ADHD

Updated 12 June 2017

Could ADHD be a visual problem?

More and more children are being diagnosed with ADHD – but one optometrist says that 67% of children diagnosed with ADHD may actually have an underlying vision problem.

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Recent figures suggest 10% of the South African population has already been positively diagnosed with ADHD

Yet one Cape Town optometrist says that 67% of children diagnosed may actually have a vision problem which could be rectified with the right treatment and/or glasses.

Children often misdiagnosed

Nikky Häberle, a Behavioural Optometrist is passionately promoting awareness of vision-based learning problems, so more parents are aware and can get their children tested and potentially avoid unnecessary medication.

Read: What is ADHD?

She explains that children with vision problems may act like they have ADD, but the behaviour is very similar to those with vision-based learning problems; highly distractible, short attention spans, careless errors in writing, failure to complete assignments, fidgety and off task.

“Their inability to remain on task is caused by the discomfort of using their eyes for long periods of time at close ranges, not true deficits in attention. Unfortunately, parents and teachers are not trained to recognise the difference and these children are often misdiagnosed,” she says.

Eye strain affects attention span

Nikky says that children with eye teaming disorders have difficulty using their two eyes together at the close-up distances required for reading and writing.

This means they cannot concentrate for an extended time and often, after only a few minutes, they cannot control their eye movements and the print on the page begins to jump and move as they struggle to aim their eyes at the same point on the page.  

Read: Symptoms of ADHD

This results in eyestrain as they fight to coordinate their eyes and the way they get relief is to look away or take a break from what they were doing. Unfortunately this "vision break" as Nikky explains, is often construed as not paying attention.

Possible ramifications

“Children with eye teaming problems have always seen this way, and most are not aware that their close-up vision is not normal. Few report eye strain or blurred or double print; all they know is that they cannot continue with their seat work one more moment. As the day progresses, they get worse.”

Nikky is not alone in her research into the connection between eye teaming problems and attention deficit disorders and investigations into this and the possible ramifications are increasing worldwide.

Read: Who gets ADHD?

According to one expert, Dr David B. Granet, director of the Ratner Children's Eye Centre of the University of California and a paediatric ophthalmologist, this kind of eye teaming problem causes children to have difficulty keeping both eyes focused on a close target making it more difficult for them to concentrate on reading – which is one of the ways doctors diagnose ADHD.  

He even goes so far as to advise that no child be diagnosed with ADD or ADHD until their visual system has been checked because the chance of a misdiagnosis is probable.

The South African situation

Current guidelines in SA do not include a visual screening to accompany a diagnosis of ADHD, a fact which Nikky laments as she believes it is a vital component of the diagnosis.

“I highly recommend that a binocular vision examination be performed as part of any ADHD diagnosis, simply to remove the visual component that may be contributing towards the problem.

“Approximately 25% of the general SA population have vision problems that are severe enough to require vision therapy.  A relatively high number of people who receive testing at NH Optometrist are in that 25% range, simply because they have been referred by a teacher, psychologist or occupational therapist, or they realise they have many of the symptoms.”

What to watch out for

If you suspect that your child may have a vision problem with or without ADHD Nikky suggests you take a look at the following checklist:

Appearance of child’s eyes:

•       Reddened

•       Often teary

•       Encrusted eyelids

•       Frequent styes on lids

Do they complain of:  

•       Headaches

•       Burning eyes 

Read more: 

Post-term babies develop behavioural and emotional problems 

ADHD causes lifelong problems  

Teens abusing ADHD drugs 

 

Ask the Expert

ADHD Expert

Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation (www.gb4adhd.co.za) She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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