diagnosis of Attention Deficit Disorder (ADD) and Attention Deficit
Hyperactivity Disorder (ADHD) have been made with increasing frequency during
the last decade. A visit to the health room in any school at noon when
the nurse is passing out medications illustrates how common this diagnosis has
become. Child after child is lining up for their mid-day dosage of
Ritalin, Adderall, or similar stimulant used to treat ADD. While the medicine
helps the child's ability to "focus," these drugs can have negative
side effects related to appetite, sleep, and growth. More than one
parent, teacher, and school nurse have asked themselves, "Do all of these
children really have ADD?"
and ADHD are psychiatric disorders characterized by inattentiveness or
hyperactivity and compulsiveness which hinder a child's academic or social
performance. Because there is not yet an objective clinical test to confirm
ADD or ADHD, the diagnosis is based on a set of subjective symptoms. If
children exhibit any six of nine characteristics in either category, they are
labeled ADD or ADHD. In an effort to help children who are struggling at
school because of their short attention spans, many parents, teachers, and
doctors make the assumption that these children have ADD and start them on
medications. Unfortunately, they are often treating the symptoms and not
the real cause. High distractibility and difficulty remaining on task are not
the sole domain of ADD. These can be symptoms of other problems.
with undetected vision problems can exhibit symptoms similar to ADD.
Studies show that approximately 20% of school-aged children suffer from eye
teaming or focusing deficits which make remaining on task for long periods of
time difficult. Like those with ADD, children with vision-based learning
problems are highly distractible, have short attention spans, make careless
errors, fail to complete assignments, and are often fidgety and off task.
However, their inability to remain on task is caused by the discomfort of
using their eyes for long periods of time at close ranges, not true deficits
in attention. Unfortunately, parents and teachers are not trained to
recognize the difference and these children are often misdiagnosed.
example, children with eye teaming disorders called convergence insufficiency
and convergence excess often appear to have ADD or ADHD. These children
have difficulty using their two eyes together at the close-up distances
required for reading and writing. After a short period of time, they can
no longer control their eye movements, and the print on the page begins to
jump and move as they struggle to aim their eyes at the same point on the
page. The result is a great deal of eyestrain as they fight to
coordinate their eyes. Soon these children are forced to exercise their
only relief--avoidance of the close-up tasks which are making them
uncomfortable. These children are often looking around the room, getting a
drink, going to the bathroom, staring out the window, or talking to their
neighbors. They're taking "vision breaks," although they don't
realize that's what they're doing. Children with eye teaming problems have
always seen this way, and most are not aware that their close-up vision is not
normal. Few report eye strain or blurred or double print; all they know
is that they cannot continue with their seat work one more moment. As
the day progresses, they become increasingly fatigued and frustrated.
(For a more detailed description of learning-related vision problems, see our
"Vision and Reading" page.)
connection between eye teaming problems and attention deficit disorders was
recently documented in medical journals. The latest research study found
children diagnosed with ADHD were three times as likely to have a convergence
insufficiency than children in the rest of the population. Dr. David B.
Granet, director of the Ratner Children's Eye Center of the University of
California in San Diego and a nationally known pediatric ophthalmologist,
explains that because this kind of eye teaming problem causes children to have
difficulty keeping both eyes focused on a close target, it becomes more
difficult for them to concentrate on reading, one of the ways doctors
diagnose ADHD. As a result of his research, Dr. Granet recommends that
no child be diagnosed with ADD or ADHD until their visual system has been
checked because the chance of a misdiagnosis is just too great. (Strabismus,
Volume 13, Number 4 / December 2005, Pages: 163 - 168)
child who is suspected of having ADD should have a complete eye exam by a
pediatric specialist in children's vision to determine if poor visual
processing is a factor in the child's behavior. Unlike ADD which is
diagnosed by a subjective checklist, objective clinical measures and tests can
be run to determine for certain if the child has a learning-related vision
problem which is making it difficult for him to remain on task.
find a qualified developmental optometrist trained to
diagnose and treat vision-based learning problems, contact the national
certifying board of the College of Optometrists in Vision Development at
1-888-268-3770 or visit their web site at http://www.covd.org.