Attention Deficit Hyperactivity Disorder or AD(H)D is being diagnosed with increasing frequency in both children and adults. Many of these individuals were previously labeled hyperactive or minimally brain damaged. It is estimated that 10 to 15% of school-age children presently have this disorder.
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, classifies three types of Attention Deficit/Hyperactivity Disorders: predominately inattentive, predominantly hyperactive, and combined. Six of nine symptoms of inattention, and six of nine of hyperactivity and impulsivity are necessary.
In each case, the symptoms must be present for at least six months to a degree that is maladaptive and inconsistent with developmental level. In addition, some symptoms must be present prior to age seven, and in two or more settings (e.g. at school, work and home). There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning, and the impairment cannot be caused by other disorders such as anxiety, psychosis or a pervasive developmental disorder.
Even though it is generally assumed that people diagnosed as having AD(H)D present a common set of characteristics emanating from a common etiology, little agreement is found among researchers regarding these symptoms. Some symptoms seen in children diagnosed as having attention deficits include:
- Making careless mistakes in schoolwork
- Not listening to what is being said
- Difficulty organizing tasks and activities
- Losing and misplacing belongings
- Fidgeting and squirming in seat
- Talking excessively
- Interrupting or intruding on others
These symptoms are also seen in both children and adults with learning-related visual problems, sensory integration dysfunction as well as with undiagnosed allergies or sensitivities to something they eat, drink or breathe. The chart that follows illustrates this graphically.
Sensory Integration Dysfunction
Learning-related Visual Problems
(Rapp, Sahky, Zimmerman)
Normal Child Under 7
|Inattention (at least 6 necessary)|
|Often fails to give close attention to details or makes careless mistakes|
|Often has difficulty sustaining attention in tasks or play activities|
|Often does not listen when spoken to directly|
|Often does not follow through on instructions or fails to finish work|
|Often has difficulty organizing tasks and activities|
|Often avoids, dislikes or is reluctant to engage in tasks requiring sustained mental effort|
|Often loses things|
|Often distracted by extraneous stimuli|
|Often forgetful in daily activities|
|Hyperactivity and Impulsivity(at least 6 necessary)|
|Often fidgets with hands or feet or squirms in seat|
|Often has difficulty remaining seated when required to do so|
|Often runs or climbs excessively|
|Often has difficulty playing quietly|
|Often “on the go”|
|Often talks excessively|
|Often blurts out answers to questions before they have been completed|
|Often has difficulty awaiting turn|
|Often interrupts or intrudes on others|
Physicians often recommend that AD(H)D be treated symptomatically with stimulant medication, special education and counseling. Although these approaches sometimes yield positive benefits, they often (may) mask the problems rather than get to their underlying causes.
Many common drugs for AD(H)D, which have the same Class 2 classification as cocaine and morphine, can have negative side affects that relate to appetite, sleep, and growth. These drugs must thus be withdrawn only under medical supervision. Placing a normal student who has difficulty paying attention in a special class and counseling could undermine, not boost, his self esteem.
If you have a child who enjoys being read to, who will sit and listen for long periods of time, but who demonstrates attention problems when using eyes for reading, deskwork, or homework, there is an excellent chance that the child’s attention problem is caused by an inability to use his eyes. There is no “biochemical imbalance” which allows children to attend when information comes in through the ears, but distracts children when information comes in through the eyes.
Similarly, if a child can pay attention for math, but not pay attention for reading, there is no “biochemical imbalance,” which occurs when the child looks at numbers but disappears when the child looks at words. In math, other than story problems, there is less visual information to cope with. The child looks at individual numbers and, as often as not, copies them one at a time, getting the hands into the act. In reading, the letters are crowded together so visual problems can more easily cause the letters to “run together.” Children who can pay attention for math but lose attention for reading, frequently have a visual problem masquerading as an attention problem.
However, if when you read to your child, his attention is better, but still a problem, then any number of causes—along with vision—could be contributing to the attention problem. For instance, your child might not understand the words, or there could be some other health problem making attention difficult.
Whatever the reason for your child’s struggle with attention, or behavior, untreated vision problems will only increase frustration, trigger behavior problems, and make things worse.
In our experience as Developmental Optometrists, undiagnosed vision disorders can often be misdiagnosed as learning disabilities or even AD(H)D. That’s why we strongly recommend that before a child is “classified” as learning disabled or ADD and treated with potent prescription drugs, a full vision screening and evaluation be performed.
Vision Therapy improves many skills that allow a person to pay attention. Anyone diagnosed with AD(H)D should have a complete evaluation by an optometrist trained in Developmental Vision Therapy. Testing should be done at distance and near point to assure that both eyes are working together as a team. Vision is more than clarity and is a complex combination of learned skills, including tracking, fixation, focus change, binocular fusion, and visualization. When all of these are well developed, children and adults can sustain attention, read and write without careless errors, give meaning to what they hear and see, and rely less on movement to stay alert.
Occupational Therapy for children with sensory integration dysfunction enhances their ability to process lower level senses related to alertness, understanding movement, body position and touch. They can then pay attention using their hearing and vision.
Biological and Nutritional Therapy for food and chemical sensitivities and metal toxicity have also been shown to eliminate many symptoms of AD(H)D. since biological problems can cause secondary visual symptoms, heavy metal detoxification is one of the most important treatments someone with an AD(H)D diagnosis should consider.
The public needs to understand that some optometrists, physicians, educators, mental health professionals, occupational therapists and allergists are all addressing the same symptoms and behaviors. The difference in that medication, special education and counseling (can) mask these symptoms and behaviors, while vision therapy, occupational therapy and treatment of allergies can (may) alleviate the underlying causes and thus eliminate the symptoms long-term.
When making a choice about treatment for attention deficits consider:
- Consulting a developmental optometrist for a vision evaluation
- Having a child evaluated by an occupational therapist with expertise in sensory processing problems
- Consulting an allergist regarding possible reactions to foods or airborne particles.
A sensible, multi-disciplinary, developmental approach treats underlying causes rather that the symptoms which are secondary. At Developmental Vision Center we work with children whose attention problems are caused by vision. We also work with the vision problems of children who have attention problems caused by other reasons. It is not, uncommon, for instance, to encounter children with ADHD who struggle with reading, whether or not they are on medication. Handling the vision problems may help solve the reading problem even though a general attention problem remains for other reasons.