Convergence Insufficiency and ADHD

The connection between ADHD and convergence insufficiency

There is a connection between attention deficit hyperactivity disorder (ADHD) and convergence insufficiency. Studies have shown that many of the academic and attention related behaviors associated with ADHD are also present in individuals with convergence insufficiency. As a result some individuals who have been diagnosed with ADHD may actually have treatable convergence insufficiency.

People with ADHD should be tested for convergence insufficiency

The best practice to avoid misdiagnosis and unnecessary medication is for a patient to have a comprehensive eye examination that tests for convergence insufficiency in cases where ADHD is suspected. It is not yet known whether convergence insufficiency causes ADHD or is only associated with ADHD.

Vision therapy can improve academic behaviours and attention

In any event, vision therapy has been shown to be the most effective treatment for convergence insufficiency indicating that individuals diagnosed with ADHD should be tested for it and if present treatment for the convergence insufficiency may resolve some or all of the observed ADHD behaviors.

In fact, research presented in October 2011 by Dr. Eric Borsting, OD, MS, FAAO, FCOVD showed exactly that, adding to the existing body of research on the connection between ADHD and convergence insufficiency.

Dr. Borsting is an optometrist who has been investigating the common behaviours associated with both ADHD and convergence insufficiency for several years.    

To the extent that the behavior of an individual thought to have ADHD is attributable to convergence insufficiency, treatment of the latter may be a benefit to the patient in resolving some or all of the patient's academic and/or behavioral issues.

The research showed that significant improvements were found in academic behaviors and attention as a result of vision therapy  for convergence insufficiency. The study involved 45 children between 9 and 17 years old with symptoms of convergence insufficiency.

All participants in the study received 16 weeks of therapy, with 8 weeks of maintenance therapy where they were not comming to the clinic every week. 

The study used two surveys to guage behaviour, the Conners 3 ADHD Index and the Academic Behavior survey.  The Conners 3 ADHD Index is a 10-item survey that screens for attention problems in children, including "inattention" and "easily distracted".  The Academic Behavior Survey is a six-item survey of behaviors that a parent can observe, such as "appears inattentive" and "avoids reading".

Dr. Borsting reported data from the two surveys and for both surveys his research team found a significant improvement in scores following vision therapy for convergence insufficiency.

• Borsting E, Rouse M, Chu R. Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: a preliminary study. Optometry. 2005;76:588–92. [PubMed]
  
  

  The results from this preliminary study suggest that school-aged children with symptomatic accommodative dysfunction or convergence insufficiency (eye movement disorders) have a higher frequency of behaviours related to school performance and attention as measured by the a survey called the Connors Parent Rating Scale–Revised Short Form.  The survey uses 27 questions to test a broad range of school-related behaviors in the following categories: oppositional, cognitive problems/inattention, hyperactivity, and ADHD Index.

• Granet DB, Gomi CF, Ventura R, Miller-Scholte A. The relationship between convergence insufficiency and ADHD. Strabismus. 2005;13:163–8. [PubMed]. 
  
  In this study, the researchers  found that people diagnosed with ADHD were three times more likely to have convergence insufficiency than the general population.
• Gronlund MA, Aring E, Landgren M, Hellstrom A. Visual function and ocular features in children and adolescents with attention deficit hyperactivity disorder, with and without treatment with stimulants. Eye. 2007;21:494–502. [PubMed].
  
  In this study, the researchers found that children diagnosed with ADHD have a higher frequency of eye problems than the general population and that the eye problems did not improve when children were on stimulants, which are the drugs that are commonly prescribed to treat ADHD.
• Rause, et al. Academic behaviors in children with and without parent-report of ADHD. Optom Vis Sci. 2009 October; 86(10):1169–1177.[PDF]

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