ADHD Or Convergence Insufficiency: Could Your Child’s Eyes Be Hiding Something?

ADHD or Convergence Insufficiency? The Eyes may tell the tale

Have you ever heard of convergence insufficiency? Did you even know that quite often, children who have convergence insufficiency are misdiagnosed with ADD, and when treated with appropriate vision therapy, become almost completely different children?

My then 8-year-old son was referred to a developmental optometrist last year. His new occupational therapist suggested Dr. Bryce Appelbaum of Appelbaum Vision in Bethesda, MD. Dr. Appelbaum is board certified in Vision Therapy and Rehabilitation by the College of Optometrists in Vision Development. My son was in Occupational therapy for dyspraxia and dysgraphia, but his OT thought his vision had something to do with his problems and since I trusted her, I figured I’d check him out. If honest, I thought I might be wasting money, though, because I’d already had my son’s eyes checked out by the ‘best’ pediatric ophthalmologist in south Florida and in Maryland. Every exam came with the same diagnosis: superior sight.

Still, I was intrigued when I began filling out the paperwork in Dr. Appelbaum’s office. It was if they thought my son might have ADHD, and many of the questions were ones I’d expect if I was having him evaluated for such a diagnosis. I was curious, as my son is a straight-A student who has never had any issue sustaining his attention or controlling his impulses, and he certainly didn’t fit what I considered the mold of a child who had ADD or ADHD. As an elementary classroom teacher for many years, I was quite familiar with those characteristics, and my son didn’t have them.

Except…he did. During the exam, that is. With each task he was asked to do in the vision exam (which was way more in-depth than any I’d had with any ophthalmologist), I watched this very agreeable and brilliant child melt in front of my eyes. He became snarky, emotional and he physically looked as if he’d not slept for days. My husband and I couldn’t believe how he’d deteriorated in just an hour and a half of some vision testing until Dr. Appelbaum explained why.

Related: Visual Stress And What It’s Doing To Our Children: The Little Known Side-Effects Of Online Learning

My son had convergence insufficiency. In a nutshell, convergence insufficiency (CI) is an issue with how the eye moves. When eyes converge (or come together, as is the case when doing near-work like reading or writing), they point inward to focus and align. With CI, the eye muscles responsible for coordinating the two eyes together as one team have a difficult time doing this and one ey may turn out or even stay straight instead of looking inward with the other. The convergence of the eyes to come together at a common point is insufficient.

Convergence insufficiency means that what you (or your child) is focusing on may be blurry or double. Every time your eyes are tasked to converge, which is essentially what every child in school is tasked to do regularly, there is eye strain. This eye strain puts more stress on the eye muscles and the brain, and that stress, in turn, can manifest in loss of impulse control, poor executive functioning skills, bad attitude and inattention.

One way to ‘adapt’ to convergence insufficiency is to cover one eye so there is no struggle to have the two eyes come together at the same point. When Dr. Appelbaum told me that, I began to cry. Every single teacher my son had ever had told me the same thing: “I constantly have to tell him to sit up because he is forever leaning on his left side.”

It made sense. He ‘leaned on his left side’ so he could cover his left eye and continue to do the schoolwork he was tasked to do without the double or blurry vision. On his own, bless his heart, my child had figured out how to accommodate for his CI, and that’s why I’d not ever seen any of the impulse control, inattention or other issues that are commonly associated with CI. Learning this broke my heart, though, because I knew what tremendous self-control and brain fatigue that cost my son.

What Does Convergence Insufficiency In Children Look Like?

Experts guess that about 5% of the population has convergence insufficiency issues. And, they’re really more issues of the brain than they are of the eyes. Our eyes are just the messengers of information; it’s the brain that works to focus and converge, and when it is laborious, it can quite easily fatigue us. Think about how cranky and miserable your child is when they desperately need a nap. Now, imagine a child in a classroom is so fatigued trying to get their brains to focus and converge on their reading and writing that they are cranky and miserable too. It’s easy to see how they could be labeled with ‘behavior’ issues.

Despite having 20/20 sight on an eye chart, their vision is not the same, and typically symptoms really start showing up by the end of 1st grade when near work tasks begin increasing. Converging and keeping things in focus is extremely difficult and laborious. Reading is a chore and they don’t want to sit still for it because it’s hard. They skip words and skip lines, and they don’t seem to understand what they’re reading.

Ironically, though, they’re completely content to sit and listen to you read to them. They often have excellent auditory processing skills and comprehension. They may beg you to read more, even, because they’re that into it. That’s when parents and teachers may start thinking the child is just lazy or rebellious when tasked to read or write on their own, and that’s just not always the case. Reading and writing are just exhausting and when they’re exhausted, their impulse control and executive functioning skills fall to the wayside.

Just like those who are diagnosed with ADD or ADHD do. 

And that’s just what research shows too. A groundbreaking study found that there was a three times greater incidence of ADHD in patients with CI than when compared to the incidence of ADHD in the general U.S. population. Additionally, there was a three-fold greater incidence of CI in the ADHD population. While this is a clear association and not a causation issue, the bottom line is that there is a chance that your child with ADD or ADHD doesn’t actually have ADHD or ADD, but instead has convergence insufficiency.

But if that was the case, why didn’t the doctors catch it? Why didn’t the vision screening catch it? Why did the eye doctor say your child had perfect sight?

Because sight and vision are different. Sight is what you see, vision is how you process what you see. The typical screening at your doctor or school or even your ophthalmologist is not looking for these vision disorders. They’re brain-based and overlooked. Instead, they’re simply looking at the anatomy of the eye and whether you can see certain things far away. Watch, though, and see how faulty that logic is:

Over 80% of school success depends on vision. If your child has issues that are missed because they’re not evaluated by a board-certified Vision Therapy and Rehabilitation Optometrist? They’re much more likely to be diagnosed with behavioral issues or learning disorders or ADD/ADHD, and at such a cost to them and to your family.

ADHD or Convergence Insufficiency? Be Sure To Be Sure

We’re aware that there are children who have ADD/ADHD and they definitely benefit from behavioral and pharmacological therapies. But, there’s a tremendous possibility that they may have visual problems like CI and if properly evaluated, may need a completely different course of treatment. Vision therapy can make an incredible difference in your entire family’s life if your child is evaluated with a visual disorder like convergence insufficiency, and this can have long-lasting effects. Imagine the gift you give your child now in evaluating and discovering a vision disorder. You can focus on it, treat it and help them focus better in school and in life as adults.

The above-mentioned study by Dr. Granet was important because it emphasizes that patients who are diagnosed with ADD/ADHD should be evaluated to see if they have convergence insufficiency and treated if they do. Misdiagnosis of ADHD is bad enough in itself, but the missing and non-treatment of a visual problem like convergence insufficiency impacts your child’s entire life. CI is one of the more common vision disorders developmental optometrists can treat, and there are tons of happily-ever-after success stories of those who go through evaluations and treatments after being misdiagnosed with ADHD.

If your child has any of the behavioral and learning traits commonly associated with ADD/ADHD or has even been diagnosed with either, I beg you to consult with a developmental optometrist who is certified in Vision Therapy and Rehabilitation by the College of Optometrists in Vision Development.

You may find that there is absolutely no vision issue and you’ll be able to confidently move toward a different direction to best help your child succeed in school and life.

But you just may find as we did when we visited Dr. Appelbaum that November day–our son had been accommodating valiantly for a pretty significant visual disorder and so many things finally made sense. Better, we were able to discuss a plan for his treatment and improvement, and feel incredibly optimistic about success in the future.

I taught in public school systems up and down the east coast for 15 years. I was special needs certified. I’d call myself a pretty good teacher, and I’d definitely say I was a researcher. But in all my education and experience, I’d NEVER heard of convergence insufficiency, and had NO idea how it could affect classroom learning. I lament over what difference I could have made in children had I only known then.

But I’m a big believer in knowing more and doing better when you do, so know you too know about convergence insufficiency and how it can impact your child’s life. If you’ve had a feeling something wasn’t quite right about your child’s learning but didn’t know how to put a finger on it, check out  Vision Help, COVD and the  Vision and Learning Project for more information and help.


Photo: Yenestime/Shutterstock


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