Is it really ADHD?

Or is it a vision problem that can be fixed without medication?

If your child is hyperactive, unfocused, and dislikes reading and schoolwork, it may seem like a no brainer that they have ADHD.

But did you know that there are several combinations of visual problems, visual skill deficits, and refractive conditions that mimic ADHD?

Read on to learn how to tell the difference and how you can accurately discover their diagnosis. Children diagnosed with ADHD are almost 3x more likely to have a vision problem that makes it even harder for them to concentrate according to a 2016 study. It is also common for children with a vision problem to be misdiagnosed with ADHD.

How can this be? Attention deficit/hyperactivity disorder is a condition that includes attention difficulty, hyperactivity, and impulsiveness. If someone is having trouble physically focusing their eyes or it is hard for them to do near work, they are not likely to want or be able to keep their attention on it for the long periods of time required during a school day. Their executive function might also be impaired since they are putting so much effort into navigating the world. This makes the attention problem a side effect, not the primary issue.

With convergence insufficiency, the eyes can't turn in together and look at the same point.

Relevant Research

Recent research has proven the links between ADHD and visual impairments, like: 

  • Convergence insufficiency: this is an eye condition where your eyes don’t work together to see clearly. A 2012 study reported that children with ADHD had more convergence insufficiency symptoms than those without ADHD — and that convergence insufficiency was more likely to negatively impact their performance when they had ADHD.
  • Hyperopic refractive error: small amounts of hyperopia are normal in most children, but significant untreated hyperopia can lead to symptoms indistinguishable from ADHD, likely due to the significant effort needed to see clearly.
  • Astigmatic refractive error: this can make objects look blurry or distorted. It occurs when the cornea (or lens) has a different shape than normal, making the light bend differently as it enters the eye.

Identifiable Symptoms

Some cases of ADHD may really be a vision problem. It isn’t always obvious that a child is having a visual problem, leading it to be misdiagnosed. Here are signs that suggest the presence of a visual deficiency:

  • Attention span becomes shorter during close-up work
  • Poor concentration when reading
  • Restless when facing near work that requires comprehension
  • Disturbs other children in class during reading or other subjects that require near focus and concentration
  • Can concentrate for longer times when playing games or other compelling near vision work
  • Seems compelled to touch everything
  • Bumps into things, doesn’t seem aware of nearby objects
  • Often trips or falls
  • Hates to read, but likes being read to
  • Continues having problems doing near work despite an increase in the ability to concentrate after taking medication

Child unable to focus on reading, avoiding near work

Dr. Jesse evaluates a child's vision

Many children aren’t able to vocalize their problems. Their eyes can’t track across a page, but for them, it is just hard. It is important to ask children about what they are seeing or experiencing to get them the help they need. If your child is showing any of these symptoms, you should have them examined by a developmental optometrist near you before considering medication. A routine eye examination may catch several visual conditions masquerading as ADHD, but typically only a developmental optometrist will test every aspect of vision thoroughly enough to rule out an underlying vision problem.

How can you help?

If a child does have a vision problem, vision therapy can dramatically help these children. Vision therapy trains the eyes and brain to work together, creating new neural pathways that allow the visual system to work in harmony with our body and brain. This allows a child to interact with their world more naturally, without having to struggle.

A study that evaluated the success rate of treating convergence insufficiency with in-office vision therapy showed a very high success of 75%-85%. A randomized study in 2012 found that children diagnosed with ADHD who also had convergence insufficiency had fewer symptoms after a program of vision therapy.

Vision therapy can help children with ADHD who have vision problems

After an evaluation, Dr. Willingham shares a list of accommodations that could help the student perform better at school or elsewhere in their life, and is willing to speak directly with a teacher or anyone else in the child’s life that may benefit from knowing how to better help them.

Connect with Brighter Outlook Vision to see if vision could be at the root of your child’s problem, or come to one of our workshops to learn more and talk directly to Dr. Willingham. We can begin the process of helping your child together!