Children with attention deficit disorder, or ADD, may have visual problems that are structural, functional or related to how the brain interprets or perceives visual information. However, it is not always clear whether visual tasks such as reading are challenging because children are impulsive and more easily distracted or if they are inattentive because performing visual tasks is stressful. Evaluations by a developmental optometrist and occupational therapist can hold the key to successful treatment.
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Identifying Visual Problems
Most people are familiar with refraction testing, which evaluates visual acuity. The patient reads charts filled with letters of different sizes so that the optometrist can prescribe glasses to correct near or distance vision. The typical optometrist, however, does not look at the many other impairments that can interfere with using vision functionally. These impairments include problems with using the eyes together (binocular vision that enables depth perception), visual fixation (gazing at a stationary object), tracking (watching a moving object), scanning (finding an object amongst many) and visual perceptual skills.
ADD, Vision Impairment and Learning Disabilities
According to optometrist, author and lecturer Dr. Mitchell Scheiman, there is a strong relationship between vision and learning, especially when a student struggles to read. Dr. Daniel G. Amen, author of "Healing ADD," states that learning disabilities occur in approximately 40 percent of people with ADD, and Dr. Sally Shaywitz, author of “Overcoming Dyslexia” reports that between 12 and 24 percent of people with dyslexia (a language based learning disability) also have attention deficit hyperactivity disorder (ADHD). These statistics indicate that children with the ADD or ADHD diagnosis should be screened for possible visual problems that impact learning and are often treatable.
Visual Efficiency Problems
According to Scheiman, studies show that children with learning disabilities have very high rates of problems with visual efficiency and visual perception. The term “visual efficiency” refers to abilities to use the eyes to perform skills such as gazing at objects (this is called “fixation”); changing fixation from one object to another (such as when reading words); maintaining eye contact on a moving object (this is called “visual pursuit” or “tracking”); and using the eyes smoothly together and quickly refocusing when looking at different distances. Children with decreased visual efficiency may find it a strain to move their eyes across a line of print and often seem inattentive as they find creative ways to avoid work.
Visual Perceptual Problems
Visual perception refers to how the child’s brain interprets what she is seeing. It has nothing to do with eyesight. These children might confuse left and right and have impaired abilities to make distinctions such as which two pictures look the same. They may struggle with scanning to find a desired crayon color in a pile scattered on the table because they have poor figure-ground discrimination and they may not perceive that a shape is still the same shape even when it has been rotated or changed in size or color.
Treatment by a Developmental Optometrist
Specially trained developmental optometrists can evaluate and treat many visual disorders that impact learning. The easiest and most obvious would be to provide glasses that improve acuity. The doctor may also recommend glasses, prisms, eye exercises, patching one eye or adapting activities, such as providing large print, to treat a variety of visual disorders.
Treatment by an Occupational Therapist
Occupational therapists often focus on adapting activities to increase success. Examples of this include: providing reading material printed on every other line or highlighting every other line with different colors to make it easier to find the beginning of the next reading line. Occupational therapists set up tasks with optimal lighting, positioning of materials and to create color contrast. They may do simple eye exercises such as tracking a slowly moving object and provide movement activities that challenge vision, such as catching a ball while jumping on a trampoline. Therapists also work with children to improve visual perceptual skills with activities that make them more aware of visual differences between objects, letters and words.