Attention Deficit Hyperactivity Disorder, or ADHD, has become one of the most commonly diagnosed childhood behavioral conditions. The Centers for Disease Control and Prevention (CDC) reports one in nine children receive a diagnosis under current clinical guidelines, a number that has caused an enormous amount of controversy between physicians, educators, parents, and other groups.
Many critics of the ADHD status quo cite overdiagnosis and overtreatment as being both widespread and possibly damaging to children, given that pharmaceutical treatment of the disorder remains the most common method of treating it. And on at least one count, they’re right. Vision disorders have been known to fool psychologists into making incorrect diagnoses. A wide range of eye problems can crop up during childhood, some of which look an awful lot like ADHD on the surface; however, lumping them in with behavioral disorders does a child no favors.
What is ADHD?
Actually defining ADHD isn’t always easy. No single conclusive test exists, instead psychologists must check off a list of subjective requirements to reach a diagnosis. The DSM-5, the current bible of American psychology, lists two categories of symptoms.
Inattention includes characteristics such as the child often having trouble organizing tasks and activities, not seeming to listen when spoken to directly, and often being easily distracted.
Hyperactivity and impulsivity, the second category, includes characteristics like often talking excessively, often ‘on the go’ acting as if ‘driven by a motor’, and often having trouble waiting his/her turn.
To actually be diagnosed, a child has to display a given number (six for kids 16 and under, five for 17 and older) of the listed symptoms.
So… What is ADHD?
As you may have noticed from the above lists, the actual definition of ADHD tends to be, well, a little rough around the edges. Supporters of the DSM entry often point to variation between children as the cause for the subjective diagnosis. Critics are less kind and have attacked the current rate of diagnosis as being driven by a new, numbers-driven approach to early education, or even by the machinations of pharmaceutical companies.
The truth is likely somewhere in between the two. Studies have found that some communities do consistently err on the side of caution when screening for the disorder and may be a little too eager to prescribe pills. On the other hand, psychological consensus is that for many children, the diagnosis is anything but unnecessary and that treatment may be the only thing that allows full concentration in school.
However, there’s no denying that the scope of symptoms do occasionally draw diagnoses where they likely don’t exist. Time and time again, studies have shown a link between ADHD diagnosis and ear infections. Children with apparent cases of ADHD are vastly more likely to have middle ear infections than their peers. Although a medical connection between the two could explain this, some sources point to a different explanation: difficulty hearing can account for many apparent symptoms of ADHD, including difficulty listening and responding to vocal cues.
Vision Disorder Diagnoses
If there’s suspicion that ear infections can give psychologists an itchy figurative trigger finger, there’s certainty that visual disorders can. Whether they’re learning ABC’s or watching equations evolve on a blackboard, children rely on visual acuity to stay engaged and successful in school. A student with myopia, or nearsightedness, can have intense difficulty in staying abreast of work.
A recent poster cause for the interplay of visual disorders and ADHD appeared when researchers from the University of San Diego released a study showing that children that suffered from a common condition called convergence insufficiency were three times more likely to be diagnosed with ADHD than those without. Convergence insufficiency occurs when a child has difficulty moving his or her eyes toward one another to focus on near-field objects. Poor, often blurry close vision is a common result, making it difficult for a student with the condition to concentrate on a book or digital screen.
Even worse, headache, fatigue, and eye strain can also be present. Taken together, these symptoms don’t just make the classroom a challenge for children with convergence insufficiency, they make it painful and frustrating. It’s not hard to imagine kids in this situation having apparent difficulties staying on task and attending to class. In fact, behavioral symptoms may be nearly identical to those seen in ADHD, they simply have a vastly different cause.
Checking for Vision Disorders
If the root cause of school trouble is convergence insufficiency, myopia, astigmatism, or any one of a whole host of common childhood vision disorders, conventional ADHD treatment might appear to help (pharmaceuticals used to treat ADHD can help focus people without the disorder), but won’t satisfactorily address the original cause of the problems.
Early vision screening is of vital importance in ensuring that children with visual problems don’t slip through the cracks just to wind up unnecessarily medicated. Many schools conduct simple screenings, with a nurse or similarly trained health professional conducting various tests to check for undiagnosed difficulties. However, even when these are in place, they’re hardly conclusive. Full eye exams are much more likely to pick up any visual disorders.
Parents can also play their part in safeguarding their child’s visual and academic health. If a child is struggling at school, then speak with them. If they mention frequent headaches, extreme difficulty reading, or any of the other hallmarks of a visual abnormality, then it may be time to schedule an exam. Other signs of degrading vision include apparent discomfort while reading, poor hand-eye coordination, closing one eye to perform delicate tasks, and exhibiting unusual posture.