Is it ADHD or a near vision problem?
What’s up with Bryson?
Here is the story of our hypothetical friend, Bryson. Bryson is in second grade now but he had a tough time in first grade with reading and handwriting. He just “made the cut” to get promoted to second grade but now he is falling behind. He hates reading. It hurts his eyes when he reads and he has a hard time seeing the words. He doesn’t know that words aren’t supposed to be blurred and moving around when you read. It is the only way he has ever seen them.
Ms. Clark, his teacher, passes out a reading sheet to the class. It is a short paragraph with a few sentences and a few questions about the paragraph. Bryson gets his paper and starts to read the paragraph, but the words are blurry and his eyes hurt as he tries to complete the reading. He keeps lifting his head up from the paper because that seems to make his eyes hurt less. He is getting nervous though because he hasn’t finished the reading and he knows Ms. Clark will be asking for the paper soon. When he gets nervous, Bryson fidgets at his desk and finds it hard to sit still. Ms. Clark asks for the papers to be passed forward and Bryson hasn’t answered any questions correctly about the paragraph.
Next, Ms. Clark is going to have the children take turns reading aloud. Bryson doesn’t like this at all. He doesn’t read as well as the other kids and it makes him really anxious. As it gets closer to his turn to read, Bryson’s neighbor reminds him of how much trouble Bryson had when they did this last time. Bryson hollers at his neighbor, “Shut up!”. This interrupts the class and Bryson gets in trouble.
Ms. Clark is a great teacher and watches Bryson. He seems really smart, but while he is supposed to be reading, Bryson is looking around the classroom and not getting his work done. He has a lot of difficulty sitting still during the school day and he has had some difficulty with interrupting the classroom. Bryson looks like a child with ADHD. She talks with Bryson’s mom who doesn’t see much of this at home but does know that Bryson hates homework. He spends hours trying to complete reading assignments but no matter how he works, he still has difficulty.
Off to the Pediatrician
So Bryson’s mom takes him to the pediatrician and discusses her concerns with the doc. The doctor completes an ADHD behavioral scale and Bryson does score high enough to be diagnosed with ADHD. The doc starts him on a typical ADHD med. After a week on the medication, the teacher and mom are not seeing much change so the doc tries another medication. This also does not seem to be helpful.
Is it ADHD or near vision focusing problems?
Several studies have shown that the behavioral symptoms of near vision focusing problems are frequently mistaken for ADHD (2). In fact, one study showed that children with near vision focusing problems score higher on ADHD scales than children with ADHD (1)
But Bryson went to the eye doctor and they said his vision was fine…20/20… he didn’t even need glasses! This is common with children with near vision focusing problems. Typical eye exams may not find this problem, so a child may stay on medication for years and struggle with academics.
Of course not all ADHD is a near vision problem, but children with ADHD do tend to have a higher incidence of eye movement problems. While vision rehabilitation can help with these eye movement problems, it does not treat ADHD.
Binocular Vision Exam
Only a binocular vision exam will reveal the problems with Bryson’s vision. Only in-clinic treatment for his near vision focusing problems will correct his problem (3). Ask your eye doctor if this exam that will be performed!
(1)Rouse, M., Borsting, E., Mitchell, G. L., Kulp, M. T., Scheiman, M., Amster, D., . . . CITT, G. R. (2009, October). Academic behaviors in children with convergence insufficiency with and without parent-reported ADHD. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19741558
(2)Borsting, E., Rouse, M., & Chu, R. (2005, October). Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: A preliminary study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16230274
(3)Scheiman, M., Mitchell, G. L., Cotter, S., Cooper, J., Kulp, M., Rouse, M., . . . Convergence, G. R. (2005, January). A randomized clinical trial of treatments for convergence insufficiency in children. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15642806