ADHD and Convergence Insufficiency


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.


Recent research has pointed out that children with visual impairments are more than twice as likely as the general population to have a diagnosis of ADHD.


Children with vision disorders are twice as likely to be labled ADHD


study published in the Journal of AAPOS : The Official Publication of the American Association for Pediatric Ophthalmology and Strabismus/American Association for Pediatric Ophthalmology and Strabismus in February, 2014, found that children with vision disorders are more then twice as likely as the general population to be diagnosed with ADHD.  The authors of the study looked at a group of visually impaired children between the ages of 4 and 17. The authors found that 22.9% of the kids in this group had a parent-reported diagnosis of ADHD. That was 2.3 times greater than the national average, which is 9.5%.


The fact that a an ADHD diagnosis is twice as common in people with vision problems suggests that may people with vision problems could be misdiagnosed with ADHD. In fact ADHD diagnoses have increased “by 33% between 1997-1999 and 2006-2008.” These statistics are worrisome and suggest a possible over-diagnosis of this condition (see Feldman HM, Reiff MI. Attention Deficit-Hyperactivity Disorder in Children and Adolescents. N Engl J Med. 2014;370:838-846)


Children should be tested for convergence insufficiency before accepting a diagnosis of ADHD


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 behaviors 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 behaviors 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 coming to the clinic every week. 

The study used two surveys to gauge behavior, 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.


What is schoolwork like for someone with convergence insufficiency?


This image simulates what reading is like for someone with convergence insufficiency:


    convergence insufficiency simulation


Is your child smart in everything except school?

Convergence insufficiency infographicContent


ADHD and convergence insufficiency research summary


  • 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. [Download]

    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 behaviors 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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