Functional Vision Disorders Misdiagnosed as ADHD

      I’ve mentioned this topic in several of my previous writings, but I feel its importance renders its own post.  The past couple decades have seen the rise of the diagnosis of ADHD, especially in school-aged children. According to the Center for Disease Control and Prevention, the American Psychiatric Association states that approximately 5% of children have ADHD. They also give statistics on children ages 4-17. Approximately 11% (6.4 million) of children in this age range have ever been diagnosed with ADHD. The percentage of children continues to increase from 7.8% in 2003 to 9.5% in 2007 to 11% in 2011-2012. While experts are still disputing exactly how often it is being misdiagnosed, there is no question that it is happening.

      The symptoms of ADHD can look strikingly similar to several disorders, but one of the most common includes functional vision disorders. The College of Optometrists in Vision Development state that, “Some children with learning difficulties exhibit specific behaviors of impulsivity, hyperactivity, and distractibility.”

      Accommodation insufficiency (difficulty changing focus from near to far) is a common functional vision disorder which can cause poor attention in the classroom. A child copying notes from the board can easily fall behind due to his eyes’ inability to change focus fast enough. This can lead to confusion, frustration, and oftentimes giving up. Their attention then goes elsewhere to relieve their suffering. When their attention is no longer on their work, they can become fidgety and easily distractible.  A teacher who has no idea of the child’s vision issues can understandably label them as having discipline or attention issues due to ADHD.

      Another vision issue that shares the same symptoms as an attention disorder is the inability or difficulty to move both eyes in a precise, coordinated way, known as eye teaming. Issues with eye teaming, especially convergence insufficiency (the reduced ability of the eyes to turn toward each other), can cause blurred vision, double vision, eye strain, headaches, and so on.  According to Dr. Granet of the Children’s Eye Center, children with convergence insufficiency are three times more likely to be misdiagnosed with ADHD than children without the disorder. If a child cannot even see the words clearly, and is having to exert much effort just to see normally, then their ability to process what they are reading is greatly reduced.  It is hard to imagine trying to understand what you are reading, remember what you read, and then answer questions about it if you are spending the majority of the time trying to decode each individual word. Between visual discomfort and low reading comprehension, it is no wonder they cannot stay on task with reading and schoolwork.

      Almost any functional vision disorder results in a reduced ability to complete any kind of near work, such as reading or writing, for a long duration. The visual demands are too great to comfortably endure for hours on end while in school. This results in difficulty completing assignments on time, especially on tasks like timed tests. In an effort to keep up, they are also prone to make careless mistakes.

      Other functional vision disorder symptoms that manifest themselves as behaviors and habits which look like an attention disorder on the surface include: losing place when reading, skipping or repeating words, poor visual memory, poor reading comprehension, inability to verbalize visual information, and so on. Each of these has the ability to create an aversion to reading and learning in the child experiencing them. This, not surprisingly, can oftentimes lead to poor self-esteem, anxiety, and depression which can continue well into adulthood.

      If you are unsure whether your child’s symptoms are due to a functional vision disorder or an attention disorder, the only way to know for certain is to have a comprehensive eye exam by a developmental optometrist. Once examined, if a visual issue is identified, a program of vision therapy is the best course of action to treat both the disorder and its symptoms. Once complete we can then determine if an attention issue is also present or if it was purely visual. Vision therapy is a much healthier and beneficial treatment option in the long run versus immediately resorting to medication to fix the issue, especially if you are unsure exactly what the issue may be.

Emily Thompson, Vision Therapist