Before you Medicate, Investigate- ADHD & Vision

Clinical research has established that there is a link between a diagnosis of ADHD and certain vision deficits or delays in children. Many children with ADHD also test positive for a saccadic eye movement deficit. This means that they have difficulty moving their eyes efficiently and accurately from one fixed visual target to another as in going from one word or line to the next on a page of text. Many children with ADHD also test positive for a convergence insufficiency (CI). This means that they are unable to cross their eyes or team them appropriately and may experience words moving, blurring, or doubling on a page. They may get headaches when reading or they may, without ever being aware of it, suppress the vision in one eye. Many children with ADHD also test positive for accommodative infacility (AI) which means that they have trouble adjusting their focus when looking from a near image to a different image in the distance.

The good news is that all three of these visual diagnoses can be addressed with a program of in-office vision therapy under the supervision of a developmental optometrist. So, if your child has been diagnosed or if you are being encouraged to obtain a diagnosis of ADHD, don't stop there. Arrange an appointment for your child to receive a comprehensive eye exam by a developmental optometrist who incorporates vision therapy into their practice. If the eye doctor finds that your child has any of these visual problems, follow through with the program of vision therapy. To find a developmental optometrist in your area, plug your zip code into the search box at www.covd.org.

You can read more about this in: Borsting, Eric; Michael Rouse, and Ray Chu. Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: a preliminary study. "Optometry", Volume 76. Number 10. October 2005

Eye Movements & a Struggling Adult Reader Who Has an MBA

I recently did a very simple eye movement activity with a friend who reads very slowly. It has always been a problem for her from the time she was in elementary school. In fact, she chose her high school and college courses to avoid reading so she became good at math and ended up with an MBA in finance. It remains agonizingly difficult for her to find the energy to tackle reading even a few pages. When she reads aloud, she lacks fluency, obviously struggling to keep her place while decoding the words and trying to process their meaning. So, I suggested that she might have some basic eye movement deficits. Now, I am not an eye doctor. Nor do I play one on TV but I am a skilled observer of a person's eye movements because of the work I do as a vision therapist. I asked my friend to cover one eye and to follow my pen as it moved in a slow arc in front of her eyes, up, down, across, and circling in toward her face. Then she covered the other eye and we repeated the activity. She had no problem making smooth eye movements to track the moving pen so her ocular pursuits look fine. She could even maintain a conversation while doing this activity. Next, one eye at a time again, I asked my friend to look at one pen and then, on my signal, jump her eye to another. She could not keep her fixation on the first object, nor could she accurately locate the second. When she visits a developmental optometrist for a thorough eye exam, I predict that she will receive a diagnosis of saccadic deficits. This is the result of poor control of the six muscles in each eye and can be addressed through a program of vision therapy. (In fact, just as a side note, the Purple Book of the Eye Can Too! Read series of e-books that I wrote has a lot of activities that rely on and can improve these eye movement skills). Next I asked my friend to use two eyes and focus on the #2 written on the side of a pencil that I was holding about a yard away from her face so that the eraser was facing up. I asked her to keep the #2 single and clear and to tell me if it got blurry or doubled. Slowly I pushed the pencil towards her face watching her eyes to make sure that they were converging. They did get closer and closer to her nose which is appropriate. However, when the pencil was about a foot away, my friend said, "That hurts!" She did not look away right then but I could see the stress that she was under. I repeated the activity and she repeated her report of discomfort at about the same place. So, when she visits the developmental optometrist she will likely receive another diagnosis related to her eye teaming skills.She should have been able to track that pencil in to three inches or nearer to her nose without pain, blur, or double vision. No wonder reading has been so difficult in spite of her willingness to tolerate significant discomfort in order to succeed. No matter your age, if you have difficulty reading, see whether there is a visual issue that can be resolved with a few eye exercises. Locate a developmental optometrist by going to www.covd.org and plugging in your zip code. Make an appointment and see what the doctor discovers.

St. Louis Examiner Article

Check out this article for more about vision and autism.

http://www.examiner.com/examiner/x-22250-Autism--Education~y2009m9d26-Understanding-the-relationship-between-vision-autism-and-learning

Peripheral Awareness & Autism Spectrum Disorders

If you stare in front of you at a small visual target like a sticker or a spot on the wall you are using your central vision. The longer you maintain that fixation, the more you should become aware that you can also see objects in your peripheral field of vision. The ability to coordinate between your central and peripheral visual systems is very important. Athletes depend on it to sense when an opponent is approaching from behind. Everyone relies on it to remain aware of cars or other potentially dangerous obstacles that should be avoided. Peripheral awareness can actually be improved with practice and certain activities.

For individuals on the Autism Spectrum, however, coordinating and transitioning between the central and peripheral visual fields may be their most significant visual challenge. Many people on the Autism Spectrum repeatedly focus on spinning objects, or on moving lights and shadows. These are enjoyed via the peripheral system. Other people on the spectrum fixate on a pen or pencil that they hold and rotate right in front of their eyes or they cannot be pulled away from small objects or details. These are enjoyed via the central visual system.

As Patricia S. Lemer explains in her helpful book, Envisioning a Bright Future: Interventions that Work for Children and Adults with Autism Spectrum Disorders, learning to coordinate central and peripheral vision may improve a child's attention, focusing, and visual perceptual skills. It may even reduce toe walking and the need to hold onto a wall when walking. Dr. Melvin Kaplan (www.autisticvision.com) wrote a book, Seeing with New Eyes, that explains how these issues can be addressed using therapeutic prisms.

Children who are on the Autism Spectrum may have other visual challenges that can be addressed with the help of a developmental optometrist and a program of in-office vision therapy. They may need glasses to see clearly. You can easily locate an experienced developmental optometrist in your area by plugging your zip code into the search box at www.covd.org. Even if your child is not on the Autism Spectrum, it is important to schedule an annual eye exam with a developmental optometrist and to follow up with the treatment, prescriptions, or therapy that the doctor advises.