A New Look at ADHD

Is your child inattentive? Impulsive? Hyperactive? If you answered 'yes' to any of those, we have established that you have a child. Every kid will be a kid, and every kid has their moments (whether sugar-induced or otherwise). Well when these behaviors are present at clinically-significant levels, it may lead to the diagnosis of Attention-Deficit/Hyperactivity Disorder (AD/HD) – sometimes called ADD or ADHD. Unfortunately, diagnosis of AD/HD often relies heavily on subjective surveys rather than objective measures. Fortunately, researchers are using eye movements to help objectively identify AD/HD.

Attention-Deficit/Hyperactivity Disorder (AD/HD) is a neurologically-based developmental disability affecting between 3% and 5% of school-aged children. So why does it seem like all BUT 3-5% of kids are diagnosed with AD/HD? Unfortunately the cause of AD/HD is not well understood. It is thought that the condition results from a deficiency in certain neurotransmitters. Without a reliable biological marker for the condition (for example a blood or urine sample), diagnosis of AD/HD often relies heavily on a subjective assessment of a child's behavior. Adults in the child's life will fill out behavioral surveys about a child's inattentiveness, impulsivity and hyperactivity. This current survey-based approach is subjective and one person's responses to the survey can change the outcome of the diagnosis.

What complicates the diagnosis of AD/HD even further, is that the behaviors on the surveys for AD/HD are not unique to AD/HD. What does this mean? Even if your child exhibits some of the symptoms of AD/HD, it does not mean that they have the condition. Furthermore, these symptoms must be present in the absence of another underlying or contributing cause, such as seizures or major life changes. This process can be complicated and ultimately frustrating for all of those involved. Many practitioners turn to medications to manage AD/HD. As a parent, wouldn't it be great to know that your child actually has the condition before starting a medication that has the potential to dramatically change your child's behavior and personality (not to mention the additional adverse drug reactions)? Well fortunately research is under way to develop objective measures of AD/HD, and researchers are looking to the eyes for help.

Researchers at Tel Aviv University have shown that involuntary eye movements can accurately and objectively identify a person with ADHD. The research determined that individuals with ADHD had a higher number of micro saccades (eye movements that allow your eyes to jump from one target to the next) as well as an increased number of blinks. As these eye movements are viewed as involuntary, the researchers believe that their results are 'sound physiological markers of ADHD'.

So in the future, we may look to the eyes to help objectively diagnose AD/HD. Well what about now, should we already be looking at the eyes in these kids? The answer is yes. Remember that AD/HD is the presence of certain symptoms in the absence of another contributing cause. There are several vision conditions that can cause difficulties with visual activities in the classroom. Binocular vision dysfunction, such as convergence insufficiency, can cause difficulties with reading. When a vision condition causes words to move on the page, gives you headaches and makes your eyes hurt, it makes you want to avoid the task (inattentive?). When accommodative dysfunction (eye focusing deficits) makes the print on the page come in and out of focus, you will re-position yourself constantly trying to make it clear (impulsive/hyperactive?). While it is important that you work with the proper professionals to rule out AD/HD, it is also important that you work with an optometrist to rule out a vision condition. Not all eyecare provides assess the visual skills of eye tracking, eye teaming and eye focusing. This is why it is important for anyone concerned about AD/HD to work with a residency-trained pediatric optometrist or an optometrist residency-trained in binocular vision. Doctors with this level of training diagnose and treat vision conditions that have many shared symptoms as AD/HD. The right diagnosis leads to the right treatment. AD/HD will not respond to glasses, just like a vision condition will not respond to AD/HD medications.

The first step to rule out a vision condition is to start with a comprehensive eye examination with a residency-trained pediatric optometrist. Depending on the results of this exam, a Binocular Vision Assessment may be recommended to investigate the extent of any vision conditions present and develop a treatment program to resolve the vision conditions. Remember, the right diagnosis allows you to get the right treatment, no matter what your condition is.