Monday, October 08, 2007

Misdiagnosing an Eye Condition as ADHD

Not that this hasn't been said before, but there is a growing list of very treatable medical conditions that are being miss diagnosed as ADHD. You would think that a decent and thorough medical exam would be routine to pick up things like this..... but no......

As reported on Canada.com

Before reaching for the Ritalin, parents of children who have difficulty paying attention in school should consider another option: getting their kids' eyes tested.

An estimated five per cent of school-age children suffer from an eye disorder called convergence insufficiency, or CI. People with the disorder, which is treatable, have difficulty seeing things at close range.

"Their eyes don't like turning in," said Lisa Christian, a lecturer at the University of Waterloo School of Optometry. "Often times, children will avoid reading or do poorly in comprehension because their eyes don't like turning in. They get headaches."

Other symptoms of the disorder include double vision, dizziness and nausea. In some cases, the brain will actually shut down one eye in an attempt to correct the problem, an occurrence known as suppression.

"You don't want that to happen," said Christian. "You lose depth perception."

Because CI makes reading difficult, some children with the disorder have trouble focusing in the classroom and are being misdiagnosed with attention-deficit hyperactivity disorder (ADHD). A 2005 University of California study of 266 people with CI found that almost 10 per cent had also been diagnosed with ADHD - triple the normal rate.

"The school thinks it's behavioural, the parents probably think it's behavioural, so the child is sent to a psychologist or somebody to take a look at and they get misdiagnosed," said Christian.


The disorder is easy to detect, says Christian, and easy to treat. She recommends vision therapy, which consists of working with an optometrist to teach the eyes to converge when looking at something at close range. The therapy involves performing exercises to strengthen eye muscles, such as looking at a pencil and bringing it to your nose.

"The problem is that there are very few children getting full eye exams done before starting school."

The Canadian Association of Optometrists recommends that children have their eyes examined before their first birthdays, but estimates that less than five per cent do. The association reports that only 15 to 20 per cent of children receive a comprehensive eye exam before entering school.

"Parents are not aware of the link between good vision and a child's learning ability," said Dorrie Morrow, an Alberta optometrist and chairwoman of the association's children's vision initiative. "We don't wait until our children's teeth fall out to take them to a dentist. We don't wait until they turn blue to make sure they're breathing properly. It just baffles me."

Morrow says many parents believe that if their children don't need glasses, their eyes are fine. But that's not always true; there are numerous eye disorders, including CI, someone can have while maintaining 20-20 vision.

According to a 2006 Canadian Journal of Optometry report, an estimated 25 per cent of children 18 years old or younger are affected by some form of vision impairment.

"Every day, there are instances when a child's visual skills are holding them back from their full potential," said Morrow.

CI can be particularly challenging for young students, says Morrow, because the inability to see things clearly at close range severely inhibits their ability to learn.

"Most of a child's learning takes place in that 12 to 13 inches range. That's a child's world when they start school."

During her residency years ago, Morrow gave eye exams to teenage boys who lived in a group home for children with social problems. She found that 75 to 80 per cent of the teenagers she examined had visual skill problems.

"Those boys never had a chance to succeed academically, so they looked for another outlet. That changed my life. It's not just academics; it's giving your child the best possible start."

In 2003, Morrow led a year-long pilot project in Alberta called Eye See, Eye Learn. Optometrists teamed with school boards in the province to educate parents on the importance of having their children's eyes tested. The percentage of children who received eye exams jumped from about 15 per cent to more than 50 per cent.

"We were not refused by one school board," said Morrow. "Now it's provincewide."

The next step, says Morrow, is to take the program national. Many provinces have already shown interest.

"Every child starting school should have at least one comprehensive eye exam. They deserve that."

No comments: