As I said in the last post, vision therapy is controversial treatment. Some vision therapist claim that they can cure your child's attention problems with vision therapy or with special prescribed prism glasses.
Earlier this year a group of Optometrist in England evaluated several programs claiming to improve visual, mental, neurological, academic, and behavioral problems. They concluded that with the exception of therapy for convergence insufficiency and vision rehabilitation after brain injury, these programs were worthless.
I think that the claims made by some vision therapist are greatly exaggerated but I believe that there may be some positive ADHD outcomes to be gained from the vision therapy modalities. Let me explain.
Children diagnosed with ADHD have a three fold increase in the incidence of Convergence Insufficiency as compared to controls and a two fold increase in the incidence of visual tracking problems. This may be related to a hyper responsive superior colliculus. The superior colliculus (SC) is a brain structure which is involved in the control of distractibility and of eye and head movements. Some researchers have proposed that in ADHD, the colliculus is hyper-responsive, which causes inattention and distractibility. Could the hyper-responsive SC also be causing the problems with convergence and tracking??
When my son was seven years old we took him to an Occupational Therapist (OT) His teachers were concerned because his handwriting was horrible and his gross motor skills were not great. They wanted me to make certain that these problems were not related to an OT issue.
The OT spent about 1 minute with him and then came to tell me that he had something 'wrong' going on with his eyes. She felt that his handwriting problems and gross motor problems were related to a convergence insufficiency and referred us to a Developmental Optometrist.
The Optometrist gave him a very thorough evaluation and determined that he had tracking delays and convergence problems. He also reported that my son was cross dominant. This happens, according to the optometrist, when you are right handed but your dominant eye is the left eye (or vice versa).
My son was a second grader reading at a 6th grade reading level. He did not have dyslexia, according to the Optometrist, but it was his cross dominance and convergence issues that caused him to write the number '9' when he meant to write a 'P' and to write the number '3' when he meant to write an 'E'. The evaluation took 4 hours and resulted in our getting a mountain of exercises that we had to do with him at home.
The exercises involved tracking letters in a newspaper, reading from materials that were near and far in a rapid manner, and what I call eye aerobics, where he had to look up, down, and all around, over and over again
After about 3 months of doing this. His tracking was faster, his letter reversals were much better, and his handwriting was better. I believe that it is possible that, just like with biofeedback, we can train our eyes to perform better. If there is an eye/attention connection maybe training the eye could in some way help.
Some folks have proposed that the increased attention which results from taking an Amphetamine, is cause by the depressesion of activity in the colliculus. Could there possibly be some visual therapy that would, like amphetamine, calm that hyper-responsive colliculus and in the process increase out attention? Who knows, maybe, just maybe…
Collicular dysfunction in attention deficit hyperactivity disorder. Overton PG.Department of Psychology, University of Sheffield, Sheffield, Western Bank, S10 2TP, UK. p.g.overton@sheffield.ac.uk
J Child Neurol. 2006 Jun;21(6):503-7.Visuomotor tracking related to attention deficit hyperactivity disorder (ADHD). Tirosh E, Perets-Dubrovsky S, Davidovitch M, Hocherman S.
The relationship between convergence insufficiency and ADHD. Granet DB, Gomi CF, Ventura R, Miller-Scholte A.
Personally I do think that there is often an element of vision problems in ADHD - and there is also, in my opinion, a significant overlap between ADHD and reading difficulties. It's not really hard to see why, of course - it is almost impossible to learn to read if you can't concentrate for an extended period of time!
ReplyDeleteI work with kids who have trouble learning to read and a lot of them respond really well to simple eye exercises; and their parents often report that there is an improvement in their other ADHD symptoms, too.
As a teacher, I worked at a charter school that employed vision therapy techniques as part of their curriculum. The school was founded by a developmental optometrist. At the beginning of the school year there were 54 students on medication for ADD/ADHD. At the end of the school year, only 4 students were still taking these medications. Convergence Insufficiency is very widespread in ADD/ADHD populations.
ReplyDeleteRachel- My son was recently (last week) diagnosed with ADHD and Irlen syndrome. You should look into Irlen Syndrome. It's totally simple to treat with colored overlays for reading, colored paper at school, and other guidelines from the Department of Education. I also put him on a section 504 (protection because of the disability) and it's helped him so much. I still need to get the ADHD taken care of. At least one thing is under control. It's helping my son with the colored overlays.
ReplyDeleteIndividuals with Irlen Syndrome seem to see words that are blurry, have patterns or appear to move on the page. My son who is an excellent reader reports that he sees patterns in the text that are related to how the spaces in how the words line up. My son also reported that sometimes the words move and 'jiggle' on the page and that the words are blurry and that all these symptoms improved tremendously with Vision Therapy. He used to get headaches and was slow at tracking and at doing math problems not because of the math but because he would see a plus sign that looked like a minus sign with a l next to it and that the vision therapy helped that as well. My ophthomologist said that my son had a few different eye problems.
ReplyDeleteMany scientists believe and have shown a link between vision and attention:
ReplyDeleteAcademic Behaviors in Children with Convergence Insufficiency with and without Parent-Reported ADHD.
Rouse M, Borsting E, Mitchell GL, Kulp MT, Scheiman M, Amster D, Coulter R, Fecho G, Gallaway M; The CITT Study Group.Optom Vis Sci. 2009 Sep 7.
Oculomotor performance identifies underlying cognitive deficits in attention-deficit/hyperactivity disorder. Loe IM, Feldman HM, Yasui E, Luna B. J Am Acad Child Adolesc Psychiatry. 2009 Apr;48(4):431-40.
The relationship between convergence insufficiency and ADHD.Granet DB, Gomi CF, Ventura R, Miller-Scholte A. Strabismus. 2005 Dec;13(4):163-8.
Nearpoint phorias after nearwork predict ADHD symptoms in college students.Wilmer JB, Buchanan GM.Optom Vis Sci. 2009 Aug;86(8):971-8.
For more info go to http://www.mainosmemos.blogspot.com and type in attention deficit in the search box