eye strain, others will find it too difficult to multi-task and their brain will struggle to keep attention on the material.

How Convergence Problems Interfere with Attention

A recent study found that children with eye coordination issues have a much more difficult time finishing schoolwork and paying attention in academic settings. Often children with convergence insufficiency will experience strain or discomfort while trying to read. Their eyes may not track across the page well, so they lose their place. Many times children are not able to identify that these symptoms are abnormal, so it is important to ask them about what they are seeing (Take the Convergence Insufficiency Quiz). But keep in mind that avoidance itself can be the biggest symptom as some children will often not focus their eyes on the page long enough to see the words as blurry or double.

With these symptoms, it is easy to see why children are incorrectly diagnosed with AD(H)D and started on medication. Convergence insufficiency cannot be found in typical school screenings or pediatrician vision exams that only test their ability to see 20/20 at distance, test each eye individually or look only at the need for glasses. Teachers, medical doctors and school nurses often do not attribute poor attention and behavior problems to functional vision problems such as convergence insufficiency. This causes the child to be mislabeled based on behavior problems or learning difficulties, when really the underlying difficulty is vision. Unfortunately, this frustration can lead to low self-esteem, anxiety or depression.

Solutions to the Underlying Vision Problem

What should you do if you suspect your child has ADHD or is showing symptoms of convergence insufficiency? Based on a recent National Institute of Health Study, vision therapy is the preferred treatment for this condition. The goal of Optometric Vision Therapy is to teach the child (or adult) how to properly coordinate the two eyes together, often using special lenses and filters. In addition to lenses and filters, the therapy may involve the use of special 3-D depth perception pictures as feedback for the patient to help determine if they are doing the activity correctly. We get our ability to see 3-D or fine depth perception (stereopsis) when the eyes are working well together. Often activities are integrated with other tasks to ensure that the process is easy and automatic.

Individual eye focusing skills, eye movement tracking skills and visual processing skills may also be treated in therapy to treat all aspects of the visual system that impact learning. The average length of treatment is about six months. Studies evaluating the success rate of treating convergence insufficiency with in-office vision therapy conclude the success rate is very high (over 75%-85%). The guided direction of a trained therapist appears to be key to success, as one study found that home-only programs were not much better than placebo in treating this condition. A 2005 study found that successful treatment of convergence insufficiency in children with AD(H)D symptoms had a significant improvement in their ability to concentrate on academics and a decrease in behavior concerns

How Do I Get Help?

Developmental Optometrists diagnose and treat functional vision problems including convergence insufficiency. They can determine if vision is the underlying cause of symptoms or refer to other professionals, such as neuropsychologists or occupational therapists, if no vision problem is found. Developmental Optometrists receive specialized training in the area of vision therapy and are qualified to diagnose and treat learning-related vision problems. Developmental Optometrists that are board-certified in this area will have the initials FCOVD to indicate they have advanced training.

In addition to vision therapy, FCOVD optometrists generally have a greater understanding of vision as it relates to child development, strabismus/amblyopia, developmental disabilities, autism and brain injuries/concussions. Their expertise is not limited to children, as adults can also have these conditions. Their understanding of visual processing goes beyond what is generally taught in medical or optometry school. The College of Optometrists in Vision Development website (www.covd.org) is a good starting point for finding a Developmental Optometrist in your area.

References

Academic Behaviors in Children with Convergence insufficiency with and without Parent Reported ADHD

Convergence Insufficiency Treatment Trial 

Improvement in Academic Behaviors Following Successful Treatment of Convergence Insufficiency

About The Author

Dr. Valerie Frazer is a board-certified Fellow of the College of Optometrists in Vision Development and specializes in vision therapy. She has over 15 years of experience with diagnosing and treating both children and adults with learning-related vision problems, binocular vision problems, strabismus (eye turn) and amblyopia (lazy eye). She also treats visual skill dysfunctions commonly seen in individuals with autism, other developmental disabilities and brain injury. Dr. Frazer owns New Horizons Vision Therapy Center and has two locations serving both the Madison, WI and Lake Country (Delafield) areas.

Contact us today for more information!
608-849-4040
www.newhorizonsvision.com
info@newhorizonsvision.com

Poor handwriting is a common problem and may be helped by improving visual skills. View Dr. Frazer’s webinar below to learn more.

The visual skills needed to improve handwriting are trainable through a well-designed vision therapy program. In this webinar, Dr. Frazer will also present the many helpful modifications available.

Children who have difficulty with good handwriting may struggle with these vision-related skills:

• Peripheral Awareness
• Visualization Ability
• Eye Movement Skills
• Eye Teaming Skills
• Visual-Motor Coordination

Watch Dr. Frazer in this webinar to learn how tracking, focusing and eye teaming can interfere with reading fluency and the learning process.

20% of children lack the visual skills necessary to succeed in school. These necessary visual skills go beyond 20/20 vision. Dr. Frazer will review the most common symptoms of learning-related vision problems and the best methods of treatment.

Learning-Related Vision Symptoms:

• Losing place on the page
• Words run together when reading
• Reversals of letters or words
• Easily distracted or fatigued
• Takes “hours” to do homework
• Low reading comprehension or fluency
• Poor or unevenly spaced handwriting
• Uses finger to keep place
• Eye fatigue or strain

Summer vacation is coming to an end and the new school year is just a few weeks away. Your child may have survived last school year, but if you want them to thrive this upcoming year you might ask yourself the following questions…

• Is reading/writing a struggle?
• Does your child skip lines or lose his/her place when reading?
• Does your child avoid reading or writing?
• Do you find yourself battling to get your child to do his/her work?
• Does your child seem tired, get headaches or complain about their eyes when reading?
• Does your child have a short attention span for reading or writing?
• Does your child struggle to complete the expected amount of reading minutes per day?
• Are they unable to comprehend what is being read?
• Is your child having difficulty transitioning into chapter books?
• Does your child have 20/20 vision, but complain that he/she can’t see well?

If you answered yes to any of these questions, your child might be suffering from a learning-related vision problem. Many children with learning-related vision problems have 20/20 eyesight and will pass a traditional eye exam or vision screening. Parents are given a false sense of security that everything is fine; when in reality their child may have significant vision coordination problems that are interfering with their ability to sustain accurate, clear and comfortable vision for near tasks such as reading, writing and math.

There are 17 visual skills that make up “good vision” and only one of those skills include eyesight or the ability to see 20/20. It is estimated that as much as 80% of all learning during a child’s first 12 years comes through vision. The three most common causes of vision and learning problems are poor eye tracking, teaming and focusing skills. Below we’ll take a closer look at these three visual skills and how they impact learning.

If you are only checking this…

Snellen Chart- Checks visual acuity

You may be missing this…

How text may look to a child with eye teaming difficulties.

Eye Tracking Skills

Eye movement or tracking skills are the ability to accurately track and follow with our eyes. Inaccurate tracking skills can cause loss of place when reading, skipping over words/lines, poor reading fluency and “careless” errors.

Eye Focusing Skills

When we look far away, the focusing muscles in our eyes relax, when we look up-close they constrict. The accurate and efficient use of these muscles allow us to focus on near-print for a sustained period of time and easily switch our focus from near to far and back again. Inefficient focusing skills may cause blurred vision, visual fatigue, trouble copying from the board, reduced reading comprehension and avoidance of near-point activities.

Eye Teaming Skills

Eye teaming is the ability of the eyes to work together as an efficient, coordinated team to create a clear and single picture. Small eye teaming problems cannot easily be detected by the untrained observer; however, they do significantly interfere with the ability to efficiently process visual information, especially at near when reading and writing. Difficulties with eye teaming skills can cause numerous symptoms and adaptations including: eyestrain, headaches, blurred or double vision, words run together or moving around the page, difficulty with handwriting/spacing, covering or closing of an eye and decreased reading comprehension. These symptoms make it very difficult to maintain attention on reading and writing, especially for children.

Many times, difficulty will exist in all three of these visual skills areas. These children are labeled as learning disabled, attention deficit or just plain lazy. The good news is that these conditions are easily treated with vision therapy. The bad news is that even though they are fairly common (1 out of every 4 children), they are frequently misdiagnosed or overlooked completely in routine vision screenings.

Many eye doctors (ophthalmologists and optometrists) fail to include the battery of tests needed to identify teaming, tracking and focusing problems. Specialized doctors of optometry who are board-certified in vision therapy have the credentials FCOVD. This designates that the doctor has the training and experience to diagnose and treat vision and learning problems.

You can find more information throughout our website or to find a FCOVD optometrist in your area check out www.covd.org.

Why doesn’t my child like to read? A common question parents find themselves asking. For some kids, it isn’t that they just don’t like it, they actually hate it and they will avoid reading at any cost. But why the strong aversion? Here are five reasons why many children (and adults) dislike reading:

Reason #1- Reading is uncomfortable

If your child gets headaches or complains about their eyes hurting with reading or doing near-work, they may be having difficulty with their eye teaming system. Eye teaming (also called convergence) is the ability to coordinate both eyes together. Our eyes have to converge with each other accurately at near to maintain clear and single vision. If the eyes struggle to converge, or sustain that convergence, they will have to work harder to compensate. This will create tension in and around the eyes, forehead and temples. Only the most motivated readers will keep reading when things become uncomfortable. Other signs of convergence insufficiency include: double vision, words appear to move on the page, decreased comprehension (related to the increased effort) and a slow reading rate.

Symptoms like those just listed make it more difficult to attend to reading and near-point tasks, which may cause symptoms that mirror attention deficit disorder (ADHD) symptoms. In fact, in a recent study, children diagnosed as having ADHD were 3x more likely to have convergence insufficiency. These children saw a significant reduction in their ADHD symptoms when their convergence insufficiency was successfully treated with vision therapy.

Reason #2- Words are blurry or hard to look at

Kids do not understand that how they’re seeing is not quite how everyone else sees. A child may have 20/20 eyesight and pass a regular vision examination, but still have poorly developed eye focusing skills (also called accommodation). When our eyes look far away, the eye focusing muscles relax to see clearly at a distance. When we look at something closer, the eye muscles contract to move the lens in the eye to see clearly at near. As we age, this lens itself becomes less flexible, which is why most people begin to need reading glasses after age 40. For a child, this skill should be easy and automatic.

Eye focusing skills allow the visual system to maintain clear and comfortable vision at near. Other signs of poor eye focusing skills include: blurry vision at near, occasional blurred distance vision after prolonged near-work, eyestrain and headaches. Some children complain that the words are hard to look at, that there are colored spots around the words or that the print is distorted. Others will have difficulty maintaining attention on reading or just avoid reading altogether.

Reason #3- They lose their place on the page frequently

To read efficiently, our eyes have to be able to make very precise eye movements, independent of head and body movements. If eye movement skills are delayed or never fully develop, it can significantly affect reading fluency and comprehension.

Reason #4- They think they are a slow reader

It isn’t hard to understand why a child with poor eye teaming, focusing and/or tracking skills might take longer to complete reading assignments. Another reason for slow reading speed can be poor span of visual awareness. Span of visual awareness refers to the amount, and speed, with which visual information can be taken in and processed. Children who are stressed about reading will often have difficulties with this and the end result is a child that seems to never “sit still”. Getting the wiggles out through movement activities and/or deep breathing exercises before sitting down to read can help combat some of the internal stress which may be making the problems worse.

Reason #5- They can’t visualize what they’ve read

Reading is more than decoding words, it is about creating a picture in your head to help you understand the author’s thoughts. Visualization, or the ability to make pictures in your head, is a skill that is often developed when children use their imaginations or play make believe. Parents can foster this skill by reading aloud to their children and then asking them questions to see if they understand what was just read.  Visualization is important not only for good reading comprehension, but also influences a child’s spelling and writing skills.

If you or your child identify with any of these five common reasons people avoid reading, you’re not alone. One out of every 10 children have an undiagnosed vision problem that can interfere with learning. The good news is there is hope! These visual skills are all learned skills that can be developed with proper guidance at any age. Developmental Optometrists specialize in the diagnosis and treatment of these common visual skill problems that can affect reading and learning. Treatment for vision-related learning problems may include therapeutic glasses designed to improve visual efficiency and/or optometric vision therapy. To learn more, check out our website, www.newhorizonsvision.com. To find a Developmental Optometrist near you, visit the College of Optometrists for Vision Development website at www.covd.org.

Valerie L. Frazer, OD, FCOVD

Click here to learn more about Dr. Valerie L. Frazer.

Vision, Behavior and Attention Webinar

View Dr. Frazer’s webinar that explores common signs of vision-related attention problems and strategies to improve these skills.

The number of children and adults diagnosed with attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) has increased significantly over the course of the last decade.

Did you know that many of the characteristics used to diagnose AD(H)D are also symptoms of vision related learning problems?

Some children and adults truly do suffer from ADD and ADHD, but certain vision and learning-related problems mirror the same symptoms and are misdiagnosed.

Symptoms for AD(H)D diagnosis that are also seen in learning-related visual problems:

• Making careless mistakes in schoolwork
• Not listening to what is being said
• Difficulty organizing tasks and activities
• Losing and misplacing belongings
• Fidgeting and squirming in seat
• Interrupting or intruding on others

Visual Skills for Reading & Learning Part II: Visual Perception

Watch Dr. Frazer’s webinar to learn why visual perception and visual processing skills are important for reading fluency and the learning process.

80% of all learning is visual and 20% of children lack the visual skills necessary to succeed in school. These necessary visual skills go beyond 20/20 vision. Dr. Frazer will review the most common symptoms of learning-related vision problems and the best methods of treatment.

Visual perception and visual processing skills include:

• Visual Directional Skills
• Visual Analysis Skills
• Visualization and Memory
• Visual Integration Skills

This webinar is beneficial for everyone; parents, teachers and other professionals who work with kids.

Webinar: Visual Skills For Reading

View Dr. Frazer’s webinar below to learn how visual skills such as tracking, focusing and eye teaming can interfere with reading fluency and the learning process.

20% of children lack visual skills required for reading and those necessary to succeed in school. These necessary visual skills go beyond 20/20 vision. Dr. Frazer will first review the most common symptoms of learning-related vision problems and then the best methods of treatment.

Learning-Related Vision Symptoms:

• Losing place on the page
• Words run together when reading
• Reversals of letters or words
• Easily distracted or fatigued
• Takes “hours” to do homework
• Low reading comprehension or fluency
• Poor or unevenly spaced handwriting
• Uses finger to keep place
• Eye fatigue or strain

This webinar is beneficial for everyone, parents, teachers and other professionals who work with kids.