Is It AD(H)D or Something Else?
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.