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The two conditions are often confused. If your child’s teacher has a behavioral or learning concern, one of your first calls should be to the eye doctor.
Does your child act out or get easily distracted? The answer is probably "sometimes," because that's a natural part of being a kid.
But for many children, symptoms like inattention, hyperactivity, and impulsivity can interfere with home life and school. Some of these children may have attention-deficit/hyperactivity disorder, or ADHD. For others, the real problem might be their eyesight.
Several studies have linked ADHD with vision problems. In one of the most recent, researchers at the University of Alabama at Birmingham examined data from more 75,000 children. After crunching the numbers, they found that children with certain vision problems were nearly twice as likely to have ADHD, compared with kids with normal vision.
What’s more, these are not the kinds of vision problems you’re likely familiar with (like nearsightedness). Generally, they’re what Mitchell Scheiman, O.D., Ph.D., calls visual efficiency problems—non-refractive issues that can’t always be fixed with standard glasses.
Kids with these disorders may see just fine, but their eyes struggle to work as a team, focus quickly, or track words on a page.
“These are problems that require additional neuromuscular effort to try to self-correct,” says Dr. Scheiman, a Salus University researcher who studies vision problems related to attention and concentration.
“You may need a higher amount of focusing effort to see an image clearly,” he says. “Or if one eye drifts out while reading, you need more effort to pull it back into alignment.”
That extra effort may limit the child’s ability to focus on the task at hand, Dr. Scheiman explains. As a result, the child may lose interest quickly, or be unable to retain or comprehend something he just read.
“The symptoms are related to sustained visual attention, like reading or working on a computer,” Dr. Scheiman says. “Every once in a while, the child may have to stop, get up, walk around, and rub their eyes. And someone may interpret that as being inattentive.”
In fact, these behaviors can so closely resemble ADHD that some children with vision problems may be misdiagnosed, Dr. Scheiman says. And the behavior only gets worse if the vision problem is left uncorrected.
In one of Dr. Scheiman’s studies that was published in the journal Optometry and Vision Science, children with an eye-teaming disorder who underwent three months of treatment saw their academic behavior improve by as much as 30%.
That’s why one of your first calls should be to the eye doctor to rule out vision problems. It may be a crucial step on the path to a correct diagnosis.
Which Vision Disorders Can Look Like ADHD?
While uncorrected refractory errors (in particular, farsightedness) can affect your child’s ability to focus, the eye problems most often linked to attention and concentration have to do with three things—the eyes’ ability to team, focus, and track.
Teaming. Eye-teaming problems, or binocular vision disorders, affect the eyes’ ability to work together as a team.
One example commonly associated with ADHD is a near-vision problem called convergence insufficiency, says optometrist Elizabeth Walsh Czirr, O.D., of Nashville Regional Eyecare, located inside an America’s Best Contacts & Eyeglasses in Kingsport, Tenn.
In fact, children with this condition are three times more likely than other children to be diagnosed with ADHD, according to a study from UC San Diego.
Kids with convergence insufficiency may be able to see just fine. But during near tasks, their eyes do not converge, or move inward, properly, Dr. Czirr explains. Instead, one eye may turn out instead of in, leading to blurry or double vision.
Focusing. When the eyes have a hard time adjusting focus, that’s known as an accommodative disorder, says Dr. Czirr.
Typically, our eyes adjust automatically when we look up close, far away, and back again—so we can see objects clearly at all distances. But in people with an impaired ability to focus, the eyes may take longer to adjust, leading to discomfort, eye strain, and fatigue.
One telltale sign: Your child squints when he looks up after reading, says Deanna Paul-Blanc, O.D., an America’s Best optometrist located outside of Nashville.
Tracking. Then there are eye-movement problems like saccadic dysfunction—when your eyes can’t move smoothly to track words across a page.
Instead, the eyes jump forward and back—so slightly that it’s almost imperceptible. But it’s enough to disrupt the brain-eye connection that allows you to process what you’re reading. Children who struggle with reading retention and comprehension may have this problem.
What Parents Can Do
Call the eye doctor to rule out vision problems, says Dr. Paul-Blanc. From there, your eye doctor may recommend vision therapy or suggest talking to your pediatrician to see if your child has ADHD or a learning disability.
Seeking multiple expert opinions across different medical fields increases the chances of an accurate diagnosis, adds Dr. Czirr. Just remember: The diagnostic tests used to spot visual efficiency problems are not part of a standard eye exam.
“A child with these conditions could have a full eye examination and the problems could potentially be left undiagnosed,” Dr. Scheiman says. “It’s unfortunate, but it does occur.”
Be sure to ask your eye doctor to perform a complete evaluation of binocular vision, accommodation, and eye movements, Dr. Scheiman recommends. Or search for a doctor through COVD.org. Members of this organization—the College of Optometrists in Vision Development—always perform these tests.
3 Simple Tests to Do at Home
Only a qualified doctor can diagnose your child, but you can do a little detective work on your own.
1. Use a pencil, pen, or your finger to check your child’s near point of convergence. That’s the distance where both eyes can focus without double vision.
Hold the pencil a couple of feet in front of your child’s face. As you move it in closer, your child should be able to track it clearly until it’s at least 5 centimeters in front of her nose.
Watch your child’s eyes as they slowly converge: If one eye breaks away, your child may have convergence insufficiency.
2. To check for an accommodative disorder, have your child look at something up close—say, a book—and then shift her gaze to an object about 10 to 20 feet away. Then tell her to look back at her book.
Have her repeat the up-down cycle at least five times. Each time, have her say, “Clear!” to indicate how long it takes for her focus to fully adjust.
“It should be pretty quick,” says Dr. Paul-Blanc. “But if it starts taking like two or three seconds, that might be a sign of accommodative disorder.”
Also note if your child complains of headaches, constantly rubs her eyes, squints, or covers one eye while reading, says Dr. Paul-Blanc.
3. Ask questions like: “Does your head hurt when you’re doing homework?” “Do you have a hard time paying attention?” “Do words that should be one ever split into two?”
Yes answers may be red flags, she says.
If you suspect something’s up with your child’s vision, always book an eye appointment to make sure.
How Doctors Treat Visual Efficiency Problems
Luckily, these conditions are often easy to treat, says Dr. Scheiman. Reading glasses, bifocals, or prism lenses may help some children.
Treatment also typically includes in-office optometric vision therapy. This is where an optometrist works with your child once or twice a week to restore normal focusing, teaming, and eye movement skills.
The program will be tailored to meet your child’s individual needs. If your optometrist doesn’t provide vision therapy, they can help connect you with a provider.
Dr. Paul-Blanc describes the vision therapy process like this: “The whole visual system includes more than just your eyes. It’s also your brain and how you perceive things. It’s like your car engine. You may just see the dashboard, but inside under the hood are all these functioning parts. Getting your eyes and brain to work together better is the goal.”
These simple steps may make a big difference in your child’s attentiveness and school performance. “If a child’s vision can’t focus, their brain can’t focus,” says Dr. Paul-Blanc. “And if kids can’t focus in life, they’re not going to be able to focus in school.”