Visual issues and ADHD misdiagnosis
Dr Shelley Hyman
Visual issues are now being shown to be a common factor unlying the misdiagnosis of ADHD. This has been largely ignored in paediatric assessment with many paediatricians referring for basic eye sight tests (of acuity), but not checking actual eye alignment and occular motor functioning.
There are many types of visual issues not assessed in a basic optometrist assessment, and often only assessed properly by specially trained orthoptists or behavioural optometrists. These issues include problems with eye muscle fatige when having to focus at near, or issues with maintaining focus at varying positions.
Accommodation insufficiencyand occular motor dysfunction have both been shown to mimic signs of ADHD on ADHD ratin gs. When children pass a basic eye test and then still show signs of being unable to maintain their gaze on a book or object, they are then often diagnosed with ADHD.
Before a diagnosis of ADHD is assumed scientific research is now showing that vision testing needs to be conducted in more depth. It is unclear as to why visual issues seem to be becoming more common place, possibly due to the use of electronic tablets and close technology.
Whatever the reason it is paramount that prior to children being prescribed strong brain altering medication for thse issues, other causes that brain dysfunction need to be ruled out Whilst medication may help a child overcome the visual fatigue associated with issues such as accommodation insufficency, it simply masks the issues which can be easily treated.
One of the greatest problems with treatment though is finding a qualified therapist who is able to treat these types of visual issues. Orthoptics is the science of treating visual problems, and many orthoptists work alongside optometrists and opthalmologists to provide this type of therapy.
Whilst many behavioural optometrists also can train these visual issues, unfortunately the field of behavioural optometry has been tainted by numerous types of unscientific treatments such as coloured lenses and various others unproven techniques.
Orthoptic treatment is often very quick, lasting between 10-12 sessions, and has been shown to have long last benefits and results.