The 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?”

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.

Children 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.

For 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, visit www.childrensvision.com.)

The 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)

Any 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.

To find out more please visit: www.childrensvision.com

To 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.